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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 59 - 59
7 Aug 2023
ANALYZING TRENDS IN PROM AND MCID REPORTING IN TOTAL JOINT REPLACEMENT OVER THE PAST DECADE
Goldberg B Deckey D Christopher Z Clarke H Spangehl M Bingham J
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Abstract

Introduction

Minimum clinically important differences (MCIDs) are critical to understanding changes in patient-reported outcome measure (PROM) scores after total joint arthroplasty (TJA). The usage and adoption of MCIDs not been well-studied. This study was performed to IDENTIFY trends in PROM and MCID use after TJA over the past decade.

Methods

All articles published in the calendar years of 2010 and 2020 in CORR, JBJS, and the Journal of Arthroplasty were reviewed. Articles relating to clinical outcomes in primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) were included. For each article, all reported PROMs and (if present) accompanying MCIDs were recorded. The use of PROMs and MCIDs were compared between articles published in 2010 and 2020.

Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 234 - 234
1 Jul 2014
NATIONAL UTILISATION TRENDS AND PERI-OPERATIVE OUTCOMES FOR TOTAL HIP ARTHROPLASTY VERSUS HEMIARTHROPLASTY FOR FEMORAL NECK FRACTURES
Moretti V Goldberg B
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Summary Statement

Total hip arthroplasty and hemi-arthroplasty are becoming increasingly popular in the treatment of femoral neck fractures in the United States. Both appear to be safe and effective treatment options, with rare acute adverse events and low mortality.

Introduction

Femoral neck fractures are one of the most frequent orthopaedic injuries seen in the United States (US). Total hip arthroplasty (THA) and hemiarthroplasty (HA) are commonly used to treat displaced intra-capsular femoral neck fractures, but controversy currently exists regarding the preferred modality. The purpose of this study was to assess recent national trends in THA and HA performed for femoral neck fracture and to evaluate perioperative outcomes for each treatment group.

Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 132 - 132
1 Mar 2008
SYNOVIAL FLUID ANTIBIOTIC LEVELS AT STAGE II REIMPLANTATION FOLLOWING EXCHANGE ARTHROPLASTY
Frost S Beauchamp C Spangehl M Donnely R Goldberg B
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Purpose: The gold standard for treatment of infected total hip or knee replacements remains a 2-stage exchange arthroplasty. This includes aggressive irrigation and debridement, implant removal, insertion of antibiotic impregnated spacers, iv antibiotics, and eventual reimplantion with a definitive prosthesis. The purpose of this study was to quantify Vancomycin and Gentamycin synovial fluid levels at the time of reimplantation following a 2-stage exchange arthroplasty for a infected total hip or knee replacements.

Methods: The senior author performed 42 two-stage reconstructions using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC). Each 40g bag of Pala-cos-R cement was impregnated with Vancomycin 2g, Gentamycin 4.8g, and plus/minus ancef 2.0g (depending on penicillin allergy). At the time of reimplantation, the synovial fluid was immediately analyzed for levels of Vancomycin and Gentamycin.

Results: 17 patients were taken for stage II within 60 days (avg. 53). The synovial fluid vancomycin and gentamycin levels were 12.7 and 20.6 respectively. Twelve patients had stage II between 60 and 90 days (avg. 79). The synovial fluid vancomycin and gentamycin levels were 6.2 and 14.9 respectively. The remaining 13 patients underwent stage II beyond 90 days (avg. 192), and their synovial fluid vancomycin and gentamycin levels were 3.3 and 2.4 respectively. 40 of 42 patients had their infections eradicated.

Conclusions: in vitro evidence predicts that antibiotics elute rapidly from bone cement. The results of this study confirm that substantial doses of vancomycin, gentamycin, and ancef per bag of Palacos-R cement does confer long term synovial fluid antibiotic levels well above the minimal inhibitory concentrations required to treat infected total joints. When stage II reimplantation is done at greater than 3 months, synovial fluid antibiotic levels decline significantly.