Medicine and Health Sciences Commons^™

Postoperative Opioid Usage And Disposal Strategies After Arthroscopic Procedures In A Young Cohort: A Prospective Observational Study, William Johns, Emma Johnson, Joseph Brutico, Matthew Sherman, Kevin Freedman, William Emper, John Salvo, Sommer Hammoud

Rothman Institute Faculty Papers

BACKGROUND: Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery.

PURPOSE: To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Patients between the ages of 15 and 40 years who were scheduled to undergo anterior cruciate ligament reconstruction (ACLR), labral repair of the hip or shoulder, meniscectomy, or meniscal repair were prospectively enrolled. Patients were prescribed either 5 mg hydrocodone-325 mg acetaminophen or 5 mg oxycodone-325 mg acetaminophen based on surgeon preference. Patients completed a daily opioid usage …

Comprehensive Guidance For The Prevention Of Periprosthetic Joint Infection After Total Joint Arthroplasty And Pitfalls In The Prevention, Javad Parvizi, Yonghan Cha, Emanuele Chisari, Kangbaek Kim, Kyung-Hoi Koo

Rothman Institute Faculty Papers

Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged population. Hip and knee are the most common joints, in which TJAs are performed. The TJA prosthesis is composed of metal, plastic, or ceramic device. Even though TJA is the most successful treatment for end-stage osteoarthritis, it is associated with various complications, and periprosthetic joint infection (PJI) is the most serious complication after TJA. With the increasing volume …

A Systematic Review Of Noncircular (Rectangle, Oval) Femoral Tunnel Anterior Cruciate Ligament Reconstruction: Does It Improve Outcomes?, S. Ali Ghasemi, Joseph Mccahon, Sangeev J. Herr, James Raphael, Gene Shaffer, Arthur Bartolozzi

Einstein Health Papers

Purpose: The purpose of this study is to systematically review the clinical and biomechanical studies regarding noncircular (rectangular and oval) femoral tunnel anterior cruciate ligament reconstruction (ACLR). We hypothesized that noncircular femoral tunnel ACLR has its advantages in unique situations while maintaining comparable clinical and radiographic outcomes when compared to conventional techniques.

Methods: A systematic review of the literature was performed in PubMed and Scopus databases to identify published articles on the clinical outcomes of noncircular (rectangle and oval) ACLR. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm and …

Minoxidil Weakens Newly Synthesized Collagen In Fibrotic Synoviocytes From Osteoarthritis Patients, Stefan Sarkovich, Peter P. Issa, Andrew Longanecker, Davis Martin, Kaitlyn Redondo, Patrick Mcternan, Jennifer Simkin, Luis Marrero

School of Medicine Faculty Publications

Purpose: Synovial fibrosis (SFb) formation and turnover attributable to knee osteoarthritis (KOA) can impart painful stiffness and persist following arthroplasty. To supplement joint conditioning aimed at maximizing peri-operative function, we evaluated the antifibrotic effect of Minoxidil (MXD) on formation of pyridinoline (Pyd) cross-links catalyzed by Plod2-encoded lysyl hydroxylase (LH)2b that strengthen newly synthesized type-I collagen (COL1) in fibroblastic synovial cells (FSCs) from KOA patients. MXD was predicted to decrease Pyd without significant alterations to Col1a1 transcription by FSCs stimulated with transforming growth factor (TGF)β1. Methods: Synovium from 10 KOA patients grouped by SFb severity was preserved for picrosirius and LH2b …

Nationwide Results Of Microorganism Antigen Testing As A Component Of Preoperative Synovial Fluid Analysis., Krista O'Shaughnessey Toler, Pearl Ravindra Paranjape, Alex Mclaren, Brett Levine, Alvin Ong, Carl Deirmengian

Rothman Institute Faculty Papers

BACKGROUND: Antigen immunoassays to detect synovial fluid (SF) microorganisms have recently been made available for clinical use. The purpose of this study was to determine the sensitivity and specificity of an SF microorganism antigen immunoassay detection (MID) panel, evaluate the panel's capability to detect microorganisms in the setting of culture-negative periprosthetic joint infection (PJI), and determine diagnostic predictive values of the MID panel for PJI.

METHODS: This study included 67,441 SF samples obtained from a hip or knee arthroplasty, from 2,365 institutions across the United States, submitted to 1 laboratory for diagnostic testing. All data were prospectively compiled and then …

One-Stage Synovectomies Result In Improved Short-Term Outcomes Compared To Two-Stage Synovectomies Of Diffuse-Type Tenosynovial Giant Cell Tumor (D-Tgct) Of The Knee: A Multicenter, Retrospective, Cohort Study, Geert Spierenburg, Floortje G M Verspoor, Jay S Wunder, Anthony M Griffin, Peter C Ferguson, Matthew T Houdek, David M King, Richard Boyle, Robert Lor Randall, Steven W Thorpe, Jacob I Priester, Erik J Geiger, Lizz Van Der Heijden, Nicholas M Bernthal, Bart H W B Schreuder, Hans Gelderblom, Michiel A J Van De Sande

Rothman Institute Faculty Papers

Diffuse-type tenosynovial giant cell tumors' (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion …

Low-Dose Aspirin For Venous Thromboembolism Prophylaxis Is Associated With Lower Rates Of Periprosthetic Joint Infection After Total Joint Arthroplasty, Farideh Najafi, Joseph K. Kendal, Nicholas V. Peterson, Kerri-Anne Ciesielka, Camilo Restrepo, Javad Parvizi, Nicholas M. Bernthal

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Aspirin as a venous thromboembolism (VTE) prophylactic agent has been shown to have antistaphylococcal and antibiofilm roles. Optimal acetylsalicylic acid (ASA) dosage would facilitate antimicrobial effects while avoiding over-aggressive inhibition of platelet antimicrobial function. Our purpose was to determine the periprosthetic joint infection (PJI) rate after total joint arthroplasty in patients receiving low-dose ASA (81 mg twice a day), in comparison to high-dose ASA (325 mg twice a day).

METHODS: We conducted a retrospective cohort study between 2008 and 2020. Eligible patients were older than 18 years, underwent primary total joint arthroplasty, both total knee arthroplasty and total hip …

Keeping The Lights On: The Impact Of The Covid-19 Pandemic On Elective Total Joint Arthroplasty Utilization In The United States, Matthew W. Cole, Lacee K. Collins, Garrett H. Williams, Olivia C. Lee, William F. Sherman

School of Medicine Faculty Publications

Background: It was estimated that up to 30,000 primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures would be cancelled each week during the moratorium on elective surgeries in the United States. The purpose of this study was to analyze the impact of the COVID-19 pandemic on elective total joint arthroplasty utilization in the United States. Methods: A retrospective study was conducted using the PearlDiver database. Patients who underwent primary elective THAs and TKAs were identified and filtered by state and month from January through September of both 2019 and 2020. The volume of these procedures immediately following …

Gut Permeability May Be Associated With Periprosthetic Joint Infection After Total Hip And Knee Arthroplasty, Emanuele Chisari, Jeongeun Cho, Marjan Wouthuyzen-Bakker, Javad Parvizi

Rothman Institute Faculty Papers

A growing number of recent investigations on the human genome, gut microbiome, and proteomics suggests that the loss of mucosal barrier function, particularly in the gastrointestinal tract, may substantially affect antigen trafficking, ultimately influencing the close bidirectional interaction between the gut microbiome and the immune system. This cross-talk is highly influential in shaping the host immune system function and ultimately affecting the outcome of interventions. We hypothesized that the loss of mucosal barrier in the gut may be associatedto acute and chronic periprosthetic joint infections (PJI). Zonulin, soluble CD14 (sCD14), and lipopolysaccharide (LPS) were tested in plasma as part of …

Meloxicam Versus Celecoxib For Postoperative Analgesia After Total Knee Arthroplasty: Safety, Efficacy And Cost, Amer Haffar, Yale A Fillingham, Leigham Breckenridge, D'Andrew Gursay, Jess H Lonner

Rothman Institute Faculty Papers

INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as part of multimodal analgesia in total knee arthroplasty (TKA). Selective cyclooxygenase (COX)-2 inhibitors (e.g., celecoxib) are believed to have fewer gastrointestinal (GI) adverse effects than nonselective NSAIDS. Meloxicam is less selective for COX-2 than celecoxib is and partially inhibits COX-1 at higher doses. Nonetheless, some surgeons prefer using nonselective NSAIDs because of their lower expense.

METHODS: Four thousand nine hundred ninety-four patients who underwent TKA between January 2015 and February 2020 and took either celecoxib (n = 3,174), meloxicam 15 mg/d (n = 1,819), or meloxicam 7.5 mg/d (n = 451) …

Rehabilitation And Return-To-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review., Michael Stark, Somnath Rao, Brendan Gleason, Robert A. Jack, Bradford Tucker, Sommer Hammoud, Kevin B. Freedman

Rothman Institute Faculty Papers

Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport.

Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria.

Study Design: Systematic review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cumulative Index …

Development Of A Mind Body Program For Obese Knee Osteoarthritis Patients With Comorbid Depression, Cale A. Jacobs, Ryan A. Mace, Jonathan Greenberg, Paula J. Popok, Mira Reichman, Christian Lattermann, Jessica L. Burris, Eric A. Macklin, Ana-Maria Vranceanu

Orthopaedic Surgery and Sports Medicine Faculty Publications

Knee osteoarthritis (OA) is the most common joint disorder in the U.S. and a leading cause of disability. Depression and obesity are highly comorbid among knee OA patients, and the combination of obesity and depression is associated with decreased physical activity, higher pain and disability, and more rapid cartilage degradation. Depression, obesity and OA exacerbate one another and share a common pathophysiology involving systemic inflammation and pro-inflammatory cytokines, reflecting a complex mind-body interaction. Current treatments for knee OA offer little to no benefit over placebo, and do not emphasize mind-body practices or physical activity to target the underlying pathophysiology. Mind-body …

Walking Kinematics In Young Children With Limb Loss Using Early Versus Traditional Prosthetic Knee Prescription Protocols, Mark Daniel Geil, Zahra Safaeepour, Brian Giavedoni, Colleen Coulter

Faculty Articles

The traditional treatment protocol for young children with congenital or acquired amputations at or proximal to the knee prescribes a prosthesis without a working knee joint, based in part on the assumption that a child learning to walk cannot properly utilize a passively flexing prosthetic knee component. An alternative to this Traditional Knee (TK) protocol is an “Early Knee” (EK) protocol, which prescribes an articulating prosthetic knee in the child’s first prosthesis, during development of crawling and transitioning into and out of upright positions. To date, no study has compared samples of children with limb loss at or proximal to …

Postoperative Delirium After Major Orthopedic Surgery., Michael K. Urban, Mayu Sasaki, Abigail M. Schmucker, Steven K. Magid

Student Papers, Posters & Projects

BACKGROUND: Postoperative delirium (POD) is one of the most common complications in older adult patients undergoing elective surgery. Few studies have compared, within the same institution, the type of surgery, risk factors and type of anesthesia and analgesia associated with the development of POD.

AIM: To investigate the following three questions: (1) What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital? (2) Does surgical procedure influence incidence of POD after non-ambulatory orthopedic surgery? And (3) For POD after non-ambulatory orthopedic surgery, what are modifiable risk factors?

METHODS: A retrospective cohort study was conducted …

Assessment Of The Composition And Biologic Activity Of Platelet Rich Plasma And Its Relationship To Clinical Outcomes In Patients With Knee Osteoarthritis, Daniel Nemirov, Bijan Dehghani, Habib Zahir, Xiaoning Yuan, Christine Kim, Reyna Bhandhari, Patrick Fava, Yurii Chinenov, Joseph Nguyen, Laura Donlin, Brian Halpern, Scott Rodeo, Miguel Otero

Phase 1

Recent studies suggest positive clinical outcomes associated with platelet-rich-plasma (PRP) administration to treat knee osteoarthritis (OA). However, the results remain inconclusive in part because of the high variability in PRP preparations and the limited information regarding the relevant biologically active components of PRP. We hypothesize that the variability in clinical response is driven by the heterogeneous composition of PRP. In this study we evaluated the composition and biological activity of PRP and further correlated our findings to clinical outcomes in patients receiving intra-articular injections for knee OA. After IRB approval and patient consent, we enrolled 51 patients (mean age: 57.9 …

Test-Retest Reliability And Minimum Detectable Change For Various Frontal Plane Projection Angles During Dynamic Tasks, David M. Werner, Stephanie Di Stasi, Cara L. Lewis, Joaquin Alberto Barrios

Physical Therapy Faculty Publications

Objective: Establish between-day test-retest reliability metrics for 2-dimensional frontal plane projection angles (FPPAs) during the lateral step-down (LSD), single-limb squat (SLS), single-limb landing (SLL), and drop vertical jump (DVJ).

Design: Test-retest reliability study

Setting: University laboratory

Participants: 20 healthy adults (12 female, age = 23.60±1.93 years old, body mass index = 24.26±2.54 kg/m²) were tested on 2 separate occasions 7-14 days apart.

Main Outcome Measures: Intraclass correlation coefficients (ICC), standard errors of the measurement (SEM), and minimal detectable change (MDC) values across the LSD, SLS, SLL, and DVJ for the following body region variables: trunk, trunk on pelvis, …

Performance Of The Promis In Patients After Anterior Cruciate Ligament Reconstruction, Elizabeth J. Scott, Robert Westermann, Nathalie A. Glass, Carolyn Hettrich, Brian R. Wolf, Matthew J. Bollier

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) is designed to advance patient-reported outcome (PRO) instruments by utilizing question banks for major health domains.

Purpose: To compare the responsiveness and construct validity of the PROMIS physical function computer adaptive test (PF CAT) with current PRO instruments for patients before and up to 2 years after anterior cruciate ligament (ACL) reconstruction.

Study Design: Cohort study (diagnosis); Level of evidence, 2.

Methods: Initially, 157 patients completed the PROMIS PF CAT, Short Form-36 Health Survey (SF-36 physical function [PF] and general health [GH]), Marx Activity Rating Scale (MARS), Knee injury and Osteoarthritis Outcome …

Seasonal Influence On Postoperative Complications After Total Knee Arthroplasty, Azeem Tariq Malik, Muhammad Shahid Khan, Arif Ali M, Syed Hamza Mufarrih, Shahryar Noordin

Section of Orthopaedic Surgery

Purpose: This study is aimed at investigating whether inpatient complications and surgical site infections (SSIs) occurred more commonly in patients undergoing total knee arthroplasty (TKA) during the summer season.
Materials and Methods: A total of 725 patients who underwent unilateral or bilateral TKA were included in this study. A total of 241 patients (33.2%) underwent TKA between May and August. Our outcomes of interest were the incidence of postoperative complications and length of stay.
Result: May-August surgeries were associated with a higher risk of postoperative inpatient complications (p=0.003). May-August surgeries (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.18 …

Serum D-Dimer Test Is Promising For The Diagnosis Of Periprosthetic Joint Infection And Timing Of Reimplantation., Alisina Shahi, Michael M. Kheir, Majd Tarabichi, Hamid R.S. Hosseinzadeh, Timothy L. Tan, Javad Parvizi

Rothman Institute Faculty Papers

BACKGROUND: Despite the availability of a battery of tests, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities that occur during infection. We hypothesized that patients with PJI may have a high level of circulating D-dimer and that the presence of a high level of serum D-dimer may be a sign of persistent infection in patients awaiting reimplantation.

METHODS: This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty. Our cohort consisted of 245 patients undergoing primary arthroplasty (n = 23), revision for …

National Football League Skilled And Unskilled Positions Vary In Opportunity And Yield In Return To Play After An Anterior Cruciate Ligament Injury., Jaewon Yang, Jonathan D. Hodax, Jason T. Machan, Eric S. Secrist, Wesley M. Durand, Brett D. Owens, Adam E.M. Eltorai, Christopher C. Dodson

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Anterior cruciate ligament (ACL) injuries pose a significant risk to the careers of players in the National Football League (NFL). The relationships between draft round and position on return to play (RTP) among NFL players are not well understood, and the ability to return to preinjury performance levels remains unknown for most positions.

PURPOSE: To test for differences in RTP rates and changes in performance after an ACL injury by position and draft round. We hypothesized that skilled positions would return at a lower rate compared to unskilled positions. We further hypothesized that early draft-round status would relate to …

Surgical Site Infection And Transfusion Rates Are Higher In Underweight Total Knee Arthroplasty Patients., Jorge Manrique, Antonia F. Chen, Md, Mba, Miguel M. Gomez, Mitchell Maltenfort, Phd, William J. Hozack Md

Rothman Institute Faculty Papers

BACKGROUND: Underweight (UW) patients undergoing total hip arthroplasty have exhibited higher complication rates, including infection and transfusion. No study to our knowledge has evaluated UW total knee arthroplasty (TKA) patients. We, therefore, conducted a study to investigate if these patients are at increased risk for complications, including infection and transfusion.

METHODS: A case-control study was conducted using a prospectively collected institutional database. Twenty-seven TKA patients were identified as UW (body mass index [BMI] < 18.5 kg/m

RESULTS: The average BMI was 17.1 kg/m

CONCLUSIONS: Our study demonstrates that UW TKA patients have a higher likelihood of developing SSI and requiring blood transfusions. The …

The Fate Of Spacers In The Treatment Of Periprosthetic Joint Infection., Miguel M Gomez, Timothy L Tan, Jorge Manrique, Gregory K Deirmengian, Javad Parvizi Md

Rothman Institute Faculty Papers

BACKGROUND: Two-stage exchange arthroplasty remains the preferred method to treat periprosthetic joint infection. The aim of this study was to investigate the clinical course of periprosthetic joint infection following resection arthroplasty and insertion of a spacer.

METHODS: Our institutional database was used to identify 504 cases of periprosthetic joint infection (326 knees and 178 hips) treated with resection arthroplasty and spacer insertion as part of a two-stage exchange arthroplasty. A review of the patient charts was performed to extract information relevant to the objectives of this study that included the details of the clinical course following resection arthroplasty.

RESULTS: The …

Periprosthetic Joint Infection Increases The Risk Of One-Year Mortality., Benjamin Zmistowski, Joseph A. Karam, M.D., Joel B Durinka, David S Casper, Md, Javad Parvizi Md

Rothman Institute Faculty Papers

BACKGROUND: Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection.

METHODS: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety …

Periprosthetic Knee Infection: Ten Strategies That Work., Javad Parvizi, Md, Priscilla Ku Cavanaugh, Claudio Diaz-Ledezma

Department of Orthopaedic Surgery Faculty Papers

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. …

Predictors Of Perioperative Blood Loss In Total Joint Arthroplasty., Jai Hyung Park, Mohammad R Rasouli, S M Javad Mortazavi, Anthony T Tokarski, Mitchell G Maltenfort, Javad Parvizi

Rothman Institute Faculty Papers

UNLABELLED: UPDATE The print version of this article has errors that have been corrected in the online version of this article. In the Materials and Methods section, the sentence that reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with a hemoglobin level of no less than 11 mg/dL or a hematocrit level of at least 33%." in the print version now reads as "During the study period, our institution offered preoperative autologous blood donation to all patients who were scheduling for total joint arthroplasty with …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Faculty Papers

No abstract provided.

Comparing Responsiveness Of Six Common Patient-Reported Outcomes To Changes Following Autologous Chondrocyte Implantation: A Systematic Review And Meta-Analysis Of Prospective Studies, Jennifer S. Howard, Christian Lattermann, Johanna M. Hoch, Carl G. Mattacola, Jennifer M. Medina Mckeon

Rehabilitation Sciences Faculty Publications

Objective: To compare the responsiveness of six common patient-reported outcomes (PROs) following autologous chondrocyte implantation (ACI). Design: A systematic search was conducted to identify reports of PROs following ACI. Study quality was evaluated using the modified Coleman Methodology Score (mCMS). For each outcome score, pre- to postoperative paired Hedge's g effect sizes were calculated with 95% confidence intervals (CIs). Random effects meta-analyses were performed to provide a summary response for each PRO at time points (TP) I (<1 year), II (1 year to <2 years), III (2 years to <4 years), IV (>= 4 years), and overall. Results: The mean mCMS for the 42 articles included was 50.9 +/- 9.2. For all evaluated instruments, …

Successful Identification Of Pathogens By Polymerase Chain Reaction (Pcr)-Based Electron Spray Ionization Time-Of-Flight Mass Spectrometry (Esi-Tof-Ms) In Culture-Negative Periprosthetic Joint Infection., Christina L Jacovides, Rachael Kreft, Bahar Adeli, Bryan Hozack, Garth D Ehrlich, Javad Parvizi

Rothman Institute Faculty Papers

BACKGROUND: The diagnosis of periprosthetic joint infection poses many challenges, one of which is the difficulty of isolating the infecting organism. Recently, a sophisticated modality (the Ibis Biosciences T5000 biosensor system) has been introduced that uses pan-domain primers in a series of polymerase chain reactions (PCRs) to identify and speciate essentially all bacteria and fungi as well as to identify key antibiotic resistance genes. We investigated the role of the Ibis in identifying infecting organisms in cases of known and suspected periprosthetic joint infection.

METHODS: Synovial fluid specimens were collected prospectively from eighty-two patients undergoing eighty-seven arthroplasty procedures (sixty-five knee …

A Prospective Analysis Of Glove Perforation In Primary And Revision Total Hip And Total Knee Arthroplasty., Aaron H Carter, Md, David S Casper, Md, Javad Parvizi, Md, Mathew Austin, Md

Department of Orthopaedic Surgery Faculty Papers

Literature in regard to glove perforation rates in revision total joint arthroplasty (TJA) is scarce. Our purpose was to determine the incidence of perforation in revision TJA. Gloves from all scrubbed personnel were tested based on the American Society for Testing and Materials. A total of 3863 gloves were collected from 58 primary and 36 revision arthroplasty cases. Surgeons had a 3.7% outer-glove perforation rate in primary TJA compared with 8.9% in revision TJA. When both gloves were perforated, the outer-glove perforation was recognized intraoperatively 100% of the time, and the inner-glove perforation was noted only 19% of the time. …

Limitations Of The Knee Society Score In Evaluating Outcomes Following Revision Total Knee Arthroplasty., Elie Ghanem, Ian Pawasarat, Adam Lindsay, Lauren May, Khalid Azzam, Ashish Joshi, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Traditionally, the results of revision total knee arthroplasty have been determined with use of surgeon-based measures such as the Knee Society rating system. Recently, outcome and quality-of-life measures have shifted toward a greater emphasis on patient-based evaluation. The aim of our study was to determine the validity and responsiveness of the Knee Society rating system compared with the Short Form-36 health survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a four-question 4-point Likert scale satisfaction questionnaire following revision total knee arthroplasty.

METHODS: A total of 152 patients underwent revision total knee arthroplasty at our institution, between …