Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2016 Musculoskeletal Infection Society Proceedings 9 articles

Articles

Sonication of Arthroplasty Implants Improves Accuracy of Periprosthetic Joint Infection Cultures

Adam C. Rothenberg MD, Alan E. Wilson BS, John P. Hayes, Michael J. O’Malley MD, Brian A. Klatt MD

There is evidence that sonication of explanted prosthetic hip and knee arthroplasty components with culture of the sonication fluid may enhance diagnostic sensitivity. Previous studies on the use of implant sonicate cultures have evaluated diagnostic thresholds but did not elaborate on the clinical importance of positive implant sonicate cultures in the setting of presumed aseptic revisions and did not utilize consensus statements on periprosthetic joint infection (PJI) diagnosis when defining their gold standard for infection.

Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin

Michael M. Kheir MD, Timothy L. Tan MD, Ibrahim Azboy MD, Dean D. Tan BS, Javad Parvizi MD, FRCS

In total joint arthroplasty (TJA), vancomycin is used as perioperative antibiotic prophylaxis in patients with penicillin allergy or in patients colonized with methicillin-resistant(MRSA). Although vancomycin dosing should be weight-based (15 mg/kg), not all surgeons are aware of this; a fixed 1-g dose is instead frequently administered.

Blended Chitosan Paste for Infection Prevention: Preliminary and Preclinical Evaluations

Joel M. Berretta MS, Jessica A. Jennings PhD, Harry S. Courtney PhD, Karen E. Beenken PhD, Mark S. Smeltzer PhD, Warren O. Haggard PhD

Local drug delivery devices offer a promising method for delivering vancomycin and amikacin for musculoskeletal wounds. However, current local delivery devices such as beads and sponges do not necessarily allow for full coverage of a wound surface with eluted antibiotics and do not address the need for reducing the antibiotic diffusion distance to help prevent contamination by bacteria or other microorganisms. We blended chitosan/polyethylene glycol (PEG) pastes/sponges to increase biocompatibility and improve antibiotic coverage within the wound.

Obesity Epidemic: Is Its Impact on Total Joint Arthroplasty Underestimated? An Analysis of National Trends

Jaiben George MBBS, Alison K. Klika MS, Suparna M. Navale MS, MPH, Jared M. Newman MD, Wael K. Barsoum MD, Carlos A. Higuera MD

Obesity is a well-established risk factor for total joint arthroplasty (TJA) and a number of complications including prosthetic joint infection. The annual changes in the prevalence of obesity among primary, revision, and infected TJA has not been studied at a national level. Given the higher costs of complications of TJA, it is important to understand the association of obesity with the annual trends of revision and infected TJA.

What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay

Raveesh Daniel Richard MD, Thomas R. Bowen MD

Contaminated operating room surfaces can increase the risk of orthopaedic infections, particularly after procedures in which hardware implantation and instrumentation are used. The question arises as to how surgeons can measure surface cleanliness to detect increased levels of bioburden. This study aims to highlight the utility of adenosine triphosphate (ATP) bioluminescence technology as a novel technique in detecting the degree of contamination within the sterile operating room environment.

Phosphatidylcholine Coatings Deliver Local Antimicrobials and Reduce Infection in a Murine Model: A Preliminary Study

Michael A. Harris BSBE, Karen E. Beenken PhD, Mark S. Smeltzer PhD, Warren O. Haggard PhD, J. Amber Jennings PhD

Phosphatidylcholine coatings have been shown to elute antibiotics for several days. A recently developed biofilm inhibitor, cis-2-decenoic acid (C2DA), has been shown to exhibit synergistic activity with several common antibiotics. This study aims to evaluate the effectiveness of C2DA and amikacin dual drug delivery from a phosphatidylcholine coating.

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

Jaiben George MBBS, Suparna M. Navale MS, MPH, Nicholas K. Schiltz PhD, Miguel Siccha MD, Alison K. Klika MS, Carlos A. Higuera MD

Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA.

False-positive Cultures After Native Knee Aspiration: True or False

Jason M. Jennings MD, DPT, Douglas A. Dennis MD, Raymond H. Kim MD, Todd M. Miner MD, Charlie C. Yang MD, David C. McNabb MD

Synovial fluid aspiration is a routine practice used by most orthopaedic surgeons to aid in the diagnosis of joint infection. In patients for whom there is a low pretest probability of infection, a positive culture—particularly if it is a broth-only culture—may be considered a contaminant, especially if the bacterial species are skin pathogens. To our knowledge no study has evaluated the incidence of contamination of aspirations from the native knee.