Publications by authors named "Incavo S"
Article Synopsis
- This study investigated TRL1068, a monoclonal antibody designed to tackle chronic periprosthetic joint infections (PJI) caused by biofilms, in 15 patients.
- TRL1068 was given as a single pre-surgical infusion in three different doses, in addition to targeted antibiotics, and showed a favorable safety profile with no adverse events linked to the treatment.
- Results indicated a significant reduction in implant bacteria in 3 out of 11 patients receiving TRL1068, with no relapses of infection by day 169, suggesting it could be a promising option for PJI treatment.
Background: Vancomycin is a prophylactic antibiotic with bactericidal activity against methicillin-resistant that is commonly used in total joint replacement surgery. In total knee arthroplasty (TKA), intraosseous infusions administered following tourniquet inflation have demonstrated improved local vancomycin concentrations with decreased systemic absorption. This administration method results in no adverse reactions locally, as well as equivalent or lower systemic complications compared with other vancomycin administration methods.
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- The study examines how correcting limb alignment during total knee replacement impacts patient outcomes and knee motion.
- It analyzes 409 patients' preoperative and postoperative limb alignments using X-rays and measures recovery through patient surveys and knee range of motion across various postoperative periods.
- Results indicate that overcorrection in varus patients leads to poorer patient-reported scores and reduced knee motion, while valgus patients who remain misaligned also show decreased knee flexion.
Article Synopsis
- - A multicenter randomized clinical trial studied the effects of anti-inflammatory medications alongside manipulation under anesthesia (MUA) on knee stiffness after total knee arthroplasty (TKA) in 124 patients.
- - The trial found that while the overall range of motion (ROM) improved significantly by 46° immediately after MUA, adding medications like dexamethasone and celecoxib did not lead to better ROM outcomes compared to control.
- - Both treatment and control groups showed similar clinical outcomes at 6 weeks and 1 year post-MUA, indicating that further research is needed to optimize anti-inflammatory treatment strategies.
Article Synopsis
- During the COVID-19 era, there has been a growing interest in same-day discharge (SDD) after total joint arthroplasty (TJA), but patients' views on SDD are not well documented.
- In a survey of 67 patients who experienced both overnight stays (ONS) and SDD, 63% preferred SDD due to greater comfort at home, while some felt better cared for during ONS.
- Overall, despite a slight difference in perceived safety, there were no significant variations in comfort levels, return to emergency care, or readmission rates between the two discharge methods.
Article Synopsis
- Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are now performed as outpatient procedures, leading to potential challenges in care and reimbursement.
- A study reviewed 2207 patients from 2015 to 2018, finding that TKA patients had higher rates of obesity and related health issues compared to THA patients, as well as shorter hospital stays.
- Despite more comorbidities, TKA patients were more likely to be discharged home after their procedures compared to THA patients, suggesting different recovery patterns that need further investigation.
Article Synopsis
- Robotic-assisted total knee arthroplasty (rTKA) offers better component positioning and reduces alignment outliers compared to manual TKA (mTKA), though overall alignment results are similar for both techniques.
- A study with 250 patients found no significant difference in achieving target alignment between rTKA and mTKA, but rTKA showed better outcomes for patients with preoperative valgus deformities.
- Additionally, patients undergoing rTKA reported higher physical scores at 3 and 6 months post-surgery, suggesting improved recovery outcomes.
Management of Hip Abductor Tears and Recalcitrant Trochanteric Bursitis in Native Hips.
J Am Acad Orthop Surg
October 2023
Hip abductor tears have recently gained recognition as a more prevalent injury than previously thought. This article will detail the pathophysiology of injury, physical symptoms commonly found at presentation, diagnostic imaging to best diagnose tears and when they should be ordered, and how to properly classify the injury and finally summarize the treatment options available with expert opinions about which are most successful.
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- A study investigated using an intraosseous infusion of morphine and ketorolac for pain management in total knee arthroplasty.
- The research involved 24 patients and compared their pain levels and opioid use to a historical group receiving morphine only.
- Results showed that the multimodal infusion reduced pain and the need for additional opioids in the first four hours post-surgery, but no significant differences were observed after that period.
Background: Literature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA.
Methods: This single-blinded randomized control trial was performed from December 2020 to May 2022.
Background: Successful fixation of the greater trochanter (GT) in total hip arthroplasty (THA) is a challenging task. A wide range of clinical results are reported in the literature despite advancements in fixation technology. Previous studies may have lacked adequate sample sizes to detect differences.
View Article and Find Full Text PDFTotal knee arthroplasty is one of the most widely performed surgical procedures today. Its widespread popularity has helped drive innovation and improvement in the field. Different schools of thought have developed regarding the best way to perform this operation.
View Article and Find Full Text PDFBackground: Modern fluted titanium-tapered stems (FTTS) have been increasingly utilized to achieve primary stability in conversion and revision total hip arthroplasty with major femoral bone loss. This study sought to determine the radiographic and clinical outcomes of a monoblock FTTS in patients who had major femoral bone loss.
Methods: A multicenter retrospective observational study of all total hip arthroplasty patients who received a monoblock FTTS who had up to 5-year radiographic follow-up was conducted.
Evaluation of local tissue peri-implant reaction in total knee arthroplasty failure cases.
Ther Adv Musculoskelet Dis
May 2022
Introduction: Implant-related hypersensitivity is emerging as a causative factor as a potential source of total knee arthroplasty (TKA) failure. Mechanistically, this type IV hypersensitivity reaction (T4HR) is mediated by effector T-cells, macrophages, and leukocytes that infiltrate to the site of implant and react to metal exposure and induce inflammatory tissue damage.
Methods: A case-control study was performed where cortical bone was taken at the time of revision surgery for all patients operated on for primary TKA in which metal allergy was suspected and for revision TKA cases done for presumed metal allergy.
Article Synopsis
- The study examines the effectiveness of adding morphine to intraosseous (IO) antibiotic injections for pain relief in total knee arthroplasty (TKA) patients.
- Patients receiving morphine reported significantly lower pain scores and reduced opioid use during the first two weeks post-surgery compared to those who only received antibiotics.
- Overall, combining IO morphine with antibiotics proved to be a safe and effective method for improving pain management after TKA.
Article Synopsis
- This study examines surgical treatment options for chronic hip abductor tears that haven't responded to nonoperative methods, comparing tenodesis and bone trough techniques based on tear types.
- The research involved 45 hips from 44 patients, focusing on pre- and postoperative evaluations, revealing significant improvements in pain, gait, and muscle strength for both tear types, with Type I repairs showing better outcomes.
- MRI results indicated that while the majority of Type I tears healed post-surgery, healing rates for Type II tears were lower, suggesting that imaging may not accurately reflect repair success for over a year following surgery.
Article Synopsis
- The study evaluated the impact of using 40 grams versus 80 grams of cement in total knee arthroplasty (TKA) to assess cost-effectiveness and radiographic outcomes.
- There was no significant difference in the quality of the cement mantle between the two groups, although a slight increase in deficiency was noted in the 40-gram group for one specific zone.
- The use of 40 grams of cement resulted in estimated annual cost savings of over $33 million in the U.S. healthcare system.
Article Synopsis
- - The study reviews the incidence of periprosthetic joint infections (PJI) in total knee arthroplasties (TKA), focusing on the effectiveness of intravenous (IV) vs. intraosseous (IO) administering of vancomycin, particularly in relation to methicillin-resistant Staphylococcus aureus (MRSA) concerns.
- - A total of 1,060 patients were analyzed, with results indicating a significantly lower infection rate in the IO group (0.22%) compared to the IV group (1.4%) over at least 90 days.
- - The findings suggest that using IO vancomycin, paired with a first-generation cephalosporin, may reduce infection rates in
Background: Revision total knee arthroplasty commonly involves stemmed components. If the diaphysis is engaged, this technique may be problematic for mechanical alignment (MA) in cases of tibial bowing, which are not infrequent (up to 30%). The aim of this study is to compare an intra-medullary(IM) and extra-medullary(EM) alignment method.
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- The study investigates the impact of limb alignment correction during total knee arthroplasty (TKA) on bone mineral density (BMD) in patients with different types of knee malalignment (valgus vs. varus).
- Results indicate that patients with varus malalignment had higher preoperative BMD in both the distal femur and proximal tibia compared to valgus patients, who showed significant BMD improvements six months post-surgery.
- The findings suggest that addressing valgus malalignment during TKA could play a critical role in promoting positive bone remodeling.
DEXA overestimates bone mineral density in adults with knee replacements.
Sports Med Health Sci
December 2020
We examined bone mineral density (BMD) measurements made by dual-energy-xray-absorptiometry (DEXA) taken from 100 patients (♂46/♀54, 66±6yr) who previously underwent single total-knee arthroplasty (TKA) to determine if automated software-based artifact detection (ASAD) adequately removes implant artifact from the DXA image before analysis and if potential inaccuracies could be overcome through manual artifact correction (MAC). We also sought to determine if software-based inaccuracies would result in fracture risk misclassification (Low-BMD/Osteopenia = Young-Adult T-Score < -1). Select Results: When using ASAD, limbs with implants had higher BMD (+12.
View Article and Find Full Text PDFUnlabelled: Hip abductor tendon tears are a well-recognized entity that results in progressive lateral hip pain, weakness, and limping. These can occur in patients with native hips or in patients following total hip arthroplasty. However, treatment of these 2 distinct groups does not differ.
View Article and Find Full Text PDFBackground: Vancomycin is a commonly used prophylactic antibiotic for total joint replacement surgery to protect against methicillin-resistant . Studies have suggested intraosseous (IO) infusions provide superior local tissue antibiotic concentration compared with intravenous (IV) access in total knee arthroplasty (TKA). We reviewed patients receiving IO vancomycin before TKA, comparing complication rates to a matched group receiving IV prophylactic vancomycin.
View Article and Find Full Text PDFPerceptions of Polymethyl Methacrylate Cement Exposure Among Female Orthopaedic Surgeons.
J Am Acad Orthop Surg Glob Res Rev
March 2020
Article Synopsis
- The study explores female orthopedic surgeons' perceptions of the risks associated with PMMA vapor exposure during pregnancy, highlighting its effect on their beliefs, practices, and career choices.
- A survey was conducted among members of the Ruth Jackson Orthopaedic Society and a Facebook group, assessing their training, PMMA usage, and willingness to remain in the operating room while pregnant or breastfeeding.
- Results showed that while some surgeons are willing to stay in the room during PMMA use, a significant portion expressed concerns, indicating a lack of consensus on the associated risks and suggesting a need for reevaluation of current beliefs and educational practices.
Case: We present here 2 cases of postoperative stress fractures in the setting of a short-stem implant. Both patients had well-aligned implants with good bone quality and presented with delayed onset and atraumatic thigh pain. They were diagnosed with periprosthetic fractures around stable implants.
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