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Arthroplasty: Advances in Surgical Techniques and Patient Outcomes
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Arthroplasty: Advances in Surgical Techniques and Patient Outcomes

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

Deadline for manuscript submissions: closed (15 December 2024) | Viewed by 4378

Special Issue Editor

Dr. Senthil Sambandam

E-Mail Website
Guest Editor
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
Interests: hip arthroplasty; knee arthroplasty; hip fractures; arthroplasty; osteoarthritis; knee arthroscopy; joint replacement
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Total hip replacement is one of the most successful orthopedic procedures offered to patients with various hip joint pathologies. Researchers, clinical scientists, surgeons, device manufacturers, and hospital policy makers are constantly striving to advance the science and practice of total hip replacement based on the availability of new evidence. The availability of large databases has made it possible to analyze outcomes in rare pathologies and situations that are often not possible from single-center studies. In this Special Issue, we invite authors to submit manuscripts relating to various technical aspects of hip replacement, including, but not limited to, robotic hip replacement, direct anterior approaches, artificial intelligence, virtual reality, and outcomes related to newer advances in total hip replacement.

Dr. Senthil Sambandam
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
  • hip fractures
  • arthroplasty
  • osteoarthritis
  • knee arthroscopy
  • joint replacement

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Published Papers (5 papers)

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Research

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11 pages, 1624 KiB  
Article
Acetabular Home Run Screw Guidance for Transiliac Fixation in Cup Revision Arthroplasty
by Martin Wessling, Carsten Gebert, Mohamed Marei, Marcel Dudda, Arne Streitbuerger, Mirko Aach, Lee Jeys, Sven Frieler, Daniela Koller and Yannik Hanusrichter
J. Clin. Med. 2025, 14(3), 922; https://doi.org/10.3390/jcm14030922 - 30 Jan 2025
Viewed by 555
Abstract
Background/Objectives: The growing incidence of acetabular revisions has highlighted the importance of achieving reliable fixation to the remaining bone. Proximal transiliac fixation (TIF) of pelvic implants is becoming an increasingly common approach for managing extensive bone defects. This study seeks to provide guidance [...] Read more.
Background/Objectives: The growing incidence of acetabular revisions has highlighted the importance of achieving reliable fixation to the remaining bone. Proximal transiliac fixation (TIF) of pelvic implants is becoming an increasingly common approach for managing extensive bone defects. This study seeks to provide guidance on TIF implantation by analyzing the optimal screw placement in partial pelvic replacements for acetabular defects. Methods: Between 2014 and 2024, a cohort of 96 consecutive patients (65 females and 31 males) who underwent customized partial pelvic replacement (PPR) with transiliac fixation (TIF) were examined. The angle and entry point of the ideal TIF were determined using preoperative three-dimensional planning and compared with potential influencing factors. Results: All PPRs were successfully implanted, with an average TIF length of 77 mm. The mean anteroposterior angle for TIF was 18° medially and 27° dorsally. Conclusions: Analysis of the entry point showed concentration around the second radius and between the eleven o’clock and one o’clock positions. The AP angle is notably affected by gender and height. Considering the precision of human judgment, a recommendation for TIF placement would be 20° medial and 30° dorsal deviation, with the entry point around the twelve o’clock position and the second ring from the center of the cup. Full article
(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)
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11 pages, 2332 KiB  
Article
Enhancing Surgical Efficiency and Radiological Outcomes Through Advances in Patient-Specific Instrument Design
by Yong-Gon Koh, Ji-Hoon Nam, Jong-Keun Kim, Dong-Suk Suh, Jai Hyun Chung, Kwan Kyu Park and Kyoung-Tak Kang
J. Clin. Med. 2025, 14(2), 307; https://doi.org/10.3390/jcm14020307 - 7 Jan 2025
Viewed by 542
Abstract
Background/Objectives: Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses preoperative three-dimensional imaging to create cutting blocks tailored to patient anatomy. However, there is debate regarding the additional benefits of PSI in terms of improved alignment or functional outcomes compared to using [...] Read more.
Background/Objectives: Patient-specific instrumentation (PSI) in total knee arthroplasty (TKA) uses preoperative three-dimensional imaging to create cutting blocks tailored to patient anatomy. However, there is debate regarding the additional benefits of PSI in terms of improved alignment or functional outcomes compared to using conventional instruments. Although PSI design has undergone continuous development, the improvements have not been incorporated. Therefore, the aim of this study was to compare the surgical time and radiological outcomes between advanced-design PSI and conventional instruments. Methods: We conducted a retrospective review of 328 patients who underwent primary TKAs using PSI for osteoarthritis and compared them with 328 matched patients who underwent TKA performed with conventional instruments during the same period (March 2023 to August 2024). We compared the surgical time and component alignment between the advanced-design PSI group and the conventional instrument group. Results: The average surgical time was significantly shorter in the advanced-design PSI group (47.6 ± 12.4 min) compared to the conventional instrument group (59.2 ± 14.2 min, p < 0.05). The advanced PSI design group had a significantly lower occurrence of outliers in hip–knee–ankle alignment (7%) compared to the conventional instrument group (36.3%). This trend was also observed in femoral coronal alignment, tibial coronal alignment, and femoral sagittal alignment. Conclusions: The use of advanced-design PSI demonstrated significantly reduced surgical time and improved alignment compared to conventional instruments. This highlights that proper design is a key factor for PSI to achieve superior biomechanical effects. Our study shows that advanced-design PSI technology has the potential to replace conventional instruments in TKA, though further research is required to determine its clinical outcomes and economic benefits. Full article
(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)
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10 pages, 226 KiB  
Article
The Effects of Syphilis Infection on Total Knee Arthroplasty Outcomes: A Retrospective Cohort Study
by Paul Gudmundsson, Marc Gadda, Aruni Areti and Senthil Sambandam
J. Clin. Med. 2024, 13(23), 7116; https://doi.org/10.3390/jcm13237116 - 25 Nov 2024
Viewed by 746
Abstract
Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a [...] Read more.
Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a history. Methods: We conducted a retrospective cohort analysis using a national insurance claims database. Our study population included 237,360 patients who underwent primary TKA between 2005 and 2024. Patients were classified into two groups based on the presence (+Syph) or absence (−Syph) of a syphilis diagnosis within one year prior to the TKA. We evaluated the rates of several postoperative complications at 30 days postsurgery, including infection, hematologic issues, and cardiac events. Statistical analyses between groups was performed using chi-squared tests and Fisher’s exact tests. Routine demographic data such as age, sex, race, and comorbidities were also analyzed. Results: Among the 237,360 TKA patients, we identified 71 with a history of syphilis within one year of their surgery. The +Syph group exhibited significantly higher rates of periprosthetic infection (4.23% vs. 0.81%, p = 0.001), need for manipulation under anesthesia (MUA) at four months (7.04% vs. 2.82%, p = 0.032), deep venous thrombosis (4.23% vs. 1.27%, p = 0.026), periprosthetic fracture (2.82% vs. 0.23%, p < 0.001), and pneumonia (2.82% vs. 0.62%, p = 0.019) within 30 days postTKA. No significant differences were observed in 30-day mortality, deep or superficial surgical site infections, wound dehiscence, blood loss anemia, or transfusion requirements. Additionally, rates of acute renal failure, pulmonary embolism, and cardiac events did not differ significantly between groups. Demographically, patients in the syphilis cohort had a higher prevalence of smoking and diabetes preoperatively within one year of their surgical date. Conclusions: A documented syphilis diagnosis within one year of TKA significantly affects postoperative outcomes, increasing the rates of prosthetic joint infection, MUA, deep venous thrombosis, periprosthetic fracture, and pneumonia. These findings underscore the need for heightened vigilance in the pre- and postoperative management of patients with a history of syphilis infection undergoing TKA. Further research is warranted to explore the relationship between prior syphilis infection and TKA outcomes, as well as to develop strategies to mitigate this increased risk. Full article
(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)
12 pages, 505 KiB  
Article
Intraoperative Periprosthetic Fractures in Total Hip Arthroplasty: A 1.6-Million-Patient Analysis of Complications, Costs, and the Challenges in AI-Based Prediction
by David Maman, Yaniv Steinfeld, Yaniv Yonai, Linor Fournier, Ofek Bar, Oleg Safir and Yaron Berkovich
J. Clin. Med. 2024, 13(22), 6862; https://doi.org/10.3390/jcm13226862 - 14 Nov 2024
Cited by 2 | Viewed by 989
Abstract
Background: Periprosthetic fractures following total hip arthroplasty are serious complications occurring in up to 2.4% of primary cases, contributing to significant morbidity, extended hospital stays, and elevated healthcare costs. Predicting these fractures remains a challenge despite advances in surgical techniques and prosthetic materials. [...] Read more.
Background: Periprosthetic fractures following total hip arthroplasty are serious complications occurring in up to 2.4% of primary cases, contributing to significant morbidity, extended hospital stays, and elevated healthcare costs. Predicting these fractures remains a challenge despite advances in surgical techniques and prosthetic materials. Methods: This study analyzed 1,634,615 cases of primary THA from the NIS database (2016–2019) using propensity score matching to compare outcomes between patients with and without intraoperative periprosthetic fractures. Predictive models, including logistic regression, decision tree, and deep neural network, were evaluated for their ability to predict fracture risk. Results: Patients with periprosthetic fractures exhibited a 14-fold increase in pulmonary embolism risk, a 12-fold increase in infections, and a 5-fold increase in hip dislocations. Fractures extended hospital stays (3.8 vs. 2.5 days) and added approximately USD 32,000 in costs per patient. The predictive models yielded low accuracy (AUC max = 0.605), underscoring the complexity of predicting periprosthetic fractures. Conclusions: Intraoperative periprosthetic fractures in THA significantly elevate complication rates, costs, and length of stay. Despite extensive modeling efforts, accurate prediction remains difficult, highlighting the need to focus on preventive strategies, such as improved surgical techniques and real-time intraoperative monitoring. Full article
(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)
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13 pages, 517 KiB  
Systematic Review
The Efficacy of Defensive Antibacterial Coating (DAC™) Periprosthetic Joint Infection Prevention in the Hip: A Systematic Review
by Antonio Bove, Adriano Braile, Giovanni Matino, Nicola Del Regno, Sabrina Sirico, Nicola Orabona and Mariantonia Braile
J. Clin. Med. 2025, 14(1), 270; https://doi.org/10.3390/jcm14010270 - 5 Jan 2025
Viewed by 927
Abstract
Background: Periprosthetic joint infections (PJIs) are a significant issue in joint replacement surgery patients, affecting results and mortality. Recent research focuses on developing hydrogels (HG) and antimicrobial coatings to reduce pressure injuries, with DAC™ HG showing lower infection risk in hip revision surgery. [...] Read more.
Background: Periprosthetic joint infections (PJIs) are a significant issue in joint replacement surgery patients, affecting results and mortality. Recent research focuses on developing hydrogels (HG) and antimicrobial coatings to reduce pressure injuries, with DAC™ HG showing lower infection risk in hip revision surgery. However, the effectiveness of DAC™ hydrogel in PIJs is still unknown. Here, we attempt to update the literature in this field, pointing out methodological flaws and providing guidance for further research. Methods: We conducted a systematic literature review using the PRISMA guidelines. Quality assessment was performed with the Newcastle–Ottawa Scale (NOS) and the Coleman Methodology Score (CMS). Results: Among 27 records from the initial search, 3 studies resulted eligible for final evaluation. It was observed that following the three surgical procedures performed in combination with DAC™ loaded with specific antibiotics, the quality of life of the treated patients had improved. No side effects associated with DAC™ treatment were in fact observed. Conclusions: The amount and quality of scientific evidence are yet insufficient to either encourage or dissuade the use of such hydrogels in hip prosthesis, despite some intriguing first results. These challenges will be better addressed by randomized controlled trials or longitudinal prospective investigations. Full article
(This article belongs to the Special Issue Arthroplasty: Advances in Surgical Techniques and Patient Outcomes)
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