The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty.

Background: Periprosthetic infection (PPI) is a difficult complication in total joint arthroplasty, and while erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are acute phase reactants thought to be of high predictive value for diagnosing infection, no clear cut-off values have been defined. The current study aimed to determine the cut-off values for ESR and CRP that improve clinical differentiation between aseptic failure and PPI in total hip arthroplasty (THA).

Methods: Four hundred and seventy-nine patients who underwent revision THA for either aseptic mechanical failure or PPI during the period of 2000 to 2005 were included in the study.

Periprosthetic infection due to resistant staphylococci: serious problems on the horizon.

Unlabelled: Prosthetic joint infections (PJI) caused by methicillin-resistant staphylococci represent a major therapeutic challenge. We examined the effectiveness of surgical treatment in treating infection of total hip or knee arthroplasty caused by methicillin-resistant staphylococcal strains and the variables influencing treatment success. One hundred and twenty-seven patients were treated at our institution between 1999 and 2006.

Postoperative pain management techniques in hip and knee arthroplasty.

Adequate control of postoperative pain following hip and knee arthroplasty can be a challenging task fraught with potential complications. Postoperative pain is perceived by the patient via a complex network and a multitude of molecular messengers in both the peripheral and central nervous systems. This allows the physician to modulate pain via an array of medications that act on different sites within the body.

Cyclooxygenase-2 inhibitors and other nonsteroidal anti-inflammatory drugs in the treatment of musculoskeletal conditions.

Selective and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat a variety of musculoskeletal conditions. The efficacy of these medications has been proved, although the risks have not been clearly delineated. Nonselective NSAIDs are associated with gastrointestinal, renal, and hematologic complications.

Resistant organisms in infected total knee arthroplasty: occurrence, prevention, and treatment regimens.

Infection of a primary joint arthroplasty can be a life-changing event for a patient. When the infecting organism demonstrates antibiotic resistance, treatment can be prolonged, and the chances for a successful outcome may be decreased. Antibiotic resistance has been an evolutionary process since the introduction of pharmacologic treatment and until recently has been more problematic with nosocomial types of infections.

Revision total hip arthroplasty for instability: surgical techniques and principles.

Instability is one of the most common complications after total hip arthroplasty. Fortunately, instability usually occurs as a single episode and can successfully be treated nonsurgically in many instances. However, recurrent instability may require surgical treatment.

Topographic features retained after antibiotic modification of Ti alloy surfaces: retention of topography with attachment of antibiotics.

Periprosthetic infection is increasingly prevalent in orthopaedics with infection rates of 2% to 15% after total hip arthroplasty. To effectively decrease bacterial attachment, colonization, and subsequent development of periprosthetic infection, we previously described a method to covalently bond vancomycin to smooth Ti alloy surfaces. To attach vancomycin, the Ti surface is first passivated to create a fresh oxide layer.

Gamma inert sterilization: a solution to polyethylene oxidation?

Background: In the 1990s, oxidation was found to occur in ultra-high molecular weight polyethylene total joint replacement components following gamma irradiation and prolonged shelf aging in air. Orthopaedic manufacturers developed barrier packaging to reduce oxidation during and after radiation sterilization. The present study explores the hypothesis that polyethylene components sterilized in a low-oxygen environment undergo similar in vivo oxidative mechanisms as inserts sterilized in air.

Periprosthetic infection: where do we stand with regard to Gram stain?

Background And Purpose: One of the routinely used intraoperative tests for diagnosis of periprosthetic infection (PPI) is the Gram stain. It is not known if the result of this test can vary according to the type of joint affected or the number of specimen samples collected. We examined the role of this diagnostic test in a large cohort of patients from a single institution.

One-stage bilateral total joint arthroplasty: a prospective, comparative study of total hip and total knee replacement.

This prospective study compared the incidence of minor and major complications in 50 patients (100 joints) undergoing bilateral total knee arthroplasty (TKA) with 50 patients (100 joints) undergoing bilateral total hip arthroplasty (THA). Gender, comorbidities, American Society of Anesthesiologists scores, and body mass indices were similar in both groups. There was no difference in preoperative hemoglobin, operative time, anesthetic management, postoperative surveillance, and hemoglobin at discharge.

Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.

This clinical practice guideline is based on a systematic review of published studies on the management of adult patients undergoing total hip replacement (THR) or total knee replacement (TKR) aimed specifically at preventing symptomatic pulmonary embolism (PE). The guideline emphasizes the need to assess the patient's risk for both PE and postoperative bleeding. Mechanical prophylaxis and early mobilization are recommended for all patients.

Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation?

Unlabelled: Erythrocyte sedimentation rate and C-reactive protein are common preoperative diagnostic markers for prosthetic joint infection but their prognostic role before reimplantation has yet to be defined. We therefore determined the prognostic value of erythrocyte sedimentation rate and C-reactive protein performed before second-stage reimplantation for the treatment of infected total knee arthroplasty (TKA). We studied 109 patients who had undergone two-stage revision TKA for sepsis from 1999 to 2006.

Outcome of a second two-stage reimplantation for periprosthetic knee infection.

Unlabelled: Recurrent or persistent infection after two-stage exchange arthroplasty for previously infected total knee replacement is a challenging clinical situation. We asked whether a second two-stage procedure could eradicate the infection and preserve knee function. We evaluated 18 selected patients with failed two-stage total knee arthroplasty implantation treated with a second two-stage reimplantation between 1999 and 2005.

Periprosthetic infection: are current treatment strategies adequate?

Two-staged resection arthroplasty with delayed reimplantation is currently the method of choice for treatment of an infected total hip arthroplasty. There is paucity of data regarding the risk factors for reinfection after reimplantation. The objective of this study was to determine the efficacy of two-stage resection arthroplasty for infected THA and to identify risk factors for reinfection.

Uncemented total hip arthroplasty in patients less than twenty-years.

A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, total hip arthroplasty may occasionally be necessary for treatment of end-stage disabling arthritis of the hip in the young. There is paucity of information documenting the outcome of uncemented total hip arthroplasty in adolescents.

Preadmission hyperglycemia is an independent risk factor for in-hospital symptomatic pulmonary embolism after major orthopedic surgery.

We investigate whether preadmission hyperglycemia is a risk factor for developing in-hospital symptomatic pulmonary embolism after major orthopedic surgery. Medical records of patients undergoing total hip or total knee arthroplasty from January 2001 to April 2006 were reviewed. The incidence of PE was 1.

Controlled release of vancomycin from thin sol-gel films on implant surfaces successfully controls osteomyelitis.

Peri-prosthetic infection remains a serious complication of joint replacement surgery. Herein, we demonstrate that a vancomycin-containing sol-gel film on Ti alloy rods can successfully treat bacterial infections in an animal model. The vancomycin-containing sol-gel films exhibited predictable release kinetics, while significantly inhibiting S.

Micro-CT analysis with multiple thresholds allows detection of bone formation and resorption during ultrasound-treated fracture healing.

Multiple threshold algorithms applied to microcomputed tomography analysis were used to probe the effects of low-intensity pulsed ultrasound on fracture healing. Rat femurs were fractured in accordance with IACUC guidelines. Ultrasound treatment was administered daily to one femur; the contralateral bone was treated with a sham transducer.

Deep venous thrombosis prophylaxis for total joint arthroplasty: American Academy of Orthopaedic Surgeons guidelines.

The orthopedic community continues to face a challenge with regard to the prevention of thromboembolism after total joint arthroplasty. The first and foremost issue facing surgeons is how to select the best agent or modality that is effective in preventing the untoward consequences of thromboembolism without causing other complications that can have dire consequences. Other challenges include the uncertainty regarding the dose and duration of various agents, the value of mechanical prophylaxis alone, and the exact end points that should be used to measure the efficacy of prophylaxis.

Early mortality after modern total hip arthroplasty.

Unlabelled: Because of improvements in surgical technique, anesthesia, and rehabilitation, mortality after hip arthroplasty may be on the decline. The purpose of this study was to determine the 90-day mortality rate after uncemented total hip arthroplasty (THA) performed under regional anesthesia. We retrospectively reviewed 7478 consecutive patients undergoing cementless primary or revision THA between January 2000 and July 2006.

Isolated polyethylene exchange versus acetabular revision for polyethylene wear.

Unlabelled: Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for polywear and osteolysis.

Periprosthetic knee fractures.

Fractures of the distal femur, proximal tibia, and patella that occur adjacent to a total knee replacement may be very difficult to treat. Fixation options are compromised because of the short articular segment, frequent comminution, pre-existing osteoporosis, previous surgical incisions, and the presence of the knee implant itself. This review article summarizes current concepts regarding the incidence, classification, treatment options, and outcomes for periprosthetic fractures of the knee.

The inhibition of Staphylococcus epidermidis biofilm formation by vancomycin-modified titanium alloy and implications for the treatment of periprosthetic infection.

Peri-prosthetic infections are notoriously difficult to treat as the biomaterial implant is ideal for bacterial adhesion and biofilm formation, resulting in decreased antibiotic sensitivity. Previously, we reported that vancomycin covalently attached to a Ti alloy surface (Vanc-Ti) could prevent bacterial colonization. Herein we examine the effect of this Vanc-Ti surface on Staphylococci epidermidis, a Gram-positive organism prevalent in orthopaedic infections.

Hypoxemia after total joint arthroplasty: a problem on the rise.

Total joint arthroplasty (TJA) is categorized as a major risk factor for thromboembolic complications. The importance of hypoxemia during the postoperative period is subject of controversy. This prospective study elucidates the incidence and etiology of hypoxemia after TJA.

Diagnosis of infected total knee: findings of a multicenter database.

Unlabelled: Although total knee arthroplasty (TKA) is an effective and successful procedure, the outcome is occasionally compromised by complications including periprosthetic joint infection (PJI). Accurate and early diagnosis is the first step in effectively managing patients with PJI. At the present time, diagnosis remains dependent on clinical judgment and reliance on standard clinical tests including serologic tests, analysis of aspirated joint fluid, and interpretation of intraoperative tissue and fluid test results.