Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 10 | Oct, 2013

Longitudinal Urban-Rural Discrepancies in the US Orthopaedic Surgeon Workforce

Michael C. Fu BS, Rafael A. Buerba BA, Jordan Gruskay BA, Jonathan N. Grauer MD

It is unclear whether the supply of orthopaedic surgeons can meet the needs of a growing and aging population. This may be especially concerning in rural areas where there are known disparities in overall healthcare provision.

Collaborative Partnerships and the Future of Global Orthopaedics

Saam Morshed MD, PhD, MPH, David W. Shearer MD, MPH, R. Richard Coughlin MD, MSc

Has the Rate of In-hospital Infections After Total Joint Arthroplasty Decreased?

Mohammad R. Rasouli MD, Mitchell Gil Maltenfort PhD, James J. Purtill MD, William J. Hozack MD, Javad Parvizi MD

Although infections are a major cause of morbidity and mortality after total joint arthroplasty (TJA), little is known about nationwide epidemiology and trends of infections after TJA.

Medical Comorbidities Are Independent Preoperative Risk Factors for Surgical Infection After Total Joint Arthroplasty

Joshua S. Everhart BS, Eric Altneu MS, Jason H. Calhoun MD

Surgical site infection (SSI) after total joint arthroplasty (TJA) is a major cause of morbidity. Multiple patient comorbidities have been identified as SSI risk factors including obesity, tobacco use, diabetes, immunosuppression, malnutrition, and coagulopathy. However, the independent effect of multiple individual patient factors on risk of subsequent periprosthetic infection is unclear.

No Infection Reduction Using Chlorhexidine Wipes in Total Joint Arthroplasty

Nicholas J. Farber BS, Antonia F. Chen MD, MBA, Sarah M. Bartsch MPH, Jody L. Feigel MSN, RN, Brian A. Klatt MD

Surgical site infection (SSI) after total joint arthroplasty (TJA) is a rare but devastating complication. Various skin antiseptic applications are used preoperatively to prevent SSI. Recent literature suggests 2% chlorhexidine gluconate (CHG) wipes reduce microbial content at surgical sites, but it is unclear whether they reduce rates of SSI.

Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Demetri M. Economedes DO, Gregory K. Deirmengian MD, Carl A. Deirmengian MD

Although testing and treatment forcolonization before total joint arthroplasty (TJA) are well described and understood, the durability of decolonization has not been studied extensively.

What is the Rate of Methicillin-resistant Staphylococcus aureus and Gram-negative Infections in Open Fractures?

Antonia F. Chen MD, MBA, Verena M. Schreiber MD, Wesley Washington, Nalini Rao MD, Andrew R. Evans MD

There have been increasing reports of methicillin-resistant(MRSA) infections in the community, but it is unclear whether infectious organisms in open fracture infections have changed and if our current regimen of antibiotic prophylaxis is therefore obsolete.

Distribution of Locally Delivered Antimicrobials Is Limited by Cortical Bone: A Pilot Study

Ryan Odgers MD, Keith Jarbo MD, Alex McLaren MD, Ryan McLemore PhD

Local delivery is required to achieve the high antimicrobial concentrations needed to treat biofilm-forming infections. The delivery site is commonly either in the intramedullary canal or at the periosteal surface. It is unknown whether locally delivered antimicrobials are transported transcortically between the endosteal and periosteal surfaces when the infection involves the opposite surface.

A Daptomycin-Xylitol-loaded Polymethylmethacrylate Bone Cement: How Much Xylitol Should Be Used?

Ali Salehi MS, Ashley Cox Parker MS, Gladius Lewis PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

The rate of release of an antibiotic from an antibiotic-loaded polymethylmethacrylate (PMMA) bone cement is low. This may be increased by adding a particulate poragen (eg, xylitol) to the cement powder. However, the appropriate poragen amount is unclear.

Chitosan Sponges for Local Synergistic Infection Therapy: A Pilot Study

J. Keaton Smith MS, Abteen R. Moshref BS, Jessica A. Jennings PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

Although bacterial antibiotic resistance is increasing, fewer new antibiotics are being developed to compensate. Localized delivery of synergistic antiseptics and antibiotics with a chitosan sponge device may offer an alternative infection treatment.

Voriconazole Is Cytotoxic at Locally Delivered Concentrations: A Pilot Study

Kenneth Schmidt MD, Alex McLaren MD, Christine Pauken PhD, Ryan McLemore PhD

Fungal infections are rare but major problems when they involve orthopaedic implants. Preferred treatment in North America is two-staged: resection and then delayed reconstruction, with local delivery of an antifungal between stages. The effect of voriconazole, a hydrophobic antifungal, on local tissues and wound healing is unclear.

The Routine Use of Atypical Cultures in Presumed Aseptic Revisions Is Unnecessary

Anthony T. Tokarski BS, Joseph O’Neil MD, Carl A. Deirmengian MD, Joseph Ferguson BS, Gregory K. Deirmengian MD

In presumed aseptic hip and knee revisions, it is common practice to send intraoperative cultures to screen for occult infection. Currently no guidelines exist for the routine use of acid-fast bacillus (AFB) and fungal cultures in this setting.

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Mitchell Gil Maltenfort PhD, Mohammad R. Rasouli MD, Todd A. Morrison BS, Javad Parvizi MD, FRCS

The prevalence ofcolitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of theinfection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA).

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Pouya Alijanipour MD, Hooman Bakhshi MD, Javad Parvizi MD, FRCS

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily.

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Vinay K. Aggarwal BS, Carlos Higuera MD, Gregory Deirmengian MD, Javad Parvizi MD, FRCS, Matthew S. Austin MD

While it is accepted accurate identification of infecting organisms is crucial in guiding treatment of periprosthetic joint infection (PJI), there remains no consensus regarding the best method for obtaining cultures.

Treatment Solutions Are Unclear for Perimegaprosthetic Infections

Lisa B. Ercolano MD, Tyson Christensen BS, Richard McGough MD, Kurt Weiss MD

Infection about a megaprosthesis is a dreaded complication. Treatment options vary from débridement alone to staged revisions, arthrodesis, and amputation. Indications for how to treat this complication are unclear.

Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection

Erik Hansen MD, Matthew Tetreault BS, Benjamin Zmistowski BS, Craig J. Della Valle MD, Javad Parvizi MD, Fares S. Haddad MD, William J. Hozack MD

Acute postoperative infection after total hip arthroplasty (THA) is typically treated with irrigation and débridement and exchange of the modular femoral head and acetabular liner. Given a rate of failure exceeding 50% in some series, a one-stage exchange has been suggested as a potential alternative because it allows more thorough débridement and removal of colonized implants. To date, most studies published on the one-stage exchange have used microbe-specific antibiotic-laden bone cement with only one small single-institution series that reported outcomes after a cementless one-stage exchange.

Cyanoacrylate Microbial Sealant May Reduce the Prevalence of Positive Cultures in Revision Shoulder Arthroplasty

Adam J. Lorenzetti MD, Montri D. Wongworawat MD, Christopher M. Jobe MD, Wesley P. Phipatanakul MD

Cyanoacrylate-based, microbial sealant is an adhesive skin barrier designed to prevent bacterial contamination in surgical wounds. This type of adhesive barrier could have use in decreasing the incidence of positive cultures and subsequent infection in shoulder arthroplasty.

Negative Pressure Wound Therapy Is Associated With Resolution of Incisional Drainage in Most Wounds After Hip Arthroplasty

Erik Hansen MD, Joel B. Durinka MD, James A. Costanzo MD, Matthew S. Austin MD, Gregory K. Deirmengian MD

Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty.

Factors Associated With Survey Response in Hand Surgery Research

Arjan G. J. Bot MD, Jade A. Anderson BS, Valentin Neuhaus MD, David Ring MD, PhD

A low response rate is believed to decrease the validity of survey studies. Factors associated with nonresponse to surveys are poorly characterized in orthopaedic research.

Efficacy of Combined Osteotomy and Ulnar Nerve Transposition for Cubitus Valgus With Ulnar Nerve Palsy in Adults

Ho Jung Kang MD, Il Hyun Koh MD, Yu Chul Jeong MD, Tae Hwan Yoon MD, Yun Rak Choi MD

Tardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus deformity. Whether both problems can be corrected together, safely and effectively, in a single surgical procedure remains unknown.

Restoration of the Hip Center During THA Performed for Protrusio Acetabuli Is Associated With Better Implant Survival

Yaser M. K. Baghdadi MD, A. Noelle Larson MD, Rafael J. Sierra MD

Acetabular protrusio is an uncommon finding in hip arthritis. Several reconstructive approaches have been used; however the best approach remains undefined.

Long-term (20- to 25-year) Results of an Uncemented Tapered Titanium Femoral Component and Factors Affecting Survivorship

Marcus R. Streit MD, MSc, Moritz M. Innmann MD, Christian Merle MD, MSc, Thomas Bruckner PhD, Peter R. Aldinger MD, PhD, Tobias Gotterbarm MD

Uncemented femoral components in primary total hip arthroplasty (THA) are commonly used today, but few studies have evaluated their survival into the third decade.

Do Ceramic Femoral Heads Reduce Taper Fretting Corrosion in Hip Arthroplasty? A Retrieval Study

Steven M. Kurtz PhD, Sevi B. Kocagöz BS, Josa A. Hanzlik MS, Richard J. Underwood PhD, Jeremy L. Gilbert PhD, Daniel W. MacDonald MS, Gwo-Chin Lee MD, Michael A. Mont MD, Matthew J. Kraay MD, Gregg R. Klein MD, Javad Parvizi MD, Clare M. Rimnac PhD

Previous studies regarding modular head-neck taper corrosion were largely based on cobalt chrome (CoCr) alloy femoral heads. Less is known about head-neck taper corrosion with ceramic femoral heads.

How Useful Is MRI in Diagnosing Isolated Bundle ACL Injuries?

Moon Jong Chang MD, Chong Bum Chang MD, PhD, Ja-Young Choi MD, PhD, Ho Hyun Won MD, Tae Kyun Kim MD, PhD

Selective bundle anterior cruciate ligament (ACL) reconstruction and/or remnant ACL preservation may be reasonable options for some patients. However, the frequency of isolated anteromedial (AM) or posterolateral (PL) bundle injuries in patients undergoing ACL reconstruction is unknown, and the value of MRI for prediction of this injury pattern is likewise unknown.

Does Proximal Rectus Femoris Release Influence Kinematics In Patients With Cerebral Palsy and Stiff Knee Gait?

Dóra Végvári MD, Sebastian I. Wolf PhD, Daniel Heitzmann MSc, Matthias C. M. Klotz MD, Thomas Dreher MD

Stiff gait resulting from rectus femoris dysfunction in cerebral palsy commonly is treated by distal rectus femoris transfer (DRFT), but varying outcomes have been reported. Proximal rectus femoris release was found to be less effective compared with DRFT. No study to our knowledge has investigated the effects of the combination of both procedures on gait.

Complications of Cemented Long-stem Hip Arthroplasty in Metastatic Bone Disease Revisited

Shawn L. Price MD, M. Aabid Farukhi BA, Kevin B. Jones MD, Stephen K. Aoki MD, R. Lor Randall MD, FACS

The literature suggests that a cemented long-stem femoral arthroplasty is associated with increased intraoperative and perioperative risks. Embolic events may precipitate cardiopulmonary complications and even death; by contrast, others have reported that the use of a cemented long-stem femoral arthroplasty in patients with metastatic bone disease is a safe procedure.

Incidence and Risk Factors for Pulmonary Embolism After Primary Musculoskeletal Tumor Surgery

Koichi Ogura MD, Hideo Yasunaga MD, PhD, Hiromasa Horiguchi PhD, Kazuhiko Ohe MD, PhD, Hirotaka Kawano MD, PhD

Limited information is available regarding the incidence, risk factors, and optimal prophylaxis in orthopaedic oncology patients, although malignancy and major orthopaedic surgery are associated with an increased pulmonary embolism (PE) risk.

Can Certain Benign Lesions of the Proximal Femur Be Treated Without Surgery?

Seung Han Shin MD, Ingwon Yeo MD, Sung Wook Seo MD, PhD

Benign lesions in the proximal femur can cause pathologic fractures. To avoid fracture, benign tumors and tumor-like lesions in this region often are treated surgically, yet there have been few reports regarding the decision-making processes or protocols for nonsurgical treatment of these lesions.

Is There a Role for Knee Arthrodesis With Modular Endoprostheses for Tumor and Revision of Failed Endoprostheses?

Andrea Angelini MD, Eric Henderson MD, Giulia Trovarelli MD, Pietro Ruggieri MD, PhD

Knee arthrodeses are performed to treat infection after arthroplasty and tumors requiring extensive soft tissue resection. Many techniques have been described, but most have important disadvantages. Currently, endoprosthetic arthrodesis implants are available, but little is known about them.

Do Psychiatric Comorbidities Influence Inpatient Death, Adverse Events, and Discharge After Lower Extremity Fractures?

Mariano E. Menendez BS, Valentin Neuhaus MD, Arjan G. J. Bot MD, Mark S. Vrahas MD, David Ring MD, PhD

Psychiatric comorbidity is known to contribute to illness (the state of feeling unwell/unable to rely on one’s body) and increased use of healthcare resources, but the effect on inpatient outcomes in fracture care is relatively unexplored.

Professional Liability in Orthopaedics and Traumatology in Italy

Umberto Tarantino MD, PhD, Alessio Giai Via MD, Ernesto Macrì LLB, Alessandro Eramo MD, Valeria Marino MD, Luigi Tonino Marsella MD, PhD

Interest in medical errors has increased during the last few years owing to the number of medical malpractice claims. Reasons for the increasing number of claims may be related to patients’ higher expectations, iatrogenic injury, and the growth of the legal services industry. Claims analysis provides helpful information in specialties in which a higher number of errors occur, highlighting areas where orthopaedic care might be improved.

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Richard J. Friedman MD, Susanne Hess MD, Scott D. Berkowitz MD, Martin Homering MSPH

Morbid obesity has been shown to be a risk factor for increased complications after THA and TKA; however, large studies that would determine the effect size are lacking.

Knee Pain in a 9-year-old Girl

Eric R. Henderson MD, Rebecca A. Pohlmann MD, Lisa A. Teot MD, Mark C. Gebhardt MD

Tuberculosis of the Pubic Symphysis: Four Unusual Cases and Literature Review

Hitesh Lal MS, Vijay Kumar Jain MS, Sudhir Kannan MS

The incidence of extrapulmonary tuberculosis (TB) has increased in the chemotherapeutic era owing to the increasing presence of immunodeficiency disorders. Pubic symphysis TB, although uncommon, is again important as these infections once were in the prechemotherapeutic era.

Letter to the Editor: New Tendon Transfer for Correction of Drop-foot in Common Peroneal Nerve Palsy

Paolo Titolo MD, Bernardino Panero MD, Davide Ciclamini MD, Bruno Battiston MD, Pierluigi Tos MD

Reply to the Letter to the Editor: Hip Resurfacing Does Not Improve Proprioception Compared With THA

Brian J. Larkin MD, Humaa Nyazee MPH, John Motley PT, ATC, Ryan M. Nunley MD, John C. Clohisy MD, Robert L. Barrack MD

Erratum to: Obesity Does Not Imply Poor Outcomes in Asians after Total Knee Arthroplasty

Hamid Rahmatullah Bin Abd Razak MBBS, Hwei Chi Chong BSc, Andrew Hwee Chye Tan MBBS, FRCS (Orth)
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