Diagnosis of periprosthetic joint infection: the threshold for serological markers.

Background: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily.

Questions/purposes: Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis.

Has the rate of in-hospital infections after total joint arthroplasty decreased?

Background: Although infections are a major cause of morbidity and mortality after total joint arthroplasty (TJA), little is known about nationwide epidemiology and trends of infections after TJA.

Questions/purposes: We therefore determined (1) trends of postoperative pneumonia, urinary tract infection (UTI), surgical site infection (SSI), sepsis, and severe sepsis after TJA; (2) risk factors of these infections; (3) effect of these infections on length of stay (LOS) and hospital charges; and (4) the infection-related mortality rate and its predictors.

Methods: The International Classification of Diseases, 9th Revision codes were used to identify patients who underwent TJA and were diagnosed with aforementioned infections during hospitalization in the Nationwide Inpatient Sample database from 2002 to 2010.

Swab cultures are not as effective as tissue cultures for diagnosis of periprosthetic joint infection.

Background: While it is accepted accurate identification of infecting organisms is crucial in guiding treatment of periprosthetic joint infection (PJI), there remains no consensus regarding the best method for obtaining cultures.

Questions/purposes: We compared the yield of intraoperative tissue samples versus swab cultures in diagnosing PJI.

Methods: Tissue and swab cultures (three each) were collected prospectively during a consecutive series of 156 aseptic and septic revision arthroplasties from October 2011 to April 2012.

Clostridium difficile colitis in patients undergoing lower-extremity arthroplasty: rare infection with major impact.

Background: The prevalence of Clostridium difficile colitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of the C difficile infection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA).

Questions/purposes: We asked: (1) What is the rate of C difficile colitis in TJA patients? (2) What are the risk factors of C difficile colitis in these patients? And (3) what is the effect of C difficile colitis on length of stay, in-hospital mortality, and estimated total charges?

Methods: Using ICD-9-CM diagnosis and procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing TJA for the years 2002 to 2010.

Mini-open femoroacetabular osteoplasty: how do these patients do?

Femoroacetabular impingement, a condition seen in young active patients, is believed to lead to early degeneration of the hip joint if left untreated. We have over the last 5 years utilized a mini-open direct anterior approach to perform femoroacetabular osteoplasty (FAO) for the hip. Between January 2006 and February 2011, 293 hips (265 patients) underwent direct anterior mini-open FAO performed by a single surgeon; 156 hips (149 patients) have reached a minimum 2-year follow-up, with an average follow-up of 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.