Advertisement for orthosearch.org.uk
Results 1 - 6 of 6
Results per page:
Applied filters
Content I can access

Include Proceedings
Dates
Year From

Year To
Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 75 - 75
1 Jan 2016
Waddell B Zahoor T Meyer MS Ochsner JL Chimento G
Full Access

Introduction

Tranexamic acid (TXA) has been shown to decrease hemoglobin loss and reduce the need for transfusions in primary hip and knee arthroplasty. Recently, authors have proven similar results in revision total knee arthroplasty (TKA). No previous paper has focused on the safety and efficacy of TXA for revision TKA for periprosthetic joint infection (PJI). The purpose of our study was to evaluate the safety and efficacy of topical TXA in revision TKA for PJI.

Methods

We performed a retrospective review of all patients who underwent two-stage revision total knee arthroplasty for infection at our institution between September 25, 2007 and July 12, 2013. We evaluated hemoglobin loss, need for transfusion, one-year reinfection rate, length of stay (LOS), complications and one-year mortality with and without the use of TXA in all patients who underwent Stage-1 removal of hardware with antibiotic spacer placement and/or revision (Stage-2) for PJI of the knee. All data sets were analyzed using a two-sample t-test.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_4 | Pages 103 - 103
1 Jan 2016
Waddell B Briski D Meyer MS Ochsner JL Chimento G
Full Access

Introduction

Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. As the number of total hip and knee replacements has increased, the number of revision procedures has also increased. Revisions for infection require a greater amount of hospital and surgeon resources than noninfectious revisions. Our study compares the financial information for all two-stage revision surgeries performed at our tertiary referral center for hip or knee PJI over the last four years, separating them into two groups: referral versus self-originating cases.

Methods

We performed a review of all patients who underwent two-stage revision hip or knee arthroplasty for infection between 2008 and 2013 at our facility. We collected detailed financial information for patients and separated them into referral versus self-originating cases, indicating whether index surgery was performed at an outside facility or at our facility, respectively. Only those patients who underwent full two-stage procedure at our facility were included.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_1 | Pages 74 - 74
1 Jan 2016
Duplantier N Briski D Meyer MS Ochsner JL Chimento G
Full Access

Background

Hospitalists have assumed an evolving role in the care of postsurgical orthopaedic patients. Literature has provided evidence to suggest improved outcomes in postsurgical hip fracture patients managed by hospitalists in nonteaching hospitals. However, the full impact of a hospitalist co-management model has not been fully investigated with regard to elective joint arthroplasty patients in a multispecialty teaching facility. We hypothesized that a hospitalist co-management model in the setting of a teaching hospital would lead to an increase in unnecessary medical workups for joint arthroplasty patients.

Methods

We retrospectively evaluated 2231 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between May 2010 and January 2014 at one teaching facility, excluding any non-elective trauma patients. The patients were separated into a non-hospitalist (NH) cohort of 1062 patients that did not receive hospitalist co-management postsurgery, and a hospitalist (H) cohort of 1169 patients that received hospitalist co-management postsurgery. We used Student t test and significance of (P<0.05) to compare the following factors between the two patient cohorts: length of stay (LOS), readmission rates at 30 and 90 days postsurgery, number of diagnoses present on admission, and number of new diagnosis given during admission. We then compared the average number of diagnostic and laboratory studies performed per patient and the average cost per hospital stay between the two cohorts.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 52 - 52
1 Dec 2013
Duplantier N Briski D Ochsner JL Meyer MS Stanga D Chimento G
Full Access

Background:

Complications following hip and knee arthroplasty can occur in any given patient. However, specific risk factors such as increased age, history of coexistent disease, and increased body mass index have been found to increase the risk of complications after such procedures. Complications often require prolonged hospital admission periods and added hospital resources which ultimately results in increased costs per hospital stay. However, if patients are pre-operatively risk stratified, and followed post-operatively for specific high risk medical issues, many complications may be avoided. By using a hospital standardised peri-operative risk stratification process, the cost per hospital stay for hip and knee arthroplasty may decrease.

Hypothesis:

Overall hospital costs related to joint arthroplasty will be decreased by using a multi-disciplinary peri-operative risk stratification programme.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 486 - 486
1 Dec 2013
Qadir R Ochsner JL Chimento GF Meyer M Waddell B Zavatsky JM
Full Access

Introduction

The utility of vancomycin powder application into the surgical site has recently shown efficacy in decreasing infections in patients undergoing thoracolumbar spine surgery. The effect on polyethylene wear after intraoperative placement of vancomycin powder at the surgical site of total joint replacements has not been determined. The purpose of this study is to compare wear behavior of material couples of Cobalt Chromium Alloy (CoCr) on ultra high molecular weight polyethylene (UHMWPE) to identical wear couples with vancomycin powder added prior to the start of wear simulation.

Methods

A custom-designed six-station wear simulator was used to establish in vitrowear characteristics of CoCr on UHMWPE on test articles fabricated from materials identical to total knee implants. Three stations included vancomycin powder added to the 36% bovine calf serum solution used in each station. Cyclic articulation simulations were run for 10 million cycles (Mc) at 4 ± 0.3 Hz under a constant axial load of 89N over 25 degrees of flexion-extension. UHMWPE wear was measured using photography, stereomicroscopic examination, and gravimetric measurements at the end of 0.5, 1, 2.5, 5, and 10 Mc.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 263 - 263
1 Dec 2013
Qadir R Sidhu S Ochsner JL Meyer MS Chimento G
Full Access

Introduction:

Deep infection after total joint arthroplasty is a devastating complication with reported incidence of 1–3% with projection to increase to 6.8% by 2030. The direct costs of revision surgery due to septic failure are estimated at over $55,000 per case. Antibiotic-Loaded Bone Cement (ALBC) has been proposed as a preventive measure to decrease post-operative infection rates. Its efficacy has been compared with plain bone cement (PBC) in multiple studies. There has been no study to our knowledge examining its efficacy in “high risk” patients. The purpose of this study is to compare infection rates in three cohorts of patients: (1) all patients receiving only PBC, (2) all patients receiving only ALBC, and (3) only “high risk” patients receiving ALBC.

Methods:

A standard cement protocol was instituted at our hospital for primary total knee arthroplasties (pTKA). From January 2000 to 2005 all pTKAs were performed with PBC. From February 2005 to May 2010, all pTKAs were performed with ALBC. From June 2010 to March 2012, all patients received regular bone cement unless they had previous diagnoses of rheumatoid arthritis, obesity, and/or diabetes mellitus. Our institutional joint registry was queried and the three cohorts' individual charts were retrospectively reviewed. Infection rates amongst cohorts were compared at 30 days, 6 months, and 1 year from index surgery date utilizing two sided proportion tests.