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Related Articles

Should Draining Wounds and Sinuses Associated With Hip and Knee Arthroplasties Be Cultured?

J Arthroplasty. 2013 Jul 29;

Authors: Tetreault MW, Wetters NG, Aggarwal VK, Moric M, Segreti J, Huddleston JI, Parvizi J, Della Valle CJ

Abstract
We assessed the utility of culturing draining wounds or sinuses in evaluating periprosthetic joint infection (PJI). Fifty-five patients with a draining wound or sinus after total joint arthroplasty (28 knees, 27 hips) who had not received antibiotics for at least two weeks were prospectively studied. Superficial wound cultures were compared to intra-articular cultures to determine accuracy in isolating infecting organism(s). The superficial cultures were concordant with deep cultures in 26 of 55 cases (47.3%) and were more likely to generate polymicrobial results (27.3% vs. 10.9%; P=0.023). In 23 cases (41.8%), the superficial cultures would have led to a change in antibiotic regimen. Superficial cultures yielded bacterial growth in 8 of the 10 cases (80%) when deep cultures and further work-up suggested the absence of deep infection. Given the potential to misguide diagnosis and treatment, we recommend against obtainment of superficial cultures in patients with a draining wound or sinus following hip or knee arthroplasty.

PMID: 23906868 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23906868?dopt=Abstract

Related Articles

A New Technique for Radiographic Measurement of Acetabular Cup Orientation.

J Arthroplasty. 2013 Jul 26;

Authors: Derbyshire B, Diggle PJ, Ingham CJ, Macnair R, Wimhurst J, Jones HW

Abstract
Accurate radiographic measurement of acetabular cup orientation is required in order to assess susceptibility to impingement, dislocation, and edge loading wear. In this study, the accuracy and precision of a new radiographic cup orientation measurement system were assessed and compared to those of two commercially available systems. Two types of resurfacing hip prostheses and an uncemented prosthesis were assessed. Radiographic images of each prosthesis were created with the cup set at different, known angles of version and inclination in a measurement jig. The new system was the most accurate and precise and could repeatedly measure version and inclination to within a fraction of a degree. In addition it has a facility to distinguish cup retroversion from anteversion on anteroposterior radiographs.

PMID: 23896357 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23896357?dopt=Abstract

Related Articles

Correlation of Magnetic Resonance Arthrography with Revision Hip Arthroscopy.

Clin Orthop Relat Res. 2013 Aug 1;

Authors: McCarthy JC, Glassner PJ

Abstract
BACKGROUND: Arthroscopic approaches for the diagnosis and treatment of hip disorders are well established; however, there are limited data regarding revision hip arthroscopy. There have been several studies evaluating the findings of MR arthrography with primary hip arthroscopy, but to our knowledge, no study has evaluated the diagnostic value of MR arthrography before revision hip arthroscopy.
QUESTIONS/PURPOSES: We obtained sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MR arthrography to detect labral lesions, chondral lesions and loose bodies before revision hip arthroscopy.
METHODS: We performed a single-surgeon, retrospective review of 70 revision hip arthroscopies (62 patients) and assessed the association between MR arthrography findings and intraoperative findings. There were 43 females and 19 males with a mean age of 36 years (range, 17-59 years). Radiographic interpretation was performed by one of four fellowship-trained musculoskeletal radiologists at three institutions, who had at least 5 years of experience. Radiographic findings were compared with surgical findings by one of the authors for calculation of sensitivity, specificity, PPV, and NPV.

Related Articles

Age-Dependent Fracture Risk in Hip Revisions With Radial Impaction Grafting Technique: A 5-10 Year Medium-Term Follow-Up Study.

J Arthroplasty. 2013 Jul 25;

Authors: Chomrikh L, Gebuhr P, Bierling R, Lind U, Zwart HJ

Abstract
Radial impaction grafting (RIG) potentially improves the durability and reliability of cementing the femoral components in revision total hip arthroplasty (THA). In this multicenter, prospective study, 88 revision THAs (87 patients) with RIG technique were performed. The average follow-up time was 7.0years (range, 5.0-10.2). There were 14 femur fractures: 2 intraoperative, 5 within 3months after surgery, and 7 later in the postoperative stage (range, 5-84months). Sixteen patients were lost to follow-up and 20 died without stem re-revision. None of the patients have been re-revised for any reason during follow-up. Age was observed to be a significant factor for determining fracture risk. In conclusion, RIG can be considered a reliable surgical technique, especially for younger patients.

PMID: 23891061 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23891061?dopt=Abstract

Related Articles

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection.

Clin Orthop Relat Res. 2013 Aug 1;

Authors: Portillo ME, Salvadó M, Alier A, Sorli L, Martínez S, Horcajada JP, Puig L

Abstract
BACKGROUND: The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI).
QUESTIONS/PURPOSES: We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis.
METHODS: All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards