Try a new search

Format these results:

Searched for:



Total Results:


NYU Clinical Practice Guidelines for VTE ProphylaxisHip and Knee Arthroplasty

Arshi, Armin; Rozell, Joshua C; Aggarwal, Vinay K; Schwarzkopf, Ran
PMID: 38739656
ISSN: 2328-5273
CID: 5658542

The James A. Rand Young Investigator's Award: Keeping It Simple: Are All Musculoskeletal Infection Society Tests Useful to Diagnose Periprosthetic Joint Infection?

Kreinces, Jason B; Ashkenazi, Itay; Shichman, Ittai; Roof, Mackenzie A; Schwarzkopf, Ran; Aggarwal, Vinay K
BACKGROUND:Current data evaluating the clinical value and cost-effectiveness of advanced diagnostic tests for periprosthetic joint infection (PJI) diagnosis, including alpha-defensin and synovial C-reactive protein (CRP), is conflicting. This study aimed to evaluate the adequacy of preoperative and intraoperative PJI workups without utilizing these tests. METHODS:This retrospective analysis identified all patients who underwent revision total knee or hip arthroplasty (rTKA and rTHA, respectively) for suspected PJI between 2018 and 2020 and had a minimum follow-up of two years. Perioperative data and lab results were collected, and cases were dichotomized based on whether they met the 2018 Musculoskeletal Infection Society (MSIS) criteria for PJI. In total, 204 rTKA and 158 rTHA cases suspected of PJI were reviewed. RESULTS:Nearly 100% of the cases were categorized as "infected" for meeting the 2018 MSIS criteria without utilization of alpha-defensin or synovial CRP (rTKA: n = 193, 94.6%; rTHA: n = 156, 98.7%). Most cases were classified as PJI preoperatively by meeting either the major MSIS or the combinational minor MSIS criteria of traditional lab tests (rTKA: n = 177, 86.8%; rTHA: n = 143, 90.5%). A subset of cases was classified as PJI by meeting combinational preoperative and intraoperative MSIS criteria (rTKA: 16, 7.8%; rTHA: 13, 8.2%). Only 3.6% of all cases were considered "inconclusive" using preoperative and intraoperative data. CONCLUSION/CONCLUSIONS:Given the high rate of cases satisfying PJI criteria during preoperative workup using our available tests, the synovial alpha-defensin and synovial CRP tests may not be necessary in the routine diagnostic workup of PJI. We suggest that the primary PJI workup process should be based on a stepwise algorithmic approach with the most economical testing necessary to determine a diagnosis first. The use of advanced, commercialized, and costly biomarkers should be utilized only when traditional testing is indeterminate.
PMID: 38810813
ISSN: 1532-8406
CID: 5663672

Perioperative Demographic and Laboratory Characteristics of Failed DAIR: Can We Determine Which Patients Will Fail?

Ashkenazi, Itay; Thomas, Jeremiah; Habibi, Akram; Di Pauli von Treuheim, Theodor; Lajam, Claudette M; Aggarwal, Vinay K; Schwarzkopf, Ran
INTRODUCTION/BACKGROUND:Debridement, antibiotics, and implant retention (DAIR) are the mainstays surgical treatment for acute periprosthetic joint infection (PJI). However, re-operation following DAIR is common, and the risk factors for DAIR failure remain unclear. This study aimed to assess the perioperative characteristics of patients who failed initial DAIR treatment. METHODS:A retrospective review was conducted on 83 patients who underwent DAIR for acute PJI within three months following index surgery from 2011 to 2022, with a minimum one-year follow-up. Surgical outcomes were categorized using the Musculoskeletal Infection Society (MSIS) outcome reporting tool (Tiers 1 to 4). Patient demographics, laboratory data, and perioperative outcomes were compared between patients who had failed (Tiers 3 and 4) (n = 32) and successful (Tiers 1 and 2) (n = 51) DAIR treatment. Logistic regression was also performed. RESULTS:After logistic regression, Charlson Comorbidity Index (CCI) (odds ratio (OR): 1.57; P = 0.003), preoperative C-reactive protein (CRP) (OR: 1.06; P = 0.014), synovial white blood cell (WBC) (OR: 1.14; P = 0.008), and polymorphonuclear cell (PMN%) counts (OR: 1.05; P = 0.015) were independently associated with failed DAIR. Compared with total hip arthroplasty (THA), total knee arthroplasty (TKA) patients (OR: 6.08; P = 0.001) were at increased risk of DAIR failure. The type of organism and time from primary surgery were not correlated with DAIR failure. CONCLUSION/CONCLUSIONS:Patients who had failed initial DAIR tended to have significantly higher CCI, CRP, synovial WBC, and PMN%. The TKA DAIRs were more likely to fail than the THA DAIRs. These characteristics should be considered when planning acute PJI management, as certain patients may be at higher risk for DAIR failure and may benefit from other surgical treatments.
PMID: 38797446
ISSN: 1532-8406
CID: 5663212

Factors influencing patient selection of orthopaedic surgeons for total hip (THA) and total knee arthroplasty (TKA)

Fabrizio, Grant M; Cardillo, Casey; Egol, Alexander; Rozell, Joshua C; Schwarzkopf, Ran; Aggarwal, Vinay K
INTRODUCTION/BACKGROUND:The importance of identifying how patients choose their healthcare providers has grown with the prevalence of consumer-centric health insurance plans. There is currently a lack of studies exploring the factors associated with how patients select their hip and knee joint arthroplasty surgeons. The purpose of this study was to determine how patients find their arthroplasty providers and the relative importance of various arthroplasty surgeon characteristics. METHODS:An electronic mail survey was sent to 3522 patients who had visited our institution for an arthroplasty surgeon office visit between August 2022 and January 2023. The survey consisted of multiple-choice questions, which aimed to inquire about the patients' referral sources for their current arthroplasty surgeon. In addition, patients were requested to rate the significance of 22 surgeon-related factors, on a scale of 1 (Not Important At All) to 5 (Very Important), in choosing their arthroplasty surgeon. RESULTS:Of the 3522 patients that received the survey, 538 patients responded (15.3%). The most common referral sources were physician referral (50.2%), family/friend referral (27.7%), and self-guided research (24.5%). Of those that were referred by a physician, 54.4% of respondents were referred by another orthopaedic provider. Patients rated board certification (4.72 ± 0.65), in-network insurance status (4.66 ± 0.71), fellowship training (4.50 ± 0.81), bedside manner/personality (4.32 ± 0.86), and facility appearance (4.26 ± 0.81) as the five most important factors in picking an arthroplasty surgeon. Television (1.42 ± 0.83), print (1.50 ± 0.88), and online (1.58 ± 0.93) advertisements, along with social media presence (1.83 ± 1.08), and practice group size (2.97 ± 1.13) were rated as the five least important factors. CONCLUSION/CONCLUSIONS:Patients are most likely to select an arthroplasty surgeon based on referral from other physicians, namely orthopedic surgeons, in addition to board certification status, in-network insurance, and fellowship training. Overall, these findings highlight the importance of physician credentials and reputation within the orthopaedic community in order to attract and retain patients.
PMID: 38641682
ISSN: 1434-3916
CID: 5655882

Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases

Huebschmann, Nathan A; Lawrence, Kyle W; Robin, Joseph X; Rozell, Joshua C; Hepinstall, Matthew S; Schwarzkopf, Ran; Aggarwal, Vinay K
BACKGROUND:Lumbar spinal fusion (LSF) is a risk factor for dislocation following total hip arthroplasty (THA). The effect of the surgical approach on this association has not been investigated. This study examined the association between the surgical approach and dislocation following THA in patients who had prior LSF. METHODS:We retrospectively reviewed 16,223 primary elective THAs at our institution from June 2011 to September 2022. Patients who had LSF prior to THA were identified using International Classification of Diseases (ICD) codes. Patients were stratified by LSF history, surgical approach, and intraoperative robot or navigation use to compare dislocation rates. There were 8,962 (55.2%) posterior, 5,971 (36.8%) anterior, and 1,290 (8.0%) laterally based THAs. Prior LSF was identified in 323 patients (2.0%). Binary logistic regressions were used to assess the association of patient factors with dislocation risk. RESULTS:There were 177 dislocations identified in total (1.1%). In nonadjusted analyses, the dislocation rate was significantly higher following the posterior approach among all patients (P = .003). Prior LSF was associated with a significantly higher dislocation rate in all patients (P < .001) and within the posterior (P < .001), but not the anterior approach (P = .514) subgroups. Multivariate regressions demonstrated anterior (OR [odds ratio] = 0.64, 95% CI [confidence interval] 0.45 to 0.91, P = .013), and laterally based (OR = 0.42, 95% CI 0.18 to 0.96, P = .039) approaches were associated with decreased dislocation risk, whereas prior LSF (OR = 4.28, 95% CI 2.38 to 7.69, P < .001) was associated with increased dislocation risk. Intraoperative technology utilization was not significantly associated with dislocation in the multivariate regressions (OR = 0.72, 95% CI 0.49 to 1.06, P = .095). CONCLUSIONS:The current study confirmed that LSF is a significant risk factor for dislocation following THA; however, anterior and laterally based approaches may mitigate dislocation risk in this population. In multivariate analyses, including surgical approach, LSF, and several perioperative variables, intraoperative technology utilization was not found to be significantly associated with dislocation risk.
PMID: 38604275
ISSN: 1532-8406
CID: 5657352

Aseptic Acetabular Revisions ≤90 Days, 91 Days to 2 Years, and >2 Years After Total Hip Arthroplasty: Comparing Etiologies, Complications, and Postoperative Outcomes

Sobba, Walter; Habibi, Akram A; Shichman, Ittai; Aggarwal, Vinay K; Rozell, Joshua C; Schwarzkopf, Ran
BACKGROUND:Isolated acetabular component revision is an effective treatment for revision total hip arthroplasty patients who have well-fixed femoral implants. We aimed to evaluate the modes of acetabular failure following primary total hip arthroplasty and to identify factors associated with increased morbidities and postoperative outcomes. METHODS:We conducted a retrospective analysis and identified 318 isolated aseptic acetabular revisions. We separated patients by ≤90 days, 91 days to 2 years, and >2 years for acetabular revisions and compared demographics, reasons for revision, 90-day readmissions, rerevisions, and postrevision infections. Revisions ≤90 days, 91 days to 2 years, and >2 years accounted for 10.7, 19.2, and 70.1% of revisions, respectively. Revisions ≤90 days, 91 days to 2 years, and >2 years had their primary total hip arthroplasty at a mean age of 66, 63, and 55 years (P < .001), respectively. RESULTS:Revisions within 90 days were mainly indicated for dislocation/instability (58.8%) or periprosthetic fracture (23.5%) while revisions over 2 years were indicated for polyethylene wear/osteolysis (37.2%). Patients with revisions past 90 days were more likely to require rerevision compared to patients with revisions within 90 days (P < .001). There were no differences in readmissions (P = .28) or infection rates (P = .37). CONCLUSIONS:Acetabular revisions within 90 days were more commonly indicated for instability and periprosthetic fracture, while those over 2 years were indicated for polyethylene wear. Revisions past 90 days were more likely to require subsequent rerevisions without increased 90-day readmissions or infections. LEVEL III EVIDENCE/METHODS:Retrospective cohort study.
PMID: 37717835
ISSN: 1532-8406
CID: 5635382

Erratum to "2023 American College of Rheumatology and American Association of Hip and Knee Surgeons Clinical Practice Guideline for the Optimal Timing of Elective Hip or Knee Arthroplasty for Patients With Symptomatic Moderate-to-Severe Osteoarthritis or Advanced Symptomatic Osteonecrosis With Secondary Arthritis for Whom Nonoperative Therapy Is Ineffective" [The Journal of Arthroplasty 38 (2023) 2193-2201]

Hannon, Charles P; Goodman, Susan M; Austin, Matthew S; Yates, Adolph; Guyatt, Gordon; Aggarwal, Vinay K; Baker, Joshua F; Bass, Phyllis; Bekele, Delamo Isaac; Dass, Danielle; Ghomrawi, Hassan M K; Jevsevar, David S; Kwoh, C Kent; Lajam, Claudette M; Meng, Charis F; Moreland, Larry W; Suleiman, Linda I; Wolfstadt, Jesse; Bartosiak, Kimberly; Bedard, Nicholas A; Blevins, Jason L; Cohen-Rosenblum, Anna; Courtney, P Maxwell; Fernandez-Ruiz, Ruth; Gausden, Elizabeth B; Ghosh, Nilasha; King, Lauren K; Meara, Alexa Simon; Mehta, Bella; Mirza, Reza; Rana, Adam J; Sullivan, Nancy; Turgunbaev, Marat; Wysham, Katherine D; Yip, Kevin; Yue, Linda; Zywiel, Michael G; Russell, Linda; Turner, Amy S; Singh, Jasvinder A
PMID: 38049357
ISSN: 1532-8406
CID: 5595422

Response to Letter to the Editor Regarding "Does the Primary Surgical Approach Matter When Choosing the Approach for Revision Total Hip Arthroplasty?" [Letter]

Christensen, Thomas H; Humphrey, Tyler J; Salimy, Mehdi S; Roundy, Robert S; Goel, Rahul K; Guild, George N; Schwarzkopf, Ran; Bedair, Hany S; Aggarwal, Vinay K
PMID: 38182330
ISSN: 1532-8406
CID: 5628482

Does the Primary Surgical Approach Matter when Choosing the Approach for Revision Total Hip Arthroplasty?

Christensen, Thomas H; Humphrey, Tyler J; Salimy, Mehdi S; Roundy, Robert; Goel, Rahul K; Guild, George N; Schwarzkopf, Ran; Bedair, Hany S; Aggarwal, Vinay K
INTRODUCTION/BACKGROUND:Multiple surgical approaches are used for primary total hip arthroplasty (pTHA) and revision total hip arthroplasty (rTHA). This study sought to investigate prevalence of discordance of pTHA and rTHA surgical approaches and to evaluate the impact of approach concordance on postoperative outcomes. METHODS:A multi-center retrospective review of patients who underwent rTHA from 2000 to 2021 was conducted at three large, urban academic centers. Patients who had a minimum one-year follow-up post-rTHA were included and grouped based on whether they received pTHA via a posterior (PA), direct anterior (DA), or laterally-based (DL) approach, and by concordance of index rTHA approach with their pTHA approach. Of the 917 patients studied, 839 (91.5%) were included in the concordant cohort and 78 (8.5%) in the discordant cohort. Patient demographics, operative characteristics, and postoperative outcomes were compared. RESULTS:Discordance was most prevalent in the DA-pTHA subset (29.5%), compared to the DL-pTHA subset (14.7%) or PA-pTHA subset (3.7%). Discordance varied significantly between primary approaches among all revisions, with DA-pTHA patients having the highest discordance rate for patients revised for aseptic loosening (46.3%, P<0.001), fracture (22.2%, P<0.001), and dislocation (33.3%, P<0.001). There were no differences between groups in dislocation rate, re-revision for infection, or re-revision for fracture. CONCLUSION/CONCLUSIONS:The results of this multicenter study showed patients who received pTHA via the DA were more likely to receive rTHA via a discordant approach compared to other primary approaches. Since approach concordance did not impact dislocation, infection, or fracture rates after rTHA, surgeons can feel reassured using a separate approach for rTHA.
PMID: 37393962
ISSN: 1532-8406
CID: 5538902

Does antibiotic bone cement reduce infection rates in primary total knee arthroplasty?

Cieremans, David; Muthusamy, Nishanth; Singh, Vivek; Rozell, Joshua C; Aggarwal, Vinay; Schwarzkopf, Ran
INTRODUCTION/BACKGROUND:Infection after total knee arthroplasty (TKA) impacts the patient, surgeon, and healthcare system significantly. Surgeons routinely use antibiotic-loaded bone cement (ALBC) in attempts to mitigate infection; however, little evidence supports the efficacy of ALBC in reducing infection rates compared to non-antibiotic-loaded bone cement (non-ALBC) in primary TKA. Our study compares infection rates of patients undergoing TKA with ALBC to those with non-ALBC to assess its efficacy in primary TKA. METHODS:A retrospective review of all primary, elective, cemented TKA patients over the age of 18 between 2011 and 2020 was conducted at an orthopedic specialty hospital. Patients were stratified into two cohorts based on cement type: ALBC (loaded with gentamicin or tobramycin) or non-ALBC. Baseline characteristics and infection rates determined by MSIS criteria were collected. Multilinear and multivariate logistic regressions were performed to limit significant differences in demographics. Independent samples t test and chi-squared test were used to compare means and proportions, respectively, between the two cohorts. RESULTS:) and Charlson Comorbidity Index values (4.51 ± 2.15 vs. 4.04 ± 1.92) were more likely to receive ALBC. The infection rate in the non-ALBC was 0.8% (63/7,980), while the rate in the ALBC was 0.5% (7/1,386). After adjusting for confounders, the difference in rates was not significant between the two groups (OR [95% CI]: 1.53 [0.69-3.38], p = 0.298). Furthermore, a sub-analysis comparing the infection rates within various demographic categories also showed no significant differences between the two groups. CONCLUSION/CONCLUSIONS:Compared to non-ALBC, the overall infection rate in primary TKA was slightly lower when using ALBC; however, the difference was not statistically significant. When stratifying by comorbidity, use of ALBC still showed no statistical significance in reducing the risk of periprosthetic joint infection. Therefore, the advantage of antibiotics in bone cement to prevent infection in primary TKA is not yet elucidated. Further prospective, multicenter studies regarding the clinical benefits of antibiotic use in bone cement for primary TKA are warranted.
PMID: 37133753
ISSN: 1432-1068
CID: 5503052