Cathodic voltage-controlled electrical stimulation and betadine decontaminate nosocomial pathogens from implant surfaces.

Periprosthetic joint infection (PJI) after total joint arthroplasty is a major concern requiring multiple surgeries and antibiotic interventions. , , and are the predominant causes of these infections. Due to biofilm formation, antibiotic treatment for patients with PJI can prolong resistance, further complicating the use of current treatments.

Pathogenic genetic variations of C. acnes are associated with clinically relevant orthopedic shoulder infections.

Many surgeons continue to face the clinical dilemma of interpreting a positive aspiration or unexpected positive Cutibacterium acnes (C. acnes) culture. There are factors that complicate the interpretation of positive cultures including variations in both frequency of false positive cultures and virulence properties.

Flexion Space Balancing Through Component Positioning and Its Relationship to Traditional Anatomic Rotational Landmarks in Robotic Total Knee Arthroplasty.

Background: The use of the femoral component position to balance the flexion space and its relationship to the transepicondylar axis (TEA) and posterior condylar angle (PCA) has not been thoroughly evaluated.

Methods: A total of 233 patients undergoing robotic arm-assisted total knee arthroplasty were evaluated. Native TEA and PCA were established on preoperative computed tomography scans.

Nationwide Organism Susceptibility Patterns to Common Preoperative Prophylactic Antibiotics: What Are We Covering?

Background: Many periprosthetic joint infections (PJIs) are caused by organisms not susceptible to first-generation cephalosporins. We sought to evaluate the national susceptibility patterns of organisms to cefazolin and, or oxacillin, clindamycin, and vancomycin using antibiogram data.

Methods: Publically available regional and state antibiograms were evaluated for antibiotic susceptibility patterns to commonly infecting gram-positive organisms.

Hemolysis Is a Diagnostic Adjuvant for Propionibacterium acnes Orthopaedic Shoulder Infections.

Introduction: The purpose of this study was to further evaluate the pathogenicity of hemolytic and nonhemolytic phenotypes of Propionibacterium acnes (P acnes) isolates from shoulders of orthopaedic patients.

Methods: Thirty-one patient records were reviewed, which had a positive P acnes shoulder culture from joint aspiration fluid and/or intraoperative tissues for demographics, clinical course, culture, and laboratory data. Patients were categorized as definite infection, probable infection, or probable contaminant.

Tranexamic Acid Reduces Perioperative Blood Loss and Hemarthrosis in Total Ankle Arthroplasty.

Tranexamic acid (TXA) is an effective agent used for reducing perioperative blood loss and decreasing the potential for postoperative hemarthrosis. We hypothesized that patients who had received intraoperative TXA during total ankle arthroplasty (TAA) would have a reduction in postoperative drain output, thereby resulting in a reduced risk of postoperative hemarthrosis and lower wound complication rates. A retrospective review was conducted on 50 consecutive patients, 25 receiving TXA (TXA-TAA) and 25 not receiving TXA (No TXA-TAA), who underwent an uncemented TAA between September 2011 and December 2015.

The Use of Antibiograms in Orthopedic Surgery.

Purpose Of Review: Organism identification and antibiotic selection remain a critical component of periprosthetic joint infection (PJI) treatment. Prior to organism identification and/or the availability of antibiotic sensitivities, empiric antibiotics are routinely started. A basic understanding of a region or institutions antibiogram is paramount for selection of an empiric treatment regimen.

Centers for Disease Control and Prevention 2017 Guidelines for Prevention of Surgical Site Infections: Review and Relevant Recommendations.

Purpose Of Review: The associated patient morbidity and resource-intensive nature of managing surgical site infections (SSI) has focused attention toward not only improving treatment protocols but also enhancing preventative measures. The purpose of this review was to summarize the relevant updated CDC guidelines for the prevention of SSI that were released in 2017. The CDC recommends the integration of the guidelines for improvement in quality metrics, reportable outcomes, and patient safety.

The Role of the Tourniquet and Patella Position on the Compartmental Loads During Sensor-Assisted Total Knee Arthroplasty.

Background: An inflated tourniquet may diminish the natural excursion of the extensor mechanism and alter compartmental loads, affecting the surgeon's ability to accurately assess ligament balance during total knee arthroplasty (TKA). In addition, patella position (reduced, lateralized, or everted) has also been known to affect compartmental loads. This study used intraoperative sensing to assess how a combination of tourniquet inflation and patella position may affect medial and lateral compartmental loads during sensor-assisted TKA.

The flexion space is more reliably balanced when using the transepicondylar axis as compared to the posterior condylar line.

Purpose: The purpose of this study was to evaluate the differences in flexion space balance when the femoral component is implanted parallel to the surgical transepicondylar axis (TEA) or with 3° of external rotation from the posterior condylar line (PoCoLi). It was hypothesized that implantation parallel to the TEA will produce a more reliably balanced flexion space.

Methods: Forty-eight consecutive patients with a varus deformity were prospectively randomized to undergo total knee arthroplasty with a femoral component implanted parallel the TEA, or with 3° of external rotation from the PoCoLi.

Uncemented vs Cemented Cruciate Retaining Total Knee Arthroplasty in Patients With Body Mass Index Greater Than 30.

Background: Aseptic loosening of cemented and uncemented tibial components continues to be a source of implant failure after total knee arthroplasty (TKA) in the obese population. There is limited literature reviewing uncemented cruciate retaining (CR) components in the obese population.

Methods: A clinical and radiographic review was performed on 325 patients who underwent a cemented or uncemented TKA with a CR knee prosthesis and body mass index ≥30 kg/m between January 2010 and June 2013.

The location of the medial parapatellar arthrotomy influences intraoperative patella tracking.

Purpose: The medial parapatellar arthrotomy (MPPA) is a commonly utilized surgical approach; however, the placement of the arthrotomy and its influence on intraoperative patellar tracking has not been evaluated.

Methods: Six knees from three fresh frozen cadavers with transthoracic amputations were operated on. All underwent standard posterior stabilized total knee arthroplasty using a medial parapatellar approach placed at the border of the vastus medialis oblique (VMO)-quadriceps junction.

Bone morphogenic protein-2 use in revision total hip arthroplasty with acetabular defects.

Introduction: The restoration of acetabular bone stock during revision hip arthroplasty remains a challenge. There have been no clinical series reporting the efficacy of bone morphogenic protein-2 (rhBMP-2) in the revision hip setting.

Methods: We retrospectively reviewed the radiographs and records of 15 patients who received rhBMP-2 mixed with allograft bone chips (+BMP), and 14 who received allograft bone chips alone (-BMP) for their acetabular defect during revision total hip arthroplasty with a mean two-year follow up.

Provider-Initiated Patient Satisfaction Reporting Yields Improved Physician Ratings Relative to Online Rating Websites.

Recently, providers have begun to publicly report the results of patient satisfaction surveys from their practices. However, these outcomes have never been compared with the findings of commercial online physician rating websites. The goals of the current study were to (1) compare overall patient satisfaction ratings for orthopedic surgeons derived from provider-based third-party surveys with existing commercial physician rating websites and (2) determine the association between patient ratings and provider characteristics.

Success rates, characteristics, and costs of articulating antibiotic spacers for total knee periprosthetic joint infection.

Background: The optimal type, characteristics, and success rates of articulating antibiotic spacers used during total knee arthroplasty (TKA) periprosthetic joint infection (PJI) have not been well defined in a single series. We sought to (1) determine the success rate for three unique spacer constructs and (2) evaluate any microbiological, surgical, or patient characteristics that would influence the success rate.

Methods: We retrospectively reviewed patients who underwent a two-stage exchange for a TKA PJI with a prefabricated spacer (PREFAB), home-made mold (MOLD), or autoclaved femoral component (AUTOCL).

Host Inflammatory Response During Periprosthetic Infection Is Joint Specific.

Background: () has become increasingly recognized as a cause of periprosthetic joint infection (PJI).

Questions/purposes: It is not currently known if the clinical presentation of varies depending on the joint being infected.

Methods: We retrospectively reviewed patients infected with after total hip, knee, and shoulder arthroplasty from two institutions.

Radiographic outcomes of cable-plate versus cable-grip fixation in periprosthetic fractures of the proximal femur.

Background: Newer generation cable-plate designs are commonly used for periprosthetic proximal femur fractures; however, comparisons relative to cable-grips remain limited. The aim of this study was to compare radiographic healing rates of cable-plate versus cable-grip fixation for periprosthetic proximal femur fractures.

Patients And Methods: Consecutive patients with an acute or chronic Vancouver A, B1, or B2 periprosthetic proximal femur fracture undergoing trochanteric fixation with a cable-plate (n = 46 cases) or cable-grip (n = 24 cases) system were identified retrospectively from a single-centre hospital database (mean follow-up 28 months [range 6-89 months]).

The Influence of a Failed Irrigation and Debridement on the Outcomes of a Subsequent 2-Stage Revision Knee Arthroplasty.

Background: Previous work has suggested a failed irrigation and debridement (I&D) before a 2-stage exchange negatively impacts the outcome of the subsequent 2-stage revision.

Methods: This was a retrospective review of 132 patients who underwent a 2-stage exchange without prior I&D (2-Stage), and 45 patients had a failed I&D before their 2-stage exchange (I&D+2Stage) between April 2009 and April 2015. Charts were reviewed for patient demographics, presenting inflammatory laboratory values, type of antibiotic spacer used, surgical details, microbiology data, length of postoperative antibiotic treatment, and reoperation.

MRI, Retrieval Analysis, and Histologic Evaluation of Adverse Local Tissue Reaction in Metal-on-Polyethylene Total Hip Arthroplasty.

Background: The severity and location of adverse local tissue reaction (ALTR) seen in metal-on-polyethylene total hip arthroplasty (THA) is not well described.

Methods: We retrospectively reviewed the records of patients who underwent a revision THA using our biomechanics database. We included all patients who underwent revision surgery for the diagnosis of ALTR with THA implants that had modularity solely at the head-neck junction and excluded patients with implant modularity at sites other than the head-neck junction.

Developing a Clinically Representative Model of Periprosthetic Joint Infection.

➤The poor treatment outcomes for periprosthetic joint infection (PJI) reflect the limited understanding that currently exists regarding the pathogenesis of this devastating clinical problem.➤Current animal models of PJI are limited in their translational nature primarily because of their inability to recreate the periprosthetic environment.➤A greater mechanistic understanding of the musculoskeletal and immune systems of small animals, such as mice and rats, provides a more robust platform for modeling and examining the pathogenesis of PJI.

Intraoperative Load-Sensing Variability During Cemented, Posterior-Stabilized Total Knee Arthroplasty.

Background: Load-sensing technology during total knee arthroplasty (TKA) provides objective measurements of ligamentous balance. The purpose of this study is to assess its intraoperative validity and reliability during TKA.

Methods: Fifty-four patients underwent TKA using the OrthoSensor VERASENSE tibial insert to assist with ligament balance.

Femoral Component Rotation in Total Knee Arthroplasty: A Comparison Between Transepicondylar Axis and Posterior Condylar Line Referencing.

Background: Proper rotational alignment of the femoral component is critical for a successful total knee arthroplasty (TKA). Controversy remains regarding the optimal intraoperative reference to determine femoral component rotation.

Methods: Thirty-one patients who underwent magnetic resonance imaging of a TKA between April 2008 and November 2015 were retrospectively reviewed.

Disposable Navigation for Total Knee Arthroplasty.

Recent developments in surgical techniques and technologies have advanced accuracy and increased implant survival of total knee arthroplasty (TKA). The introduction of mechanical guides and computer-assisted navigation has improved component alignment and the ability to accurately reproduce component position. Over the past decade, computer navigation and intraoperative guides have been introduced to help control surgical variables and overcome the limitations and inaccuracies of traditional mechanical instrumentation.