The prevention and treatment of periprosthetic joint infection is of utmost importance to orthopedic surgeons. Irrigation solutions have become a popular additive to the prevention and treatment ...armamentarium.
This symposium summarizes the mechanism of action, basic science, and clinical research to date on the use of irrigation solutions. The four most commonly used irrigation solutions, povidone iodine, chlorhexidine, hydrogen peroxide, and acetic acid, are discussed. In addition, the role of antibiotic powers is reviewed.
Each solution has its risks and benefits that must be weighed by the surgeon. There is no clear irrigation solution that is superior. The role of additive antibiotic powder (vancomycin) remains controversial.
More rigorous prospective clinical trials are needed to determine the optimal irrigation solution for the prevention and treatment of periprosthetic joint infection.
Obesity in the United States has reached epidemic proportions. It is associated with multiple higher rates of osteoarthritis of the hip and knee and thus an increasing need for total hip and knee ...arthroplasty. The demand for total joint arthroplasty among obese patients has increased and outpaces that of a non-obese cohort. The complications associated with obese patients undergoing hip or knee replacement is well defined in the literature.
Many practices have set restriction on body mass index (BMI) prior to elective total join arthroplasty. We review the implications of these BMI cutoffs as it is related to access to care for morbidly obese patients in need of hip and knee arthroplasty.
Of the 289 patients who presented with BMI >40, only 19% of patients underwent total hip or knee arthroplasty at a minimum of 2 years of follow-up.
This symposium discusses the implications of withholding surgery in the morbidly obese and sets the stage for the development of more collaborative work to ensure optimal care and optimal outcome for the morbidly obese.
Abstract Periprosthetic joint infection remains one of the most common failure modes following total hip and total knee arthroplasty. As such, a systematic and cost effective approach to the ...evaluation and work-up of a patient with a suspected periprosthetic joint infection should be undertaken in every patient with a painful total joint. Although we have many diagnostic tools, a history and physical remain the most important. Many of the current laboratory tests are indirect measure of infection, lack specificity for diagnosis of infection, but serve as sensitive and cost effective screening tools. In addition, a new definition of periprosthetic infection helps to standardize the diagnosis. Biomarkers hold the promise of improved specificity and are becoming increasingly popular as a diagnostic tool.
Abstract Background Infection remains a leading cause of failure of hip and knee replacements. Infection burden is the ratio of implants revised for infection to the total number of arthroplasties in ...a specific period, measuring the steady state of infection in a registry. We hypothesized infection burden would be similar among arthroplasty registries. Methods We evaluated publicly reported data from 6 arthroplasty registries (Australian Orthopaedic Association National Joint Replacement Registry AOANJRR, New Zealand Joint Registry, Swedish Hip Arthroplasty Register, Swedish Knee Arthroplasty Register, National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man, and the American Joint Replacement Registry) for revisions performed with an infection diagnosis over the last 6 years. Results The 2015 hip infection burden varied between registries from 0.76% (AOANJRR) to 1.24% (Swedish Hip Arthroplasty Register), and the unweighted overall average for hip infection burden was 0.97%. In 2012, 2013, and 2014, average hip infection burden held steady at 0.87%, 0.93%, and 0.94%, respectively, higher than the preceding 2 years. The 2015 knee infection burden varied from 0.88% (AOANJRR) to 1.28% (Swedish Knee Arthroplasty Register), and the unweighted average was 1.03%. In 2012, 2013, and 2014, knee infection burden was 1.04%, 1.11%, and 1.02%, respectively. These numbers were also higher than the preceding 2 years. Conclusions Infection burden may be one measure of the overall success in registry populations as well as monitoring the steady state of infection worldwide. Despite global efforts to reduce postoperative infection, infection burden has actually increased in the selected registries over time.
Periprosthetic joint infection (PJI) is one of the most devastating complications following total joint arthroplasty, accounting for a projected 10,000 revision surgeries per year by 2030. Chronic ...PJI is complicated by the presence of bacterial biofilm, requiring removal of components, thorough debridement, and administration of antibiotics for effective eradication. Chronic PJI is currently managed with single-stage or 2-stage revision surgery. To date, there are no randomized, prospective studies available evaluating eradication rates and functional outcomes between the 2 techniques. In this review, both treatment options are described with the most current literature to guide effective surgical decision-making that is cost-effective while decreasing patient morbidity.
Abstract This study sought to prospectively examine the clinical and radiographic differences between direct anterior (DA-THA) and mini-posterior approach total hip arthroplasty (MPA-THA). Fifty-four ...patients were prospectively randomized to either MPA or DA-THA. Patient recorded diaries were collected. Radiographs were reviewed. SF-36, WOMAC and HHS scores were tabulated. Time to ambulation without any assistive device favored DA-THA (22 vs. 28 days, P = 0.04). Three week SF mental scores favored MPA-THA (60.66 vs. 58.43, P = 0.01). In a randomized prospective trial, patients undergoing DA-THA voluntarily quit use of all walking aids on average 6 days earlier than patients with a MPA-THA. Little additional clinical or radiographic benefit was seen between the cohorts.
Abstract Smoking and nicotine use remain a major health care crisis in the United States. Although rates have dropped dramatically over the last 50 years, approximately 18% of the US adult population ...still smokes. The musculoskeletal effects of nicotine and other byproducts of smoking place patients at increased risk for perioperative complications including medical complication, wound healing problems, infection, and death. A comprehensive behavioral modification program with or without the use of nicotine replacement therapy has been shown to be most effective at smoking cessation around the time of planned surgery. Although literature suggests that smoking cessation 4-6 weeks before surgery can diminish risk, both current and former smokers are at increased risk for perioperative complications compared with those that have never smoked. Cotinine, a metabolite of nicotine, can be used to monitor smoking cessation before surgery.
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