Aims. Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits. Methods. We retrospectively reviewed all patients who underwent TJA from 2011 to 2021 at a single, large, tertiary urban institution. Patients were separated into two cohorts based on whether they underwent primary or
Aim. Prosthetic joint infection (PJI) is a devastating and costly complication of total joint arthroplasty (TJA). Use of extended oral antibiotic prophylaxis (EOAP) has become increasingly popular in the United States following a highly publicized study (Inabathula et al) from a single center demonstrating a significant protective effect (81% reduction) against PJI in ‘high-risk’ patients. However, these results have not been reproduced elsewhere and EOAP use directly conflicts with current antibiotic stewardship efforts. In order to study the role of EOAP in PJI prevention, consensus is needed for what defines ‘high-risk’ patients. The
Wear induces osteolysis leading to periprosthetic bone loss and TJA loosening. Inflammatory immune cells can form an aggressive interface membrane activating osteoclasts. The current study shows the effect of metal particles and ions triggering cellular responses. Blood samples from primary and
Aim. While metagenomic (microbial DNA) sequencing technologies can detect the presence of microbes in a clinical sample, it is unknown whether this signal represents dead or live organisms. Metatranscriptomics (sequencing of RNA) offers the potential to detect transcriptionally “active” organisms within a microbial community, and map expressed genes to functional pathways of interest (e.g. antibiotic resistance). We used this approach to evaluate the utility of metatrancriptomics to diagnose PJI and predict antibiotic resistance. Method. In this prospective study, samples were collected from 20 patients undergoing
The number of Americans over the age of 80 is increasing at a faster rate than that of the 65–80 population. The cohort age 85–94 years had the fastest rate of growth from 2000–2010. The number of Americans older than 95 years grew at approximately 26% during the same period. This rapid growth has been associated with an increasing incidence of osteoarthritis of the hip and knee in this population. This surge in the growth rate of the elderly population has coincided with an increasing demand for primary and revision total joint arthroplasty. Surgeons need to be prepared to perform safely and appropriately these procedures in this rapidly growing segment of the population. Surgeons need to be aware of the 1) clinical outcomes that can be expected when total joint procedures are performed in this group of patients; 2) the morbidity and mortality associated with the performance of these procedures; and 3) the relative cost effectiveness of these interventions. Clinical outcomes of TJA in this population are generally good. Pain and satisfaction scores are similar to those of younger patients. Although pre-operative pain and functional impairment scores are higher pre-operatively in elderly patients, these improve significantly following TJA. However, functional outcome scores decline noticeably after 5 years, reflecting the impact of coexistent comorbidities. The continued need for assistive devices is greater in this age group than in younger total joint patients. The risk of falls, a particular issue of concern in this age group, is reduced after total hip and knee surgery. The rate of complications, including mortality, following TJA in this age group is greater than in the 65–79-year-old group. The use of hospitalists to co-manage peri-operative care is particularly important in this age group. The increased rate of complications is associated with longer lengths of stay. However, the length of stay for this age group after primary total joint replacement is decreasing significantly; reflecting the widespread streamlining of peri-operative care that is being incentivised and implemented nationwide. The use of extended care facilities is also greater in this age group. The performance of
Aim. Hospital systems have recently instituted early systemic sepsis recognition systems, where vital signs and laboratory findings are monitored and automatically alert providers to potential sepsis. Although there are very few reports evaluating the use of sepsis alert systems outside of the emergency room or intensive care unit, many hospital systems have made the decision to apply the sepsis alarm protocols to all inpatients. The purpose of this study was to evaluate if an alarm system using systemic inflammatory response syndrome (SIRS) criteria is a valuable tool to predict systemic sepsis in the immediate postoperative period (POD#0–4) after total joint arthroplasty (TJA). Method. 10,791 primary and
Introduction. Next generation sequencing (NGS) has been shown to facilitate detection of microbes in a clinical sample, particularly in the setting of culture-negative periprosthetic joint infection (PJI). However, it is unknown whether every microbial DNA signal detected by NGS is clinically relevant. This multi-institutional study was conceived to 1) identify species detected by NGS that may predict PJI, then 2) build a predictive model for PJI in a developmental cohort; and 3) validate the predictive utility of the model in a separate multi-institutional cohort. Methods. This multicenter investigation involving 15 academic institutions prospectively collected samples from 194 revision total knee arthroplasties (TKA) and 184 revision hip arthroplasties (THA) between 2017–2019. Patients undergoing reimplantation or spacer exchange procedures were excluded. Synovial fluid, deep tissue and swabs were obtained at the time of surgery and shipped to MicrogenDx (Lubbock, TX) for NGS analysis. Deep tissue specimens were also sent to the institutional labs for culture. All patients were classified per the 2018 Consensus definition of PJI. Microbial DNA analysis of community similarities (ANCOM) was used to identify 17 candidate bacterial species out of 294 (W-value >50) for differentiating infected vs. noninfected cases. Logistic Regression with LASSO model selection and random forest algorithms were then used to build a model for predicting PJI. For this analysis, ICM classification was the response variable (gold standard) and the species identified through ANCOM were the predictor variables. Recruited cases were randomly split in half, with one half designated as the training set, and the other half as the validation set. Using the training set, a model for PJI diagnosis was generated. The optimal resulting model was then tested for prediction ability with the validation set. The entire model-building procedure and validation was iterated 1000 times. From the model set, distributions of overall assignment rate, specificity, sensitivity, positive predictive value (PPV) and negative predicative value (NPV) were assessed. Results. The overall predictive accuracy achieved in the model was 75.9% (Figure 1). There was a high accuracy in true-negative and false-negative classification of patients using this predictive model (Figure 2), which has previously been a criticism of NGS interpretation and reporting. Specificity was 97.1%, PPV was 75.0%, and NPV was 76.2%. On comparison of the distribution of abundances between ICM-positive and ICM-negative patients, Staphylococcus aureus was the strongest contributor (F=0.99) to the predictive power of the model (Figure 3). In contrast, Cutibacterium acnes was less predictive (F=0.309) and noted to be abundant across both infected and noninfected
Total hip arthroplasty (THA) and Total knee arthroplasty (TKA) are successful operations that predictably restore function and provide pain relief for up to 20 years. What happens if they fail in the elderly patient? The purpose of this review was to evaluate pain relief, function and quality of life (QOL) in octogenarian patients undergoing revision total joint arthroplasty (TJA). We reviewed our surgical database to find all patients who were 80 years or older at the time of revision surgery. From 1993 through 2008, there were 61 revision THAs (52 patients) and 33 revision TKAs (29 patients). This represented 3% and 8% respectively of all arthroplasties and revision arthroplasties done during the same period. Outcomes evaluated include Harris Hip Scores (HHS), Knee Society Scores (KSS), complications, and QOL. The average follow-up for revision THA patients with completed Harris Hip Evaluations was 27 months (range: 3 – 126 months). HHS improved from 47 pre-operatively to 74 at most recent follow-up. Pain Scores improved from 20 to 39, Function Scores from 11 to 16, Activities Scores from 9 to 10, Deformity Scores from 2 to 4 and ROM Scores from 5 to 6. Complications occurred in 34% of these cases. The average follow-up for revision TKA patients with completed Knee Society Evaluations was 38 months (range: 11 – 98 months). KSS improved from 48 preoperatively to 84 at the most recent follow-up. Pain Scores improved from 22 to 43 and Function Scores from 20 to 34. Complications occurred in 47% of these cases. Total HHS and KSS greatly improved postoperatively with the most notable improvement in the Pain category. Complications were common, although most were considered minor. More severe complications occurred when revisions of all components were needed, more likely in TKA than THA. With careful selection, patient education and preoperative planning,
