The Journal of arthroplasty
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Although current evidence is limited, obstructive sleep apnea (OSA) has been suggested as a risk factor for morbidity after primary joint arthroplasty. Our objective was to determine if patients with OSA have a higher likelihood of postoperative in-hospital complications or increased costs after revision arthroplasty. The Nationwide Inpatient Sample was used to identify 258,455 patients who underwent revision total hip arthroplasty or revision total knee arthroplasty between 2006 and 2008. ⋯ Multivariate analysis with logistic regression modeling was used to compare patients with and without OSA. Obstructive sleep apnea was associated with increased in-hospital mortality (odds ratio, 1.9; P = .002), pulmonary embolism (odds ratio, 2.1; P = .001), wound hematomas or seromas (odds ratio, 1.36; P < .001), and increased postoperative charges ($61,044 vs $58,813; P < .001). Further research is warranted.
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Multicenter Study
Are metal ion levels a useful trigger for surgical intervention?
The purpose of this study was to determine if cobalt and chromium ion levels can predict soft tissue damage at total hip revision. This study included 90 metal-on-metal total hip patients with preoperative cobalt and chromium ion levels. Tissue damage noted at revision surgery was graded on a 4-point scale. ⋯ The area under the curve was 0.37 for cobalt and 0.44 for chromium. The length of time to revision significantly correlated with tissue damage (P = .001). Ion levels are unreliable predictors of periarticular soft tissue damage and should not be used in isolation as surgical intervention triggers.
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We assessed important patient risk factors for postoperative periprosthetic fractures after revision total hip arthroplasty (THA) using prospectively collected Institutional Joint Registry data. We used univariate and multivariable-adjusted Cox regression analyses. ⋯ Hazard ratio was lower in patients 61 to 70 years old (0.64 [0.49-0.84]) and 71 to 80 years old (0.57 [0.43-0.76]) compared with those younger than 60 years (overall, P < .0001). Our study identified important modifiable and unmodifiable risk factors for fractures after revision THA.
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Thirteen patients with infected total knee arthroplasty treated by 2-stage revision requiring tibial tubercle osteotomy in both stages for extensile exposure were retrospectively analyzed. The preoperative mean range of knee motion improved from 60° (range, 30°-90°) to 94° (range, 70°-120°) at latest follow-up. ⋯ Although proximal migration occurred in 3 cases and a partial proximal avulsion fracture of the osteotomy segment occurred in 1 case after the second-stage reimplantation, radiographic bony union was observed in all cases. Sequential repeated tibial tubercle osteotomy can be a useful extensile surgical approach in staged revision for infected total knee arthroplasty with satisfactory clinical and radiographic outcomes.
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In an effort to reduce methicillin-resistant Staphylococcus aureus (MRSA) and overall periprosthetic joint infections (PJI), we switched the perioperative prophylactic antibiotic during total knee arthroplasty and total hip arthroplasty from cefazolin to vancomycin in June 2008. We retrospectively reviewed the total and MRSA PJI in 5036 primary total joint arthroplasties, as well as the cure rate of PJI from January 2006 to June 2008 (Ancef Period) and June 2008 to December 2010 (Vanco Period). ⋯ Periprosthetic joint infections that occurred were more successfully treated with irrigation and debridement only, not requiring spacer (76.9% vs 22.2%). The use of vancomycin as the perioperative prophylactic antibiotic for primary total joint arthroplasties appeared to be effective in decreasing the rate of PJI and may result, when they occur, in infections with less virulent organisms.