Thomas L. Bradbury

The Fate of Acute Methicillin-Resistant Staphylococcus aureus Periprosthetic Knee Infections Treated by Open Debridement and Retention of Components

The success of open irrigation and debridement with component retention (ODCR) for acute periprosthetic knee joint infection varies widely. The species and virulence of the infecting organism have been shown to influence outcome. This multicenter, retrospective study identified 19 cases of acute periprosthetic methicillin-resistant Staphylococcus aureus (MRSA) knee infections managed by ODCR and at least 4 weeks of postoperative intravenous vancomycin therapy. At minimum follow-up of 2 years, the treatment failed to eradicate the infection in 16 cases (84% failure rate). Of those 16 failures, 13 patients required a 2-stage exchange arthroplasty, 2 patients required repeat incision and debridement with antibiotic suppression, and 1 patient died of MRSA sepsis. In addition, a systematic review of the literature revealed failure to eradicate infection in 10 of 13 patients managed with a similar protocol. The total success rate of ODCR in acute periprosthetic MRSA knee infection was 18%.

Inpatient Enoxaparin and Outpatient Aspirin Chemoprophylaxis Regimen After Primary Hip and Knee Arthroplasty: A Preliminary Study

Our institution has used a thromboprophylaxis regimen consisting of inpatient enoxaparin and outpatient aspirin for patients at standard risk for venous thrombosis after hip and knee arthroplasty. We reviewed 500 cases using this protocol. Inpatient treatment with enoxaparin averaged 2.75 days, followed by a 28-day course of aspirin. The overall thrombosis rate was 0.6% (1 deep venous thrombosis and 2 pulmonary emboli). Bleeding requiring transfusion of 3 or more units of packed red blood cells occurred in 1.8% of the cases. Fifteen infections were noted, 14 superficial and 1 deep. This compared favorably with a control group of 500 patients using a 14-day course of enoxaparin followed by 14 days of aspirin. We believe that a brief course of inpatient enoxaparin and outpatient aspirin is a safe and effective form of thromboprophylaxis.

Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination

BACKGROUND A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training. METHODS Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer). RESULTS Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (average 5.2) (P < .001). Fellowship-trained surgeons performed significantly more revision surgeries for infection (71% vs 29%)(P < .001). High-volume surgeons had significantly fewer complications in both primary (11.1% vs 19.6%) and revision surgeries (29% vs 35.5%) (P < .001). Those who passed the Part II examination reported higher rates of complications (21.5% vs 19.9%). CONCLUSION In early practice, primary and revision hip arthroplasties are often performed by surgeons without adult reconstruction fellowship training. Complications are less frequently reported by surgeons with larger volumes of joint replacement surgery who perform either primary or more complex cases. Primary hip arthroplasty is increasingly performed by surgeons early in practice who have completed an adult reconstructive fellowship after residency training. This trend is even more pronounced for more complex cases such as revision or management of infection.

Femoral neuropathy following direct anterior total hip arthroplasty: an anatomic review and case series†

Abstract The popularity of the direct anterior approach for total hip arthroplasty (THA) has dramatically increased in recent years. Many patients request this muscle sparing approach for the theorized benefits of quicker recovery and reduced post-operative pain. Femoral nerve injury is a rare, yet serious complication following the anterior approach for THA. During the 7-year period from 2008 to 2016, 1756 patients underwent primary THA with a direct anterior approach by a single senior surgeon for end-stage osteoarthritis. Six (0.34%) of these patients had a post-operative femoral nerve palsy. We aim to discuss anatomic considerations, risk factors, and a timeline of severity and recovery for femoral nerve palsy following direct anterior THA in six patients.

Current Review; Biomarkers in Diagnosing PeriprostheticJoint Infection

Periprosthetic joint infection (PJI) is one of the most dreaded complications after total joint arthroplasty [1]. There is no gold standard for diagnosing PJI, hence, a clinician who encounters a suspected PJI case, ought to use a combination of tests. All of which, besides their expense can be invasive and even this can’t provide 100% accuracy [2]. Several biomarkers have been introduced that are potentially reliable tools for diagnosing PJI [3]. In this article, we aimed to review the current diagnostic measures of PJI with a special focus on molecular biomarkers.

Renal failure after placement of an articulating, antibiotic impregnated polymethylmethacrlyate hip spacer

A 58-year-old male presented with native joint septic arthritis of the hip and osteomyelitis. After treatment with an articulating antibiotic spacer, he developed acute renal failure requiring dialysis. He continued to have elevated serum tobramycin levels exclusively from the antibiotic spacer elution as no intravenous tobramycin was used. Subsequent explantation was required to correct his renal failure. Although renal failure after antibiotic impregnated cement placement is rare, the risk of this potential complication should be considered preoperatively and in the postoperative management of these patients.

Resection Arthroplasty and Hip Joint Fusion

The continued improvement in both prosthetic bearing technology and the methods by which prosthetic implants are fixed to host bone have reduced the frequency of both wear particle induced osteolysis and aseptic implant loosening after total hip arthroplasty. Improvements in surgical technique and operative efficiency have helped reduce complications related to infection and intraoperative soft-tissue damage. Infection rates in many high volume joint replacement centers have stabilized below 1 % (J Bone Joint Surg Am. 89(8):1675–84, 2007). Even in the setting of significant bone destruction, viable options for reconstruction via revision arthroplasty often exist. As such, the need for salvage operations for failed total hip arthroplasty has diminished.