Acetabular Component Positioning in Primary THA via an Anterior, Posterolateral, or Posterolateral-navigated Surgical Technique

The purpose of this study was to compare the acetabular component alignment in patients undergoing primary total hip arthroplasty (THA) via 3 surgical techniques: direct anterior using intraoperative fluoroscopy, posterolateral using an external alignment guide (posterolateral conventional), and posterolateral using computer navigation (posterolateral navigated). Two surgeons performed the direct, anterior THAs; 2 surgeons performed the posterolateral-conventional THAs; and 1 surgeon performed the posterolateral-navigated THAs. The most recent 110 THAs performed using each approach were reviewed, and Einsel-Bild-Roentgen analysis software was used to measure the acetabular component abduction and anteversion. One-way analysis of variance showed the anterior cohort to have a more horizontal alignment of the acetabular component (P,.001); 90.9% of the acetabular components in the posterolateral-navigated cohort were within 40°610° and 15°610° for both acetabular abduction and anteversion, respectively, vs 70% in the posterolateral-conventional (P,.001), and 68.2% in the anterior cohort (P,.001). The anterior technique using intraoperative fluoroscopy does not improve acetabular positioning compared with the conventional, posterolateral technique

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137753/1/acr23274.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137753/2/acr23274_am.pd

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137769/1/art40149.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137769/2/art40149_am.pd

Machine learning identification of thresholds to discriminate osteoarthritis and rheumatoid arthritis synovial inflammation

Background We sought to identify features that distinguish osteoarthritis (OA) and rheumatoid arthritis (RA) hematoxylin and eosin (H&E)-stained synovial tissue samples. Methods We compared fourteen pathologist-scored histology features and computer vision-quantified cell density (147 OA and 60 RA patients) in H&E-stained synovial tissue samples from total knee replacement (TKR) explants. A random forest model was trained using disease state (OA vs RA) as a classifier and histology features and/or computer vision-quantified cell density as inputs. Results Synovium from OA patients had increased mast cells and fibrosis (p < 0.001), while synovium from RA patients exhibited increased lymphocytic inflammation, lining hyperplasia, neutrophils, detritus, plasma cells, binucleate plasma cells, sub-lining giant cells, fibrin (all p < 0.001), Russell bodies (p = 0.019), and synovial lining giant cells (p = 0.003). Fourteen pathologist-scored features allowed for discrimination between OA and RA, producing a micro-averaged area under the receiver operating curve (micro-AUC) of 0.85±0.06. This discriminatory ability was comparable to that of computer vision cell density alone (micro-AUC = 0.87±0.04). Combining the pathologist scores with the cell density metric improved the discriminatory power of the model (micro-AUC = 0.92±0.06). The optimal cell density threshold to distinguish OA from RA synovium was 3400 cells/mm2, which yielded a sensitivity of 0.82 and specificity of 0.82. Conclusions H&E-stained images of TKR explant synovium can be correctly classified as OA or RA in 82% of samples. Cell density greater than 3400 cells/mm2 and the presence of mast cells and fibrosis are the most important features for making this distinction

Relationship Between Perioperative Urinary Tract Infection and Deep Infection After Joint Arthroplasty

Abstract Surgical wound infection is a serious and potentially catastrophic complication after joint arthroplasty. Urinary tract infection is a common infection that creates a potential reservoir of resistant pathogens and increases patient morbidity. We asked whether treated preoperative and postoperative urinary tract infections are risk factors for deep joint infection. We examined the medical records of 19,735 patients. The minimum had joint infections develop. Of these, three had preoperative and four had postoperative urinary tract infections. The majority of bacteria were not enteric. The bacteria in the two types of infections were not identical. Control subjects were randomly selected from a list of patients matched with patients having infections. Of these, eight had preoperative and one had postoperative urinary tract infections. We found no association between the preoperative urinary tract infection (odds ratio, 0.341; 95% confidence interval, 0.086-1.357) or postoperative urinary tract infection (odds ratio, 4.222; 95% confidence interval, 0.457-38.9) and wound infection. Only one of the 58 patients with wound infections had a urinary tract infection with the same bacteria in both infections. Given the infection rate was very low (0.29%), the power of the study was only 25%. Although limited, the data suggest patients with urinary tract infections had no more likelihood of postoperative infection. We believe treated urinary tract infection should not be a reason to delay or postpone surgery. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence

Perioperative Complications and Impact of Diabetes Mellitus Severity on Revision Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a common and effective treatment of knee osteoarthritis. As the amount of TKAs performed increases, so does the number of TKA failures and subsequent revisions. Diabetes mellitus (DM) has been shown to increase complications following orthopedic procedures. For these reasons, it is important to understand the association between severity of DM and the risk of perioperative adverse events following revision TKA. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2007 and 2014 were identified and recorded as having non-insulin-dependent DM (NIDDM), insulin-dependent DM (IDDM), or no DM. Univariate and multivariate analysis were used to evaluate the incidence of multiple adverse events within 30 days after revision TKA. Results: A total of 9,921 patients who underwent revision TKA were selected (without DM = 7845 [79.1%]; NIDDM = 1349 [13.6%]; IDDM = 727 [7.3%]). Patients with NIDDM were found to have an increased risk of developing 1 of 20 adverse events studied compared to patients without DM, while patients with IDDM were found to have an increased risk of developing 6 of 20 adverse events compared to patients without DM. Conclusion: Relative to patients with NIDDM, those with IDDM have a greater likelihood of developing more adverse perioperative outcomes than patients without DM. Although complication rates remain relatively low, orthopedic surgeons must consider the implications of diabetes and insulin dependence on patient selection, preoperative risk stratification, and postoperative outcomes

The Impact of COPD on Postoperative Outcome and Complications in Patients Undergoing Primary Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is one of the most common operating room procedures performed in the United States and has been increasing over the past decade as the population continues to age. The incidence of chronic obstructive pulmonary disease (COPD) in the aging population has been steadily increasing as well. As a result, a larger percentage of patients who undergo TKA have COPD. In this study we assessed the following: (1) What demographics and comorbidities are most likely to present concurrently in patients with COPD? (2) Are patients with COPD undergoing TKA at increased risk for development of postoperative complications within 30 days? (3) Do patients with COPD have a higher propensity for extended hospital stay or unplanned return to operating room? (4) Does COPD act as an independent risk factor for development of postoperative complications within 30 days? Methods: A retrospective cohort study was conducted utilizing data collected via the American College of Surgeons National Quality Improvement Program Database. Patients who underwent primary TKA from 2005 to 2014 were included in this study. Complications were classified into operative, directly related to surgical procedure, and non-operative, indirectly related to surgical procedure. Univariate and multivariate analyses were conducted on appropriate data. Results: COPD was an independent risk factor for complications including deep surgical site infections (DSSI), pneumonia, re-intubation, failure to wean \u3e 48 hours, progressive renal insufficiency, acute renal failure and cardiac arrest requiring resuscitation. Patients with COPD were additionally found to have longer hospital stays and non-home discharge