Vancomycin is a commonly used antibiotic for prophylaxis in total joint replacement surgery. Several studies have reported superior local tissue concentration of vancomycin using intraosseous (IO) infusion compared with standard intravenous (IV) administration in total knee arthroplasty (TKA). We reviewed patients undergoing primary TKA who received IO vancomycin to a group receiving IV vancomycin. A retrospective review of 1038 patient who underwent primary TKA at our institution was performed from May 1, 2016 to May 1, 2019. This was a consecutive series of patients before and after we adopted this technique. IO vancomycin administration technique has been previously reported from our institution (500mg vancomycin in 200mL solution). Comparisons included preoperative and postoperative creatinine values, adverse reaction to vancomycin, tourniquet time, re-operation rates, periprosthetic joint infection rate at 1 year.Introduction
Methods
The medical field has long held largely anecdotal beliefs that polymethyl methacrylate (PMMA) vapors are dangerous to a growing fetus, and as such, women who are pregnant should avoid exposure. This study investigates the perceptions of female orthopedic surgeons regarding PMMA cement exposure during pregnancy, and if it influences 1) currently held beliefs / practices and 2) clinical and career choices. A 23-question survey was distributed via e-mail to active members of the Ruth Jackson Orthopaedic Society and a private social media group for women in orthopedics. Questions included demographics, current usage of PMMA, previous exposure during pregnancy and/or breastfeeding, and beliefs regarding current or future willingness of exposure. Additionally, questions were asked regarding PMMA training and whether beliefs influenced specialty choices.Introduction
Methods
Vancomycin is a prophylactic antibiotic used to protect against methicillin resistant staph aureus. Recent literature has suggested that using intraosseus (IO) infusions are capable of providing improved local tissue concentrations compared to intravenous (IV) access. The purpose of this study is to evaluate clinical outcomes of patients who received pre-operative IO vancomycin for total knee arthroplasty (TKA). Patients who received IO vancomycin (500mg vancomycin in 200ml NS) as standard of care from September 1, 2018 to March 1, 2019 were retrospectively evaluated. This data was compared to primary and revision TKAs performed immediately prior to the initiation of IO administration. Evaluation included pre and post-op creatinine values, tourniquet time (TT), and knee-related 30 and 90-day complications. Data for primary and revision TKA cases were analyzed independently.Introduction
Methods
Hip abductor tendon tears have been referred to as “rotator cuff tears of the hip,” and are a recognized etiology for persistent, often progressive, lateral hip pain, weakness, and limp. Multiple repair techniques and salvage procedures for abductor tendon tears have been reported in the literature; however, re-tear remains a frequent complication following surgical repair. This study compares the short-term outcomes of open abductor tendon repairs with decortication and suture fixation (DSF) compared to a modified technique repair into a bone trough (BT), to determine best surgical results for large abductor tendon avulsions. Additionally, surgical treatment of small tears versus large tears was examined. The outcomes of 37 consecutive hip abductor tendon repairs treated between January 2009 and December 2017 were retrospectively reviewed. Large tears were defined as detachment of 33–100% of the gluteus medius insertion. There were 15 DSF and 10 BT cases. Postoperative pain, ability to perform single leg stance, hip abduction, and Trendelenburg lurch, were examined. Small tears (12 cases) were defined as having no gluteus medius avulsion from the trochanteric insertion and were comprised of longitudinal tears (repaired side-by-side) and isolated gluteus minimus tears (repaired by tenodesis to the overlying gluteus medius). Standard statistical analyses were utilized. Type I error for all analyses was set at α=0.05.Introduction
Methods
The Rejuvenate modular neck stem (Stryker, Mahwah, NJ) was recently recalled due to corrosion at the neck-stem junction. The purpose of this study was to investigate the rate of corrosion related failures and survivorship of this implant, and analyze the correlation between the implant and patient factors with serum metal ion levels. Between June 2009 and July 2012, 123 Rejuvenate stems (97 modular and 26 non-modular) THAs were implanted in 104 patients by a single surgeon via a modified anterolateral approach. Serum Cobalt (Co) and Chromium (Cr) levels (microgram per liter [μg/L]) were obtained in all patients. In cases of elevated serum metal ion levels or symptomatic hip, patients underwent magnetic resonance imaging (MRI) for assessment of osteolysis or adverse local tissue reactions (ALTR). Correlation between implant factors (implant size, head size, head length, offset), patient factors (age, gender, BMI) with serum metal ion levels and revisions were analyzed using logistic regression models.Background:
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Kneeling is an important aspect of daily living. Our goal was to describe the in vivo tibiofemoral kinematics during standing and kneeling after total knee arthroplasty (TKA). Ten posterior substituting (PS) and 10 cruciate retaining (CR) TKA designs were studied in 18 patients. Radiographs were taken when standing, kneeling at 90°, and kneeling at maximal flexion. An image matching technique provided three-dimensional measurements of the femoral component position relative to the AP midpoint of the tibial baseplate. When standing, the CR tibiofemoral contact position (medial: 7 mm ± 3; lateral: 6 mm ± 3) was more posterior than the PS design (medial: 5 mm ± 2; lateral: 5 mm ± 2). Movement from standing to kneeling at 90° produced different responses. CR knees translated anteriorly (medial: 4 mm ± 4; lateral: 2 mm ± 6), while PS knees translated posteriorly (medial: 0.2 mm ± 3; lateral: 1 mm ± 4). During kneeling, movement from 90° to maximum flexion produced posterior translation of the femur (CR medial: 5 mm ± 4: CR lateral: 5 mm ± 4; PS medial: 6 mm ± 4; PS lateral: 6 mm ± 3). The relationship between the tibiofemoral contact position and flexion angle during kneeling was more variable for CR knees (r2=0.38) than PS knees (r2=0.64), indicating that PS knees provide a more reliable AP position than CR knees. PS knees dislocate when the arch of the femoral cam slides over the tibial post; CR knees sublux when the femoral contact position translates beyond the edge of the tibial baseplate. The distance to dislocation averaged 13 mm ± 2 for PS knees, and 20 mm±4 for CR knees. Many patients wish to resume normal activities, including kneeling after TKA. This study provides information for surgeons and patients considering kneeling after TKA.
