Midthun, William R.

Aims Two-stage exchange arthroplasty with an antibiotic-eluting cement spacer remains the predominant strategy in the USA for managing chronic periprosthetic joint infection (PJI) following total hip arthroplasty (THA). The aim of this study was to evaluate a commercially available, partially intraoperatively fabricated articulating high-dose antibiotic cement spacer, focusing on survival, complications, and patient-reported outcomes. Methods A total of 298 patients (302 THAs) underwent two-stage exchange arthroplasty for PJI using a specific articulating antibiotic spacer between August 2005 and May 2022. Patients with a previous failed two-stage exchange were excluded, although 121 THAs (302, 40%) had undergone previous PJI-related procedures. The mean age of the patients was 65 years (SD 11), the mean BMI was 32 kg/m 2 (SD 7), and 116 (38%) were female. Most patients were classified as McPherson host B (158; 52%) and limb grade 2 (165; 55%), and 265 (88%) met the 2011 Musculoskeletal Infection Society criteria. The mean follow-up was six years (2 to 16). Results At five years after reimplantation, survival free of reinfection, aseptic rerevision, any rerevision, or any reoperation were 89% (95% CI 85.2 to 93.1), 93% (95% CI 89.3 to 96.1), 86% (95% CI 81.3 to 90.3), and 80% (95% CI 74.7 to 84.9), respectively. Dislocation accounted for most aseptic rerevisions (15/20). McPherson host C (HR 3.7 (95% CI 1.4 to 9.6); p = 0.007) and limb grade 3 (HR 3.3 (95% CI 1.0 to 11.1); p = 0.049) were significantly associated with an increased risk of reinfection. The mean Harris Hip Score at the latest follow-up was 76 (29 to 100). A total of 17 patients underwent revision or removal of a spacer for concerns about persistent infection and two for dislocation of the spacer. Eight patients underwent a non-rerevision reoperation during the spacer interval for wound drainage (n = 5), dislocation of the spacer (n = 2), and perispacer fracture (n = 1). A total of 26 spacer-related complications were treated nonoperatively (15 perispacer fractures, 11 dislocations). Dislocation of the spacer was strongly associated with dislocation after reimplantation (HR 6.2 (95% CI 2.3 to 16.9); p < 0.001). Conclusion This commercially available, partially intraoperatively fabricated articulating spacer showed excellent reinfection-free five-year survival (89%). Spacer-related fracture and dislocation each occurred in 5% of patients. Dislocation of the spacer significantly increased the risk of dislocation following reimplantation, supporting the use of higher-stability bearings in these high-risk patients. Cite this article: Bone Joint J 2026;108-B(9):1104–1112.

Purpose: Lifestyle and social frailty factors are a new focus in the multidimensional concept of frailty, as recent reports have found strong associations with negative health outcomes. We searched for specific social and lifestyle frailty factors independently associated with 5-year survival and the risk of hospitalization in patients with severe chronic obstructive pulmonary disease (COPD). Methods: We retrospectively analyzed questionnaire data from the National Emphysema Treatment Trial (NETT) and identified items related to the published definition of social frailty. Classification and Regression Tree, a machine learning method, was used to select variables most strongly associated with survival time or hospitalizations beyond 12 months of NETT study enrollment. Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models were used to determine relationships between social/lifestyle variables and hospitalization and survival. Results: Four social and lifestyle frailty factors were significantly related to survival (impaired lifting, bathing and dressing, in-store shopping, and loneliness). Two social and lifestyle frailty factors were significantly related to risk of hospitalization (emotional distress and difficulty performing work or activities). A combination of 6 questions provided clinical phenotypes that were robustly and independently associated with mortality risk and hospitalization with hazard ratios that ranged from 2.4 to 11.2 and 2.2 to 3.5 for survival and hospitalization, respectively, after adjustment for age, sex, disease severity, and physical frailty. Conclusion: Lifestyle and social frailty factors that could be easily identified in practice may represent a novel approach to a multidimensional frailty assessment to predict survival and hospitalization in patients with severe COPD.