Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 470 | Issue 10 | Oct, 2012

Jeannette Wilkins Award: Can Locally Delivered Gadolinium Be Visualized on MRI? A Pilot Study

Morgan B. Giers BS, Chris S. Estes DO, Alex C. McLaren MD, Michael R. Caplan PhD, Ryan McLemore PhD

Management of orthopaedic infections relies on débridement and local delivery of antimicrobials; however, the distribution and concentration of locally delivered antimicrobials in postdébridement surgical sites is unknown. Gadolinium-DTPA (Gd-DTPA) has been proposed as an imaging surrogate for antimicrobials because it is similar in size and diffusion coefficient to gentamicin.

Cis-2-decenoic Acid Inhibits S. aureus Growth and Biofilm In Vitro: A Pilot Study

Jessica Amber Jennings PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

Cis-2 decenoic acid (C2DA) disperses biofilm in many strains of microorganisms. However, whether C2DA inhibits bacterial growth or has potential to boost the actions of antibiotics is unknown.

Liposomal Formulation Increases Local Delivery of Amphotericin from Bone Cement: A Pilot Study

Brian Cunningham MD, Alex C. McLaren MD, Christine Pauken PhD, Ryan McLemore PhD

Amphotericin is a highly toxic hydrophobic antifungal. Delivery of amphotericin from antifungal-loaded bone cement (ALBC) is much lower than would be expected for an equivalent load of water-soluble antibacterials. Lipid formulations have been developed to decrease amphotericin toxicity. It is unknown how lipid formulations affect amphotericin release and compressive strength of amphotericin ALBC.

Mixing Method Affects Elution and Strength of High-dose ALBC: A Pilot Study

Ryan Miller MD, Alex McLaren MD, Christine Leon MS, Ryan McLemore PhD

High-dose antimicrobial-loaded bone cement (ALBC) is used to treat orthopaedic infections. High-dose ALBC is not commercially available and requires surgeon directed formulation, and there are several different methods used to mix high-dose ALBC.

What Is the Prevalence of MRSA Colonization in Elective Spine Cases?

Antonia F. Chen MD, MBA, Srinivas Chivukula BS, Lloydine J. Jacobs MD, Matthew W. Tetreault BA, Joon Y. Lee MD

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. However, the prevalence of MRSA colonization among patients undergoing spine surgery is unclear.

Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

Pedram Panahi MBBS, Mitchell Stroh BS, David S. Casper BS, Javad Parvizi MD, FRCS, Matthew S. Austin MD

Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty (TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, and may lead to increased rates of infection.

Preoperative Anemia in Total Joint Arthroplasty: Is It Associated with Periprosthetic Joint Infection?

Max Greenky BA, Kishor Gandhi MD, MPH, Luis Pulido MD, Camilo Restrepo MD, Javad Parvizi MD

Anemia is common in patients undergoing total joint arthroplasty (TJA). Numerous studies have associated anemia with increased risk of infection, length of hospital stay, and mortality in surgical populations. However, it is unclear whether and to what degree preoperative anemia in patients undergoing TJA influences postoperative periprosthetic joint infection (PJI) and mortality.

Does Dual Antibiotic Prophylaxis Better Prevent Surgical Site Infections in Total Joint Arthroplasty?

Amy Sewick MD, Amun Makani MD, Chia Wu MD, Judith O’Donnell MD, Keith D. Baldwin MD, MPH, MSPT, Gwo-Chin Lee MD

It is unclear which antibiotic regimen provides the best prophylaxis against surgical site infection (SSI) in patients undergoing hip and knee surgery.

Low Rate of Infection Control in Enterococcal Periprosthetic Joint Infections

Mohammad R. Rasouli MD, Mohan S. Tripathi BA, Robert Kenyon BS, Nathan Wetters MD, Craig J. Della Valle MD, Javad Parvizi MD

Enterococcal periprosthetic joint infections (PJIs) are rare after joint arthroplasty. These cases are usually reported in series of PJIs caused by other pathogens. Because few studies have focused only on enterococcal PJIs, management and control of infection of these cases have not yet been well defined.

Culture-negative Periprosthetic Joint Infection Does Not Preclude Infection Control

Ronald Huang MD, Chi-Chien Hu MD, Bahar Adeli BS, Javad Mortazavi MD, Javad Parvizi MD

Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty. Lack of confirmation of an infecting organism poses a challenge with regard to the selection of an appropriate antibiotic agent and surgical treatment. It is unclear whether patients with negative cultures presumed to have infections achieve similar rates of infection-free survival as those with positive cultures.

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Ryan M. Degen BSc, MD, John R. Davey BSc, J. Roderick Davey MD, FRCSC, James L. Howard MD, FRCSC, Richard W. McCalden MD, FRCSC, Douglas D. R. Naudie MD, FRCSC

Treating deep infection following THA has been a challenge. While the standard treatment has remained a two-stage revision, spacer designs, incorporated antibiotics, and concentrations have varied. Since control of infection may relate to choice and concentration of antibiotics, it is important to report rates of control from various spacers.

Assessing the Gold Standard: A Review of 253 Two-Stage Revisions for Infected TKA

Tahir Mahmud MBBS, FRCS(Tr&Orth), Matthew C. Lyons MBBS, FRACS, Douglas D. Naudie MD, FRCSC, Steven J. MacDonald MD, FRCSC, Richard W. McCalden MD, FRCSC

Periprosthetic joint infection has been the leading cause of failure following TKA surgery. The gold standard for infection control has been a two-staged revision TKA. There have been few reports on mid- to long-term survivorship, functional outcomes, and fate of patients with a failed two-stage revision TKA.

Better Function for Fusions Versus Above-the-knee Amputations for Recurrent Periprosthetic Knee Infection

Antonia F. Chen MD, MBA, Nicholas C. Kinback BS, Alma E. Heyl LAS, RTR, CCRC, Edward J. McClain MD, Brian A. Klatt MD

Treatment of chronic periprosthetic joint infections (PJIs) after TKA is limited to fusions, above-the-knee amputations (AKAs), revision TKA, and antibiotic suppression and is often based on the patient’s medical condition. However, when both fusion and AKA are options, it is important to compare these two procedures with regard to function.

In Vivo Three-dimensional Motion Analysis of Chronic Radial Head Dislocations

Junichi Miyake MD, Hisao Moritomo MD, PhD, Toshiyuki Kataoka MD, Tsuyoshi Murase MD, PhD, Kazuomi Sugamoto MD, PhD

Forearm kinematics and interosseous membrane function in chronic radial head dislocations sustained in childhood are unknown. Several procedures have been performed to reduce the radial head on the basis of static preoperative assessment in only one forearm position, but clinical results are not always favorable.

A Promising Thumb Basal Joint Hemiarthroplasty for Treatment of Trapeziometacarpal Osteoarthritis

James W. Pritchett MD, Louis S. Habryl DO

Trapeziometacarpal joint osteoarthritis is a painful, disabling condition that primarily affects women who are postmenopausal. Arthroplasty has been performed to treat this condition; however, subluxation has been a problem with all previous implants. We report the results of hemiarthroplasty using a prosthesis designed to address the problems associated with previous implants.

Effectiveness of Four-Corner Arthrodesis with Use of a Locked Dorsal Circular Plate

Matthias Luegmair MD, Patrick Houvet MD

Compared with traditional methods of fixation in four-corner arthrodesis, reviews of results using a dorsal circular plate (DCP) have identified higher complication rates. As the use of circular plate fixation for limited wrist arthrodesis was found to be a valuable concept per se and continued innovation and technical advancement are crucial to improve future treatment, changes in plate design were encouraged.

Peripheral Triangular Fibrocartilage Complex Tears Cause Ulnocarpal Instability: A Biomechanical Pilot Study

Christopher J. Dy MD, MSPH, E. Anne Ouellette MD, MBA, Anna-Lena H. Makowski HTL, Edward Milne BSc, Loren L. Latta PE, PhD

Instability at the ulnocarpal joint has many causes, but the common thread among these causes is the presence of abnormalities in the triangular fibrocartilage complex (TFCC). However, the biomechanical consequences at the ulnocarpal joint after detachment of the TFCC from the ulnar styloid are not clearly defined. Better delineation of whether peripheral TFCC detachments cause ulnocarpal instability will help to design surgical treatments.

Does Open Repair of Anterosuperior Rotator Cuff Tear Prevent Muscular Atrophy and Fatty Infiltration?

Marion Schino MD, Bernard Augereau MD, Christophe Nich MD, PhD

Repair of cuff tears involving rotator interval reportedly improves function. However, it is unclear whether successful repair prevents shoulder degenerative changes.

Is There Really No Benefit of Vertebroplasty for Osteoporotic Vertebral Fractures? A Meta-analysis

Ming-Min Shi MD, Xun-Zi Cai MD, Tiao Lin MD, Wei Wang MD, Shi-Gui Yan MD

Osteoporotic vertebral compressed fractures (VCFs) are the most common osteoporotic fractures. Although percutaneous vertebroplasty (PVP) reportedly relieves pain and improves function, a recent pooled analysis from two multicenter randomized controlled trials concluded the improvement in pain and disability treated with PVP was similar to those with sham surgery.

What Are the Risks Accompanying the Reduced Wear Benefit of Low-clearance Hip Resurfacing?

Joseph Daniel FRCS MS(Orth), Hena Ziaee BSc(Hons), Amir Kamali PhD, MEng, Chandra Pradhan FRCS MCh(Orth), Derek McMinn MD, FRCS

Clearance is an important determinant of metal-metal bearing function. Tribologic theory and laboratory evidence suggest low clearance (LC) reduces wear but with a potential to increase friction and clinical reports show LC resurfacings have high implant failure rates. Thus, the role of LC is unclear.

Measuring Acetabular Component Version After THA: CT or Plain Radiograph?

Benjamin McArthur MD, Michael Cross MD, Christina Geatrakas MD, David Mayman MD, Bernard Ghelman MD

Although cross-table lateral radiographs are commonly used to measure acetabular component version after THA, recent studies suggest that CT-based measurement is more accurate. This has been attributed to variations in pelvic tilt, pelvic rotation, and component inclination. Furthermore, it has been suggested, based on limited data, that even with ideal positioning of the cross-table lateral radiograph, CT remains the more accurate modality.

The Vascularized Fibular Graft in Precollapse Osteonecrosis: Is Long-term Hip Preservation Possible?

William C. Eward DVM, MD, Craig A. Rineer MD, James R. Urbaniak MD, Marc J. Richard MD, David S. Ruch MD

Osteonecrosis of the femoral head (ONFH) is a debilitating condition affecting primarily young patients. Free vascularized fibular grafting (FVFG) may provide a durable means to preserve the femoral head. When used in the precollapse stages of ONFH, this treatment may alter the course of disease.

Acetabular Tilt Correlates with Acetabular Version and Coverage in Hip Dysplasia

Masanori Fujii MD, PhD, Yasuharu Nakashima MD, PhD, Taishi Sato MD, Mio Akiyama MD, Yukihide Iwamoto MD, PhD

The rotational position of the acetabulum to the pelvis (acetabular tilt) may influence acetabular version and coverage of the femoral head. To date, the pathologic significance of acetabular tilt in hip dysplasia is unknown.

Extent of Tibiofemoral Osteoarthritis Before Knee Arthroplasty: Multicenter Data from the Osteoarthritis Initiative

Daniel L. Riddle PhD, William A. Jiranek MD, Robert S. Neff MD, Derek Whitaker MD, Jason R. Hull MD

Knee arthroplasty traditionally is recommended for persons with substantial disability and disabling pain attributable to moderate or severe osteoarthritis (OA). Pain and functional status after arthroplasty may be influenced by the extent of knee OA before surgery and recent evidence suggests persons with less severe knee OA before undergoing TKA have greater pain levels and worse function than persons with more severe knee OA.

Do Patient Expectations About Arthroplasty at Initial Presentation for Hip or Knee Pain Differ by Sex and Ethnicity?

Carlos J. Lavernia MD, Juan S. Contreras MD, Javad Parvizi MD, Peter F. Sharkey MD, Robert Barrack MD, Mark D. Rossi PhD

Many studies show gender and ethnic differences in healthcare utilization and outcomes. Patients’ presurgical cognitions regarding surgical outcomes also may vary by gender and ethnicity and play a role in explaining utilization and outcome differences. However, it is unclear whether and to what extent gender and ethnicity play a role in patients’ presurgical cognitions.

Surgical Technique: Lateral Retinaculum Release in Knee Arthroplasty Using a Stepwise, Outside-in Technique

Rajesh N. Maniar MS(Orth), MCh(Orth), Tushar Singhi MS, Suyog Shashimohan Rathi MS, Jayesh Vinod Baviskar MS, Ravi Mohan Nayak MS

Lateral release of a tight lateral retinaculum in a TKA is intended to correct patellar maltracking but the widely used inside-out technique has associated risks. We describe an alternate stepwise outside-in technique, with titrated release intended to maximize the chance of preserving the superior lateral genicular artery (SLGA).

Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion

Austin T. Fragomen MD, Eugene Borst BA, Lindsay Schachter BS, Stephen Lyman PhD, S. Robert Rozbruch MD

Ankle arthrodesis may be achieved using the Ilizarov method. Comorbidities, such as diabetes, Charcot neuroarthropathy, osteomyelitis, leg length discrepancy, and smoking, can make an ankle fusion complex and may be associated with lower rates of healing.

Osteoporosis in Children and Young Adults: A Late Effect After Chemotherapy for Bone Sarcoma

Ulrike Michaela Pirker-Frühauf MD, Jörg Friesenbichler MD, Ernst-Christian Urban MD, Barbara Obermayer-Pietsch MD, Andreas Leithner MD

Premature bone loss after childhood chemotherapy may be underestimated in patients with bone sarcoma. Methotrexate (MTX), a standard agent in osteosarcoma protocols, reportedly reduces bone mineral density (BMD). The literature, however, has reported cases of BMD reduction in patients with Ewing's sarcoma treated without MTX. Thus, it is unclear whether osteoporosis after chemotherapy relates to MTX or to other factors.

Which Treatment is the Best for Giant Cell Tumors of the Distal Radius? A Meta-analysis

Yu-peng Liu MD, PhD, Kang-hua Li MD, Bu-hua Sun MD, PhD

Intralesional excision and en bloc resection are used to treat giant cell tumors (GCTs) of the distal radius. However, it is unclear whether one provides lower rates of recurrences and fewer complications, and whether the use of polymethylmethacrylate (PMMA) after curettage reduces the risk of recurrence.

Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care

Daniel B. Sonshine BA, Amber Caldwell BA, Richard A. Gosselin MD, MSc, MPH, FRCS(C), Christopher T. Born MD, R. Richard Coughlin MD, MSc

Although numerous authors have described surgical experiences following major disasters, little is known regarding the needs of and barriers to care faced by surgeons during such disasters.

Allogenic Serum Improves Cold Preservation of Osteochondral Allografts

Kenji Onuma MD, PhD, Ken Urabe MD, PhD, Kouji Naruse MD, PhD, Kentaro Uchida PhD, Moritoshi Itoman MD, PhD

Although several types of culture medium have been used for preservation of osteochondral allografts, the viability of chondrocytes decreases with increasing storage duration. We previously showed the University of Wisconsin solution is more suitable for graft preservation than culture medium.

Does Dithiothreitol Improve Bacterial Detection from Infected Prostheses? A Pilot Study

Lorenzo Drago PhD, Carlo Luca Romanò MD, Roberto Mattina PhD, Valentina Signori BSc, Elena Vecchi MSc

Sonication and scraping of infected prostheses usually are used to improve diagnosis of prosthetic infections, reducing false negatives. Chemical methods that reduce biofilms also may allow higher levels of detection.

The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury

Timothy E. Hewett PhD, Gregory D. Myer PhD, Kevin R. Ford PhD, Mark V. Paterno PhD, PT, Carmen E. Quatman MD, PhD

ACL injuries are common, often devastating injuries that lead to short-term disability and long-term sequelae, many of which lack effective treatment, such as osteoarthritis. Therefore, prevention of ACL injury is currently the only effective intervention for these life-altering sequelae, while much of the literature has a rehabilitative focus.

Case Report: Bilateral Femoral Neck Fractures in a Child and a Rare Complication of Slipped Capital Epiphysis After Internal Fixation

Nirmal Raj Gopinathan MS, Dip SICOT, Devendra Chouhan MS, Narendranadh Akkina MS, Prateek Behera MBBS

Bilateral traumatic femoral neck fractures are uncommon in children. The most commonly reported complications are nonunion, avascular necrosis of the femoral head, and chondrolysis. Slipped capital femoral epiphysis (SCFE) associated with nonunion after percutaneous partially threaded cancellous screw (PTCS) fixation of the fracture is an unreported complication.

Complications in Brief: Arthroscopic Lateral Release

Hussein Elkousy MD Arthroscopic lateral release refers to an arthroscopic procedure that incises the lateral stabilizing structures of the patella, in particular, the lateral retinaculum. The lateral retinaculum attaches the lateral patella to the lateral femoral epicondyle, the iliotibial band, and the anterolateral tibia. Arthroscopic lateral release rarely is performed as an isolated procedure and rather is generally performed in combination with medially based stabilization procedures to more effectively allow for medial realignment. The procedure is relatively simple and straightforward, but, if not done for the appropriate indications or if done technically poorly, either it will not achieve the desired result or it may result in additional pain, instability, and weakness. This In Brief article provides an overview of potential complications of lateral release.
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