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https://www.readbyqxmd.com/read/30100137/defining-treatment-success-after-2-stage-exchange-arthroplasty-for-periprosthetic-joint-infection
#1
Timothy L Tan, Karan Goswami, Yale A Fillingham, Noam Shohat, Alexander J Rondon, Javad Parvizi
BACKGROUND: Two-stage exchange arthroplasty remains the preferred surgical treatment method for patients with chronic periprosthetic joint infection (PJI). The success of this procedure is not known exactly as various definitions of success have been used. This study aimed at analyzing the difference in outcome following 2-stage exchange arthroplasty using different definitions for success. METHODS: A retrospective study of 703 patients with PJI who underwent resection arthroplasty and spacer insertion between January 1999 and June 2015 was performed...
June 20, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30100135/patients-with-infected-total-hip-arthroplasty-undergoing-2-stage-exchange-arthroplasty-experience-massive-blood-loss
#2
Rahul Goel, Patrick Buckley, Emily Sterbis, Javad Parvizi
BACKGROUND: Two-stage exchange arthroplasty is the preferred treatment for chronic periprosthetic joint infection following total hip arthroplasty (THA). These patients are at high risk of substantial blood loss and perioperative blood transfusion. Our study aimed at determining risk factors for blood transfusion during a 2-stage exchange for infected THA. METHODS: Medical records of 297 patients with infected THA who underwent 2-stage exchange arthroplasty from 1997 to 2016 were reviewed...
July 2, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30100134/diagnosing-periprosthetic-joint-infection-in-inflammatory-arthritis-assumption-is-the-enemy-of-true-understanding
#3
Noam Shohat, Karan Goswami, Yale Fillingham, Timothy L Tan, Tyler Calkins, Craig J Della Valle, Jaiben George, Carlos Higuera, Javad Parvizi
BACKGROUND: Despite concern over the interpretation of serum and synovial fluid tests to screen and diagnose periprosthetic joint infection (PJI) in patients with inflammatory arthritis, only a single study has investigated this area. We aimed to assess accuracy of clinical and laboratory markers for PJI diagnosis in the context of underlying inflammatory arthritis. METHODS: This multicenter study was conducted on total joint arthroplasty patients at 3 different centers between 2001 and 2016...
July 24, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30093266/cefazolin-prophylaxis-for-total-joint-arthroplasty-obese-patients-are-frequently-underdosed-and-at-increased-risk-of-periprosthetic-joint-infection
#4
Alexander J Rondon, Michael M Kheir, Timothy L Tan, Noam Shohat, Max R Greenky, Javad Parvizi
BACKGROUND: One of the most effective prophylactic strategies against periprosthetic joint infection (PJI) is administration of perioperative antibiotics. Many orthopedic surgeons are unaware of the weight-based dosing protocol for cefazolin. This study aimed at elucidating what proportion of patients receiving cefazolin prophylaxis are underdosed and whether this increases the risk of PJI. METHODS: A retrospective study of 17,393 primary total joint arthroplasties receiving cefazolin as perioperative prophylaxis from 2005 to 2017 was performed...
July 5, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30093264/culturing-periprosthetic-joint-infection-number-of-samples-growth-duration-and-organisms
#5
Michael M Kheir, Timothy L Tan, Colin T Ackerman, Ronuk Modi, Carol Foltz, Javad Parvizi
BACKGROUND: Owing to the difficulty isolating microorganisms in periprosthetic joint infection (PJI), current guidelines recommend that 3-5 intraoperative samples be cultured and maintained for 3-14 days. We investigated (1) the optimal number of culture samples and growth duration to diagnose PJI and (2) the microbiology profile at our institution. METHODS: A retrospective review of 711 patients (329 hips, 382 knees) with PJI that met Musculoskeletal Infection Society criteria from 2000 to 2014 was performed...
July 11, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30092305/clinical-outcome-and-risk-factors-for-failure-in-late-acute-prosthetic-joint-infections-treated-with-debridement-and-implant-retention
#6
Marjan Wouthuyzen-Bakker, Marine Sebillotte, Jose Lomas, Adrian Taylor, Eva Benavent Palomares, Oscar Murillo, Javad Parvizi, Noam Shohat, Javier Cobo Reinoso, Rosa Escudero Sánchez, Marta Fernandez-Sampedro, Eric Senneville, Kaisa Huotari, José Maria Barbero Allende, Joaquín Garcia-Cañete, Jaime Lora-Tamayo, Matteo Carlo Ferrari, Danguole Vaznaisiene, Erlangga Yusuf, Craig Aboltins, Rihard Trebse, Mauro José Salles, Natividad Benito, Andrea Vila, Maria Dolores Del Toro, Tobias Siegfried Kramer, Sabine Petersdorf, Vicens Diaz-Brito, Zeliha Kocak Tufan, Marisa Sanchez, Cédric Arvieux, Alex Soriano
OBJECTIVES: Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described. METHODS: Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: i) the need for implant removal, ii) infection related death, iii) the need for suppressive antibiotic therapy and/or iv) relapse or reinfection during follow-up...
August 6, 2018: Journal of Infection
https://www.readbyqxmd.com/read/30072185/red-cell-distribution-width-an-unacknowledged-predictor-of-mortality-and-adverse-outcomes-following-revision-arthroplasty
#7
Arash Aali-Rezaie, Pouya Alijanipour, Noam Shohat, Hamed Vahedi, Carol Foltz, Javad Parvizi
BACKGROUND: Revision total joint arthroplasties (TJAs) have been empirically associated with significant postoperative morbidity and mortality. Red blood cell distribution width (RDW), a frequently measured hematological parameter, has been shown to predict mortality in hip fracture patients. However, its utility in risk-stratifying patients before revision TJA remains unknown. The aim of this study was to investigate the possible relationship between preoperative RDW levels and outcome of revision arthroplasty in terms of mortality, adverse outcomes, and length of hospital stay...
July 4, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30062484/current-recommendations-for-the-diagnosis-of-acute-and-chronic-pji-for-hip-and-knee-cell-counts-alpha-defensin-leukocyte-esterase-next-generation-sequencing
#8
REVIEW
Karan Goswami, Javad Parvizi, P Maxwell Courtney
PURPOSE OF REVIEW: Despite significant progress in recent years, the diagnosis of periprosthetic joint infection (PJI) remains a challenge and no gold standard test exists. A combination of serological, synovial, microbiological, histological, and radiological investigations is performed that are expensive, often invasive, and imperfect. Novel biomarkers and molecular methods have shown promise in recent years. The purpose of this review is to provide an update about the diagnostic recommendations for PJI and cover a selection of emerging diagnostic tools...
July 31, 2018: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/30054211/preoperative-opioids-increase-the-risk-of-periprosthetic-joint-infection-after-total-joint-arthroplasty
#9
Kerri L Bell, Noam Shohat, Karan Goswami, Timothy L Tan, Irene Kalbian, Javad Parvizi
BACKGROUND: Opioids have well-known immunosuppressive properties and preoperative opioid consumption is relatively common among patients undergoing total joint arthroplasty (TJA). The hypothesis of this study was that utilization of opioids preoperatively would increase the incidence of subsequent periprosthetic joint infection (PJI) in patients undergoing primary TJA. METHODS: A comparative cohort study design was set up that used a cohort of 23,754 TJA patients at a single institution...
May 29, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30029928/the-role-of-perioperative-surveillance-in-90-day-total-joint-arthroplasty-care
#10
Andrew J Luzzi, Meredith P Crizer, Andrew N Fleischman, Carol Foltz, Javad Parvizi
BACKGROUND: With the recent implementation of a bundled payment model for total joint arthroplasty, healthcare providers are financially responsible for management of complications throughout the 90-day perioperative period. Our aim was to assess the effectiveness of a surveillance system that was implemented to enhance communication during this period. METHODS: A retrospective study was conducted using a prospectively collected database of patients who underwent primary total joint arthroplasty from January 2015 to April 2016...
June 20, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/30017220/differences-in-reported-outcomes-in-industry-funded-vs-nonfunded-studies-assessing-thromboprophylaxis-after-total-joint-arthroplasty
#11
Hannah Groff, Ibrahim Azboy, Javad Parvizi
BACKGROUND: There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), with varying conclusions. Patient inclusion criteria may be different for each study, which may lead to selection bias and misrepresentation of data. This study aimed to investigate if industry funding impacted patient demographics and overall reported outcomes of studies analyzing venous thromboembolism (VTE) prevention after TJA. METHODS: Electronic searches were completed using Ovid, PubMed, and Embase databases...
June 28, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29975266/increased-postoperative-glucose-variability-is-associated-with-adverse-outcomes-following-total-joint-arthroplasty
#12
Noam Shohat, Camilo Restrepo, Arash Allierezaie, Majd Tarabichi, Rahul Goel, Javad Parvizi
BACKGROUND: Increased glucose variability during hospitalization has been associated with a longer length of stay in the hospital and a higher mortality rate following non-orthopaedic surgical procedures. Our aim was to investigate the association between glucose variability and postoperative complications following total joint arthroplasty. METHODS: We analyzed data on 21,487 patients who had undergone total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single center from 2001 to 2017...
July 5, 2018: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29914821/are-we-winning-or-losing-the-battle-with-periprosthetic-joint-infection-trends-in-periprosthetic-joint-infection-and-mortality-risk-for-the-medicare-population
#13
Steven M Kurtz, Edmund C Lau, Min-Sun Son, Ellen T Chang, Werner Zimmerli, Javad Parvizi
BACKGROUND: Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time. METHODS: Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends...
June 1, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29903458/the-bundle-busters-incidence-and-costs-of-postacute-complications-following-total-joint-arthroplasty
#14
Andrew J Luzzi, Andrew N Fleischman, Christopher N Matthews, Meredith P Crizer, John Wilsman, Javad Parvizi
BACKGROUND: Recently, a bundled payment model was implemented in the United States to improve quality and reduce costs. While hospitals may be rewarded for lowering costs, they may be financially exposed by high cost complications, the so-called bundle busters. We aimed at determining the incidence, etiology, and costs of postacute complications after total joint arthroplasty (TJA). METHODS: A retrospective study was conducted using a prospectively collected database of patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from January 2015 to April 2016...
June 11, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29885971/development-and-evaluation-of-a-prognostic-calculator-for-the-surgical-treatment-of-periprosthetic-joint-infection
#15
Michael M Kheir, Timothy L Tan, Jaiben George, Carlos A Higuera, Mitchell G Maltenfort, Javad Parvizi
BACKGROUND: Preoperative identification of patients at risk of failing surgical treatment for periprosthetic joint infection (PJI) is imperative to allow medical optimization and targeted prevention. The purpose of this study was to create a preoperative prognostic calculator for PJI treatment by assessing a patient's individual risk for treatment failure based on many preoperative variables. METHODS: A retrospective review was performed of 1438 PJIs, treated at 2 institutions from 2000 to 2014...
April 30, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29885970/intraoperative-dexamethasone-reduces-readmission-rates-without-effecting-risk-of-thromboembolic-events-or-infection-after-total-joint-arthroplasty
#16
Mitchell R Klement, Hugh S Wilkens, Yale A Fillingham, Jorge Manrique, Matthew S Austin, Javad Parvizi
BACKGROUND: The use of perioperative dexamethasone has been proven to reduce pain and shorten recovery for patients undergoing total hip and knee arthroplasty. However, the effect of these medications on 90-day readmissions and the rates of clinically significant venous thromboembolic events (VTE) after total joint arthroplasty (TJA) remains unknown. METHODS: Patients undergoing unilateral, primary total joint arthroplasty between 2009 and 2016 in a single institution were identified...
May 18, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29876128/aspirin-provides-adequate-vte-prophylaxis-for-patients-undergoing-hip-preservation-surgery-including-periacetabular-osteotomy
#17
Ibrahim Azboy, Michael M Kheir, Ronald Huang, Javad Parvizi
There are no clear guidelines regarding optimal venous thromboembolism (VTE) prophylaxis for patients undergoing hip preservation surgery (HPS), in particular pelvic osteotomy, which is considered to be a major orthopaedic procedure. The aim of this study was to determine the efficacy of aspirin for VTE prophylaxis in a large cohort of patients undergoing femoroacetabular osteoplasty (FAO) and periacetabular osteotomy (PAO). This was a retrospective study of prospectively collected data on patients undergoing HPS...
July 2018: Journal of Hip Preservation Surgery
https://www.readbyqxmd.com/read/29871833/majority-of-total-joint-arthroplasties-are-subtherapeutic-on-warfarin-at-time-of-discharge-another-reason-to-avoid-warfarin-as-a-venous-thromboembolism-prophylaxis
#18
Alexander J Rondon, Karan Goswami, Timothy L Tan, Noam Shohat, Javad Parvizi
BACKGROUND: Warfarin has been used as prophylaxis against venous thromboembolism (VTE) after total joint arthroplasty (TJA) for over 60 years. With trends of shorter hospital stays for TJA patients, it is important to examine how many patients achieve therapeutic international normalized ratio (INR) at time of discharge. We aimed at elucidating the proportion of patients discharged at therapeutic INR and whether this is affected by inpatient specialty anticoagulation management service (AMS) involvement...
May 3, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29866503/determining-the-role-and-duration-of-the-antibiotic-holiday-period-in-periprosthetic-joint-infection
#19
Timothy L Tan, Michael M Kheir, Alexander J Rondon, Javad Parvizi, Jaiben George, Carlos A Higuera, Noam Shohat, Antonia F Chen
BACKGROUND: Two-stage exchange arthroplasty involves resection and reimplantation of new implants at a later stage. An antibiotic-free period is often advocated by surgeons before reimplantation. However, there is no conclusive evidence supporting the utility or duration of this practice. This study evaluated the utility and optimal duration of the antibiotic-free period before reimplantation. METHODS: Electronic infection databases of 2 institutions were retrospectively reviewed from 2000 to 2014 to identify 785 patients who underwent 2-stage exchange arthroplasty, of which 409 were reimplanted without any surgeries between the first and second stage...
April 26, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29759856/malnutrition-and-the-development-of-periprosthetic-joint-infection-in-patients-undergoing-primary-elective-total-joint-arthroplasty
#20
Kier Blevins, Arash Aalirezaie, Noam Shohat, Javad Parvizi
BACKGROUND: Although an abundance of literature exists linking malnutrition with infectious complications in surgical patients, there is little specifically examining the link between malnutrition and periprosthetic joint infection (PJI). This study evaluated the relationship between abnormal nutritional parameters and development of PJI in patients undergoing primary total joint arthroplasty (TJA). METHODS: We retrospectively reviewed TJA patients from 2000 to 2016 with preoperative nutritional screening at a single institution...
April 23, 2018: Journal of Arthroplasty
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