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Microbiology Spectrum Jun 2024Sonicating explanted prosthetic implants to physically remove biofilms is a recognized method for improving the microbiological diagnosis of prosthetic joint infection...
UNLABELLED
Sonicating explanted prosthetic implants to physically remove biofilms is a recognized method for improving the microbiological diagnosis of prosthetic joint infection (PJI); however, chemical and enzymatic treatments have been investigated as alternative biofilm removal methods. We compared the biofilm dislodging efficacy of sonication followed by the addition of enzyme cocktails with different activity spectra in the diagnosis of PJI with that of the sonication of fluid cultures alone. Consecutive patients who underwent prosthesis explantation due to infection at our institution were prospectively enrolled for 1 year. The diagnostic procedure included the collection of five intraoperative tissue cultures, sonication of the removed devices, and conventional culture of the sonication fluid. The resulting sonication fluid was also treated with an enzyme cocktail consisting of homemade dispersin B (0.04 µg/mL) and proteinase K (Sigma; 100 µg/mL) for 45 minutes at 37°C. The resulting sonication (S) and sonication with subsequent enzymatic treatment (SE) fluids were plated for aerobic and anaerobic culture broth for 7 days (aerobic) or 14 days (anaerobic). Identification was performed by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (Bruker). We included 107 patients from whom a prosthetic implant had been removed, among which PJI was diagnosed in 36 (34%). The sensitivity of S alone was significantly greater than that of SE alone (82% vs 71%; < 0.05). Four patients with PJI were positive after sonication alone but negative after sonication plus enzymatic treatment. The four microorganisms missed after the addition of the enzyme cocktail were , two coagulase-negative and . In conclusion, sonication alone was more sensitive than sonication followed by enzymatic treatment. The combination of these two methods had no synergistic effect; in contrast, the results suggest that the combination of both dislodgment methods affects the viability of gram-positive microorganisms.
IMPORTANCE
While the potential of sonication and enzymes as biofilm dispersal agents has been previously described, the originality of our work resides in the combination of both methods, which is hypothesized to enhance the ability to remove biofilm and, therefore, improve the microbiological diagnosis of PJI.
PubMed: 38916322
DOI: 10.1128/spectrum.00020-24 -
Hip International : the Journal of... Jun 2024The growing adoption of robotic-assistance during total hip arthroplasty (THA) has provided novel means through which a patient's anatomy and dynamic spinopelvic...
BACKGROUND
The growing adoption of robotic-assistance during total hip arthroplasty (THA) has provided novel means through which a patient's anatomy and dynamic spinopelvic relationship can be incorporated into surgical planning. However, the impact of enhanced technologies on intraoperative decision-making and changes to component positioning has not yet been described.
METHODS
A multicentre, prospective study included 105 patients (52% women) patients who underwent robotic-assisted THA with the integration of software that incorporates a patient's pelvic tilt (PT) and virtual range-of-motion (VROM) for impingement modeling. The primary outcome of the study was the percentage of patients who underwent changes to the preoperative plan for cup position after incorporating the data from the software.
RESULTS
Utilising the intraoperative VROM information, the preoperative plan for cup position was changed from the default (40° inclination and 20° anteversion) in 82/105 (78%) cases. When stratifying by spinopelvic mobility, 64% were considered normal (change ⩾ 10° and ⩽30°), 27% were stiff (change < 10°), and 9% were hypermobile (change > 30°). For all cohorts, the majority of cases (78%) deviated from the 40° inclination and 20° version target. When evaluating the proportion of cases within the Lewinnek and Callanan safe zones based on spinopelvic mobility, 19% of cases within the normal group were planned outside of both zones compared to 39% of stiff cases and 10% of hypermobile cases.
CONCLUSIONS
Utilising the latest version of robotic-assisted THA software, the preoperative plan for cup position was changed in the vast majority (78%) of patients, causing substantial deviations from traditional, generic cup targets.
PubMed: 38916080
DOI: 10.1177/11207000241254353 -
Journal of Orthopaedic Surgery and... Jun 2024The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear...
BACKGROUND
The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19.
METHODS
Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay.
RESULTS
The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259-39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03-1.55, p = 0.027).
CONCLUSION
This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).
Topics: Humans; COVID-19; Arthroplasty, Replacement, Hip; Male; Female; Groin; Middle Aged; Aged; Cross-Over Studies; Pain, Postoperative; Length of Stay; Time Factors; Adult; Aged, 80 and over; Risk Factors
PubMed: 38915048
DOI: 10.1186/s13018-024-04862-1 -
JBJS Case Connector Apr 2024A 64-year-old man presented with a 3-year history of right wrist pain and swelling 33 years after a silicone scaphoid arthroplasty for chronic scaphoid nonunion....
CASE
A 64-year-old man presented with a 3-year history of right wrist pain and swelling 33 years after a silicone scaphoid arthroplasty for chronic scaphoid nonunion. Radiographs demonstrated a deformed scaphoid implant, carpal and distal radius cysts, and mild carpal collapse. He elected to undergo a wrist arthrodesis with a dorsal fusion plate after failing conservative management.
CONCLUSION
Although carpal bone silicone implant arthroplasties of the wrist have long been abandoned, our patient was pain free and fully functional for 3 decades. He was pleased to undergo serial examinations with radiographs for 30 years without any therapeutic intervention.
Topics: Humans; Male; Middle Aged; Scaphoid Bone; Silicones; Arthroplasty, Replacement; Wrist Joint; Joint Prosthesis; Arthrodesis; Follow-Up Studies
PubMed: 38913810
DOI: 10.2106/JBJS.CC.24.00027 -
JBJS Case Connector Apr 2024A 32-year-old woman with a history of hip fusion presented with significant lower back, hip, and knee pain as well as severely limited hip mobility and function....
CASE
A 32-year-old woman with a history of hip fusion presented with significant lower back, hip, and knee pain as well as severely limited hip mobility and function. Single-stage fusion takedown and conversion to total hip arthroplasty (THA) was performed using augmented reality navigation. At 1 year, the patient was pain free with improved function. This study is the first to report the technique and outcomes of surgical fusion conversion to THA, using mixed reality navigation.
CONCLUSION
Mixed reality navigation in complex conversion THA can be useful for identifying the patient's true acetabulum and for patient-specific acetabular component placement to maximize outcomes.
Topics: Humans; Female; Adult; Arthroplasty, Replacement, Hip; Augmented Reality; Surgery, Computer-Assisted; Hip Joint
PubMed: 38913787
DOI: 10.2106/JBJS.CC.24.00128 -
The American Journal of Managed Care Jun 2024To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to... (Observational Study)
Observational Study
OBJECTIVES
To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs).
STUDY DESIGN
Retrospective observational study using 2009-2015 inpatient and outpatient claims from a 20% sample of Medicare beneficiaries undergoing joint replacement in US hospitals (N = 146,074) linked with data from Medicare's BPCI program and Nursing Home Compare.
METHODS
We ran fixed effect regression models regressing BPCI participation on hospital-SNF referral patterns (number of SNF discharges, number of SNF partners, and SNF referral concentration) and SNF quality (facility inspection survey rating, patient outcome rating, staffing rating, and registered nurse staffing rating).
RESULTS
We found that BPCI participation was associated with a decrease in the number of SNF referrals and no significant change in the number of SNF partners or concentration of SNF partners. BPCI participation was associated with discharge to SNFs with a higher patient outcome rating by 0.04 stars (95% CI, 0.04-0.26). BPCI participation was not associated with improvements in discharge to SNFs with a higher facility survey rating (95% CI, -0.03 to 0.11), staffing rating (95% CI, -0.07 to 0.04), or registered nurse staffing rating (95% CI, -0.09 to 0.02).
CONCLUSIONS
BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks.
Topics: Skilled Nursing Facilities; Humans; United States; Retrospective Studies; Medicare; Referral and Consultation; Quality Improvement; Female; Patient Care Bundles; Male; Arthroplasty, Replacement; Aged
PubMed: 38912933
DOI: 10.37765/ajmc.2024.89566 -
Foot & Ankle International Jun 2024There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed...
BACKGROUND
There are limited data regarding risk factors associated with periprosthetic medial malleolar fractures in total ankle arthroplasty (TAA). This case-control study aimed to identify the risk factors and analyze the effect of prophylactic screw fixation in preventing a medial malleolar fracture after TAA.
METHODS
A case-control study was conducted on 149 patients who underwent primary TAA. Twenty patients with postoperative medial malleolar fractures >4 weeks postoperatively (cases) were identified. An additional 129 patients (controls) were randomly selected from the TAA database. Radiographic evaluation included tibial component coronal alignment and postoperative medial malleolar width. Demographics and radiographic variables were compared between cohorts. Logistic regression was used to investigate the association between medial malleolar fracture and postoperative coronal alignment, medial malleolar width, and prophylactic fixation of the medial malleolus.
RESULTS
Mean (SD) medial malleolar width was significantly smaller in the fracture cohort (8.52 mm [1.6]) than in the control group (11.78 mm [1.74]) ( < .001). Mean (SD) tibial component coronal alignment was 92.17 degrees (2.77) in the fracture cohort and 90.21 degrees (1.66) in the control group ( = .002). Regression analysis identified a significant negative association between postoperative medial malleolar width and the probability of fracture (OR = 0.06, 95% CI 0.01, 0.26, < .001). Varus malalignment of the tibial component was positively associated with the probability of fracture (OR = 1.90, 95% CI 1.27, 2.86, = .002). Prophylactic screw fixation resulted in more than 90% reduction in the odds of a fracture (OR = 0.04, 95% CI 0.01, 0.45, = .01). ROC curve analysis determined a medial malleolar width of 10.3 mm as a potential threshold for predicting fracture.
CONCLUSION
Decreased medial malleolar width and postoperative varus malalignment were associated with an increased risk of postoperative medial malleolar fracture. Therefore, surgeons should consider prophylactic screw fixation in patients with a medial malleolar width <10.3 mm or at risk of postoperative varus deformity.
PubMed: 38912602
DOI: 10.1177/10711007241258167 -
Infection and Drug Resistance 2024Periprosthetic joint infection (PJI) is a catastrophic complication following joint replacement surgery, posing significant challenges to orthopedic surgeons. Due to the... (Review)
Review
Periprosthetic joint infection (PJI) is a catastrophic complication following joint replacement surgery, posing significant challenges to orthopedic surgeons. Due to the lack of a definitive diagnostic gold standard, timely treatment initiation is problematic, resulting in substantial economic burdens on patients and society. In this review, we thoroughly analyze the complexities of PJI and emphasize the importance of accurate diagnosis and effective treatment. The article specifically focuses on the advancements in diagnostic techniques, ranging from traditional pathogen culture to advanced molecular diagnostics, and discusses their role in enhancing diagnostic accuracy. Additionally, we review the latest surgical management strategies, including everything from debridement to revision surgeries. Our summary aims to provide practical information for the diagnosis and treatment of PJI and encourages further research to improve diagnostic accuracy and treatment outcomes.
PubMed: 38912221
DOI: 10.2147/IDR.S457644 -
Arthroplasty Today Jun 2024As state, regional, and national registries have rapidly expanded, the goal of this study is to assess the frequency of registry abstracts accepted for both podium and...
BACKGROUND
As state, regional, and national registries have rapidly expanded, the goal of this study is to assess the frequency of registry abstracts accepted for both podium and poster presentations at the American Association of Hip and Knee Surgeons between 2012 and 2022.
METHODS
Final programs and poster e-collections were examined over the past 11 years. Two reviewers evaluated each abstract to determine if they utilized large datasets and the location of each registry. Studies were excluded if they used institutional registries. Reviewers also identified the most frequently utilized registries to determine how their use has fluctuated over this time frame.
RESULTS
A total of 3354 abstracts were reviewed and included. Of those, 577 abstracts utilized data obtained from orthopaedic registries (17.2%): 450 of which were poster presentations (16.5% of total poster acceptances), and 127 were podium presentations (20.5% of accepted podiums). The National Surgical Quality Improvement Program (NSQIP) was the most frequent dataset utilized, with 118 (20.5%) abstracts. Of note, NSQIP's use peaked between 2018 and 2020 and has since slowly trended downward. On the other hand, use of both American Joint Replacement Registry (AJRR) and PearlDiver registry have drastically increased since 2019, with only 6 abstracts chosen in 2019 and 28 abstracts in 2022 (10 AJRR [3 podiums] and 18 PearlDiver [6 podiums]). The proportion of registry data has increased, with the registry abstracts peaking in 2022 as 24% of posters and 37% of podium utilized data from large registry data sets ( < .001).
CONCLUSIONS
There has been a significant increase in the number of studies utilizing registry data for both podium and poster presentations at the American Association of Hip and Knee Surgeons annual meeting. While NSQIP was the most utilized, its use has steadily declined while AJRR and PearlDiver use have increased over the past 3 years. Individuals should understand the strengths and weaknesses of each registry before making conclusions on study results.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38912096
DOI: 10.1016/j.artd.2024.101413 -
Anatomic Total Shoulder Arthroplasty Outcomes Were Not Negatively Affected by the COVID-19 Pandemic.Revista Brasileira de Ortopedia Jun 2024To investigate whether patients undergoing anatomic total shoulder arthroplasty (ATSA) between January and March 2020 experienced different postoperative outcomes...
To investigate whether patients undergoing anatomic total shoulder arthroplasty (ATSA) between January and March 2020 experienced different postoperative outcomes than patients in 2019. We hypothesized that patients in 2020 would have less access to physical therapy (PT) and experience different postoperative outcomes. Records from patients who received ATSA between January 1st, 2019, and March 17th, 2019, and January 1st, 2020, to March 17th, 2020, were analyzed. Patient data, including demographic information, range of motion (ROM), strength, and PT was collected and compared between the two groups. The 2020 patients were contacted by phone during October 2022 and patient-reported metrics were gathered. The present study identified 24 patients in 2019 and 27 patients in 2020 who underwent ATSA during the specified time frame and had a minimum 1-year follow-up. Patients in 2019 experienced improvements in forward elevation (FE) ROM (125.4° to 146.7°; = 0.008), external rotation (ER; 33.0° to 47.7°; < 0.001), and internal rotation (IR; S1 to L4; = 0.019). Patients in 2020 also experienced significant improvements in FE (120.2° to 141.1°; = 0.009), ER (32.9° to 42.0°; = 0.037), and IR (S1 to L3; = 0.002). Patients in 2020 terminated PT earlier (2019: 125.8 days; 2020: 91.1 days; = 0.046) and completed fewer sessions (2019: 21.4 sessions; 2020: 13.1 sessions; = 0.003). At the final follow-up, patients in 2020 reported an average Visual Analogue Scale (VAS) pain score of 1.67 ± 1.1. Despite decreased PT, patients who underwent ATSA in 2020 had significant improvements in ROM and strength and were comparable to patients in 2019.
PubMed: 38911891
DOI: 10.1055/s-0044-1785661