The Journal of arthroplasty
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Preoperative screening and decolonization of methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA, respectively) are advocated to reduce surgical site infections. We determined the rate and duration of decolonization in patients undergoing elective orthopedic surgery. Patients undergoing elective orthopedic surgery were seen in our preoperative testing program (PAT) and had their anterior nares cultured for MRSA and MSSA. ⋯ Staphylococcus aureus decolonization with intranasal mupirocin and topical chlorhexidine was effective but not persistent in a significant proportion of patients. A small number of previously uncolonized patients became colonized. Staphylococcus aureus screening and decolonization protocols must be repeated before any readmission, regardless of prior colonization status.
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Randomized Controlled Trial
Three-in-one nerve block with different concentrations of bupivacaine in total knee arthroplasty: randomized, placebo-controlled, double-blind trial.
Pain after total knee arthroplasty may be severe and lead to adverse outcomes. Using 2 concentrations of bupivacaine, we investigated 3-in-1 nerve block's effect on pain control, narcotic use, sedation, and patient satisfaction. One hundred five patients undergoing unilateral total knee arthroplasty were randomized into 3 groups: low-dose or high-dose bupivacaine or placebo. ⋯ There were no significant differences among groups with respect to nausea or sedation. Patients in each group exhibited high overall satisfaction. Low-dose bupivacaine was superior to high-dose bupivacaine for pain relief, narcotic consumption, and patient satisfaction in the early postoperative period.
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Comparative Study
A biomechanical comparison of periprosthetic femoral fracture fixation in normal and osteoporotic cadaveric bone.
Several techniques are described for fixation of Vancouver B1 femoral shaft fractures after total hip arthroplasty. Twenty-four femurs were scanned by dual x-ray absorptiometry scanned and matched for bone mineral density. Femurs were implanted with a cemented simulated total hip prosthesis with a simulated periprosthetic femur fracture distal to the stem. ⋯ Cable constructs failed proximally. No proximal failures occurred in specimens fixed with screws and cables. A combination of locked or nonlocked screws and supplemental cable fixation is recommended for the treatment of Vancouver B1 periprosthetic femur fractures.
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We asked what the incidence of asymptomatic filling defects is on routine multidetector computed tomography (MDCT) in primary hip (total hip arthroplasty [THA]) and knee arthroplasties (TKA) patients. We prospectively performed MDCT scans on the first postoperative day for THA (n = 21)/TKA (n = 27). ⋯ All patients diagnosed with a filling defect were discharged from the hospital without treatment of symptomatic pulmonary embolism. Our study demonstrates a high rate of abnormal MDCT early after lower extremity arthroplasty, the clinical importance of which may be benign.
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The term pseudotumor was coined by Pandit et al (J Bone Joint Surg Br. 2008; 90:847) to describe the features of a soft tissue mass, which is neither infective nor malignant, that is found in association with hip arthroplasty. Most previously reported cases have been associated with a metal-on-metal articulation, with the largest series occurring after hip resurfacing. The author describes a patient who developed a pseudotumor secondary to particulate disease arising after polyethylene liner wear that led to a metal-on-metal articulation in conventional hip arthroplasty.