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Gonzalez MR, Acosta JI, Clunk MJ, Bedi ADS, Karczewski D, Newman ET, Raskin KA, Lozano-Calderon SA. Debridement, Antibiotics, and Implant Retention (DAIR) Plus Offers Similar Periprosthetic Joint Infection Treatment Success Rates to Two-Stage Revision in Oncologic Megaprosthesis. J Arthroplasty 2024; 39:1820-1827. [PMID: 38224789 DOI: 10.1016/j.arth.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Prosthetic joint infections (PJIs) after megaprosthesis implantation are associated with high rates of treatment failure and amputation. Our study analyzed PJI treatment success rates by surgical strategy and assessed risks of reinfection and amputation. METHODS We retrospectively analyzed the outcomes of patients diagnosed with PJI after undergoing megaprosthesis implantation for oncologic indications. The 2011 Musculoskeletal Infection Society criteria were used to define PJI. Reinfection, reoperation, and amputation for PJI recurrence were assessed. A total of 67 patients with megaprosthesis PJIs were included. There were fourteen patients who were treated with debridement, antibiotics, and implant retention (DAIR), 31 with DAIR plus (DAIR with modular component exchange and stem retention), and 21 with two-stage revisions. Kaplan-Meier estimates were used for survival analyses and Cox proportional hazards for risk factor analyses. RESULTS The two-year reinfection-free survival was 25% for DAIR and 60% for DAIR plus or two-stage revision (P = .049). The five-year amputation-free survival was 84% for DAIR plus or two-stage revision, and 48% for DAIR (P = .13). Reinfection-free, reoperation-free, and amputation-free survival were similar between DAIR plus and two-stage revision at the 2- and 5-year marks. Body mass index ≥30 (hazard ratio [HR] = 2.65) and chronic kidney disease (HR = 11.53) were risk factors for reinfection. Treatment with DAIR plus or two-stage revision (HR = 0.44) was a protective factor against reinfection. CONCLUSIONS A DAIR was associated with high rates of treatment failure and higher amputation rates than DAIR plus or 2-stage surgery. A DAIR plus was not inferior to 2-stage revision clearing a PJI and might be performed in patients who cannot withstand two-stage revision surgery.
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Affiliation(s)
- Marcos R Gonzalez
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - José I Acosta
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts; School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico; Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marilee J Clunk
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Angad D S Bedi
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Daniel Karczewski
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Erik T Newman
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Kevin A Raskin
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Santiago A Lozano-Calderon
- Musculoskeletal Oncology Service, Department of Orthopaedic Surgery, Massachusetts General Hospital Boston/Harvard Medical School, Boston, Massachusetts
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Kim S, Won SJ, Lee NK, Chang CB. Life Expectancy of Patients Undergoing Total Knee Arthroplasty: Comparison With General Population. J Korean Med Sci 2024; 39:e106. [PMID: 38529576 DOI: 10.3346/jkms.2024.39.e106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aimed to analyze the life expectancy and cause of death in osteoarthritis (OA) patients who underwent total knee arthroplasty (TKA) and to identify risk factors that affect long-term mortality rate after TKA. METHODS Among 601 patients, who underwent primary TKA due to OA by a single surgeon from July 2005 to December 2011, we identified patients who died after the operation using data obtained from the National Statistical Office of Korea. We calculated 5-, 10-, and 15-year survival rates of the patients and age-specific standardized mortality ratios (SMRs) compared to general population of South Korea according to the causes of death. We also identified risk factors for death. RESULTS The 5-year, 10-year, and 15-year survival rates were 94%, 84%, and 75%, respectively. The overall age-specific SMR of the TKA cohort was lower than that of the general population (0.69; P < 0.001). Cause-specific SMRs for circulatory diseases, neoplasms, and digestive diseases after TKA were significantly lower than those of the general population (0.65, 0.58, and 0.16, respectively; all P < 0.05). Male gender, older age, lower body mass index (BMI), anemia, and higher Charlson comorbidity index (CCI) were significant factors associated with higher mortality after TKA. CONCLUSION TKA is a worthwhile surgery that can improve life expectancy, especially from diseases of the circulatory system, neoplasms, and digestive system, in patients with OA compared to the general population. However, careful follow-up is needed for patients with male gender, older age, lower BMI, anemia, and higher CCI, as these factors may increase long-term mortality risk after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sanghyo Kim
- Department of Orthopaedic Surgery, Busan Mirae Hospital, Busan, Korea
| | - Samuel Jaeyoon Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Na-Kyoung Lee
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Carender CN, Fruth KM, Lewallen DG, Berry DJ, Abdel MP, Bedard NA. Obesity and Primary Total Hip Arthroplasty: The Absolute versus Relative Risk of Periprosthetic Joint Infection at 15 Years. J Arthroplasty 2024:S0883-5403(24)00249-3. [PMID: 38521248 DOI: 10.1016/j.arth.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND To make an informed decision about total hip arthroplasty (THA), surgeons and patients need to understand the absolute and relative risks of periprosthetic joint infection (PJI). We sought to evaluate the long-term risk of PJI following primary THA stratified by body mass index (BMI) and PJI-related risk factors. METHODS We identified 21,550 primary THAs performed from 2000 to 2021 at a single institution. Patients were stratified as having 0, 1, or ≥ 2 PJI risk factors (diabetes, chronic kidney disease, nonprimary osteoarthritis, immunosuppression, or active smoking) and into BMI categories. The 15-year cumulative risk of PJI was evaluated by BMI and PJI risk factors. RESULTS For the entire cohort, the 15-year absolute risk of PJI was 2%. For patients who did not have PJI risk factors, the absolute risk of PJI at 15 years was 1% in normal weight, 2% in class III obesity, and 4% in class IV obesity. Patients who had class III and IV obesity had a 3-times and 9-times higher relative risk of PJI, respectively (P = .03, P < .001). Among patients who had ≥ 2 PJI risk factors, the absolute risk of PJI at 15 years was 2% in normal weight, 4% in class III obesity, and 18% in class IV obesity. CONCLUSIONS Healthy patients who had class III and IV obesity had a 3-times and 9-times increased risk of PJI at 15 years relative to normal weight patients. However, the absolute risk of PJI at 15 years was 2 and 4%, respectively. Given emerging data questioning whether BMI modification decreases PJI risk, surgeons and patients must consider both a 3-times to 9-times increased relative risk of PJI and a 2 to 4% absolute risk of PJI at 15 years for healthy patients who had a BMI ≥ 40. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Kristin M Fruth
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Lin CR, Lee CC, Kuo YF, Huang SP, Chen YC, Chang SH. Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: A retrospective cohort study. Orthop Traumatol Surg Res 2024:103847. [PMID: 38417784 DOI: 10.1016/j.otsr.2024.103847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database. METHODS The study analyzed 3078 patients who received TKA from 2012 to 2017, equally divided into three groups: none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias. RESULTS After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD: 0.71 95% CI=0.36-1.38, p=0.3073; adjusted HR of severe CKD: 1.14, 95% CI=0.63-2.06, p=0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR: 1.98, 95% CI=1.57-2.50, p<0.001) and readmission within 90days of any causes (adjusted HR: 1.83, 95% CI=1.48-2.26, p<0.001) than non-CKD and mild CKD patients. CONCLUSION Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients. LEVEL OF EVIDENCE IV; well-designed cohort study.
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Affiliation(s)
- Chun-Ru Lin
- Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, No. 5, Fuxing Street, Guishan District, Taoyuan City 333423, Taiwan, ROC
| | - Chune-Chen Lee
- Data Science Center, College of Medicine, Fu-Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 242062, Taiwan
| | - Yu-Feng Kuo
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan
| | - Shih-Pei Huang
- Department of Medical Education & Bioethics, Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, No. 1, Section 1, Ren'ai Road, Zhongzheng District, Taipei City 100233, Taiwan
| | - Yong-Chen Chen
- Data Science Center, College of Medicine, Fu-Jen Catholic University - Master Program of Big Data in Biomedicine, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 242062, Taiwan
| | - Shu-Hao Chang
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan.
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Weinstein EJ, Stephens-Shields AJ, Newcomb CW, Silibovsky R, Nelson CL, O'Donnell JA, Glaser LJ, Hsieh E, Hanberg JS, Tate JP, Akgün KM, King JT, Lo Re V. Incidence, Microbiological Studies, and Factors Associated With Prosthetic Joint Infection After Total Knee Arthroplasty. JAMA Netw Open 2023; 6:e2340457. [PMID: 37906194 PMCID: PMC10618849 DOI: 10.1001/jamanetworkopen.2023.40457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Importance Despite the frequency of total knee arthroplasty (TKA) and clinical implications of prosthetic joint infections (PJIs), knowledge gaps remain concerning the incidence, microbiological study results, and factors associated with these infections. Objectives To identify the incidence rates, organisms isolated from microbiological studies, and patient and surgical factors of PJI occurring early, delayed, and late after primary TKA. Design, Setting, and Participants This cohort study obtained data from the US Department of Veterans Affairs (VA) Corporate Data Warehouse on patients who underwent elective primary TKA in the VA system between October 1, 1999, and September 30, 2019, and had at least 1 year of care in the VA prior to TKA. Patients who met these criteria were included in the overall cohort, and patients with linked Veterans Affairs Surgical Quality Improvement Program (VASQIP) data composed the VASQIP cohort. Data were analyzed between December 9, 2021, and September 18, 2023. Exposures Primary TKA as well as demographic, clinical, and perioperative factors. Main Outcomes and Measures Incident hospitalization with early, delayed, or late PJI. Incidence rate (events per 10 000 person-months) was measured in 3 postoperative periods: early (≤3 months), delayed (between >3 and ≤12 months), and late (>12 months). Unadjusted Poisson regression was used to estimate incidence rate ratios (IRRs) with 95% CIs of early and delayed PJI compared with late PJI. The frequency of organisms isolated from synovial or operative tissue culture results of PJIs during each postoperative period was identified. A piecewise exponential parametric survival model was used to estimate IRRs with 95% CIs associated with demographic and clinical factors in each postoperative period. Results The 79 367 patients (median (IQR) age of 65 (60-71) years) in the overall cohort who underwent primary TKA included 75 274 males (94.8%). A total of 1599 PJIs (2.0%) were identified. The incidence rate of PJI was higher in the early (26.8 [95% CI, 24.8-29.0] events per 10 000 person-months; IRR, 20.7 [95% CI, 18.5-23.1]) and delayed periods (5.4 [95% CI, 4.9-6.0] events per 10 000 person-months; IRR, 4.2 [95% CI, 3.7-4.8]) vs the late postoperative period (1.3 events per 10 000 person-months). Staphylococcus aureus was the most common organism isolated overall (489 [33.2%]); however, gram-negative infections were isolated in 15.4% (86) of early PJIs. In multivariable analyses, hepatitis C virus infection, peripheral artery disease, and autoimmune inflammatory arthritis were associated with PJI across all postoperative periods. Diabetes, chronic kidney disease, and obesity (body mass index of ≥30) were not associated factors. Other period-specific factors were identified. Conclusions and Relevance This cohort study found that incidence rates of PJIs were higher in the early and delayed vs late post-TKA period; there were differences in microbiological cultures and factors associated with each postoperative period. These findings have implications for postoperative antibiotic use, stratification of PJI risk according to postoperative time, and PJI risk factor modification.
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Affiliation(s)
- Erica J Weinstein
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Real-World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alisa J Stephens-Shields
- Center for Real-World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Craig W Newcomb
- Center for Real-World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Randi Silibovsky
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Charles L Nelson
- Department of Orthopedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judith A O'Donnell
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Laurel J Glaser
- Department of Pathology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Evelyn Hsieh
- Veterans Affairs (VA) Connecticut Health System, West Haven
- Section of Rheumatology, Allergy and Immunology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer S Hanberg
- Veterans Affairs (VA) Connecticut Health System, West Haven
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Janet P Tate
- Veterans Affairs (VA) Connecticut Health System, West Haven
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kathleen M Akgün
- Section of Pulmonary, Critical Care, and Sleep Medicine, VA Connecticut Health System, West Haven
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph T King
- Veterans Affairs (VA) Connecticut Health System, West Haven
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Real-World Effectiveness and Safety of Therapeutics, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Karczewski D, Salmons HI, Leung N, Larson DR, Berry DJ, Abdel MP. Primary Total Hip Arthroplasty in Dialysis-Dependent Patients: 35% Mortality at 5 years. J Arthroplasty 2023; 38:2159-2163. [PMID: 37172793 PMCID: PMC10653652 DOI: 10.1016/j.arth.2023.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Limited knowledge exists on contemporary results of primary total hip arthroplasty (THA) in dialysis-dependent patients. We sought to analyze the mortality rates and cumulative incidences of any revision or reoperation in dialysis-dependent patients undergoing primary THAs. METHODS We identified 24 dialysis-dependent patients who underwent 28 primary THAs between 2000 and 2019 using our institutional total joint registry. Mean age was 57 years (range, 32 to 86), with 43% being women and mean body mass index was 31 (range, 20 to 50). The leading cause for dialysis was diabetic nephropathy (18%). The mean preoperative creatinine and glomerular filtration rate were 6 mg/dL and 13 mL/min, respectively. Kaplan-Meier survivorship methods and a competing risk analysis using death as the competing risk were performed. The mean follow-up was 7 years (range, 2 to 15). RESULTS The 5-year survivorship free from death was 65%. The 5-year cumulative incidence of any revision was 8%. There were a total of 3 revisions as follows: 2 for aseptic loosening of the femoral component and one for a Vancouver B2 fracture. The 5-year cumulative incidence of any reoperation was 19%. There were 3 additional reoperations, and all were irrigation and debridement. Postoperative creatinine and glomerular filtration rate were 6 mg/dL and 15 mL/min, respectively. At a mean of 2 years after THA, 25% successfully received a renal transplant. CONCLUSIONS Dialysis-dependent patients undergoing primary THAs had high 5-year mortality (35%) but an acceptably low cumulative incidence of any revision. While renal metrics remained consistent after THA, only one in 4 patients underwent successful renal transplant. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Harold I. Salmons
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Nelson Leung
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Dirk R. Larson
- Department of Quantitative Health Sciences (QHS), Division of Clinical Trials and Biostatistics (CTB), Mayo Clinic, 200 First Street SW, Rochester, MN 559056
| | - Daniel J. Berry
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Matthew P. Abdel
- Department of Orthopedic Surgery (D.K., H.I.S., D.R.L., D.J.B., M.P.A.) and Division of Nephrology and Hypertension, Department of Medicine (N.L.), Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Kramer TS, Soriano A, Tedeschi S, Chen AF, Tattevin P, Senneville E, Gomez-Junyent J, Birlutiu V, Petersdorf S, de Brito VD, Gonzalez IS, Belden KA, Wouthuyzen-Bakker M. Should We Use Rifampicin in Periprosthetic Joint Infections Caused by Staphylococci When the Implant Has Been Exchanged? A Multicenter Observational Cohort Study. Open Forum Infect Dis 2023; 10:ofad491. [PMID: 37901121 PMCID: PMC10604993 DOI: 10.1093/ofid/ofad491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
Background Previous studies demonstrated the efficacy of a rifampicin-based regimen in the treatment of acute staphylococcal periprosthetic joint infections (PJIs) treated with surgical debridement. However, evidence is lacking to support the use of rifampicin in cases where the implant is exchanged during revision. Methods We included all consecutive cases of staphylococcal PJIs treated from January 2013 to December 2018 with revision surgery in this international, retrospective, multicenter observational cohort study. PJI was defined according to the European Bone and Joint Infection Society diagnostic criteria. A relapse or reinfection during follow-up, the need for antibiotic suppressive therapy, the need for implant removal, and PJI-related death were defined as clinical failure. Cases without reimplantation or with follow-up <12 months were excluded. Results A total of 375 cases were included in the final analysis, including 124 1-stage exchanges (33.1%) and 251 2-stage exchanges (66.9%). Of those, 101 cases failed (26.9%). There was no statistically significant difference in failure of patients receiving rifampicin (22.5%, 42/187) and those not receiving rifampicin (31.4%, 59/188; P = .051). A subanalysis of chronic PJIs treated by 2-stage exchange arthroplasty demonstrated a lower failure rate in cases treated with rifampicin (15%) compared with the no-rifampicin group (35.5%; P = .005). In this subgroup, the use of rifampicin and an antibiotic holiday of >2 weeks were independent predictors of clinical success (odds ratio [OR], 0.36; 95% CI, 0.15-0.88; and OR, 0.19; 95% CI, 0.04-0.90; respectively). Conclusions Combination treatment with rifampicin increases treatment success in patients with chronic staphylococcal PJI treated with 2-stage exchange arthroplasty.
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Affiliation(s)
- Tobias Siegfried Kramer
- Institute for Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- Clinic for Orthopedic Surgery and Traumatology, Evangelisches Waldkrankenhaus Berlin, Berlin, Deutschland
- LADR der Laborverbund Dr. Kramer & Kollegen, Geesthacht, Germany
| | - Alex Soriano
- Department of Infectious Diseases, University of Barcelona, IDIBAPS, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Sarah Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universistaria di Bologna, Bologna, Italy
| | - Antonia F Chen
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Eric Senneville
- French National Referent Centre for Complex Bone and Joint Infections, CRIOAC Lille-Tourcoing, Lille, France
| | - Joan Gomez-Junyent
- Department of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - Victoria Birlutiu
- County Clinical Emergency Hospital of Sibiu, Faculty of Medicine, Lucian Blaga University of Sibiu, Romania
| | - Sabine Petersdorf
- Institute for Medical Laboratory Diagnostics, Helios University Clinic Wuppertal, Wuppertal, Germany
| | - Vicens Diaz de Brito
- Department of Infectious Diseases, Parc Sanitari Sant Joan de Deu, Sant Boi (Barcelona), Spain
| | - Ignacio Sancho Gonzalez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Navarra, Pamplona, España
| | - Katherine A Belden
- Division of Infectious Diseases, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Lee D, Lee R, Weinreb J, Chalif E, Mohile N, Heyer JH, O'Brien J. Risk Factors for Surgical Site Infections After Single-Level Anterior Lumbar Interbody Fusion. Surg Infect (Larchmt) 2023. [PMID: 37327050 DOI: 10.1089/sur.2023.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Abstract Background: Anterior lumbar interbody fusion (ALIF) has become an increasingly popular and effective treatment modality for various conditions of the lumbar spine. However, complications after this procedure can be costly. Surgical site infections (SSIs) are one of these types of complications. The present study identifies independent risk factors for SSI after single-level ALIF to identify high-risk patients better. Patients and Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify single-level ALIF patients from 2005 to 2016. Multilevel fusions and non-anterior approach procedures were excluded. Mann-Pearson χ2 tests analyzed categorical variables, whereas one-way analysis of variance (ANOVA) and independent t-tests analyzed differences in mean values of continuous variables. Risk factors for SSI were identified via a multivariable logistic regression model. A receiver operating characteristic (ROC) curve was generated utilizing the predicted probabilities. Results: A total of 10,017 patients met inclusion criteria; 80 (0.80%) had developed SSI and 9,937 (99.20%) had not. On multivariable logistic regression models, class 3 obesity (p = 0.014), dialysis (p = 0.025), long-term steroid use (p = 0.010), and wound classification 4 (dirty/infected) (p = 0.002) all independently increased the risk for SSI in single-level ALIF. The area under the receiver operating characteristic curve (AUROC; C-statistic) was 0.728 (p < 0.001), indicating relatively strong reliability of the final model. Conclusions: Several independent risk factors including obesity, dialysis, long-term steroid use, and dirty wound classification all increased risk for SSI after single-level ALIF. By identifying these high-risk patients, surgeons and patients can have more informed pre-operative discussions. In addition, identifying and optimizing these patients prior to operative intervention may help to minimize infection risk.
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Affiliation(s)
- Danny Lee
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Ryan Lee
- Department of Anesthesiology, Rutgers University Newark Health System, Newark, New Jersey, USA
| | - Jeffrey Weinreb
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Eric Chalif
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Neil Mohile
- Department of Orthopaedic Surgery, University of Miami-Jackson Memorial Health System, Miami, Florida, USA
| | - Jessica H Heyer
- Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joseph O'Brien
- Washington Spine and Scoliosis Institute, OrthoBethesda, Bethesda, Maryland, USA
- Department of Spine Surgery, Virginia Hospital Center, Arlington, Virginia, USA
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9
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dos Santos LS, de Oliveira Sant’Anna L, Theodoro R, dos Santos NNC, Armond BKL, Seabra LF, Alvim LB, Araújo MRB. Prosthetic joint infection caused by an imipenem-resistant Mycobacterium senegalense. Braz J Microbiol 2023; 54:929-934. [PMID: 37020078 PMCID: PMC10234977 DOI: 10.1007/s42770-023-00960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/29/2023] [Indexed: 04/07/2023] Open
Abstract
Periprosthetic joint infection (PJI) remains one of the most common complications of total knee arthroplasty. Although mainly caused by Staphylococcus aureus and other Gram-positive microorganisms, occasionally, commensal or environmental bacteria are reported as causative agents of these infections. The present work aimed to report a case of PJI caused by an imipenem-resistant Mycobacterium senegalense strain. A bacterial strain isolated from the culture of intraoperative samples was observed by optical microscopy after Gram and Ziehl-Neelsen staining. The species identification was performed by mass spectrometry analysis and partial sequencing of the heat shock protein 65 (hsp65) gene. The antimicrobial profile of the clinical isolate was determined according to the Clinical and Laboratory Standards Institute. Mass spectrometry and gene sequencing analysis identified the bacterial isolate as Mycobacterium fortuitum complex and M. senegalense, respectively. The isolated was found exhibiting an imipenem-resistant profile. The accurate and timely identification, as well as investigation of the antimicrobial susceptibility profile, of fast-growing nontuberculous mycobacteria species are crucial for establishing the prompt and correct treatment of the infection, particularly in cases of patients at greater risk for opportunistic and severe infections.
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Affiliation(s)
- Louisy Sanches dos Santos
- Department of Microbiology, Immunology and Parasitology, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lincoln de Oliveira Sant’Anna
- Department of Microbiology, Immunology and Parasitology, Rio de Janeiro State University, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Theodoro
- Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Luisa Ferreira Seabra
- Operational Technical Nucleus, Microbiology, Hermes Pardini Institute, Vespasiano, Minas Gerais Brazil
| | - Luige Biciati Alvim
- Operational Technical Nucleus, Research and Development, Hermes Pardini Institute, Minas Gerais Vespasiano, Brazil
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10
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Harris IA, Lorimer MF, Davies CE, Keuskamp D, Dansie KB, Lewis PL, Graves SE, McDonald SP. Hip Arthroplasty Outcomes in the Presence of Kidney Failure: A National Data Linkage Study. J Arthroplasty 2023:S0883-5403(23)00014-1. [PMID: 36708938 DOI: 10.1016/j.arth.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Patients who have kidney failure are at higher risk of requiring total hip arthroplasty (THA) and are at higher risk of complications. This study compared the rate of revision surgery and mortality following THA between patients who have kidney failure receiving long term dialysis or who had a kidney transplant and those who did not have kidney failure. METHODS A data linkage study was performed using data from 2 national registries: a registry of dialysis and kidney transplant patients and a registry of THA procedures. Both registries had coverage of almost all procedures or treatments in Australia. Data from September 1999 to December 2016 were used. Mortality and revision surgery were compared between patients receiving dialysis, those who had a functioning kidney transplant, and patients who did not have kidney failure using Cox and Fine-Gray (competing risk) regression models. A total of 383,478 primary THA procedures were identified as people receiving dialysis (n = 490), who had a functioning kidney transplant (n = 459), or who did not have kidney failure (n = 382,529). RESULTS There was no significant difference in the overall rate of revision surgery between the groups (dialysis versus no kidney failure HR = 1.20; 95% CI 0.76, 1.88, transplant versus no kidney failure (hazard ratio) HR = 1.01; 95% (confidence interval) CI 0.66, 1.53). The risk for death after surgery was significantly higher in the dialysis group compared to both the functioning transplant group (HR = 3.44; 95%CI 1.58, 7.5), and in those without kidney failure (HR = 4.13; 95%CI 3.25, 5.25). CONCLUSION The rate of mortality after THA in patients on dialysis is higher than in patients who have a functioning transplant or those who do not have kidney failure, but there is no early excess mortality to suggest a difference in this metric due to the surgery.
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Affiliation(s)
- Ian A Harris
- AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; School of Clinical Medicine, UNSW Medicine and Health, Liverpool, Australia
| | - Michelle F Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Christopher E Davies
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; ANZDATA (Australia and New Zealand Dialysis and Transplant Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Dominic Keuskamp
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; ANZDATA (Australia and New Zealand Dialysis and Transplant Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Kathryn B Dansie
- ANZDATA (Australia and New Zealand Dialysis and Transplant Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter L Lewis
- AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Stephen E Graves
- AOANJRR (Australian Orthopaedic Association National Joint Replacement Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen P McDonald
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; ANZDATA (Australia and New Zealand Dialysis and Transplant Registry), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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11
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Advancement in the Treatment of Osteoporosis and the Effects on Bone Healing. J Clin Med 2022; 11:jcm11247477. [PMID: 36556093 PMCID: PMC9781093 DOI: 10.3390/jcm11247477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Osteoporosis (OP) is a major global health concern, with aging being one of the most important risk factors. Osteoarthritis (OA) is also an age-related disorder. Patients with OP and/or OA may be treated surgically for fractures or when their quality of life is impaired. Poor bone quality due to OP can seriously complicate the stability of a bone fixation construct and/or surgical fracture treatment. This review summarizes the current knowledge on the pathophysiology of normal and osteoporotic bone healing, the effect of a bone fracture on bone turnover markers, the diagnosis of a low bone mineral density (BMD) before surgical intervention, and the effect of available anti-osteoporosis treatment. Interventions that improve bone health may enhance the probability of favorable surgical outcomes. Fracture healing and the treatment of atypical femoral fractures are also discussed.
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12
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Impact of Chronic Obstructive Pulmonary Disease on Outcomes After Total Joint Arthroplasty: A Meta-analysis and Systematic Review. Indian J Orthop 2022; 57:211-226. [PMID: 36777112 PMCID: PMC9880123 DOI: 10.1007/s43465-022-00794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/29/2022] [Indexed: 12/14/2022]
Abstract
Background Comorbid chronic obstructive pulmonary disease (COPD) is increasingly common and may have an adverse impact on outcomes in patients undergoing total joint arthroplasty (TJA) of lower extremity. The purpose of this meta-analysis is to compare the postoperative complications between COPD and non-COPD patients undergoing primary TJA including total hip and knee arthroplasty. Methods PubMed, EMBASE, and Cochrane Library were systematically searched for relevant studies published before December 2021. Postoperative outcomes were compared between patients with COPD versus those without COPD as controls. The outcomes were mortality, re-admission, pulmonary, cardiac, renal, thromboembolic complications, surgical site infection (SSI), periprosthetic joint infection (PJI), and sepsis. Results A total of 1,002,779 patients from nine studies were finally included in this meta-analysis. Patients with COPD had an increased risk of mortality (OR [odds ratio] = 1.69, 95% confidence interval [CI] 1.42-2.02), re-admission (OR = 1.54, 95% CI 1.38-1.71), pulmonary complications (OR = 2.73, 95% CI 2.26-3.30), cardiac complications (OR = 1.40, 95% CI 1.15-1.69), thromboembolic complications (OR = 1.21, 95% CI 1.15-1.28), renal complications (OR = 1.50, 95% CI 1.14-1.26), SSI (OR = 1.23, 95% CI 1.18-1.30), PJI (OR = 1.26, 95% CI 1.15-1.38), and sepsis (OR = 1.36, 95% CI 1.22-1.52). Conclusion Patients with comorbid COPD showed an increased risk of mortality and postoperative complications following TJA compared with patients without COPD. Therefore, orthopedic surgeons can use the study to adequately educate these potential complications when obtaining informed consent. Furthermore, preoperative evaluation and medical optimization are crucial to minimizing postoperative complications from arising in this difficult-to-treat population. Level of evidence Level III. Registration None. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00794-2.
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13
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Movement is Life-Optimizing Patient Access to Total Joint Arthroplasty: Chronic Kidney Disease Disparities. J Am Acad Orthop Surg 2022; 30:1064-1068. [PMID: 35427242 DOI: 10.5435/jaaos-d-21-00919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
Approximately 15% of the American adults have chronic kidney disease (CKD). Rates of CKD are higher in underserved communities: It is highest in African Americans (16%) and Hispanic individuals (14%). African Americans are more than 3 times as likely compared with their White counterparts to develop end-stage kidney disease, requiring dialysis or a kidney transplant. Rates of CKD are higher in the geriatric and socioeconomic disadvantaged populations, groups with higher rates of hip and knee osteoarthritis and with comorbidities, including obesity, diabetes mellitus, heart disease, and hypertension. CKD of any stage is associated with increased postoperative readmission, complications, and mortality. Patients on hemodialysis after total joint arthroplasty are at increased risk for complications, including periprosthetic joint infection, and given the reduction in risk after kidney transplant, there is varying opinion regarding whether patients on hemodialysis are safe arthroplasty candidates.
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14
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Ahlquist S, Kim ST, Hsiue PP, Benharash P, Ponzio DY, Photopoulos C, Zeegen EN, Stavrakis AI. Comparison of total hip arthroplasty outcomes between hemodialysis and renal transplant patients. Hip Int 2022:11207000221091994. [PMID: 35437061 DOI: 10.1177/11207000221091994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) in end-stage renal disease (ESRD) patients is associated with increased complications. Controversy exists whether elective THA should be performed while these patients are on haemodialysis (HD) or following renal transplant (RT). This study seeks to compare THA outcomes in HD versus RT patients. METHODS A national database was retrospectively reviewed using ICD codes to identify all HD and RT patients who underwent primary THA from 2010 to 2018. Demographics, comorbidities, and hospital factors were compared between cohorts using Wald and chi-square tests. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), non-home discharge, cost, readmission, and medical/surgical complications. Multivariate regression was used to determine independent associations. Significance was determined with a 2-tailed p-value of 0.05. RESULTS 11,133 patients underwent THA, 61.6% HD and 39.4% RT patients. RT patients were younger, had fewer comorbidities, and more likely to have private insurance. After adjusting for these differences, RT patients had a lower rate of mortality (OR 0.31, p = 0.01), complications (OR 0.54, p < 0.01), cardiopulmonary complications (OR 0.54, p = 0.04), sepsis (OR 0.43, p < 0.01), and blood transfusion (OR 0.39, p < 0.001) during the index hospitalisation. RT was associated with decreased LOS (-2.0 days, p < 0.001), non-home discharge (OR 0.35, p < 0.001), and hospital cost (-$6,000, p < 0.001). RT had a lower rate of readmission (OR 0.60, p < 0.001) and revision surgery (OR 0.24, p = 0.01) within 90 days. CONCLUSIONS These findings suggest HD patients are a high-risk population in THA compared to RT patients and warrant stringent perioperative monitoring.
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Affiliation(s)
- Seth Ahlquist
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Samuel T Kim
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Peyman Benharash
- Department of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Danielle Y Ponzio
- Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Erik N Zeegen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
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15
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Comparison of Total Knee Arthroplasty Outcomes Between Renal Transplant and End Stage Renal Disease Patients. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202203000-00017. [PMID: 35311760 PMCID: PMC8939923 DOI: 10.5435/jaaosglobal-d-21-00288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/29/2022]
Abstract
Patients with end-stage renal disease (ESRD) have increased risk for periprosthetic joint infection (PJI) due to their predisposition for bacteremia and subsequent implant inoculation secondary to dialysis. PJI risk is also elevated in transplant patients secondary to chronic immunosuppressive therapy. The purpose of this study was to compare medical and surgical complications after primary total knee arthroplasty (TKA) in patients with ESRD or renal transplant (RT).
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16
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Fontalis A, Berry DJ, Shimmin A, Slullitel PA, Buttaro MA, Li C, Malchau H, Haddad FS. Prevention of early complications following total hip replacement. SICOT J 2021; 7:61. [PMID: 34851264 PMCID: PMC8634898 DOI: 10.1051/sicotj/2021060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023] Open
Abstract
Total hip arthroplasty (THA) has been quoted as "the operation of the century", owing to its efficacy and the substantial improvements evidenced with respect to functional patient outcomes and quality of life. However, early postoperative complications are often inevitable, hence it is imperative to take every step to prevent them and minimise morbidity and mortality. This manuscript focuses on the most common early complications following THA, namely venous thromboembolism (VTE), prosthetic joint infection, periprosthetic fracture, instability, and leg length inequality. It aims to outline effective risk stratification strategies and prevention measures that could apply to the wider Orthopaedic community.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK - University College London, Division of Surgery and Interventional Science, Gower Street, London, WC1E 6BT, UK
| | | | - Andrew Shimmin
- Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia - Monash University, Windsor, Ontario N9B 3P4, Australia
| | - Pablo A Slullitel
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin A Buttaro
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cao Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, 137 South LiYuShan Road, Urumqi, Xinjiang 830054, China
| | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK - University College London, Division of Surgery and Interventional Science, Gower Street, London, WC1E 6BT, UK
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17
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Chun YS, Lee DH, Won TG, Kim CS, Shetty AA, Kim SJ. Cell therapy for osteonecrosis of femoral head and joint preservation. J Clin Orthop Trauma 2021; 24:101713. [PMID: 34926146 PMCID: PMC8646149 DOI: 10.1016/j.jcot.2021.101713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Osteonecrosis of femoral head (ONFH) is a disease of the femoral head and can cause femoral head collapse and arthritis. This can lead to pain and gait disorders. ONFH has various risk factors, it is often progressive, and if untreated results in secondary osteo-arthritis. Biological therapy makes use of bone marrow concentrate, cultured osteoblast and mesenchymal stem cell (MSC) obtained from various sources. These are often used in conjunction with core decompression surgery. In this review article, we discuss the current status of cell therapy and its limitations. We also present the future development of biological approach to treat ONFH.
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Affiliation(s)
- You Seung Chun
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong Hwan Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea,Corresponding author. Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63-Ro, Yeongdeungpo-Gu, Seoul, 07345, South Korea.
| | - Tae Gu Won
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chan Sik Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Asode Ananthram Shetty
- Canterbury Christ Church University, Faculty of Medicine, Health and Social Care, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, United Kingdom
| | - Seok Jung Kim
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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18
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Incidence and risk factors analysis for mortality after total knee arthroplasty based on a large national database in Korea. Sci Rep 2021; 11:15772. [PMID: 34349179 PMCID: PMC8338983 DOI: 10.1038/s41598-021-95346-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
This study aimed to analyze the rates and risk factors of postoperative mortality among 560,954 patients who underwent total knee arthroplasty (TKA) in Korea. The National Health Insurance Service-Health Screening database was used to analyze 560,954 patients who underwent TKA between 2005 and 2018. In-hospital, ninety-day, and one-year postoperative mortality, and their association with patient’s demographic factors and various comorbidities (ie., cerebrovascular disease, congestive heart failure, and myocardial infarction) were assessed. In-hospital, ninety-day and one-year mortality rates after TKA were similar from 2005 to 2018. The risk of in-hospital mortality increased with comorbidities like cerebrovascular disease (hazard ratio [HR] = 1.401; 95% confidence interval [CI] = 1.064–1.844), congestive heart failure (HR = 2.004; 95% CI = 1.394 to 2.881), myocardial infarction (HR = 2.111; 95% CI = 1.115 to 3.998), and renal disease (HR = 2.641; 95% CI = 1.348–5.173). These co-morbidities were also independent predictors of ninety-day and one-year mortality. Male sex and old age were independent predictors for ninety-day and one-year mortality. And malignancy was risk factor for one-year mortality. The common preoperative risk factors for mortality in all periods were male sex, old age, cerebrovascular disease, congestive heart failure, myocardial infarction, and renal disease. Malignancy was identified as risk factor for one-year mortality. Patients with these comorbidities should be provided better perioperative care.
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