K. Keely Boyle

Propionibacterium acnes Susceptibility and Correlation with Hemolytic Phenotype

Background Many studies have noted an increase in the number of recognized cases of invasive infections due to Propionibacterium acnes, especially after shoulder replacement surgery. The increase in the number of recognized cases of P. acnes, a nonspore-forming, anaerobic, Gram-positive organism, appears due to both an increase in the number of shoulder operations being performed and more specimens being sent for anaerobic cultures. Nevertheless, the optimal surgical and antibiotic management of P. acnes remains controversial. Methods We tested the susceptibility of 106 P. acnes strains from sterile body sites collected at the Erie County Medical Center between 2012 and 2015, using Etest gradient antibiotic strips. Results P. acnes is very susceptible to the penicillins and the first-generation cephalosporins. We noted an association between hemolytic phenotype on Brucella Blood Agar and clindamycin resistance. Conclusions Antimicrobial susceptibility testing of P. acnes should no longer just be confined to the research laboratory but expanded and incorporated into routine microbiological evaluation of P. acnes. This would improve patient care as well as help clarify the relationship between hemolysis and clindamycin resistance.

Tranexamic Acid Reduces Perioperative Blood Loss and Hemarthrosis in Total Ankle Arthroplasty

Tranexamic acid (TXA) is an effective agent used for reducing perioperative blood loss and decreasing the potential for postoperative hemarthrosis. We hypothesized that patients who had received intraoperative TXA during total ankle arthroplasty (TAA) would have a reduction in postoperative drain output, thereby resulting in a reduced risk of postoperative hemarthrosis and lower wound complication rates. A retrospective review was conducted on 50 consecutive patients, 25 receiving TXA (TXA-TAA) and 25 not receiving TXA (No TXA-TAA), who underwent an uncemented TAA between September 2011 and December 2015. Demographic characteristics, drain output, preoperative and postoperative hemoglobin levels, operative and postoperative course, and minor and major wound complications of the patients were reviewed. Drain output was significantly less in the TXA-TAA group compared to that in the No TXA-TAA group (71.6 ± 60.3 vs 200.2 ± 117.0 mL, respectively, P < .0001). The overall wound complication rate in the No TXA-TAA group was higher (20%, 5/25) than that in the TXA-TAA group (8%, 2/25) (P = .114). The mean change in preoperative to postoperative hemoglobin level was significantly less in the TXA-TAA group compared to that in the No TXA-TAA group (1.5 ± 0.6 vs 2.0 ± 0.4 g/dL, respectively, P = .01). TXA is an effective hemostatic agent when used during TAA. TXA reduces perioperative blood loss, hemarthrosis, and the risk of wound complications.

Antibiotic Prophylaxis and Prevention of Surgical Site Infection in Shoulder and Elbow Surgery

Infection after orthopedic procedures is a devastating and serious complication associated with significant clinical and financial challenges to the health care system and unfortunate patient. The time and resource-intensive nature of treating infection after orthopedic procedures has turned attention toward enhancing prevention and establishing quality improvement measures. Prevention strategies throughout the perioperative period include host optimization, risk mitigation, reducing bacterial burden and proper wound management. Understanding the most common offending organisms of the shoulder, Propionibacterium acnes and coagulase negative Staphylococcus species, and their hypothesized mechanism of infection is crucial to selecting appropriate preventative measures.

Tennis and Golfer’s Elbow: Epicondylitis

Epicondylitis is a common cause of elbow pain typically affecting adults between the ages of 40 and 50. Lateral epicondylitis, often referred to as “tennis elbow,” is more prevalent than medial or “golfers elbow.” Epicondylitis is encountered equally amongst men and women as a result of overuse. Repetitive stressors on the elbow from wrist flexion and extension results in micro-trauma and tears to the pronator-flexor mass or extensor mass. Patient history is usually consistent with hobbies that require repetitive flexion/extension of the elbow and wrist. With pure epicondylitis, imaging studies are negative for occult fractures and dislocations, resulting in a clinical diagnosis. On exam, patients are often tender over the affect epicondyle or just distally. Treatment options include ice, rest, activity modification, NSAIDS, bracing, physical therapy, and steroid injections. In the rare circumstance where nonoperative treatment fails, debridement of the pathologic tissue may be performed with decortication of the involved epicondyle.