Orthopedics Commons^™

Burden Of Periprosthetic Joint Infection And Its Treatment On Kidney Function

Rothman Institute Conference Posters

Introduction:

Patients with periprosthetic joint infection (PJI) are subjected to several potentially nephrotoxic conditions such as acute and chronic systemic inflammatory reactions, multiple surgical procedures and noxious antibiotics. This study aims to investigate 1) the incidence and severity of kidney injury in patients undergoing surgical treatment for PJI, 2) whether the number of surgeries affects renal function in PJI patients and 3) the potential risk factors for kidney injury.

Red Cell Distribution Width: An Unacknowledged Predictor Of Mortality And Length Of Stay Following Revision Arthroplasty, Pouya Alijanipour, Md, Snir Heller, Md, Fatih Kucukdurmaz, Md, Benjamin Zmistowski, Md, Maryam Rezapoor, Ms, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

Introduction

Red blood cell distribution width (RDW), a measure of variability in size of circulating erythrocytes, is routinely reported in complete blood cell analysis, and together with mean cell volume (MCV) has conventionally been used to distinguish the cause of anemia. It is calculated by (Standard deviation of MCV÷ mean MCV) x 100, with normal range being 11.5%-14.5%. Several recent publications have described RDW as an independent predictor of adverse outcome and mortality in patients with different underlying medical conditions such as acute and chronic heart failure, peripheral artery disease, chronic pulmonary disease and acute kidney injury1. The purposes of …

Low Dose Aspirin: An Effective Chemoprophylaxis For Preventing Venous Thromboembolic Events, Javad Parvizi, Md, Frcs, Antonia F. Chen, Md, Mba, Camilo Restrepo, Md, Ronald Huang, Md, Jenny Cal, Bs, William J. Hozack, Md, Jess H. Lonner, Md

Rothman Institute Conference Posters

The available guidelines, endorsed by Surgical Care Improvement Project (SCIP), have advocated that aspirin (ASA) is a safe and eff­ective strategy for venous thromboembolic events (VTE) prophylaxis following total joint arthroplasty (TJA). The optimal dose of aspirin for this purpose is not known. The first guidelines for prevention of VTE that were issued by the American Academy of Orthopedic Surgeons recommended 325 mg Bis in die (twice a day) (bid) for this purpose with the recommendation having a 1C grade (little evidence to support the recommendation). It is known that platelet aggregation inhibition occurs at lower doses. Traditionally, ASA 81mg …

Radiation Exposure To The Eye With Mini C-Arm Use During Hand Surgery, Mark L. Wang, Md, Phd, C. Edward Hoffler, Md, Phd, Frederick E. Liss, Md, Asif Ilyas, Md, Charles Leinberry, Md, Pedro Beredjiklian, Md

Rothman Institute Conference Posters

Introduction:

Fluoroscopic radiation exposure is a potential occupational health risk to the Hand Surgeon, given operator proximity and the relative lack of eye shielding. The association of eye radiation exposure and the early development of cataracts have been previously reported. Mini C-arm fluoroscopy is commonly utilized during routine Hand Surgery. At present, the amount of radiation exposure to the eye, associated with the routine use of mini C-arm fluoroscopy, is unknown, thus warranting further investigation. The purpose of this study is to test the hypothesis that eye radiation exposure, sustained during routine mini C-arm use, does not exceed that of …

Rotational Alignment In Medial Unicompartmental Knee Arthroplasty: Comparison Of Anatomic Landmarks, Glenn J. Kerr, Md, Patrick O'Toole, Md, Eddie Wu, Do, Jess H. Lonner, Md

Rothman Institute Conference Posters

Introduction:

The landmarks used for tibial component rotation in total knee arthroplasty (TKA) and medial unicompartmental knee arthroplasty (UKA) may differ, utilizing the medial edge of the tibial tubercle and the medial edge of the tibial spine, respectively. However, some surgeons reference from the medial edge of the tibial tubercle in UKA. Use of the tibial tubercle to determine orientation of the sagittal cut in medial UKA can result in external rotation of the tibial component, leading to rotational mismatch between the femoral and tibial components, potential disruption of the ACL and tibial component undersizing. The purpose of this study …

Trigger Finger Release Performed Wide Awake: Prospective Comparison Of Local Anesthetics, Constantinos Ketonis, Md, Phd, Nayoung Kim, Bs, Frederic Liss, Md, Benjamin Zmistowski, Md, Jonas L. Matzon, Md, Charles Leinberry, Md, Mark L. Wang, Md, Phd, Christopher Jones, Md, William Kirkpatrick, Md, Asif M Ilyas, Md

Rothman Institute Conference Posters

Introduction:

Trigger fi­nger (TF) is one of the most common conditions treated by hand surgeons with a lifetime risk up to 10% in patients with diabetes. If conservative management fails, surgical treatment is undertaken, with or without sedation and a tourniquet, via a small incision to release the A1 pulley. A number of local anesthetics are readily available including Lidocaine, Ropivacaine and Marcaine as well as encapsulated formulations thereof such as Exparel. Since it’s approval in 2011, there have been numerous reports of successfully achieving prolonged pain relief with locally injected Exparel after various procedures, but to the best of …

The Patellar Tendon Can Cause External Tibial Component Malrotation In Lateral Unicondylar Knee Arthroplasty, Glenn J. Kerr, Md, Patrick O'Toole, Md, Eddie Wu, Do, Jess H. Lonner, Md

Rothman Institute Conference Posters

Introduction:

The optimal rotational axis of the tibial component in lateral unicompartmental knee arthroplasty (UKA) should be aligned parallel to the lateral tibial spine. However, the relatively lateral positions of the tibial tubercle and patellar tendon make the sagittal tibial cut in lateral UKA difficult and commonly predisposes to inadvertent external rotation of the tibial component. The purpose of this study was to quantify the potential rotational impact that occurs when aligning the anterior edge of the sagittal tibial cut with the lateral edge of the patellar tendon in lateral UKA.

When Is It Safe For Patients To Drive After Right Total Hip Arthroplasty?, Victor H. Hernandez, Md, Alvin C. Ong, Md, Fabio Orozco, Md, Anne Marie Madden, Zachary D. Post, Md

Rothman Institute Conference Posters

Introduction:

• Driving restrictions after total hip arthroplasty (THA) can be inconvenient and burdensome for patients.
• When patients may safely be allowed to drive remains controversial.
• Most studies recommend 6 weeks but recent advances in surgical approach, pain management and rapid recovery may have changed this time frame.
• The purpose of this study was to prospectively evaluate driving safety after THA through brake reaction time.

Aspirin May Be Adequate For Venous Thromboembolic Event Prophylaxis After Revision Hip And Knee Arthroplasty, Greg K. Deirmengian, Md, Snir Heller, Md, Eric B. Smith, Md, Mitchell Maltenfort, Phd, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

Introduction:

The optimal prophylaxis for prevention of venous thromboembolic events (VTE) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) remains unknown.(1) Current studies focus on primary arthroplasty and there are little to no data on the ideal prophylaxis for VTE following revision arthroplasty.(2) Revision surgery, due to its complexity, longer operative time, higher risk of bleeding and infection diff­ers from primary arthroplasty.(3) The objective of this study was to evaluate whether aspirin, known to be e­ffective for prevention of VTE after primary arthroplasty, is also e­ffective against such events following revision THA and TKA.

Anterior Talofibular Ligament Abnormality On Routine Magnetic Resonance Imaging Of The Ankle, Patrick Kane, Md, David Pedowitz, Md, Adam C C. Zoga, Md, Steven M. Raikin, Md

Rothman Institute Conference Posters

The anterior talo­fibular ligament (ATFL) extends from the anteroinferior border of the ­fibula to the talar neck. Primary restraint to ankle inversion in plantar‑exion. Injury (acute or chronic) can be diagnosed with physical exam, stress X-Rays, ultrasound or magnetic resonance imaging (MRI).

Purpose:

MRI abnormalities in asymptomatic individuals known in other areas of orthopaedics (shoulder and spine). Purpose of our study: determine the prevalence of ATFL abnormalities found on MRI in asymptomatic individuals. Asymptomatic individuals - those undergoing MRI for pathology unrelated to lateral ankle trauma, instability, or inversion injuries.

Is Further Treatment Necessary For Patellar Crepitus After Total Knee Arthroplasty?, Bo-Hyun Hwang, Md, Chang-Hyun Nam, Md, Kwang-Am Jung, Md, Alvin Ong, Md, Su-Chan Lee, Md

Rothman Institute Conference Posters

Introduction:

• Posterior-stabilized (PS) TKA that sacrifice the cruciate ligaments improves pain and function in patients with advanced osteoarthritis.
• Patellar crepitus appears to be due to a spectrum of peripatellar fibrosynovial formations and is usually encountered after PS-TKA, which uniquely has an intercondylar box to accept the tibial post.
• Symptoms of patellar crepitus occur most commonly during terminal knee extension and occur usually from 3 to 9 months after PS-TKA, and in some cases, this phenomenon is symptomatic enough to warrant an arthroscopic procedure or open arthrotomy.
• The development of patellar crepitus after PS-TKA appears related to many factors such as …

Postoperative Urinary Retention (Pour): What Are The Risk Factors?, Eric H. Tischler, Ba, Camilo Restrepo, Md, Jennifer Oh, Ba, Mitchell Maltenfort, Phd, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

Introduction

Total hip arthroplasty (THA) is a successful procedure alleviating pain in patients with debilitating arthritis. Postoperative urinary retention (POUR) is a common complication following surgery and is managed with intermittent or continued urinary catheterization. POUR has been estimated in retrospective literature to be on the order of 5% – 70% of surgical cases with early catheter removal or without a catheter. At our institution, and based on a Level 1 study here, urinary catheter is not used routinely in patients undergoing THA under regional anesthesia. The purpose of this study was to evaluate the incidence of POUR and risk …

A Clinical Decision Support Tool To Predict The Risk Of Failure In Patients With Femoroacetabular Impingement Undergoing Hip Preservation Surgery, Claudio Diaz-Ledezma, Md, Mitchell Maltenfort, Phd, Lesley Walinchus, Bs, Benjamin Hendy, Bs, Thomas Novack, Bs, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

In modern orthopaedics, risk prediction scores can help discriminate between ideal and poor candidates for a specifi­c therapeutic intervention. We consider these tools useful during the process of shared medical decision-making1. To our knowledge, such a strategy has never been explored in the ­field of hip preservation surgery.

The aim of our study is to generate a clinical decision support tool to predict risk of failure after hip preservation surgery among patients with femoroacetabular impingement (FAI).

Cost Benefit Analysis Of Athletic Team Coverage By An Orthopaedic Practice, Brandon Eck, Bs, Fotios Tjoumakaris, Md, Matthew Pepe, Md, Kevin Freedman, Md, Katherine Bagnato, Atc, Bradford Tucker, Md

Rothman Institute Conference Posters

Introduction

- Coverage of high school football by an orthopaedic practice is considered standard of care in many localities.

- Taking time away from an orthopaedic practice to provide on ­field athletic care has potential advantages and disadvantages.

- To this date, the economic value of this endeavor has never been investigated.

- Purpose: to perform a cost/benefi­t analysis of local high school sports coverage by an orthopaedic sports medicine practice.

High Variability In Outcomes Of Two-Stage Exchange To Treat Periprosthetic Joint Infection, Benjamin Zmistowski, Bs, Paul Lichstein, Md, Aaron H Carter, Md, Joshua J. Minori, Do, Javad Parvizi, Md

Rothman Institute Conference Posters

Introduction:

Periprosthetic joint infection (PJI) is a challenging condition to manage with sobering morbidity and mortality.1,2 Treatment options range from simple irrigation and debridement with prosthetic retention to explantation and placement of a temporary cement spacer. Indictations for each option are unclear and non-uniform despite signi­cant efforts to understand the management outcomes. Until recently, a uniform de­nition of success was unavailable, thus clouding the discussion of treatment options. Two-stage exchange is currently considered the “gold-standard” in North America, yet an appropriate understanding of the actual success and ancillary effects of treatment is needed. With the advantage of an expert opinion …

Threshold For Synovial Cell Count And Neutrophil Differential In Diagnosis Of Periprosthetic Knee Infection: A Multi-Institutional Study, Benjamin Zmistowski, Bs, Carlos Higuera, Md, Jane Liu, Ba, Wael Barsoum, Md, Joseph Mendelis, Ba, Craig Della Valle, Md, Javad Parvizi, Md

Rothman Institute Conference Posters

Introduction:

Synovial fl­uid analysis is an important tool in the work-up of suspected periprosthetic joint infection (PJI). Yet, there is confl­icting guidance for the analysis of synovial fl­uid aspiration, including a lack of uniform thresholds for white blood cell (WBC) count and neutrophil percentage (PMN%)1-3. Therefore, a multi-institutional study was undertaken to reassess these thresholds, compare preoperative versus intraoperative sample collection, and assess variation in results between institutions.

Risk Factors For Surgical Site Infection Following Total Joint Arthroplasty, Mohammad Rasouli, Md, Camilo Restrepo, Md, Mitchell Maltenfort, Phd, James J. Purtill, Md, Javad Parvizi, Md

Rothman Institute Conference Posters

Surgical Site Infection (SSI) after total joint arthroplasty (TJA) is a rare but devastating complication1. In spite of improvement in the prevention of SSI, these infections are still a signi­ficant cause of morbidity in surgical patients2. Management of Hospital Acquired infections (HAI) including SSI poses a huge economic burden on healthcare3. As part of the mission to reduce the burden of HAI, the Centers for Disease Control and Prevention (CDC) has issued guidelines for the prevention of SSI that are currently being updated4. In addition, CDC requires all hospitals to report HAI through the National Healthcare Safety Network (NHSN) surveillance …