Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Patients undergoing revision for PJI may experience considerable psychological distress and symptoms of depression, both of which are linked to poor post-operative outcomes. We therefore aim to identify the prevalence of depressive symptoms in patients prior to treatment for PJI. All patients between September 2008 – October 2018 undergoing single or 2-stage revision for PJI with minimum 1-year follow-up were retrospectively reviewed at a single institution. The 2-stage (n=37) and single stage (n=39) patients that met inclusion criteria were matched based off age (+/−5), gender and BMI (+/−5) to patients undergoing aseptic revisions. Based on prior literature, patients were considered to have depressive symptoms if their VR-12 mental component score (MCS) was below 42. Using Student's t-tests, outcomes evaluated included pre-operative and 1-year post-operative VR-12 MCS and physical component scores (PCS).Introduction
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Cross table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). CTL measurements may differ by >10 degrees from CT scan measurements, but the reasons for this discrepancy are poorly understood. We compare anteversion measurements made on CTL radiographs and CT scans to identify spinopelvic parameters predictive of inaccuracy. THA patients (n=47) with preoperative spinopelvic radiographic analysis and postoperative CT scans were retrospectively reviewed. Acetabular component anteversion was measured on post-operative CTL radiographs, and CT scans using 3D reconstructions of the pelvis. Patients were grouped by error (CTL-CT)>10° (n=11) or <10° (n=36), and spinopelvic mobility parameters were compared using t-tests. Correlation between error and mobility parameters was assessed with Pearson coefficient.Introduction
Methods
Cutibacterium acnes (C. acnes) is now recognized as a clinical entity in periprosthetic joint infections (PJI) of the shoulder and spine. However, the colonization rate of C. acnes in the adult hip is currently unknown. Therefore, the purpose of this study was to investigate the rate of C. acnes colonization from the skin of healthy subjects from various anatomic locations corresponding to direct anterior and lateral/posterolateral surgical approaches. 90 patients scheduled for hip or knee surgery were recruited for cultured biopsies. Four 3-mm dermal punch biopsies were collected after administration of anesthesia, but prior to delivery of perioperative antibiotics. Pre-biopsy skin prep consisted of a standardized pre-operative 2% chlorhexidine skin cleanse and an additional 70% isopropyl alcohol mechanical skin scrub immediately prior to biopsy collection. Two culture samples 10-cm apart were collected from a location approximating a standard direct anterior skin incision, and two samples 10-cm apart were collected from a location approximating a lateral skin incision (suitable for a posterior, direct-lateral or anterolateral surgical approach). Samples were cultured for two weeks.Introduction
Methods
Optimal perioperative fluid management has not been established in patients undergoing orthopaedic surgical procedures. Our purpose was to investigate the effects of perioperative fluid management on patients experiencing TKA. One hundred thirty patients who met inclusion criteria undergoing primary unilateral TKA were prospectively randomized into traditional (TFG) vs. oral (OFG) perioperative fluid management groups. The TFG had a predetermined (4L) amount of intravenous fluids (IVF) administered in the perioperative period. The OFG began drinking a minimum of three, 20-ounces servings of clear fluids daily for three days prior to surgery. This cohort also drank 10-ounces of clear fluids 4 hours prior to surgery. Perioperative IVF were discontinued when the patient began oral intake or when the total amount of IVF reached 500mL. Outcome measures included: body-weight (BW) fluctuations, knee motion, leg girth, bioelectrical impendence, quadriceps activation, functional outcomes testing, KOOS JR, VR-12, laboratory values, vital signs, patient satisfaction, pain scores, and adverse events.Background
Methods
Closed suction intraarticular drain (CSD) use after total knee arthroplasty (TKA) has been studied with regards to wound healing and range of motion, however, no data exist on how CSD use impacts knee joint effusion and quadriceps strength. The primary purpose of this study was to determine whether CSD use influences recovery of quadriceps strength. Secondary outcomes examined effects of CSD on intraarticular effusion, lower limb swelling, knee range of motion (ROM), pain and wound healing complications. Twenty-nine patients undergoing same-day bilateral TKA were enrolled in a prospective, randomized blinded study. Subjects were randomized to receive a CSD on one lower extremity while the contralateral limb had the use of a subcutaneous drain (SCDRN) without the use of suction. Isometric quadriceps strength was collected as the primary outcome. Secondary outcomes consisted of quadriceps muscle activation, intraarticular effusion measured via ultrasound, lower extremity swelling measured with bioelectrical impendence, lower extremity girth, ROM, and pain. Outcomes were assessed preoperatively and postoperatively at day 2, 2 and 6 weeks and 3 months. Differences in limbs were determined using paired t-tests or Wilcoxon signed rank tests.Introduction
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