Preoperative aspiration culture for preoperative diagnosis of infection in total hip or knee arthroplasty.
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ABSTRACT:
SUBMITTER: Qu X
PROVIDER: S-EPMC3889774 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PurposeThe purpose of this hospital-based case-control study was to evaluate the risk factors for periprosthetic joint infection (PJI) of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Chinese patients.MethodFrom January 2000 to December 2012, 45 patients undergoing THA and TKA who developed PJI were recruited for case subjects; controls were 252 without PJI, matched by year of index for surgery and type of surgery. Conditional logistic regressions were run to compute odds ratios (ORs) and 95% confidence intervals (CIs).ResultsDemographic factors and comorbid conditions associated with an increased adjusted risk of PJI (in decreasing order of significance) were diabetes (OR?=?5.47, 95% CI: 1.77-16.97; p?=?0.003), age (65-75 vs. 45-65 years) (OR?=?3.36, 95% CI: 1.30-8.69; p?=?0.013), BMI (?28 vs. 18.5-28 kg/m2) (OR?=?2.77, 95% CI: 1.20-6.40; p?=?0.017), place of residence (rural) (OR?=?2.63, 95% CI: 1.13-6.10; p?=?0.025) and alcohol abuse (OR?=?2.95, 95% CI: 1.06-8.23; p?=?0.039).ConclusionPatients with diabetes, older age, BMI of ?28 kg/m2 and alcohol abuse or living in rural areas, had increased PJI risk. Additional systematic large-scale studies are needed to verify these results.
| S-EPMC3991645 | biostudies-literature
Project description:Background:Surgical site irrigation during total hip (THA) and total knee (TKA) arthroplasty is a routine practice among orthopaedic surgeons to prevent periprosthetic joint infection. The purpose of this study was to evaluate the effect of chlorhexidine gluconate (CHG) irrigation on infection rates following THA and TKA. Methods:Arthroplasties performed before September 2014 served as controls. THA performed before September 2014 (N = 253) underwent intraoperative irrigation with 0.9% saline followed by a 2-minute soak with <2% dilute povidone-iodine. TKA (N = 411) patients underwent only intraoperative saline irrigation. After October 2014, all patients (248 TKA and 138 THA) received intraoperative irrigation with 0.9% saline and periodic 0.05% CHG solution followed by a final 1-minute soak in CHG with immediate closure afterward. Results:In this 2:1 comparison of consecutive patients, there were no differences in patient demographics between the 2 groups. No difference was noted in wound healing concerns subjectively, and no statistically significant association in nonsurgical site infections, superficial surgical site infection, and deep surgical site infection rates between the 2 groups (nonsurgical site infections [THA: P = .244, TKA: P = .125]; superficial surgical site infection [THA: P = .555, TKA: P = .913]; and deep surgical site infection [THA: P = .302, TKA: P = .534]). Conclusions:We were unable to discern a difference in infection rates between chlorhexidine irrigation and our prior protocols using dilute Betadine for THA and 0.9% saline for TKA. The theoretic advantages of dilute CHG retention during closure appear to be safe without infectious concerns.
| S-EPMC5712016 | biostudies-literature
Project description:BackgroundAs America's third highest opioid prescribers, orthopedic surgeons have contributed to the opioid abuse crisis. This study evaluated opioid use after primary total joint replacement. We hypothesized that patients who underwent total hip arthroplasty (THA) use fewer opioids than patients who underwent total knee arthroplasty (TKA) and that both groups use fewer opioids than prescribed.MethodsA prospective study of 110 patients undergoing primary THA or TKA by surgeons at an academic center during 2018 was performed. All were prescribed oxycodone 5 mg, 84 tablets, without refills. Demographics, medical history, and operative details were collected. Pain medication consumption and patient-reported outcomes were collected at 2 and 6 weeks postoperatively. Analysis of variance was performed on patient and surgical variables.ResultsSixty-one patients scheduled for THA and 49 for TKA were included. THA patients consumed significantly fewer opioids than TKA patients at 2 weeks (28.1 tablets vs 48.4, P = .0003) and 6 weeks (33.1 vs 59.3, P = .0004). Linear regression showed opioid use decreased with age at both time points (P = .0002). A preoperative mental health disorder was associated with higher usage at 2 weeks (58.3 vs 31.4, P < .0001) and 6 weeks (64.7 vs 39.2, P = .006). Higher consumption at 2 weeks was correlated with worse outcome scores at all time points.ConclusionsTKA patients required more pain medication than THA patients, and both groups received more opioids than necessary. In addition, younger patients and those with a preexisting mental health disorder required more pain medication. These data provide guidance on prescribing pain medication to help limit excess opioid distribution.
| S-EPMC7851352 | biostudies-literature
Project description:Total knee arthroplasty (TKA) in the setting of previous hip fusion is rare with a paucity of evidence in the orthopaedic literature. Traditionally, TKA is performed supine, with the aid of knee-positioning devices allowing for hip flexion and range of motion of the knee to facilitate ease of surgical intervention. However, TKA using traditional positioning would not be possible in the presence of ipsilateral hip arthrodesis preventing hip motion. This case report describes a TKA performed for a 72-year-old woman with end-stage osteoarthritis of the right knee, ipsilateral hip arthrodesis, and leg-length discrepancy as the sequelae of slipped capital femoral epiphysis. We describe novel surgical positioning to be used to facilitate TKA in the absence of ipsilateral hip motion with bed modifications and the use of an extremity positioning device.
| S-EPMC7527288 | biostudies-literature
Project description:ImportanceCardiac stress testing is often performed prior to noncardiac surgery, although trends in use of preoperative stress testing and the effect of testing on cardiovascular outcomes are currently unknown.ObjectiveTo describe temporal trends and outcomes of preoperative cardiac stress testing from 2004 to 2017.Design, setting, and participantsCross-sectional study of patients undergoing elective total hip or total knee arthroplasty from 2004 to 2017. Trend analysis was conducted using Joinpoint and generalized estimating equation regression. The study searched IBM MarketScan Research Databases inpatient and outpatient health care claims for private insurers including supplemental Medicare coverage and included patients with a claim indicating an elective total hip or total knee arthroplasty from January 1, 2004, to December 31, 2017.ExposuresElective total hip or knee arthroplasty.Main outcomes and measuresTrend in yearly frequency of preoperative cardiac stress testing.ResultsThe study cohort consisted of 801 396 elective total hip (27.9%; n = 246 168 of 801 396) and total knee (72.1%; 555 228 of 801 396) arthroplasty procedures, with a median age of 62 years (interquartile range, 57-70 years) and 58.1% women (n = 465 545 of 801 396). The overall rate of stress testing during the study period was 10.4% (n = 83 307 of 801 396). The rate of stress tests increased 0.65% (95% CI, 0.09-1.21; P = .03) annually from quarter (Q) 1 of 2004 until Q2 of 2006. A joinpoint was identified at Q3 of 2006 (95% CI, 2005 Q4 to 2007 Q4) when preoperative stress test use decreased by -0.71% (95% CI, -0.79% to 0.63%; P < .001) annually. A second joinpoint was identified at the Q4 of 2013 (95% CI, 2011 Q3 to 2015 Q3), when the decline in stress testing rates slowed to -0.40% (95% CI, -0.57% to -0.24%; P < .001) annually. The overall rate of myocardial infarction and cardiac arrest was 0.24% (n = 1677 of 686 067). Rates of myocardial infraction and cardiac arrest were not different in patients with at least 1 Revised Cardiac Risk Index condition who received a preoperative stress test and those who did not (0.60%; n = 221 of 36 554 vs 0.57%; n = 694 of 122 466; P = .51).Conclusions and relevanceThe frequency of preoperative stress testing declined annually from 2006 through 2017. Among patients with at least 1 Revised Cardiac Risk Index condition, no difference was observed in cardiovascular outcomes between patients who did and did not undergo preoperative testing.
| S-EPMC7527943 | biostudies-literature
Project description:Vascular complications in revision total hip arthroplasty may occur in cases where the components of the hip implant migrate through the acetabular wall, through the iliopectineal line of the pelvis, and into the pelvic cavity. This migration may lead to substantial intrapelvic vascular compromise, drastically increasing the surgical complexity and potential risk for morbidity and mortality in these surgical cases. Here, we present a case of a 78-year-old woman with significant acetabular protrusio, which resulted in intraoperative compromise of the external iliac artery with rapid extravasation. As a result of prudent preoperative planning, interdisciplinary collaboration, and precautionary measures, significant patient morbidity and mortality was averted. Level of Evidence:Level V, Case Report.
| S-EPMC6287237 | biostudies-literature
Project description:Ischaemic preconditioning is a method of protecting tissue against ischaemia-reperfusion injury. It is an innate protective mechanism that increases a tissue's tolerance to prolonged ischaemia when it is first subjected to short burst of ischaemia and reperfusion. It is thought to provide this protection by increasing the tissue's tolerance to ischaemia, therby reducing oxidative stress, inflammation and apoptosis in the preconditioned tissue. We used microarrays to investigate the genomic response induced by ischaemic preconditioning in muscle biopsies taken from the operative leg of total knee arthroplasty patients in order to gain insight into the ischaemic preconditioning mechanism. Patients undergoing primary knee arthroplasty were randomised to control and treatment (ischaemic preconditioning) groups. Patients in the treatment group received a preconditioning stimulus immediately prior to surgery. The ischaemic preconditioning stimulus consisted of three five-minute periods of tourniquet insufflation on the lower operative limb, interrupted by five minute periods of reperfusion. All patients had a tourniquet applied to the lower limb after the administration of spinal anaesthesia, as per normal protocol for knee arthroplasty surgery. Muscle biopsies were taken from the quadriceps muscle of the operative knee at the immediate onset of surgery (T0) and at 1 hour into surgery (T1). Total RNA was extracted from biospies of four control and four treatment patients and hybridised to the Affymetrix Human U133 2.0 chip.
2010-04-12 | E-GEOD-21164 | biostudies-arrayexpress
Project description:Total Knee Arthroplasty (TKA) is performed more in working-age (<65 years) patients. Until now, research in this patient population has been conducted mainly among retired (?65 years) patients. Aim of this study was therefore to describe demographic, physical, psychological and social characteristics of working TKA patients and to subsequently compare these characteristics with retired TKA patients and the general population.A cross-sectional analysis. Preoperative data of 152 working TKA patients was used. These data were compared with existing data of retired TKA patients in hospital registers and with normative values from literature on the general population. Demographic, physical, psychological and social (including work) characteristics were analyzed.The majority (83.8%) of working TKA patients was overweight (42.6%) or obese (41.2%), a majority (72.4%) was dealing with two or more comorbidities, and most (90%) had few depressive symptoms. Mean physical activity level was 2950 minutes per week. Compared to the retired TKA population, working TKA patients perceived significantly more stiffness and better physical functioning and vitality, were more physically active, and perceived better mental health. Compared to the general population working TKA patients perceived worse physical functioning, worse physical health and better mental health, and worked fewer hours.This study shows that a majority of working TKA patients are overweight/obese, have multiple comorbidities, but are highly active in light-intensity activities and have few depressive symptoms. Working patients scored overall better on preoperative characteristics than retired patients, and except for physical activity scored overall worse than the general population.
| S-EPMC5571908 | biostudies-literature
Project description:BackgroundIn January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA.MethodsA retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 one-day length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC.ResultsControlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] = 0.935, P < .001), body mass index ≥35 (OR = 0.491, P = .002), female (OR = 0.535, P < .001), nonwhite race (OR = 0.456, P = .003), primary hypertension (OR = 0.710, P = .032), ≥3 comorbidities (OR = 0.507, P = .002), American Society of Anesthesiologists score ≥3 (OR = 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (χ2 = 12.437, P = .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination.ConclusionFor patients undergoing primary TKA, increased age, body mass index ≥35, female gender, nonwhite race, primary hypertension, ≥3 comorbidities, and American Society of Anesthesiologists score ≥3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.
| S-EPMC7856419 | biostudies-literature
Project description:BackgroundIn countries with publicly funded health care, there is an increasing need for explicit rationing for total joint arthroplasty (TJA). The Oxford Hip and Knee Scores (OHS/OKS) have been used to set access thresholds for TJA despite not being developed for that purpose. The aim of this study was to determine whether preoperative OHS/OKS can aid rationing decisions by investigating the changes in general health-related quality of life after TJA.MethodsOHS/OKS, Short Form-12, and Short Form-6D (SF-6D) scores were collected preoperatively and at 1 year postoperatively in a cohort of patients undergoing total hip arthroplasty (THA; n = 713) and total knee arthroplasty (TKA; n = 520). The association between preoperative OHS/OKS and postoperative score and the change in OHS/OKS and SF-6D was investigated, adjusting for age and gender.ResultsThe mean Oxford scores improved from 13.9 to 40.7 (OHS) and 15.6 to 37.4 (OKS). The mean SF-6D improved after THA (0.53 to 0.80) and TKA (0.56 to 0.78) (all P < .0001). Poorer preoperative Oxford scores were associated with poorer postoperative OHS/OKS and SF-6D but larger improvements. For every 5 points lower preoperative OHS/OKS, the postoperative SF-6D score was worse by a margin of 0.019 (THA) and 0.023 (TKA).ConclusionsPreoperative OHS/OKS can help inform rationing decisions. A lower preoperative OHS/OKS will result in greater gains but a lower final outcome score in general health-related quality of life.
| S-EPMC7502579 | biostudies-literature