Mohammad Taghi Ghazavi

Reconstruction of massive bone defects with allograft in revision total knee arthroplasty

Allograft bone was used to reconstruct a defect in the proximal aspect of the tibia or the distal aspect of the femur, or both, in thirty knees of twenty-eight patients who had a revision total knee arthroplasty. The average age of the patients at the time of the index procedure was 65.8 years (range, twenty-four to eighty-nine years). At an average of fifty months (range, twenty-four to 132 months; median, thirty-six months) postoperatively, the score for twenty-three knees (twenty-one patients) had increased by at least 20 points, and these knees did not need additional operative treatment. Thus, the rate of success was 77 per cent. The procedure was considered a failure for the remaining seven knees because of infection (three), loosening of the tibial component (two), fracture of the graft (one), and non-union at the allograft-host junction (one). Properly applied allograft can be used to reconstruct massive bone defects, provide stability and support for implants, and restore bone stock in the event that additional operative treatment is necessary.

Optimal Timing and Antibiotic Prophylaxis in Periprosthetic Joint Infection: Literature Review and World Consensus (Part Two)

Context: There is a need to find the optimal doses and any need for weight adjustment in patients who have higher than standard BMI. There is also a need to determine if repeating doses of antibiotics is necessary when the surgery takes longer than usual. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 28 of 221 articles were relevant to the 2 following questions regarding perioperative antibiotic prophylaxis to prevent PJI. Results: Preoperative antibiotics have different pharmacokinetics based on patient weight and should be weight-adjusted. An additional dose of antibiotic should be administered intraoperatively after two half-lives of the prophylactic agent. The general guidelines for frequency of intraoperative antibiotic administration are provided. We recommend that re-dosing of antibiotics be considered in cases of large blood volume loss (> 2000 cc) and fluid resuscitation (> 2000 cc). As these are independent variables, re-dosing should be considered as soon as the first of these parameters are met. Conclusions: Recommendations for need for weight adjustment doses and repeat of doses in longer duration surgeries in terms of perioperative antibiotic prophylaxis in hip and knee arthroplasty were provided based on evidences in the literature and consensus of expert delegates from consensus meeting.