Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2019
Multicenter StudyPositive Alpha-defensin at Reimplantation of a Two-stage Revision Arthroplasty Is Not Associated with Infection at 1 Year.
Diagnosing periprosthetic joint infection (PJI) represents a challenge that relies on multiple clinical and laboratory criteria that may not be consistently present. The synovial alpha-defensin-1 (AD-1) test has been shown to correlate accurately with the Musculoskeletal Infection Society (MSIS) criteria for the diagnosis of PJI, however, its association with persistent PJI has not been elucidated in the setting of patients receiving antibiotic spacers during second-stage reimplantation. Applying a Delphi-based consensus to define successful eradication of PJI offers an opportunity to test the utility of AD-1 in this setting. ⋯ Level IV, diagnostic study.
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Clin. Orthop. Relat. Res. · Jun 2019
Multicenter StudyWhat Preoperative Factors are Associated With Not Achieving a Minimum Clinically Important Difference After THA? Findings from an International Multicenter Study.
Despite innovations in THA, there remains a subgroup of patients who experience only modest pain relief and/or functional improvement after the procedure. Although several studies have previously sought to identify factors before surgery that were associated with achieving or not achieving a meaningful improvement after THA, there is no consensus on which factors are most associated; many studies have relied on single-center or single-country multicenter studies for their cohorts. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Jun 2019
Preoperative Exposure to Benzodiazepines or Sedative/hypnotics Increases the Risk of Greater Filled Opioid Prescriptions After Surgery.
The effect of the preoperative exposure to controlled substances such as benzodiazepines and sedative/hypnotics on prolonged opioid consumption after hand surgery is not known. ⋯ Patients exposed to benzodiazepines and sedative/hypnotics have prolonged use of opioids after surgery. Undergoing outpatient upper extremity surgery and being prescribed an opioid did not change the patterns of controlled substance use. Based on the results of this study, we are now more aware of the potential problems of patients with exposure to controlled substances, and are more attentive about reviewing their history of substance use in the PDMP website, an important resource. In addition, we now provide much more detailed preoperative counseling regarding the use and abuse of opioid medication in patients with exposure to benzodiazepines, sedatives, and those with a smoking history and mood disorders.Level of Evidence Level II, therapeutic study.
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Clin. Orthop. Relat. Res. · Jun 2019
Diabetes Disease Severity Was Not Associated with Risk of Deep Infection or Revision After Shoulder Arthroplasty.
Prior studies have identified diabetes and disease severity (defined using hemoglobin A1c [HbA1c]) as potential risk factors for complications after shoulder arthroplasty. Evaluations of diabetes status and risk of adverse outcomes beyond the 30-day window either are limited or have not accounted for disease severity. Further, measures of diabetes severity other than HbA1c have yet to be investigated in a shoulder arthroplasty population. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Jun 2019
Observational StudyDo Trabecular Metal Acetabular Components Reduce the Risk of Rerevision After Revision THA Performed for Periprosthetic Joint Infection? A Study Using the NJR Data Set.
A single-center study of 144 THAs revised specifically for periprosthetic joint infection (PJI) observed that trabecular metal (TM) acetabular components had a reduced risk of rerevision for subsequent infection compared with non-TM implants. It was suggested that TM was protective against infection after revision and that TM may be useful when revising THAs for PJI. Three registry studies have subsequently assessed the effect of TM on future infection. In the National Joint Registry (NJR) for England and Wales, we earlier reported lower revision rates for infection when TM (versus non-TM) was used in primary THA, but no difference in rerevision rates for infection when TM was used for all-cause revision THAs. The latter findings in all-cause revisions were also confirmed in a study from the Swedish and Australian registries. It is possible that TM only reduces the risk of infection when it is specifically used for PJI revisions (rather than all-causes). However, to date, the registry analyses have not had large enough cohorts of such cases to assess this meaningfully. ⋯ Level III, therapeutic study.