Browsing by Subject "Orthopedic Surgery"

Now showing 1 - 8 of 8
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    Complications and Outcomes Associated with Two-Stage Treatment of Periprosthetic Total Knee Infection
    (2022-07-22) Thomas, Jacob; Ziemba-Davis, Mary; Meneghini, R. Michael
    Background and Hypothesis: Periprosthetic joint infection (PJI) is treated with implant resection, debridement, and component reimplantation after infection eradication. Treatment consists of either a single surgery or two-stage surgery with intravenous antibiotic therapy between stages. We replicated a recent study which concluded two-stage treatment is associated with high morbidity, hypothesizing that complication rates would be similar, but that morbidity is not always conclusively a consequence of two-stage treatment for PJI Project Methods: Prospectively documented data on all primary and revision knees undergoing two-stage treatment for PJI by a single surgeon were retrospectively reviewed. Surgical complications were quantified for the interstage and post-reimplantation periods. Chi-squared tests were used to compare current findings to published findings. Results: Patient demographics and comorbidities were equivalent in the two studies (p ≥ .137). More complex infections characterized the current study as evidenced by significantly more polymicrobial infections (p < .001) and greater use of static spacers due to bone loss (p = .002). Nonetheless, only 1.5% of cases in the current study did not undergo component reimplantation compared to 7.8% in the comparison study (p = .129). There were no differences in the number of additional interstage and post-reimplantation septic surgeries (p ≥ .492). Using a proposed system which penalizes additional operations required to eradicate infection, treatment success rates at minimum one year follow-up were 64% and 71%, respectively (p = .473). Without these penalties, treatment success in the current study was 95.6% (equivalent proportion not available for comparison study). All-cause mortality was statistically equivalent in the two studies (15.6 versus 7.6%, p = .144) but no deaths from PJI were observed in the current study (unknown for comparison study). Potential Impact: Study findings suggest that morbidity attributed to two-stage treatment reflect the inherent complexity of this patient group, and not the two-stage treatment itself.
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    Complications and Outcomes Associated with Two-Stage Treatment of Periprosthetic Total Knee Infection
    (2024-04-19) Thomas, Jacob; Ziemba-Davis, Mary; Buller, Leonard T.; Meneghini, R. Michael
    Background: Chronic periprosthetic joint infection (PJI) has been traditionally treated with two-stage revision. However, single-stage treatment is gaining popularity based on claims of decreased morbidity and mortality. This study sought to evaluate whether two-stage treatment for chronic knee PJI is associated with high morbidity and complication rates compared to existing literature. Methods: Prospectively collected data on all two-stage knee revisions were retrospectively reviewed (n=97). Modern perioperative optimization protocols were implemented during the interstage and post-reimplantation periods. Surgical complications were quantified for interstage and post-reimplantation periods. Chi-squared tests compared current findings to published data. Results: Patient sex and age were equivalent, with more current smokers in the present study (P=.001) and more renal failure (P=.002) in the comparison study. Infection complexity in the current study is indicated by 84% late chronic infections in compromised (McPherson) hosts (70%) with 14% polymicrobial infections (unknown for comparison). One percent of cases in the current study did not undergo component reimplantation compared to 8.2% in the comparison study (P=.015). There were no differences in interstage and post-reimplantation septic surgeries (P=.566). Within a year of reimplantation, 9% versus 29% underwent septic reoperation (P=.0002). Using a proposed system from the comparison study penalizing additional operations required to eradicate infection, treatment success rates at minimum one-year follow-up were 56% (current study) and 51% (comparison study) (P=.412). Without these penalties, treatment success in the current study was 64% (unknown for comparison). All-cause mortality rates were the same in both samples (13.4%); however, 9/13 deaths in the current study were unrelated to PJI (unknown for comparison). No patients in the current sample died within the first postoperative year compared to 6.7% in the comparison (P=.024). Conclusion: Study data suggest morbidity attributed to two-stage treatment for PJI reflects the inherent complexity of this patient group, and not the two-stage treatment itself.
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    Indiana Orthopaedic Journal, Volume 1
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2007) Feinberg, Judy R.; Roberts, Donna L.
    Inaugural edition (volume 1) of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana Orthopaedic Journal, Volume 2
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2008) Feinberg, Judy R.; Roberts, Donna L.
    Volume 2 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana Orthopaedic Journal, Volume 3
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2009) Feinberg, Judy R.; Roberts, Donna L.
    Volume 3 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana Orthopaedic Journal, Volume 4
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2010) Feinberg, Judy R.; Roberts, Donna L.
    Volume 4 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana University School of Medicine Orthopaedic Surgery Annual Report 2022
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2022) Orthopaedic Surgery, Indiana University School of Medicine
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    The Effect of Large Femoral Heads and Acetabular Cup Position on PROMs after Modern Posterior Approach THA
    (2024-04-26) Darden, Austin; Deckard, Evan; Meneghini, R. Michael
    INTRODUCTION: Use of large femoral heads (≥40mm) in total hip arthroplasty (THA) decreases postoperative dislocation by increasing impingement-free range of motion, however, may leave patients more susceptible to groin pain. Also, limited data exist for the effect of large femoral heads and acetabular cup position on modern patient-reported outcome measures (PROMs). Therefore, the purpose of this study was to evaluate the effect of large femoral heads (≥40mm) and acetabular cup position on PROMs after primary THA. METHODS: 328 primary THAs performed by a single surgeon were retrospectively reviewed. Acetabular cup inclination and anteversion were measured using Martell Hip Analysis Suite software. Femoral head and acetabular cup sizes were recorded from the electronic medical record. Prospectively collected PROMs (and covariates) related to activity level, satisfaction, and overall hip health were evaluated. RESULTS: Age, covariates related to PROMs, and acetabular cup position did not differ between ≥40mm and <40mm femoral head groups (p≥0.177). The ≥40mm head group had significantly higher mean BMI and proportion of males (p≤0.022). UCLA Activity level and satisfaction scores did not differ preoperatively or postoperatively at 4-months or minimum 1-year follow-up between femoral head groups (p≥0.209). Preoperative HOOS JR scores did not differ by femoral head groups (p=0.538). At 4-months, mean HOOS JR score was significantly higher in the ≥40mm head group compared to the <40mm head group (p=0.027); however, both groups achieved similar mean HOOS JR scores by minimum 1-year follow-up (p=0.956). HOOS JR score >90 and being ‘very satisfied or satisfied’ correlated with wide ranges and several combinations of acetabular cup inclination and anteversion. CONCLUSION: Patients achieved comparable PROMs regardless of femoral head size suggesting large femoral heads may not leave patients susceptible to groin pain in addition to reducing the risk of postoperative dislocation. Excellent patient outcomes correlated with wide ranges of acetabular cup position.