• blood loss
• learning curve
• procedure duration
• revision hip arthroplasty
• revision knee arthroplasty
• surgeon experience

• Humans
• Reoperation/statistics & numerical data
• Arthroplasty, Replacement, Knee/education
• Arthroplasty, Replacement, Hip/education
• Female
• Male
• Learning Curve
• Middle Aged
• Retrospective Studies
• Aged
• Fellowships and Scholarships
• Clinical Competence
• Operative Time
• Surgeons/education

• Arthroplasty
• Complication
• Register data
• Revision
• Total hip arthroplasty
• Total knee arthroplasty

• Humans
• Reoperation/statistics & numerical data
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/statistics & numerical data
• Registries
• Prosthesis Failure
• Arthroplasty, Replacement, Knee/adverse effects
• Arthroplasty, Replacement, Knee/statistics & numerical data
• Prosthesis-Related Infections/epidemiology
• Prosthesis-Related Infections/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Periprosthetic Fractures/epidemiology
• Periprosthetic Fractures/etiology

• Medical University of Graz

• Debridement antibiotic and implant retention (DAIR)
• Hip
• Irrigation solution
• Knee
• Periprosthetic joint infection

• Humans
• Acetic Acid
• Anti-Bacterial Agents/administration & dosage
• Anti-Bacterial Agents/therapeutic use
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Arthroplasty, Replacement, Knee/adverse effects
• Biofilms/drug effects
• Biofilms/growth & development
• Debridement
• Ethanol/administration & dosage
• Hip Prosthesis/microbiology
• Hip Prosthesis/adverse effects
• Knee Prosthesis/adverse effects
• Knee Prosthesis/microbiology
• Prospective Studies
• Prosthesis-Related Infections/microbiology
• Prosthesis-Related Infections/diagnosis
• Randomized Controlled Trials as Topic
• Saline Solution/administration & dosage
• Therapeutic Irrigation/methods
• Treatment Outcome

• Arthroplasty
• Aseptic loosening
• Classification
• Knee
• Ratio
• Rotating hinge

• Humans
• Female
• Male
• Knee Prosthesis/adverse effects
• Retrospective Studies
• Aged
• Prosthesis Failure
• Femur/surgery
• Femur/anatomy & histology
• Risk Factors
• Arthroplasty, Replacement, Knee/adverse effects
• Arthroplasty, Replacement, Knee/methods
• Aged, 80 and over
• Prosthesis Design

• Health education
• Kinesiophobia
• Knee function
• Rehabilitation self-efficacy
• Total knee arthroplasty
• Transtheoretical model

• Implant breakage
• metaphyseal length
• modular fluted tapered stem
• revision total hip arthroplasty
• subsidence
• survivorship

• Humans
• Male
• Aged
• Female
• Arthroplasty, Replacement, Hip/adverse effects
• Reoperation
• Hip Prosthesis
• Retrospective Studies
• Prosthesis Design
• Femur/surgery
• Treatment Outcome
• Prosthesis Failure

• biomaterials
• cementless
• survivorship
• total knee arthroplasty

• pathogenesis
• bone

• arthroplasty
• complications
• fragility fractures
• knee
• readmission

• 3D modeling
• Press-fit stem
• Revision total knee
• Total knee replacement

• UL1 TR001863 NCATS NIH HHS

• ankle arthritis
• database
• incidence
• length of stay
• total ankle arthroplasty
• total ankle replacement
• trends

• Adult
• Arthroplasty
• Arthroplasty, Replacement, Shoulder
• Demography
• Hospitals, High-Volume
• Humans
• Surgeons

• Acetabulum/injuries
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/adverse effects
• Hip Fractures/surgery
• Hip Prosthesis/adverse effects
• Humans
• Periprosthetic Fractures/etiology
• Periprosthetic Fractures/surgery
• Reoperation/adverse effects
• Spinal Fractures/surgery

• adductor
• arthroplasty
• bupivacaine
• exparel
• knee
• liposomal

• bupivacaine
• mepivacaine
• primary THA
• primary TKA
• short acting spinal

• Cost
• Cost of care
• Dislocation
• Instability
• Prosthetic complication
• THA

• PJI
• Staphylococcus epidermidis
• coagulase-negative staphylococcus
• outcomes
• periprosthetic joint infection
• staphylococcus lugdunensis

• complications
• joint replacement
• staged bilateral
• total hip arthroplasty (THA)
• total joint arthroplasty (TJA)
• total knee arthroplasty (TKA)

• SF-36
• functional status
• indications
• meta-analysis
• total hip arthroplasty

Periprosthetic joint infections (PJI) are a rare but severe complication of total joint arthroplasty (TJA). However, the diagnosis of PJI remains difficult. It is one of the research that focuses about diagnosis for PJI for majority researchers to discover a novel biomarker. This meta-analysis tried to evaluate diagnostic value of synovial calprotectin for PJI.

This meta-analysis search of the literature was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. Literature quality was appraised using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) based on RevMan (version 5.3). The diagnostic value of calprotectin for PJI was evaluated by calculating sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), diagnostic score and area under SROC (AUC) based on the Stata version 14.0 software. We conduct subgroup analysis according to the study design, cutoff values, the country of study, and gold standard.

Seven studies were included in this meta-analysis. The pooled sensitivity of synovial calprotectin for the diagnosis of PJI was 0.94 (95% CI, 0.87–0.98), and the specificity was 0.93 (95% CI, 0.87–0.96). The pooled AUC, PLR, and NLR for synovial calprotectin were 0.98 (95% CI, 0.96–0.99), 13.65 (95% CI, 6.89–27.07), and 0.06 (95% CI, 0.02–0.15), respectively. The pooled diagnostic score and DOR were 5.4 (95% CI, 3.96–6.85) and 222.32 (95% CI, 52.52–941.12), respectively.

In summary, this meta-analysis indicates that synovial calprotectin is a promising biomarker of assistant diagnosis for PJI, as well as recommended test for excluding diagnostic tool.

The online version contains supplementary material available at 10.1186/s13018-021-02746-2.

• Calprotectin
• Diagnosis
• Meta-analysis
• Periprosthetic joint infection

Patients after joint arthroplasty tend to be less physically active; however, studies measuring objective physical activity (PA) and sedentary behavior (SB) in these patients provide conflicting results. The aim of this meta-analysis was to assess objectively measured PA, SB and performance at periods up to and greater than 12 months after lower limb arthroplasty. Two electronic databases (PubMed and Medline) were searched to identify prospective and cross-sectional studies from 1 January 2000 to 31 December 2020. Studies including objectively measured SB, PA or specific performance tests in patients with knee or hip arthroplasty, were included in the analyses both pre- and post-operatively. The risk of bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN). After identification and exclusion, 35 studies were included. The data were analyzed using the inverse variance method with the random effects model and expressed as standardized mean difference and corresponding 95% confidence intervals. In total, we assessed 1943 subjects with a mean age of 64.9 (±5.85). Less than 3 months post-operative, studies showed no differences in PA, SB and performance. At 3 months post-operation, there was a significant increase in the 6 min walk test (6MWT) (SMD 0.65; CI: 0.48, 0.82). After 6 months, changes in moderate to vigorous physical activity (MVPA) (SMD 0.33; CI: 0.20, 0.46) and the number of steps (SMD 0.45; CI: 0.34, 0.54) with a large decrease in the timed-up-and-go test (SMD −0.61; CI: −0.94, −0.28) and increase in the 6MWT (SMD 0.62; CI: 0.26–0.98) were observed. Finally, a large increase in MVPA (SMD 0.70; CI: 0.53–0.87) and a moderate increase in step count (SMD 0.52; CI: 0.36, 0.69) were observed after 12 months. The comparison between patients and healthy individuals pre-operatively showed a very large difference in the number of steps (SMD −1.02; CI: −1.42, −0.62), but not at 12 months (SMD −0.75; −1.89, 0.38). Three to six months after knee or hip arthroplasty, functional performance already exceeded pre-operative levels, yet PA levels from this time period remained the same. Although PA and functional performance seemed to fully restore and exceed the pre-operation levels at six to nine months, SB did not. Moreover, PA remained lower compared to healthy individuals even longer than twelve months post-operation. Novel rehabilitation protocols and studies should focus on the effects of long-term behavioral changes (increasing PA and reducing SB) as soon as functional performance is restored.

• lower limb
• orthopedics
• rehabilitation
• replacement
• sitting
• surgery

• arthroplasty research
• clinical orthopedic research
• joint replacement registries
• nationwide databases
• state registries

• Employment
• sports
• total hip arthroplasty
• work

• Complications
• Knee arthroplasty
• Obesity
• Outcomes
• Public health
• Total knee

Peri-prosthetic osteolysis (PPO) and following aseptic loosening are regarded as the prime reasons for implant failure after joint replacement. Increasing evidence indicated that wear-debris-irritated inflammatory response and macrophage polarization state play essential roles in this osteolytic process. Harmine, a β-carboline alkaloid primitively extracted from the Peganum harmala seeds, has been reported to have various pharmacological effects on monoamine oxidase action, insulin intake, vasodilatation and central nervous systems. However, the impact of harmine on debris-induced osteolysis has not been demonstrated, and whether harmine participates in regulating macrophage polarization and subsequent osteogenic differentiation in particle-irritated osteolysis remains unknown. In the present study, we investigated the effect of harmine on titanium (Ti) particle-induced osteolysis in vivo and in vitro. The results suggested harmine notably alleviated Ti particle-induced bone resorption in a murine PPO model. Harmine was also found to suppress the particle-induced inflammatory response and shift the polarization of macrophages from M1 phenotypes to M2 phenotypes in vivo and in vitro, which improved anti-inflammatory and bone-related cytokines levels. In the conditioned medium from Ti particle-stimulated murine macrophage RAW264.7 cells treated with harmine, the osteoblast differentiation ability of mouse pre-osteoblastic MC3T3-E1 cells was greatly increased. And we also provided evidences that the immunomodulatory capacity of harmine might be attributed to the inhibition of the c-Jun N-terminal kinase (JNK) in wear particle-treated macrophages. All the results strongly show that harmine might be a promising therapeutic agent to treat PPO.

• chronic inflammation
• harmine
• macrophage polarization
• osteoimmunomodulatory
• peri-prosthetic osteolysis

• arthroplasty
• fungal
• infection
• joint
• periprosthetic

Implant-derived wear particles can be phagocytosed by local macrophages, triggering an inflammatory cascade that can drive the activation and recruitment of osteoclasts, thereby inducing peri-prosthetic osteolysis. Efforts to suppress pro-inflammatory cytokine release and osteoclastsogenesis thus represent primary approaches to treating and preventing such osteolysis. Sirtuin 3 (SIRT3) is a NAD⁺-dependent deacetylases that control diverse metabolic processes. However, whether SIRT3 could mitigate wear debris-induced osteolysis has not been reported. Herein we explored the impact of the SIRT3 on titanium particle-induced osteolysis. Tartrate resistant acid phosphatase (TRAP) staining revealed that the inhibition of SIRT3 suppressed nuclear factor-κB ligand (RANKL)-mediated osteoclasts activation in a dose-dependent fashion. Notably, inhibition of SIRT3 also suppressed matrix metallopeptidase 9 (MMP9) and nuclear factor of activated T‐cell cytoplasmic 1 (NFATc1) expression at the mRNA and protein levels, while also inhibiting the mRNA expression of dendritic cell-specific transmembrane protein (DC-STAMP), ATPase H⁺ Transporting V0 Subunit D2 (Atp6v0d2), TRAP and Cathepsin K (CTSK) . In addition, inhibition of SIRT3 suppressed titanium particle-induced tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) expression and prevented titanium particle-induced osteolysis and bone loss in vivo. This inhibition of osteoclasts differentiation was found to be linked to the downregulation and reduced phosphorylation of JNK and ERK. Taken together, inhibition of SIRT3 may be a potential target for titanium particle-induced bone loss.

• Sirtuin 3
• inflammatory factors
• osteoclasts
• peri-prosthetic osteolysis

• RA-TKA
• robotic-assisted total knee arthroplasty
• total knee arthroplasty

• Arthroplasty
• Complications
• Mortality
• Periprosthetic joint infection
• Revision arthroplasty
• Total hip arthroplasty
• Total knee arthroplasty

• Medicare
• Total shoulder arthroplasty
• health care costs
• reimbursements
• shoulder arthroplasty
• utilization

• osteoarthritis
• physical function
• prehabilitation
• preoperative exercise
• total hip replacement
• total knee replacement

• arthroplasty fellow
• epidemiology
• orthopedic resident
• orthopedic surgeon
• projection
• total joint arthroplasty

• Incidence
• anatomic
• hemiarthroplasty
• hip and knee arthroplasty
• projections
• reverse
• shoulder arthroplasty

• Aged
• Arthroplasty, Replacement, Hip/statistics & numerical data
• Arthroplasty, Replacement, Hip/trends
• Arthroplasty, Replacement, Knee/statistics & numerical data
• Arthroplasty, Replacement, Knee/trends
• Arthroplasty, Replacement, Shoulder/statistics & numerical data
• Arthroplasty, Replacement, Shoulder/trends
• Female
• Forecasting
• Hemiarthroplasty/statistics & numerical data
• Hemiarthroplasty/trends
• Humans
• Incidence
• Joint Diseases/epidemiology
• Joint Diseases/surgery
• Male
• Middle Aged
• Retrospective Studies
• Shoulder Joint/surgery
• United States/epidemiology

Rehabilitation has been shown to improve functional outcomes following total knee replacement (TKR). However, its delivery and associated costs are highly variable. The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study’s objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after TKR and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Specifically, we tested post-operative outpatient rehabilitation supplemented with interACTION (n = 13) by comparing it to a standard post-operative outpatient rehabilitation program (n = 12) using a randomized design. Attrition rates were relatively low and not significantly different between groups, indicating that participants found both interventions acceptable. A small (not statistically significant) decrease in the number of physical therapy visits was observed in the interACTION Group, therefore no significant difference in total cost could be observed. All patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial. Trial registration: ClinicalTrials.gov NCT02646761 “interACTION: A Portable Joint Function Monitoring and Training System for Remote Rehabilitation Following TKA” 6 January 2016.

• interactive health technologies
• remote rehabilitation
• total knee replacement

• Aged
• Arthroplasty, Replacement, Knee/rehabilitation
• Female
• Humans
• Male
• Middle Aged
• Physical Therapy Modalities
• Pilot Projects
• Telerehabilitation
• Treatment Outcome

• Carnosol
• NFATc1
• Osteoclast
• RANKL

• Arthroplasty
• DTT
• Difficult-to-treat
• Infection
• Periprosthetic joint infection
• Revision

• AORI classification
• Metaphyseal sleeves
• Revision TKA
• Total knee arthroplasty

Aseptic loosening caused by periprosthetic osteolysis (PPO) is the main reason for the primary artificial joint replacement. Inhibition of inflammatory osteolysis has become the main target of drug therapy for prosthesis loosening. MiR‐106b is a newly discovered miRNA that plays an important role in tumour biology, inflammation and the regulation of bone mass. In this study, we analysed the in vivo effect of miR‐106b on wear debris‐induced PPO. A rat implant loosening model was established. The rats were then administrated a lentivirus‐mediated miR‐106b inhibitor, miR‐106b mimics or an equivalent volume of PBS by tail vein injection. The expression levels of miR‐106b were analysed by real‐time PCR. Morphological changes in the distal femurs were assessed via micro‐CT and histopathological analysis, and cytokine expression levels were examined via immunohistochemical staining and ELISA. The results showed that treatment with the miR‐106b inhibitor markedly suppressed the expression of miR‐106b in distal femur and alleviated titanium particle‐induced osteolysis and bone loss. Moreover, the miR‐106b inhibitor decreased TRAP‐positive cell numbers and suppressed osteoclast formation, in addition to promoting the activity of osteoblasts and increasing bone formation. MiR‐106b inhibition also significantly regulated macrophage polarization and decreased the inflammatory response as compared to the control group. Furthermore, miR‐106b inhibition blocked the activation of the PTEN/PI3K/AKT and NF‐κB signalling pathways. Our findings indicated that miR‐106b inhibition suppresses wear particles‐induced osteolysis and bone destruction and thus may serve as a potential therapy for PPO and aseptic loosening.

• bone formation
• bone resorption
• miR-106b
• periprosthetic osteolysis
• wear debris

• aseptic loosening
• biomarker
• osteocalcin
• osteolysis
• rat

Surface treatments are considered as a good alternative to increase biocompatibility and the lifetime of Ti-based alloys used for implants in the human body. The present research reports the comparison of bare and modified Ti6Al4V substrates on hydrophilicity and corrosion resistance properties in body fluid environment at 37 °C. Several surface treatments were conducted separately to obtain either a porous oxide layer using nanostructuration (N) in ethylene glycol containing fluoride solution, or bulk oxide thin films through heat treatment at 450 °C for 3 h (HT), or electrochemical oxidation at 1 V for 3 h (EO), as well as combined treatments (N-HT and N-EO). In-situ X-ray diffraction and ex-situ transmission electron microscopy have shown that heat treatment gave first rise to the formation of a 30 nm thick amorphous layer which crystallized in rutile around 620 °C. Electrochemical oxidations gave rise to a 10 nm thick amorphous film on the top of the surface (EO) or below the amorphous nanotube layer (N-EO). Dual treated samples presented similar results with a more stable behavior for N-EO. Finally, for both corrosion and hydrophilicity points of view, the new combined treatment to get a total amorphous N-EO sample seems to be the best and even better than the partially crystallized N-HT sample.

• TiO2 nanotubes
• bulk oxide layer
• bulk thermal treatment
• corrosion
• wettability

Periprosthetic joint infection (PJI) is a disastrous complication after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The relationship between body mass index (BMI) and the incidence of PJI remains controversial. To better understand the impact of increasing BMI on PJI, we conducted this study to investigate the dose-response relationship between BMI and the risk of PJI after primary THA or TKA.

A systematic search was conducted in PubMed, Embase, and Cochrane Library databases from inception to August 17, 2019. After study selection and data extraction, a dose-response meta-analysis was performed to investigate the relationship between BMI and PJI. Adjusted relative risks (RRs) with 95% confidence intervals (CIs) were pooled using fixed-effects or random-effects models.

Eleven studies comprising 505,303 arthroplasties were included. The dose-response analysis showed a significant non-linear relationship between BMI and the risk of PJI (P_{non-linearity} <0.001). Patients following THA (RR, 1.489; 95% CI, 1.343–1.651; P<0.001) were more likely to suffer from PJI than patients following TKA. Furthermore, American Society of Anesthesiologists (ASA) score ≥3 (RR, 2.287; 95% CI, 1.650–3.170; P<0.001), lung disease (RR, 1.484; 95% CI, 1.208–1.823; P<0.001) and diabetes (RR, 1.695; 95% CI, 1.071–2.685; P=0.024) were identified as risk factors for PJI, but male (RR, 1.649; 95% CI, 0.987–2.755; P=0.056) and hypertension (RR, 0.980; 95% CI, 0.502–1.916; P=0.954) were not recognized as risk factors for PJI.

The J-shaped non-linear relationship demonstrated that increased BMI was associated with an increased risk for PJI after primary THA or TKA. Patients following THA were more likely to suffer from PJI than patients following TKA. Also, patients with ASA score ≥3, lung disease and diabetes have a higher risk of PJI. Gender and hypertension did not influence the incidence of PJI.

• Body mass index (BMI)
• periprosthetic joint infection (PJI)
• risk factors
• total hip arthroplasty (THA)
• total knee arthroplasty (TKA)