Medicine and Health Sciences Commons^™

The Use Of Iodophor-Impregnated Drapes In Patients With Iodine-Related Allergies: A Case Series And Review Of The Literature, Andrew Fraval, Nicolina Zappley, William J. Hozack

Rothman Institute Faculty Papers

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Background

The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes.

Methods

This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an …

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Assessing General Vs. Spinal Anesthesia As A Risk Factor For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

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INTRODUCTION: As bundle payment care initiatives become ever prevalent in total knee arthroplasty (TKA), institutions have increasingly focused on cost-saving measures which maintain or improve upon the standard of care. One area of interest is identifying potential modifiable and non-modifiable risk factors. Here we evaluate the correlations of general versus spinal anesthesia in TKAs in perioperative outcomes. METHODS: All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data includes baseline demographics, select medical comorbidities, intraoperative variables and postoperative course/complications. Patients were separated into two …

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Assessing Risk Factors For 90-Day Emergency Department Visits Status-Post Index Total Knee Arthroplasty: A Retrospective Case Control Study, Ian Penvose, Helen E. Huetteman, Phil Vartanyan, James Feng, Robert Runner, Drew Douglas Moore, Mark S. Karadsheh

Conference Presentation Abstracts

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INTRODUCTION: With the increasing adoption of value-based healthcare initiatives in total knee arthroplasty (TKA), a greater emphasis has been placed on implementing cost-saving measures while maintaining or improving quality of care. One area of interest has been postoperative ED visits. Here we evaluate potential risk factors for 90-day ED visits. METHODS: This is a case control study from a large, tertiary, private, academic institution. All primary TKAs between 7/1/2013 to 12/31/2017 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. All patient charts were subsequently verified and reviewed for all-cause 90-day ED …

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Not All Patients Need Supervised Physical Therapy After Primary Total Knee Arthroplasty: A Systematic Review And Meta-Analysis., Yash P Chaudhry, Hunter Hayes, Zachary Wells, Efstratios Papadelis, Harpal S Khanuja, Carl Deirmengian

Orthopedic Surgery Resident Research

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Although postoperative physical therapy (PT) has long been considered essential to successful total knee arthroplasty (TKA) recovery, recent literature has suggested that unsupervised home exercise regimens may offer similar benefits to formal supervised sessions. We aimed to compare objectively measured physical function and subjective patient-reported outcomes (PROs) between primary TKA patients who received formal supervised physical therapy sessions and those who received unsupervised home exercise regimens after discharge. Six electronic databases were queried to identify randomized controlled trials comparing supervised physical therapy to unsupervised home exercise regimens in primary TKA patients after discharge. Outcomes of interest included change from baseline …

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Comparison Of Surgical Site Infection After Skin Closure By Prolene Or Staples In Bilateral Simultaneous Knee Arthroplasty Patients: A Parallel Design Randomized Controlled Trial Protocol, Obada Hussein Hasan, Ahsun Jiwani, Laraib Mazhar, Dilshad Begum, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Medicine

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Introduction: Knee arthroplasty also known as the total knee replacement is an orthopedic surgical procedure done to resurface the knee that has been severely damaged by arthritis. After the completion of the surgical procedure, the skin closure is done. The optimal goal of skin closure after the procedure is to promote rapid healing and an acceptable cosmetic result while minimizing the risk of infection. Skin closure after knee arthroplasty is done by using either of the two widely used sutures i.e., polypropylene (Prolene) sutures or the skin staple sutures. There are no standard guidelines as which type of the suture …

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Total Knee Arthroplasty In Patients With Prior Meniscus Surgery: A Matched Case Control Study, Lasya Rangavajjula, Steven B. Cohen, Md, Meghan E. Bishop, Md, Shyam Brahmabhatt, Md, Michael G. Ciccotti, Md, Ashley Bassett, Md, Christopher Hadley

Phase 1

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Introduction: Meniscus surgery is one of the most commonly performed orthopedic surgical procedures in the United States. However, outcomes following a Total Knee Arthroplasty (TKA) in patients with a history of prior knee arthroscopy are varied with small patient cohorts, warranting further research. The research question investigates how the clinical outcomes of TKA compare between patients with and without prior meniscectomy history. It is hypothesized that there will be no significant difference in clinical outcomes between the two cohorts.

Methods: The study design is a retrospective case-control study. The study population included patients from Rothman Institute with TKA and …

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Think Twice Before Prescribing Antibiotics For That Swollen Knee: The Influence Of Antibiotics On The Diagnosis Of Periprosthetic Joint Infection., Graham S Goh, Javad Parvizi Md

Rothman Institute Faculty Papers

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Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. An estimated 7-12% of patients have negative cultures despite clear clinical evidence of infection. One oft-cited reason for this occurrence is the administration of antibiotics in the weeks prior to obtaining cultures. This article reviews the influence of antibiotics on the diagnosis of PJI. Specifically, we examine the effect of prophylactic and therapeutic antibiotic administration on the diagnostic accuracy of microbiological cultures as well as serum and synovial biomarkers. We also explore the potential of molecular techniques in overcoming these limitations in patients who have received …

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Inflammatory Arthritis And Mycobacterium Tuberculosis Infection: A Diagnostic And Management Challenge For Knee Arthroplasty In Endemic Areas, Obada Hasan, Riaz Hussain Lakhdawala, Vickash Kumar, Syed Faisal Mahmood, Shahryar Noordin

Section of Orthopaedic Surgery

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Tuberculosis continues to be one of the most challenging health problems more prevalent in developing countries. Pakistan ranks 5th in tuberculosis prevalence among the high-burden countries. Prosthetic joint infection of the knee by acid fast bacilli is a rare and distressing complication, occurring in nearly 1% of primary joint arthroplasties requiring prolonged medical treatment and multiple surgeries. A recent publication extensively reviewed English literature from 1952 to 2016, and repor ted only 64 prosthetic joint infec tion with tuberculosis, of which 27 cases involved the knee. Tuberculosis is a global health problem adding to the challenges that arthroplasty surgeons face …

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A Us Hospital Budget Impact Analysis Of A Skin Closure System Compared With Standard Of Care In Hip And Knee Arthroplasty., Kay Sadik, Jana Flener, Jeanine Gargiulo, Zachary D. Post, Steven Wurzelbacher, Andrew Hogan, Sarah Hollmann, Nicole Ferko

Department of Orthopaedic Surgery Faculty Papers

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Background: Medicare's mandatory bundle for hip and knee arthroplasty necessitates provider accountability for quality and cost of care to 90 days, and wound closure may be a key area of consideration. The DERMABOND

Methods: A 90-day economic model was developed assuming 500 annual hip/knee arthroplasties for a typical US hospital setting. In current practice, wound closure methods for the final skin layer were set to 50% sutures and 50% staples. In future practice, this distribution shifted to 20% sutures, 20% staples, and 60% Skin Closure System. Health care resources included materials (eg, staplers, steri-strips, and traditional/barbed sutures), standard or premium …

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Effect Of Continuous Passive Motion On Knee Flexion Range Of Motion After Total Knee Arthroplasty, Naveed Baloch, Akbar Jaleel Zubairi, Rizwan Haroon Rashid, Pervaiz Hashmi, Riaz Hussain Lakdawala

Department of Surgery

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Abstract

OBJECTIVE:

To compare mean knee flexion in patients on continuous passive motion and those without it after total knee arthroplasty.

METHODS:

The randomised controlled study was conducted at Aga Khan University Hospital, from July 2013 to June 2014, and comprised patients who underwent total knee arthroplasty. Patients were randomly assigned to either group, with Group A receiving standardised physiotherapy from 1st postoperative day, and Group B receiving physiotherapy and one hour of continuous passive motion twice a day from 1st postoperative day until discharge. Outcome assessment was done on the day of discharge.

RESULTS:

Of the 76 patients, there …

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Aquacel Surgical Dressing Reduces The Rate Of Acute Pji Following Total Joint Arthroplasty: A Case-Control Study., Jenny Cai, Joseph A Karam, Javad Parvizi, Eric B Smith, Peter F. Sharkey

Rothman Institute Faculty Papers

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An effort to prevent PJI has led to the development of antimicrobial dressings that support wound healing. We sought to determine whether Aquacel Surgical dressing independently reduces the rate of acute PJI following TJA. A single institution retrospective chart review of 903 consecutive cases who received the Aquacel Surgical dressing and 875 consecutive cases who received standard gauze dressing was conducted to determine the incidence of acute PJI (within 3months). The incidence of acute PJI is 0.44% in the Aquacel dressing group compared to 1.7% in the standard gauze dressing group (P=0.005). Multivariate analysis revealed that use of Aquacel dressing …

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Mast Cells And Hypoxia Drive Tissue Metaplasia And Heterotopic Ossification In Idiopathic Arthrofibrosis After Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Dela Valle, Marla J Steinbeck

Theresa A Freeman

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ABSTRACT: BACKGROUND: Idiopathic arthrofibrosis occurs in 3-4% of patients who undergo total knee arthroplasty (TKA). However, little is known about the cellular or molecular changes involved in the onset or progression of this condition. To classify the histomorphologic changes and evaluate potential contributing factors, periarticular tissues from the knees of patients with arthrofibrosis were analyzed for fibroblast and mast cell proliferation, heterotopic ossification, cellular apoptosis, hypoxia and oxidative stress. RESULTS: The arthrofibrotic tissue was composed of dense fibroblastic regions, with limited vascularity along the outer edges. Within the fibrotic regions, elevated numbers of chymase/fibroblast growth factor (FGF)-expressing mast cells were …

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Periprosthetic Joint Infection: Are Patients With Multiple Prosthetic Joints At Risk?, S Mehdi Jafari, David S Casper, Camilo Restrepo, Benjamin Zmistowski, Javad Parvizi, Peter F Sharkey

Rothman Institute Faculty Papers

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Patients who present with a periprosthetic joint infection in a single joint may have multiple prosthetic joints. The risk of these patients developing a subsequent infection in another prosthetic joint is unknown. Our purposes were (1) to identify the risk of developing a subsequent infection in another prosthetic joint and (2) to describe the time span and organism profile to the second prosthetic infection. We retrospectively identified 55 patients with periprosthetic joint infection who had another prosthetic joint in place at the time of presentation. Of the 55 patients, 11 (20%) developed a periprosthetic joint infection in a second joint. …

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Mast Cells And Hypoxia Drive Tissue Metaplasia And Heterotopic Ossification In Idiopathic Arthrofibrosis After Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Dela Valle, Marla J Steinbeck

Department of Orthopaedic Surgery Faculty Papers

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ABSTRACT: BACKGROUND: Idiopathic arthrofibrosis occurs in 3-4% of patients who undergo total knee arthroplasty (TKA). However, little is known about the cellular or molecular changes involved in the onset or progression of this condition. To classify the histomorphologic changes and evaluate potential contributing factors, periarticular tissues from the knees of patients with arthrofibrosis were analyzed for fibroblast and mast cell proliferation, heterotopic ossification, cellular apoptosis, hypoxia and oxidative stress. RESULTS: The arthrofibrotic tissue was composed of dense fibroblastic regions, with limited vascularity along the outer edges. Within the fibrotic regions, elevated numbers of chymase/fibroblast growth factor (FGF)-expressing mast cells were …

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Reactive Oxygen And Nitrogen Species Induce Protein And Dna Modifications Driving Arthrofibrosis Following Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Della Valle, Marla J Steinbeck

Department of Orthopaedic Surgery Faculty Papers

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BACKGROUND: Arthrofibrosis, occurring in 3%-4% of patients following total knee arthroplasty (TKA), is a challenging condition for which there is no defined cause. The hypothesis for this study was that disregulated production of reactive oxygen species (ROS) and nitrogen species (RNS) mediates matrix protein and DNA modifications, which result in excessive fibroblastic proliferation. RESULTS: We found increased numbers of macrophages and lymphocytes, along with elevated amounts of myeloperoxidase (MPO) in arthrofibrotic tissues when compared to control tissues. MPO expression, an enzyme that generates ROS/RNS, is usually limited to neutrophils and some macrophages, but was found by immunohistochemistry to be expressed …

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