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.

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.

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.

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.

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.

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.

Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty.

Background: Although there is no absolute diagnostic test for periprosthetic infection, the synovial fluid leukocyte count and neutrophil percentage have been reported to have high sensitivity and specificity. However, the cutoff values for these tests are not agreed upon. We sought to identify definite cutoff values for both the fluid leukocyte count and the neutrophil percentage that may help to diagnose infection at the site of a prosthetic joint.

Vascular injuries after total joint arthroplasty.

Vascular injuries, although highly feared, can occur after total joint arthroplasty, often resulting in legal suits. This study evaluates the circumstances related to vascular injuries after joint arthroplasty. Using prospectively collected data on 13,517 patients undergoing total joint arthroplasty at our institution, 16 (0.

The noisy ceramic hip: is component malpositioning the cause?

Noisy ceramics bearing surfaces are a recently recognized problem in total hip arthroplasty. Component malposition as a potential cause has been proposed. Squeaking occurred in 28 (2.

The assessment of intraoperative prosthetic knee range of motion using two methods.

The commonly used standard goniometer has been shown to underestimate knee flexion. Computer-assisted navigation for total knee arthroplasty offers itself as an alternative method to quantify knee flexion. The goal of our study was to determine the reliability of each instrument in measuring intraoperative range of motion during total knee arthroplasty.

Periprosthetic joint infection: the incidence, timing, and predisposing factors.

Unlabelled: Periprosthetic joint infection is one of the most challenging complications of joint arthroplasty. We identified current risk factors of periprosthetic joint infection after modern joint arthroplasty, and determined the incidence and timing of periprosthetic joint infection. We reviewed prospectively collected data from our database on 9245 patients undergoing primary hip or knee arthroplasty between January 2001 and April 2006.

Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty.

Unlabelled: The association between wound drainage and subsequent periprosthetic infection is well known. However, the most appropriate treatment of wound drainage is not well understood. We retrospectively reviewed the records of 10,325 patients (11,785 procedures), among whom 300 patients (2.

Postoperative ileus after total joint arthroplasty.

We evaluated the incidence and risk factors for postoperative ileus (POI) after total joint arthroplasty in a consecutive group of patients between January 2004 and December 2005 using regional anesthesia and multimodal pain management protocols. Postoperative ileus developed in 31 (0.7%) of 4567 patients.

Determining "true" leukocytosis in bloody joint aspiration.

This study intends to determine the diagnostic value of implementing a corrective formula that can adjust for serum leukocytes in bloody joint fluid. Our cohort included 91 infected and 37 aseptic total knee arthroplasties. Joint fluid leukocyte count (>1760/microL) and neutrophil percentage (>73%) were the cutoff values for deep infection.

Does "excessive" anticoagulation predispose to periprosthetic infection?

Although persistent drainage and hematoma formation are recognized risk factors for the development of periprosthetic infection, it is not known if excess anticoagulation is a predisposing factor. We conducted a 2 to 1 case-control study with 78 cases who underwent revision for septic failure. The controls underwent the same index procedure but did not develop consequent infection.

The rise in the incidence of pulmonary embolus after joint arthroplasty: is modern imaging to blame?

In recent years, there has been an apparent increase in the incidence of pulmonary embolus after joint arthroplasty at our institution. We hypothesized the use of sophisticated imaging modalities such as the multidetector computed tomography scan, with better sensitivity, resulted in an apparent increase in the incidence of pulmonary embolus. We studied all patients with pulmonary embolus after joint arthroplasty between 2000 and 2005.

Late instability following total hip arthroplasty.

Instability is one of the most common complications after total hip arthroplasty and can present early or late after hip replacement. Late instability is considered if the event occurs five or more years after the primary arthroplasty, and in contrast to early dislocation, it appears to require operative intervention. The incidence of late instability may be greater than initially appreciated, and the cumulative rate rises with longer follow-up.

Periprosthetic infection does not preclude good outcome for revision arthroplasty.

Periprosthetic infection of a total knee arthroplasty (TKA) can be successfully eradicated by two-stage resection arthroplasty. However, the outcome of surgical intervention for infection is believed inferior to revision surgery for aseptic failures. We hypothesized patients having revision arthroplasty for infected TKA have worse functional outcome compared to patients having revisions arthroplasty for aseptic reasons.

Perioperative antibiotics should not be withheld in proven cases of periprosthetic infection.

Intraoperative tissue or fluid culture remains the gold standard in diagnosing periprosthetic infection. However, an organism is not always isolated from intraoperative cultures. We asked whether preoperative antibiotics interfered with the isolation of organisms from intraoperative tissue samples.

Uncemented total hip arthroplasty in patients with a history of pelvic irradiation for prostate cancer.

Background: Pelvic irradiation for a malignant tumor may cause osteonecrosis of the acetabulum. The purpose of this study was to evaluate the outcome of uncemented total hip arthroplasty in patients with a history of pelvic irradiation for the treatment of prostate cancer.

Methods: We performed a retrospective review of the clinical records and radiographs of fifty-eight patients (sixty-six hips) who had had radiation therapy for prostate cancer and had subsequently undergone an elective primary uncemented total hip arthroplasty at our institution.

The inferior vena cava filter is effective in preventing fatal pulmonary embolus after hip and knee arthroplasties.

Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and/or migration of venous emboli into the pulmonary circulation.

Bilateral total hip arthroplasty: one-stage versus two-stage procedures.

We compared the outcomes of bilateral total hip arthroplasty performed as a one-stage or two-stage procedure. We retrospectively identified 196 patients (392 hips) with bilateral arthritis of the hip who underwent total hip arthroplasties: 98 patients (196 hips) as a one-stage procedure (one-stage group) and 98 (196 hips) as a two-stage procedure (two-stage group). All patients had uncemented components implanted under spinal anesthesia and had the same postoperative rehabilitation protocol.

Institutional review board approval: why it matters.

The modern institutional review boards originated in the 1970s. They exist to protect human subjects participating in research from potential harm. The Belmont Report provided the ethical principles (respect for persons, beneficence, and justice) that should be observed while conducting research on human subjects.