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Fluoroscopic Imaging of Acetabular Cup Position During THA Through a Direct Anterior Approach [Letter]
Deshmukh, Ajit J; Rathod, Parthiv A; Rodriguez, Jose A
PMID: 24410594
ISSN: 0147-7447
CID: 771552
Antimicrobial properties and elution kinetics of linezolid from polymethylmethacrylate
Snir, Nimrod; Meron-Sudai, Shiri; Deshmukh, Ajit J; Dekel, Shmuel; Ofek, Itzhak
Polymethylmethacrylate (PMMA) impregnated with antibiotics is widely used in the treatment of osteomyelitis and infected arthroplasties. With the emergence of resistant bacterial strains, linezolid, which is active against gram-positive bacteria and toward which resistance has been scarce, has been suggested as an alternative. In the current in vitro study, the authors sought to determine and compare the efficacy and elution kinetics of linezolid from PMMA. Polymethylmethacrylate beads impregnated with linezolid, vancomycin, or gentamicin alone and in combinations were placed in suspensions of vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, and Staphylococcus epidermidis. The leaching out concentrations of antibiotics and growth inhibitory time in days were recorded. The mechanical strength of cement beads was evaluated in accordance with International Standard 5833. The growth inhibitory time of linezolid was significantly longer than that of vancomycin and gentamicin for methicillin-resistant S aureus, vancomycin-resistant enterococci, and S epidermidis. The combination of linezolid with gentamicin and vancomycin significantly increased the growth inhibitory time compared with either antibiotic used alone. Linezolid alone or in combination with vancomycin and gentamicin showed satisfactory elution kinetics and antimicrobial activity in vitro without compromising the mechanical strength of PMMA. Future research evaluating the in vivo profile of linezolid-loaded PMMA in experimental animals is needed before it can be considered for human use.
PMID: 24200446
ISSN: 0147-7447
CID: 771582
Thromboembolic complications in arthroscopic surgery
Greene, Joseph W; Deshmukh, Ajit J; Cushner, Fred D
Venous thromboembolism (VTE) is a relatively rare complication of arthroscopic surgery but has the potential to cause significant morbidity and even mortality. VTE has been reported after shoulder and knee arthroscopy prompting controversial guidelines to be proposed. More limited studies are available regarding hip and ankle arthroscopy and 1 case of deep venous thrombosis in the contralateral leg status after hip arthroscopy exists. No reports have been published regarding VTE after elbow or wrist arthroscopy to these authors' knowledge. In this article, a systematic review of the literature was conducted to analyze the incidence, treatment, and prevention of thromboembolic complications in arthroscopy.
PMID: 23649153
ISSN: 1062-8592
CID: 771592
Early Failure of a Ceramic-on-Metal Total Hip Arthroplasty: A Case Report
Deshmukh, Ajit J; Rathod, Parthiv A; Rodgers, William H; Rodriguez, Jose A
PMID: 29252426
ISSN: 2160-3251
CID: 3063312
Does total knee arthroplasty change frontal plane knee biomechanics during gait?
Orishimo, Karl F; Kremenic, Ian J; Deshmukh, Ajit J; Nicholas, Stephen J; Rodriguez, Jose A
BACKGROUND: Dynamic knee varus angle and adduction moments have been reported to be reduced after TKA. However, it is unclear whether this reduction is maintained long term. QUESTIONS/PURPOSES: We therefore asked whether (1) the dynamic knee adduction angle and moment remain reduced 1 year after TKA, (2) if changes in adduction moment are related to static alignment and varus angle during gait 6 months and 1 year after TKA, and (3) if these changes in loading pattern are related to changes in Knee Society scores. METHODS: We performed gait analysis on 15 patients (17 TKAs) before surgery and 6 months and 1 year after TKA. Weightbearing radiographs were used to assess coronal plane knee alignment. RESULTS: TKA corrected static knee alignment from 2.2 degrees (2.5 degrees ) varus to 3.5 degrees (2.7 degrees ) valgus at 6 months. Peak varus angle during gait was reduced from 9.7 degrees (6.5 degrees ) to 3.6 degrees (5.8 degrees ) at 6 months and 5.2 degrees (7.6 degrees ) at 1 year. Peak adduction moment was reduced to 85% of the preoperative level at 6 months but increased to 94% of the preoperative level at 1 year. We observed a correlation between the increase in dynamic varus angle and increase in adduction moment from the 6-month to 1-year followups. CONCLUSIONS: TKA improves knee adduction moment at 6 months, but this effect is lost with time (1 year). CLINICAL RELEVANCE: Despite restoration of static knee alignment, knee adduction moment remains high presumably predisposing to medial polyethylene wear as noted by retrieval studies.
PMCID:3293981
PMID: 22125248
ISSN: 0009-921x
CID: 771602
Patterns of osseointegration and remodeling in femoral revision with bone loss using modular, tapered, fluted, titanium stems
Rodriguez, Jose A; Deshmukh, Ajit J; Klauser, Wolfgang U; Rasquinha, Vijay J; Lubinus, Philipp; Ranawat, Chitranjan S
Radiographic signs of osseointegration with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss have not been previously categorized. Serial radiographs of 64 consecutive hips with mean follow-up of 6.2 years were retrospectively reviewed. Bone loss was classified as per Paprosky classification, osseointegration was assessed according to a modified system of Engh et al, and Harris Hip Score was used to document pain and function. Seventy-four percent of the hips had type 3 or 4 bone loss. All stems were radiographically osseointegrated. Early minor subsidence was seen in 6.2% of the hips; definite bony regeneration, 73% of the hips; and stress shielding, 26% of the hips. These osseointegration patterns were different from those described for extensively porous-coated cobalt-chromium stems and had a bearing on the evaluation of fixation of these stems.
PMID: 21855273
ISSN: 0883-5403
CID: 771612
Intra-articular hip injection: does pain relief correlate with radiographic severity of osteoarthritis?
Deshmukh, Ajit J; Panagopoulos, Georgia; Alizadeh, Ahmadreza; Rodriguez, Jose A; Klein, Devon A
OBJECTIVE: Intra-articular injection is being used widely for both diagnostic and therapeutic purposes in the hip. However, its efficacy is not always predictable in patients with hip osteoarthritis (OA). The purpose of this study was to determine whether the degree of radiographic severity of OA was predictive of the response to intra-articular injection of local anesthetic with corticosteroid and to determine the relationship between immediate pain relief resulting from the anesthetic and delayed pain relief resulting from corticosteroid administration. MATERIALS AND METHODS: This retrospective study included 217 patients (220 injections) with diagnosis of hip OA who underwent a fluoroscopically guided therapeutic hip injection of local anesthetic and corticosteroid. Hip radiographs were scored using the Kellgren-Lawrence scale. Immediate and delayed pain relief was documented using a visual analog scale. Logistic regression analysis was performed to investigate whether age, gender or radiographic severity of OA were independent predictors of pain relief. Degree of agreement between immediate and delayed response was assessed with the kappa coefficient. RESULTS: Immediate pain relief was reported in 68.2% of hips and delayed relief in 71.4% of hips. A high level of agreement was observed between immediate and delayed pain relief (kappa = 0.80, p < 0.001). 94% of patients reporting immediate relief also reported relief 2 weeks later. Univariate and multivariate analysis revealed that neither gender nor age was related to immediate or delayed pain relief. Only severity of OA (based on radiographic analysis) was observed to be predictive of pain relief. CONCLUSION: Pain relief following intra-articular hip injection correlated with radiographic severity of OA. This intervention may be of therapeutic and prognostic value in patients awaiting hip arthroplasty.
PMID: 21331511
ISSN: 0364-2348
CID: 771622
Management of failed trochanteric fracture fixation with cementless modular hip arthroplasty using a distally fixing stem
Thakur, Raman R; Deshmukh, Ajit J; Goyal, Amrit; Ranawat, Amar S; Rasquinha, Vijay J; Rodriguez, Jose A
Failure of internal fixation of intertrochanteric fractures is associated with delayed union or malunion resulting in persistent pain and diminished function. We evaluated 15 elderly patients treated with a tapered, fluted, modular, distally fixing cementless stem. At an average follow-up of 2.86 years, mean Harris hip score improved from 35.90 preoperatively to 83.01 (P < .01). Fourteen stems had stable bony on growth, and one stem was loose. Distal fixation with a tapered, fluted, modular cementless stem allows stable fixation with good functional outcome in a reproducible fashion in this challenging cohort of patients.
PMID: 20399600
ISSN: 0883-5403
CID: 771632
Accuracy of diagnostic injection in differentiating source of atypical hip pain
Deshmukh, Ajit J; Thakur, Raman R; Goyal, Amrit; Klein, Devon A; Ranawat, Amar S; Rodriguez, Jose A
It is not uncommon to encounter patients with atypical hip or lower extremity pain, ill-defined clinicoradiological features, and concomitant hip and lumbar spine arthritis. The purpose of this study is to present our experience using the response resulting from a combined anesthetic-steroid hip injection for treatment selection in these patients. A retrospective analysis of 204 consecutive diagnostic hip injections was undertaken. Patient charts were scrutinized for outcomes of injection and treatment. Our findings suggest that the relief of symptoms following injection of local anesthetic and steroid into the hip joint has a sensitivity of 91.5%, specificity and positive predictive value of 100%, and negative predictive value of 84.6% for response to total hip arthroplasty. We thereby believe that this is a reliable test with low morbidity and can predict the potential benefit of total hip arthroplasty in this diagnostically challenging group of patients.
PMID: 20570105
ISSN: 0883-5403
CID: 771642