• Shoulder arthroplasty for treatment of infected shoulder had low risk of reinfection

    Source - Healio

    Shoulder arthroplasty can be performed for the treatment of the sequelae of an infected shoulder with low risk of reinfection, according to study results.

    Twenty-four shoulders underwent shoulder arthroplasty for postinfectious glenohumeral arthritis between 1977 and 2009. Researchers monitored 23 shoulders for a minimum of 2 years or until reoperation and documented complications and clinical and radiographic results at the most recent follow-up.

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  • 'Therapy car' helps orthopedic patients avoid falls

    Source - Science Daily

    A “therapy car” is being used by physical and occupational therapists to help patients recovering from hip and knee replacement surgery simulate getting in and out of a real vehicle without falling or injuring themselves.

    Concurrently, Virginia Mason's application for a patent on this invention is being reviewed by the United States Patent and Trademark Office.

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  • THA outcomes, surgeon volume effects can be effectively managed

    Source - Healio

    Studies dating back nearly 20 years have shown a correlation between surgeon volume and the rate of complications in total hip arthroplasty, with higher-volume surgeons yielding lower complication rates.

    “There are a fair number of studies now that establish pretty clearly that volume matters — independent of the volume done by the hospital,” said Jeffrey N. Katz, MD, MSc, professor of medicine and orthopedic surgery at Harvard Medical School and Brigham & Women’s Hospital in Boston.

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  • New frailty test predicts risk of poor outcomes in elderly patients

    Source - Science Daily

    A simplified frailty index created by surgeons at Wayne State University School of Medicine in Detroit, Mich., is a reliable tool for assessing risk of mortality and serious complications in older patients considering total hip and knee replacement procedures, according to new study findings presented at the 2014 Clinical Congress of the American College of Surgeons.

    As more seniors stay healthier longer, elective operations such as hip and knee replacements are becoming more common. Traditionally, a person's eligibility for surgery has been based largely upon biological age. In recent years, however, a person's level of frailty (under-stood as a general decline in functional status) has come to be recognized as an independent risk factor for adverse health outcomes.

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  • Ankle Replacements of the Future

    Source - Ivanhoe

    It’s a surgery that is becoming increasingly more common. Ankle replacements usually are needed because of a bad accident or arthritis. But artificial ankles have come a long way and not all of them are the same.

    David Sander believes he is a walking medical marvel and told Ivanhoe, “It’s really a miracle.”

    The miracle is that he's walking at all after he slipped on an icy city sidewalk in the middle of winter. Sander said, “I lifted up my leg and my foot was backwards, and I said to myself oh my god.”

    After his initial surgery David knew it would eventually come to a replacement, his cartilage was gone leaving him with painful, debilitating arthritis. But he worried failure rates were high for artificial ankles.

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  • Chronic kidney disease increases prosthetic joint infection rates after TJA

    Source - Healio

    Patients with stage 1, 2 or 3 chronic kidney disease may have a higher rate of prosthetic joint injection after total joint arthroplasty, according to study results.

    Researchers retrospectively reviewed electronic medical records for 377 patients with stage 1 to 2 kidney disease with 402 patients who had stage 3 chronic kidney disease. All patients underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2004 and 2011.

    Patients with stage 3 chronic kidney disease had a greater rate of overall mortality compared with patients with stage 1 to 2 chronic kidney disease, according to the researchers.

    When adjusted for comorbid disease, the researchers found no significant increases in joint infection, readmission or early revision between patients with stage 1 to 2 chronic kidney disease compared with patients with stage 3 chronic kidney disease.

    Compared with patients with end-stage renal disease, dialysis and kidney transplant, overall incidence of infection was high but much less in chronic kidney disease patients.

    In a subgroup analysis, the significant difference in mortality rate persisted between the stage 1 to 2 group vs. the stage 3 group in patients who had undergone THA, but not in patients who had undergone TKA, according to the researchers.

    Study results showed a slightly lower rate of 90-day readmission in patients with stage 1 to 2 chronic kidney disease who underwent TKA than in patients with stage 3 chronic kidney disease, whereas 90-day readmission was slightly higher in the THA subgroup.

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  • Antibiotic cement during primary TKA may not decrease infection rates

    Source - Healio

    Judicious risk-stratified usage of antibiotic cement during primary total knee arthroplasty may not decrease infection at 1 year, according to study results. Researchers retrospectively reviewed data for 3,292 patients who underwent primary total knee arthroplasty (TKA). Patients were grouped into cohorts based on whether their surgery involved plain or antibiotic cement, or if they were high-risk patients who received antibiotic cement, and infection rates were compared between the cohorts.

    Study results showed a 30-day infection rate of 0.29% in cohort 1, 0.2% in cohort 2 and 0.13% in cohort 3.

    Infection rates in all cohorts increased at all time points, with 6-month rates at 0.39% in cohort 1, 0.54% in cohort 2 and 0.38% in cohort 3, and 1-year rates at 0.78% in cohort 1, 0.61% in cohort 2 and 0.64% in cohort 3. However, no statistically significant between-group differences in infection rates were seen at any of the time intervals studied, according to the researchers.

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  • Older patients still fastest-growing demographic for TKA

    Source - Healio

    Despite total knee arthroplasty becoming more prevalent in patients younger than 65 years of age, the main demographic of growth is still among patients older than 65, according to recent study data.
    Researchers compared 1999 to 2008 U.S. census data for individuals 18 to 44 years old, 45 to 64 years old, and 65 years and older and the number of total knee arthroplasties (TKAs) performed annually in each age group. Per-capita incidence rates were calculated, and the growth rate in all demographics was determined.

    Approximately 305,000 TKAs were performed beyond the number predicted by population growth alone in 2008. Patients older than 65 years of age represented the largest growing cohort, as 151,000 recorded TKA procedures and a per-capita growth rate from 5.2 to 9.1 procedures per 1,000 individuals was observed. Per-capita growth rate also increased from 1.4 to 3.3 procedures per 1,000 individuals among patients 45 to 64 years old.

    TKAs were found to have increased 234% during the span of this study, from 264,000 in 1999 and approximately 616,000 in 2008, with fewer than 48,000 of the additional procedures able to be explained by population increase, according to the researchers.

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  • Multiple predictors of unstable syndesmotic SER ankle fractures identified

    Source - Healio

    Fracture height, medial joint space and bone attenuation were determined to be useful predictors of unstable syndesmotic SER-type ankle fractures, according to a study.

    The retrospective study included 191 patients who underwent surgical fixation of SER-type ankle fractures. Age, sex and mechanism of injury (ie, low- or high-energy trauma), as well as radiographs and CT imaging scans, were reviewed for all patients. Researchers performed binary logistic regression analysis to identify all predictors of unstable syndesmotic injuries.

    Overall, 38 patients (19.9%) had a concurrent unstable syndesmotic injury. Age, sex, mechanism of injury, fracture height, medial joint space and bone attenuation were significantly different between stable or unstable syndesmotic patients, according to the researchers.

    Through binary logistic analysis, the researchers found that fracture height, medial joint space and bone attenuation were significant factors contributing to unstable syndesmotic injuries.

    Cutoff values for predicting unstable syndesmotic injuries on CT scans were fracture height of 3 mm or larger and medial joint space of 4.9 mm or larger; cutoff values on radiograph were fracture height of 7 mm or larger and medial joint space of 4.5 mm or larger.

    Disclosure: The authors have no relevant financial disclosures.

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  • New approach to total knee replacement spares muscle, decreases pain

    Source - The Daily Progress

    Total knee arthroplasty, also known as total knee replacement, is one of the most commonly performed orthopedic procedures. According to the American Academy of Orthopedic Surgeons, as of 2010, more than600,000 total knee replacements were being performed annually in the United States. The number of total knee replacements performed annually in the U.S. is expected to grow by 673 percent to 3.48 million procedures by 2030.

    To start, a rigorous preoperative optimization process is now in place to help minimize the risk of complications after surgery. Patients also attend a joint education class to be advised of what to expect before, during and after the surgery. Studies have shown that these educational classes improve patient outcomes.

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