Metallosis in Total Hip Arthroplasty.

» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.

Serum CD64 as a Marker for Chronic Periprosthetic Joint Infection.

Background: Serum cluster of differentiation 64 (CD64) has emerged as a diagnostic test for musculoskeletal infections. The purpose of this study was to evaluate the utility of serum CD64 in diagnosing periprosthetic joint infections (PJIs) compared to conventional markers like white blood count (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6).

Methods: A prospective case-control study on patients undergoing revision hip or knee arthroplasty surgery >6 weeks after their index surgery was performed at a single institution.

Revision total knee arthroplasty for arthrofibrosis improves range of motion.

Purpose: Arthrofibrosis after primary total knee arthroplasty (TKA) is a significant contributor to patient dissatisfaction. While treatment algorithms involve early physical therapy and manipulation under anaesthesia (MUA), some patients ultimately require revision TKA. It is unclear whether revision TKA can consistently improve these patient's range of motion (ROM).

Clean or Dirty? A Systematic Review of Splash Basin Use and Its Infectious Potential in Orthopaedic Surgery.

Background: Splash basins are used in orthopaedic surgery cases to wash and hold instrumentsintraoperatively. This systematic review aims to summarize information on contamination of splash basins intraoperatively.

Methods: A systematic review was conducted using the following search terms: "splash basin" or "splash bucket.

Impact of Antibiotic-Impregnated Spacer Design in the Treatment of Periprosthetic Hip Infection.

Background: Although 2-stage exchange arthroplasty, consisting of temporary insertion of an antibiotic-impregnated cement spacer (AICS), is considered the standard of care for chronic periprosthetic joint infection (PJI) in total hip arthroplasty (THA), a consensus on the AICS design has not yet been established. Ceramic-on-polyethylene AICSs (Poly-AICS) are theorized to cause less pain and better function than cement-on-bone AICS (CemB-AICS) but use non-antibiotic-impregnated components that may harbor bacteria. This study evaluates the impact of spacer design on infection-free survivorship following THA reimplantation as well as pain and function during the interim AICS stage.

There is an App for That: Mobile Technology Improves Complication Reporting and Resident Perception of Their Role in Patient Safety.

Unlabelled: Morbidity and mortality (M&M) conferences are rooted within the culture of medicine. They serve a role in every training program and have been mandated by the Accreditation Council for Graduate Medical Education in surgical programs since 1983. Despite the patient safety improvements and educational benefits of these conferences, many adverse events are grossly under-reported.

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty.

Background: The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA).

Methods: This study was a prospective, observational study at a single medical center from 2000-2017.

How Are Orthopaedic Surgery Residencies Responding to the COVID-19 Pandemic? An Assessment of Resident Experiences in Cities of Major Virus Outbreak.

Background: In response to COVID-19, American medical centers have enacted elective case restrictions, markedly affecting the training of orthopaedic residents. Residencies must develop new strategies to provide patient care while ensuring the health and continued education of trainees. We aimed to describe the evolving impact of COVID-19 on orthopaedic surgery residents.

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty.

Given a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of "tobacco use disorder.

Smoking and Total Hip Arthroplasty: Increased Inpatient Complications, Costs, and Length of Stay.

Background: Smoking is a potentially modifiable risk factor that may impact the overall outcomes of total hip arthroplasty (THA). In an era of bundled payments for THA, the purpose of this study was to evaluate, on a national level, the inpatient complications and additional costs of smokers undergoing THA.

Methods: The Nationwide Inpatient Sample was used to identify all primary elective THAs performed in the United States in 2014.

Association of Wearable Activity Monitors With Assessment of Daily Ambulation and Length of Stay Among Patients Undergoing Major Surgery.

Importance: Early postoperative ambulation is vital to minimizing length of stay (LOS), but few hospitals objectively measure ambulation to predict outcomes. Wearable activity monitors have the potential to transform assessment of postoperative ambulation, but key implementation data, including whether digitally monitored step count can identify patients at risk for poor efficiency outcomes, are lacking.

Objectives: To define the distribution of digitally measured daily step counts after major inpatient surgical procedures, to assess the accuracy of physician assessment and ordering of ambulation, and to quantify the association of digitally measured step count with LOS.

Increasing Burden of Total Hip Arthroplasty Revisions in Patients Between 45 and 64 Years of Age.

Background: This study provides a comprehensive analysis of total hip arthroplasty (THA) revisions in the U.S. from 2007 to 2013.

Inflammatory pseudotumor after ceramic-on-ceramic total hip arthroplasty.

We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.

Venous thromboembolic disease after total hip and knee arthroplasty: current perspectives in a regulated environment.

Venous thromboembolic disease is the single most common reason for readmission to the hospital following total hip and total knee arthroplasty and remains a genuine threat to the life of the patient. Nevertheless, advances in surgical procedure, anesthetic management, and postoperative convalescence have altered the risks of venous thromboembolism after total joint arthroplasty in the lower extremity. Regional anesthetic techniques reduce the prevalence of venographic thrombosis by approximately 50%, and intraoperative monitoring has identified preparation of the femoral canal as the sentinel event that activates the coagulation cascade by the intravasation of marrow fat into the systemic circulation.

Recombinant human bone morphogenetic protein-2 in open tibial fractures. A subgroup analysis of data combined from two prospective randomized studies.

Background: The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) to improve the healing of open tibial shaft fractures has been the focus of two prospective clinical studies. The objective of the current study was to perform a subgroup analysis of the combined data from these studies.

Methods: Two prospective, randomized clinical studies were conducted.

Oral direct thrombin inhibitor ximelagatran compared with warfarin for the prevention of venous thromboembolism after total knee arthroplasty.

Background: Warfarin, which requires coagulation monitoring, is associated with relatively high rates of thromboembolism despite providing adequate prophylaxis. This study compared an oral direct thrombin inhibitor, ximelagatran, with warfarin in order to evaluate the safety and efficacy of the medication for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty.

Methods: Following surgery, patients were randomly assigned to fixed-dose oral ximelagatran (36 mg twice daily) or warfarin (target international normalized ratio, 2.

Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement.

Background: In a previous study of the prevention of venous thromboembolism after total knee replacement, the efficacy of ximelagatran, an oral direct thrombin inhibitor that does not require monitoring of coagulation or dose adjustment, was found to be similar to that of warfarin at a dose of 24 mg of ximelagatran twice daily. The purpose of the present study was to determine whether a higher dose of ximelagatran is superior to warfarin.

Methods: This randomized, double-blind trial compared a regimen of 7 to 12 days of oral ximelagatran, at a dose of 24 or 36 mg twice daily, starting the morning after surgery, with warfarin therapy started the evening of the day of surgery.

Population demographics and socioeconomic impact of osteoporotic fractures in Canada.

Through a survey of the literature and an analysis of selected national and regional statistics, a review of the incidence of osteoporosis and its consequences was performed. Results illustrate that the consequences of osteoporosis are preventable and should sensitize clinicians to the importance of early detection and the identification of risk factors for disease prevention and to early treatment once disease has been established. A marked increase in the annual incidence of hip fractures in all Canadians is noted.

Musculoskeletal manifestations of human immunodeficiency virus infection.

Musculoskeletal manifestations of the human immunodeficiency virus (HIV) are common and are sometimes the initial presentation of the disease. Knowledge of the conditions affecting muscle, bone, and joints in HIV-infected patients is essential for successful management. Myopathies may be caused by pyogenic infection (eg, pyomyositis), idiopathic inflammation (eg, polymyositis), or drug effect (eg, AZT myopathy).

Association between human immunodeficiency virus and osteonecrosis of the femoral head.

The records of a consecutive series of 50 patients treated operatively for osteonecrosis of the femoral head were reviewed to determine the prevalence of human immunodeficiency virus (HIV) as an isolated risk factor for osteonecrosis. Twelve patients had a history of trauma to the hip and were excluded from the study. The remaining 38 patients were treated operatively for nontraumatic osteonecrosis of the femoral head.