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Joint Arthroplasty: Current Status, Challenges, and Future Directions
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Joint Arthroplasty: Current Status, Challenges, and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (20 February 2024) | Viewed by 10711

Special Issue Editor

Dr. Alexander B. Christ

E-Mail Website
Guest Editor
Department of Orthopaedic Surgery, University of California, Los Angeles, 1225 15th Street, Suite 2100, Santa Monca, CA, 90404, USA
Interests: hip and knee arthroplasty; computer navigation; robotic total joint arthroplasty; sarcoma; metastatic bone disease

Special Issue Information

Dear Colleagues,

Total joint arthroplasty procedures are among the most prevalent and utilized surgeries in modern medicine, improving pain and function for millions of patients annually. Improvements in surgical technique, implant design and materials, intra-operative enabling technologies, and perioperative management have all contributed to the resounding success of total joint arthroplasty. Furthermore, an ever-increasing body of research has helped clinicians better optimize and indicate patients for these procedures, thereby improving their rates of success.

Despite monumental strides in the fields of joint arthroplasty over the past 40‒50 years, there are still many unsolved problems. Populations undergoing total joint arthroplasty are increasingly comorbid, thus highlighting the importance of preoperative optimization and evidence-based recovery pathways. Periprosthetic joint infection continues to be a leading cause of failure, with significant associated morbidity, mortality, and cost. With the wide adoption of cementless hip implants and an aging population, periprosthetic fracture remains a clinical challenge that is increasing in prevalence. Finally, patients expect higher levels of post-operative function. This has sparked interest in alternative concepts of lower extremity alignment about the knee, spinopelvic mechanics in the hip, and the rapid development of new implants and technologies to enable these concepts.

Research regarding patient selection and optimization, mitigation and treatment of major complications, and optimizing function and recovery is still necessary. By understanding the current state of the art and challenges in joint arthroplasty, future options may offer safer, higher-functioning joint replacements for patients.

Dr. Alexander B. Christ
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hip arthroplasty
  • knee arthroplasty
  • revision arthroplasty
  • periprosthetic joint infection
  • computer navigation
  • robotic total joint replacement
  • minimally invasive joint replacement
  • periprosthetic fracture

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Published Papers (3 papers)

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Research

11 pages, 708 KiB  
Article
Does COVID-19 Infection within 1 Week after Total Knee Arthroplasty Affect Patients’ Early Clinical Outcomes? A Matched Case–Control Study
by Jung-Kwon Bae, Jae-Sung Seo, Seong-Kee Shin, Seo-Jin Kim and Jun-Ho Kim
J. Clin. Med. 2023, 12(13), 4496; https://doi.org/10.3390/jcm12134496 - 5 Jul 2023
Cited by 2 | Viewed by 3054
Abstract
Recent studies have reported the impact of previous COVID-19 infection on the early clinical outcome after total knee arthroplasty (TKA). However, the timing of infection before the surgery was not constant and a study on patients with COVID-19 infection within 1 week after [...] Read more.
Recent studies have reported the impact of previous COVID-19 infection on the early clinical outcome after total knee arthroplasty (TKA). However, the timing of infection before the surgery was not constant and a study on patients with COVID-19 infection within 1 week after TKA is lacking. This study aimed to determine the effect of COVID-19 infection within one week after TKA on the postoperative outcomes and to compare the early clinical outcomes to those who were not infected with COVID-19 before and after surgery. No significant differences were observed between the two groups in terms of clinical outcomes or complications. The length of the hospital stay (LOS) was significantly longer for the COVID-19 group than for the non-COVID-19 group (p < 0.05). The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were higher for the study group on postoperative days 9 and 12 than for those in the control group (p < 0.05). However, D-dimer levels were not significantly different between the two groups. We should cautiously consider that COVID-19 infection within 1 week after TKA may be associated with increased ESR, CRP levels, and length of hospital stay, but they are not associated with the worsening of early clinical outcomes or the occurrence of complications. Full article
(This article belongs to the Special Issue Joint Arthroplasty: Current Status, Challenges, and Future Directions)
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15 pages, 11300 KiB  
Article
Is Modular Dual Mobility Superior to Standard Bearings for Reducing Dislocation Risk after Primary Total Hip Arthroplasty? A Retrospective Comparative Multicenter Study
by Vincenzo Ciriello, Roberta La China, Danilo Francesco Chirillo, Giuseppe Bianco, Federico Fusini, Ugo Scarlato, Carlo Albanese, Giancarlo Bonzanini, Lorenzo Banci and Lucio Piovani
J. Clin. Med. 2023, 12(13), 4200; https://doi.org/10.3390/jcm12134200 - 21 Jun 2023
Cited by 8 | Viewed by 5090
Abstract
Background: Dual mobility (DM) has been proven to reduce dislocation risk after total hip arthroplasty (THA). In the last decade modular DM (modDM) constructs have been introduced to allow the use of DM articulation with standard cementless acetabular shells. However, clinical evidence of [...] Read more.
Background: Dual mobility (DM) has been proven to reduce dislocation risk after total hip arthroplasty (THA). In the last decade modular DM (modDM) constructs have been introduced to allow the use of DM articulation with standard cementless acetabular shells. However, clinical evidence of modDM effectiveness is still low in primary THA and concerns about implant-related complications are increasing. This retrospective comparative multicenter study is aimed to investigate if the dislocation rate after primary THA could be reduced with modDM in comparison to standard bearing (SB). Methods: 262 THAs were performed between 2017 and 2019, using SB (129 hips) or modDM (133) with the same cementless highly porous modular acetabular cup. Dislocations, complications and revisions were recorded and implant survival was analyzed. Results: At 2.5-year mean follow-up, dislocation occurred in 4 hips (3.1%) within the SB group while intraprosthetic dislocation in 2 hips (1.5%) within the modDM group (p = 0.44). Implant survivals with revision due to dislocation were 95.2% and 95.9% at 4-year follow-up for SB and modDM, respectively (p = 0.50). Conclusions: modDM used in primary THA might reduce dislocation rate in comparison to SB, even in high-risk patients, however, caution is advocated due to specific intraprosthetic dislocation. Full article
(This article belongs to the Special Issue Joint Arthroplasty: Current Status, Challenges, and Future Directions)
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Graphical abstract

14 pages, 1039 KiB  
Article
Cemented versus Cementless Femoral Fixation for Elective Primary Total Hip Arthroplasty: A Nationwide Analysis of Short-Term Complication and Readmission Rates
by Xiao T. Chen, Alexander B. Christ, Brian C. Chung, Andy Ton, Alexander M. Ballatori, Shane Shahrestani, Brandon S. Gettleman and Nathanael D. Heckmann
J. Clin. Med. 2023, 12(12), 3945; https://doi.org/10.3390/jcm12123945 - 9 Jun 2023
Cited by 3 | Viewed by 1984
Abstract
Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients [...] Read more.
Cementless fixation during total hip arthroplasty (THA) is the predominant mode of fixation utilized for both acetabular and femoral components during elective primary THAs performed in the United States. This study aims to compare early complication and readmission rates between primary THA patients receiving cemented versus cementless femoral fixation. The 2016–2017 National Readmissions Database was queried to identify patients undergoing elective primary THA. Postoperative complication and readmission rates at 30, 90, and 180 days were compared between cemented and cementless cohorts. Univariate analysis was conducted to compare differences between cohorts. Multivariate analysis was performed to account for confounding variables. Of 447,902 patients, 35,226 (7.9%) received cemented femoral fixation, while 412,676 (92.1%) did not. The cemented group was older (70.0 vs. 64.8, p < 0.001), more female (65.0% vs. 54.3%, p < 0.001), and more comorbid (CCI 3.65 vs. 3.22, p < 0.001) compared to the cementless group. On univariate analysis, the cemented cohort had decreased odds of periprosthetic fracture at 30 days postoperatively (OR: 0.556, 95%-CI 0.424–0.729, p < 0.0001), but higher odds of hip dislocation, periprosthetic joint infection, aseptic loosening, wound dehiscence, readmission, medical complications, and death at all timepoints. On multivariate analysis, the cemented fixation cohort demonstrated reduced odds of periprosthetic fracture at all postoperative timepoints: 30 (OR: 0.350, 95%-CI 0.233–0.506, p < 0.0001), 90 (OR: 0.544, 95%-CI 0.400–0.725, p < 0.0001), and 180 days (OR: 0.573, 95%-CI 0.396–0.803, p = 0.002). Cemented femoral fixation was associated with significantly fewer short-term periprosthetic fractures, but more unplanned readmissions, deaths, and postoperative complications compared to cementless femoral fixation in patients undergoing elective THA. Full article
(This article belongs to the Special Issue Joint Arthroplasty: Current Status, Challenges, and Future Directions)
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