Medicine and Health Sciences Commons^™

Giardia Lamblia Reactive Arthritis Mimicking Acute Periprosthetic Knee Infection: A Case Report, Rachael A. Turner, Justin N. Duke, Jared R.H. Foran

Research Symposium

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Background: The difficulty in diagnosing Periprosthetic joint infection (PJI) is exacerbated by the more varied presentation of PJI and the lower synovial fluid WBC count thresholds applied when a prosthesis is present. Multiple reports have described pseudosepsis after total knee arthroplasty (TKA) due to gout or pseudogout. Further confusing the picture, periprosthetic infection also frequently coexists with crystalline arthropathy. Our review of the literature revealed no reports describing reactive arthritis (ReA) mimicking acute infection in the setting of previous TKA. In this case report, we describe a pseudo-periprosthetic infection of a well-functioning TKA secondary to ReA in the setting of …

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Republication Of “Open Repair Of Acute Achilles Tendon Ruptures: Is The Incidence Of Clinically Significant Wound Complications Overestimated?”, Meghan E. Bishop, Carly D. Comer, Justin M. Kane, Mitchell G. Maltenfort, Steven M. Raikin

Department of Orthopaedic Surgery Faculty Papers

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Background:

Conflicting evidence exists regarding the optimal management of acute Achilles tendon ruptures. Operative repair is thought to afford patients a lower risk of rerupture, albeit at a higher overall risk of wound complications.

Methods:

A retrospective chart review of 369 consecutive patients undergoing open repair of acute Achilles tendon ruptures performed by a single foot and ankle fellowship-trained orthopedic surgeon was undertaken. Healing was classified as no complications, complications without prolonging treatment, complications requiring prolonged local treatment, and complications requiring operative intervention. A statistical analysis comparing the rates of complications in this cohort to that reported in the literature …

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Multiple Sterile Withdrawals From Iohexol Bottles Does Not Increase Contamination Risk, Caroline Purtill, Manraj Dhesi, Daniel Haber, Nicholas D'Antonio, Noreen J. Hickok, Jeremy I. Simon

Department of Orthopaedic Surgery Faculty Papers

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BACKGROUND: There is a global shortage of iohexol contrast media, commonly used in epidural injections, as a result of lockdown and decreased production due to COVID-19. Iohexol bottles are designated for single use, which, depending on the vials available, often leads to wasting up to 95% of this limited resource. However, avoiding multiple withdrawals may be unnecessary if withdrawing multiple times using sterile technique does not increase the risk for contamination.

OBJECTIVES: The purpose of our study is to determine whether multiple withdrawals from iohexol injection bottles using a sterile technique poses a greater risk of introducing contaminants than a …

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Laboratory-Reported Normal Value Ranges Should Not Be Used To Diagnose Periprosthetic Joint Infection., Salvador A. Forte, Joseph A. D'Alonzo, Zachary Wells, Brett Levine, Stephen Sizer, Carl Deirmengian

Orthopedic Surgery Resident Research

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INTRODUCTION: Clinical laboratories offer several multipurpose tests, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are not intended to diagnose any specific disease but are used by clinicians in multiple fields. The results and laboratory interpretation (normal/abnormal) of these multipurpose tests are based on laboratory-reported normal thresholds, which vary across clinical laboratories. In 2018, the International Consensus Meeting on Musculoskeletal Infection (2018 ICM) provided a gold-standard definition to diagnose periprosthetic joint infection (PJI) which included many multipurpose laboratory tests, along with thresholds optimized to diagnose PJI. The discrepancy between laboratory-reported normal thresholds and 2018 ICM-recommended PJI-optimized …

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Unicompartmental Knee Arthroplasty Is Associated With A Lower Rate Of Periprosthetic Joint Infection Compared To Total Knee Arthroplasty, Cody S. Lee, Edwin P. Su, Michael B. Cross, Alberto V. Carli, David C. Landy, Brian P. Chalmers

Orthopaedic Surgery and Sports Medicine Faculty Publications

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Background: Several studies have reported lower perioperative complications with unicompartmental knee arthroplasty (UKA) than with total knee arthroplasty (TKA). However, there is a paucity of data analyzing the incidence of periprosthetic joint infection (PJI) in similar patients undergoing UKA and TKA. As such, we sought to analyze the incidence of UKA and TKA PJI in a large matched population.

Material and Methods: The Mariner data set of the PearlDiver database was queried for all patients undergoing UKA or TKA during 2010-2017. Included patients were required to have at least 2 years of database inclusion after surgery. Patients were then matched …

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Diagnosing Total Joint Arthroplasty-Associated Periprosthetic Joint Infections In Immunocompromised Patient Populations, Philip Zakko, Erin A. Baker, Christian M. Huber, Corinn Gehrke, Brett J. Friedman, Michael A. Flierl

Conference Presentation Abstracts

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The 2018 ICM/MSIS classification system was used to assess PJI diagnosis in immunocompromised vs. non-immunocompromised patient populations to determine applicability of the scoring criteria.

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Microorganisms In Presumed Aseptic Revision Hip And Knee Arthroplasty, Michael E. Neufeld

Electronic Thesis and Dissertation Repository

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The role and clinical significance of microorganisms in presumed aseptic revision total hip (THA) and knee arthroplasty (TKA) is unclear. The primary aim of this thesis was to determine the prevalence and infection-free survival of presumed aseptic revisions with unexpected positive intraoperative cultures (UPC) by analyzing the largest cohorts of UPC in the literature. Secondarily, a prospective pilot study using modern molecular techniques with an emphasis on stringent control of contamination was designed to determine how frequently microorganisms are present on implants of presumed aseptic revisions, as well as their location and association with reason for revision.

The prevalence of …

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Novel Infection Status Post Electrocution Requiring A 4th Ray Amputation, William R. Judson, John D. Murphy, Phillip H. Sussman, John N. Harker

West Florida Division GME Research Day 2020

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• Prevotella bivia is an anaerobic, non-pigmented, Gram-negative bacillus species that is known to inhabit the human female vaginal tract and oral flora. It is most commonly associated with endometritis and pelvic inflammatory disease.^{1, 2}
• Rarely, P. bivia has been found in the nail bed, chest wall, intervertebral discs, and hip and knee joints.¹ The bacteria has been linked to necrotizing fasciitis, osteomyelitis, or septic arthritis.^{3, 4}
• Only 3 other reports have described P. bivia infections in the upper extremity with one patient requiring amputation2, and one with deep soft tissue infection requiring multiple debridements and extensive tenosynovectomy. …

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Localized Cytokine Responses To Total Knee Arthroplasty And Total Knee Revision Complications, Nicole Prince, Julia A. Penatzer, Matthew J. Dietz, Jonathan W. Boyd

Faculty & Staff Scholarship

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Background

The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly.

Methods

This exploratory study investigated tissue-level cytokines in a cohort of patients (N = 17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). …

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Microbial Colonization Of Pneumatic Tourniquets In The Orthopedic Operating Room, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Rizwan Haroon Rashid, Bilal Ahmed, Seema Irfan, Akbar Jaleel Zubair, Shahryar Noordin

Section of Orthopaedic Surgery

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Background: The rate of surgical site infections following orthopedic procedures is approximately 2% globally. Potential sources of contamination in the operating room include pneumatic tourniquets, blood pressure cuffs, and stethoscopes, among others. Our study aims to investigate microbial colonization on reusable pneumatic tourniquets stored and used in the orthopedic department of our institution and evaluate the efficacy of the cleaning protocols employed. Methods: Over a course of two weeks, 26 samples were obtained. A total of 14 pneumatic tourniquets were sampled preoperatively on Monday morning following the weekly cleaning protocol of soaking the tourniquets in sodium hypochlorite for 30 minutes …

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Infected Non-Union Of Tibia Treated With Ilizarov External Fixator: Our Experience, Shah Fahad, Aysha Habib, Muhammad Awais, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

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Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes.
Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one …

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A 6-Year Trends Analysis Of Infections After Revision Total Hip Arthroplasty, P. A. Gold, L. J. Garbarino, N. Sodhi, H. K. Anis, J. O. Ehiorobo, S. M. Kurtz, J. R. Danoff, V. J. Rasquinha, C. A. Higuera, M. A. Mont

Journal Articles

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No abstract provided.

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Tibiotalar Arthrodesis: Development Of A Novel Jig And Alignment Guide, Adam Mathew Ropchan

Electronic Thesis and Dissertation Repository

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Tibiotalar arthrodesis is a surgical procedure, used for the treatment of end-stage ankle arthrosis and instability. There are dozens of described procedures in the literature, all with varying rates of success. Two of the most common reasons for reoperation in tibiotalar arthrodesis are nonunion and infection; few studies have established any associations between patient/surgical factors and reoperation for nonunion and infection.

The first part of this thesis focuses on determining the rate of reoperation to the ipsilateral lower limb and if any patient/surgical factors are associated with reoperation for nonunion and infection. The second part of this thesis turns attention …

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What Are Biofilms?, Noreen J. Hickok

Department of Orthopaedic Surgery Faculty Papers

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No abstract provided.

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Are Prophylactic Intravenous Antibiotics Required In Routine Shoulder Arthroscopic Surgery? A Systematic Review Of The Literature, Njalalle Baraza, Jordan Leith

General Surgery, East Africa

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Purpose: The purpose of this study was to find out from the literature the difference in infection rates between patients who did and patients who did not receive prophylactic antibiotics in arthroscopic shoulder surgery.

Methods: We conducted a comprehensive search of the literature using Medline Ovid for prospective studies that looked at infection as the primary outcome following shoulder arthroscopy. The articles were then assessed for study design, outcome, and relevance to the specific question as part of the critical appraisal.

Results: Eight partially relevant articles were obtained from the search, but there were no prospective studies comparing infection in …

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Season Of The Year Influences Infection Rates Following Total Hip Arthroplasty, Samuel Rosas, Alvin C. Ong, Leonard T. Buller, Karim G. Sabeh, Tsun Yee Law, Martin W. Roche, Victor H. Hernandez

Department of Orthopaedic Surgery Faculty Papers

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To research the influence of season of the year on periprosthetic joint infections. METHODS We conducted a retrospective review of the entire Medicare files from 2005 to 2014. Seasons were classified as spring, summer, fall or winter. Regional variations were accounted for by dividing patients into four geographic regions as per the United States Census Bureau (Northeast, Midwest, West and South). Acute postoperative infection and deep periprosthetic infections within 90 d after surgery were tracked. RESULTS In all regions, winter had the highest incidence of periprosthetic infections (mean 0.98%, SD 0.1%) and was significantly higher than other seasons in the …

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Operative Environment, Pouya Alijanipour Md, Joseph Karam Md, Adolfo Llinas Md, Kelly G. Vince Md, Charalampos Zalavras Md, Matthew Austin Md, Grant Garrigues Md, Snir Heller Md, James Huddleston Md, Brian Klatt Md, Viktor Krebs Md, Christoph Lohmann Md, Edward J. Mcpherson Md, Robert Molloy Md, Ali Oliashirazi Md, Mitchell Schwaber Md, Eoin Sheehan Md, Eric Smith Md, Robert Sterling Md, Gregory Stocks Md, Shrinand Vaidya Md

Ali Oliashirazi

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Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.2 The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the defense capacity of …

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Operative Environment, Pouya Alijanipour Md, Joseph Karam Md, Adolfo Llinas Md, Kelly G. Vince Md, Charalampos Zalavras Md, Matthew Austin Md, Grant Garrigues Md, Snir Heller Md, James Huddleston Md, Brian Klatt Md, Viktor Krebs Md, Christoph Lohmann Md, Edward J. Mcpherson Md, Robert Molloy Md, Ali Oliashirazi Md, Mitchell Schwaber Md, Eoin Sheehan Md, Eric Smith Md, Robert Sterling Md, Gregory Stocks Md, Shrinand Vaidya Md

Orthopaedics

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Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.^1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.² The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the defense …

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The Fate Of The Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty, Robert L. Barrack, Ajay Aggarwal, R. Stephen J. Burnett, John C. Clohisy, Elie Ghanem, Peter Sharkey, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

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Of a consecutive series of 692 revision total knees at 3 centers, intraoperative cultures were unexpectedly found to be positive in 41 cases (5.9%). Of the 41, 29 (71%) cases had a single positive intraoperative culture and were determined to be a probable false positive based on absence of any other evidence of infection, of which 5 were treated with extended course of intravenous antibiotics after hospital discharge and the remaining 24 received no further treatment. None of these 24 patients manifested any sign of infection at follow-up, averaging 46 months (range, 24-74 months). Twelve patients were determined to have …

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