Author: Made Winatra Satya Putra [1], Anak Agung Gde Yuda Asmara [1]
[1] Department of Orthopaedics and Traumatology, General Hospital Prof. IGNG Ngoerah, Faculty of Medicine Udayana University, Bali, Indonesia
Address of Correspondence
Dr. Made Winatra Satya Putra,
JL. Diponegoro, Dauh Puri Klod, Bali, Indonesia.
E-mail: borthopaedi@gmail.com
Abstract
Neglected elbow dislocations pose a challenge to orthopedic surgeons, leading to contracture and functional limitations. This case involves a 51-year-old female patient experiencing pain and stiffness in her left elbow for the past 5 months due to neglected dislocation. Previous traditional treatment showed no improvement. Disuse atrophy was suspected, prompting open reduction, ligament reconstruction, and a 3-week temporary pinning. The intervention aimed to address the late-presenting unreduced elbow, utilizing autograft for ligament reconstruction. The subsequent supervised physiotherapy played a crucial role in restoring functional, stable, and painless elbow movement. This case underscores the importance of timely intervention in neglected elbow dislocations to prevent disability and enhance the quality of life for affected individuals. Keywords: Neglected elbow dislocation, ligament reconstruction, autograft.
References
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How to Cite this article: Putra MWS, Asmara AAGY. Open Reduction with Collateral Ligaments Reconstruction in Neglected Elbow Dislocation – A Case Report. Journal of Clinical Orthopaedics 2024;January-June:9(1)57-60.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-06-30 09:20:062024-06-30 09:24:36Open Reduction with Collateral Ligaments Reconstruction in Neglected Elbow Dislocation – A Case Report
Journal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 22-27 | Jamie C Heimroth, Max L Willinger, Nipun Sodhi, B A Ariel Henig, Alain E Sherman, Jonathan R Danoff
Author: Jamie C Heimroth [1], Max L Willinger [1], Nipun Sodhi1, B A Ariel Henig [2], Alain E Sherman [3], Jonathan R Danoff [1]
[1] Department of Orthopedic Surgery, Long Island Jewish Medical Center, New York, USA,
[2] Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra, New York, USA,
[3] Department of Orthopedic Surgery, Lenox Hill Hospital, New York, USA.
Address of Correspondence
Dr. Jonathan Danoff,
Department of Orthopedic Surgery, Long Island Jewish Medical Center, New York, USA.
Email: jdanoff@northwell.edu
Abstract
Introduction: Risk stratification is used in total joint arthroplasty (TKA) to optimize outcomes and minimize complications. Modifiable risk factors such as surgical duration can be influenced by surgeons; however, under certain circumstances, prolonged surgery cannot be avoided. While previous studies have investigated the impact of surgical duration on post-operative complications, we felt that research was lacking in comparing both surgical duration and tourniquet time and the rate of infection following a TKA. Our learning objective was to investigate the risk of surgical site infections (SSIs) and periprosthetic joint infections (PJIs) from prolonged (1) surgical duration or (2) tourniquet time during primary TKAs. Materials and Methods: A multicenter health-care system database consisting of 15 hospitals was queried for all patients undergoing TKA between March 2020 and December 2020. Patient demographics, comorbidities, and infection data were collected. The surgical duration and tourniquet time were calculated for each patient undergoing a TKA and compared against the rate of PJI or SSI rate. PJI was defined based on the 2018 musculoskeletal infection society (MSIS) criteria, and superficial SSI was defined as any infection that did not meet MSIS criteria. Results: Of the 2511 patients who underwent primary TKA, 19 were found to have an infection. Average surgical duration of 126.17 min for patients with an infection compared to 103.44 min without infection (P = 0.02). There was a significantly increased infection rate with increased surgical duration after univariate analysis. Patients who developed any infection had an average tourniquet time of 78.5 min, whereas those without infections had an average of 62.14 min (P = 0.004). Infection rate began to increase once the surgical duration reached 70 min; however, the infection rate increase per 10-min increments was not statistically significant (P = 0.09). The infection rate began to increase at 50 min of tourniquet time and significantly increased as tourniquet time increased (P = 0.004). Conclusion: Surgical duration is associated with an increased risk of infection following TKA. Our study demonstrated tourniquet time had a greater impact on infection. There are many circumstances that lead to increased surgical and tourniquet duration, including increased body mass index, and severe deformity. Surgeons should consider deflating the tourniquet as soon as the critical parts of the surgery are complete to decrease the risk of post-operative infections. Keywords: Total knee replacement, infection, knee joint, tourniquets.
References
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7. Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative time and risk of surgical site infection and periprosthetic joint infection: A systematic review and meta-analysis. Iowa Orthop J 2022;42:155-61.
8. Anis HK, Sodhi N, Klika AK, Mont MA, Barsoum WK, Higuera CA, et al. Is operative time a predictor for post-operative infection in primary total knee arthroplasty? J Arthroplasty 2019;34:S331-6.
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How to Cite this article: Heimroth JC, Willinger ML, Sodhi N, Henig BAA, Sherman AE, Danoff JR. Surgical Duration Increases the Risk of Infection Following Total Knee Arthroplasty. Journal of Clinical Orthopaedics 2024;January-June:9(1):22-27.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-06-30 09:10:482024-06-30 09:22:23Surgical Duration Increases the Risk of Infection Following Total Knee Arthroplasty
Author: Ida Bagus Anom Krishna Caitanya [1], Made Agus Maharjana [1], Nyoman Gede Grenata Nanda Ustriyana [1]
[1] Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Denpasar, Indonesia
Address of Correspondence
Dr. Ida Bagus Anom Krishna Caitanya,
Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Denpasar, Indonesia.
E-mail: borthopaedi@gmail.com
Abstract
This case series presents five pediatric patients diagnosed with septic arthritis in Sanglah General Hospital from 2019 to 2021. The most common infecting organism was Staphylococcus aureus, comprising 66.7% of all infections. Other organisms described in literatures are Salmonella, Staphylococcus epidermidis, Enterobacter cloacae, and Mycobacterium tuberculosis. Antibiotic treatment should be started as soon as the diagnosis is suspected and modified once the organism isolated from the synovial fluid (SF) has been characterized. Unfortunately, in many cases, despite a high clinical suspicion of SA, the diagnosis cannot be confirmed because the SF is sterile on bacterial culture. This may lead to difficulties in patient management. The case series also analyzed the possible causes of negative culture results. The data showed three cases with no pathogen organism detected, which can be turned to false negative that ruled out the infection cause of the arthritis. The study suggests that in the future, other techniques might prove useful in increasing the sensitivity of the detection of bacterial infection, such as Polymerase chain reaction and detection of antibodies against the teichoic acid staphylococcal cell wall component. The detection and identification of Kingela kingae in synovial fluid have improved significantly since the development of PCR. The specificity of these assays relies on the ability of the PCR to generate only the expected amplification product. The duration of the laboratory to process is also a factor that affects the result. The study concludes that early diagnosis and prompt treatment are crucial in achieving good functional outcomes in pediatric septic arthritis. Keywords: septic arthritis, pediatric patients, bacterial spectrum, diagnosis, culture methods
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How to Cite this article: Caitanya IBAK, Maharjana MA, Ustriyana NGGN. Bacterial Spectrum Analysis of Pediatric Septic Arthritis in Sanglah General Hospital (2019-2021): A Case Series. Journal of Clinical Orthopaedics 2024;January-June:9(1):61-69.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-06-30 09:10:472024-06-30 09:24:24Bacterial Spectrum Analysis of Pediatric Septic Arthritis in Sanglah General Hospital (2019-2021): A Case Series
[1] Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.
Address of Correspondence Dr. Vaibhav Bagaria,
Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.
E-mail: drbagaria@gmail.com
Abstract
Ensuring precise prosthesis positioning is one of the key elements for improving long-term survival rates in knee arthroplasty. The evolution of Total knee arthroplasty surgeries from Computer assisted navigation to robotic assisted techniques has improved the precision of bone preparation, component positioning and has reduced alignment outliers and surgeon-related errors. The present article gives an overview of the existing robotic arthroplasty systems available.
The present review describes the types of robots, their classification system, comparisons between various robotic assisted devices available in the market. This review highlights the key steps involved in using various systems, current concepts and the future scope of development in this field. This review also proposes the concept of intelligent alignment philosophy which is more patient specific combining different philosophies. Keywords– Robotic Assisted techniques, current updates, intelligent alignment, total knee arthroplasty
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How to Cite this article: Deshmukh S, Bagaria V. Current Concept Update on Robotic Technology in Arthroplasty. Journal of Clinical Orthopaedics 2024 January-June;9(1):35-41
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-06-30 09:10:262024-06-30 09:25:47Current Concept Update on Robotic Technology in Arthroplasty- A Narrative review
[1] Department of Orthopedics, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India,
[2] Department of Hematology Oncology and Stem Cell Transplant, Apollo Hospitals, Navi Mumbai, Maharashtra, India,
[3] HematCare-Speciality Hematology Clinic, Powai, Mumbai, India,
[4] Department of Orthopedics, Peerless Hospital, Kolkata, West Bengal, India,
[5] Department of Orthopedics, Sunrise Group of Hospitals, Kochi, Kerala, India,
[6] Department of Orthopedics Surgery Manipal Hospital, Bengaluru, Karnataka, India,
[7] Department of Arthroplasty and Joint Replacement, Surana Group of Hospitals, Malad, Mumbai, Maharashtra, India,
[8] Department of Joint Replacement Surgery, Jehangir Hospital, Pune, Maharashtra, India,
[9] Department of Orthopedics, Oyster and Pearl Hospital, Pune, Maharashtra, India,
[10] SportsMed Arthroscopy and Shoulder Surgery Centre, Nagpur, Maharashtra, India,
[11] Department of Orthopaedics, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta – The Medicity, Gurugram, Haryana, India,
[12] Department ofArthroscopy and Joint Replacement Surgery, Sterling Multispeciality Hospital, Nigadi, Pradhikaran, Pune, Maharashtra, India,
[13] The Knee Clinic, Mumbai, Maharashtra, India,
[14] Medical Services, Emcure Pharmaceuticals Ltd, Mumbai, Maharashtra, India,
[15] Medical Services, Emcure Pharmaceuticals Ltd, Pune, Maharashtra, India.
Address of Correspondence Dr. Ketan Kulkarni,
Medical Services, Emcure Pharmaceuticals Ltd, Pune, Maharashtra, India.
E-mail: Ketan.Kulkarni@emcure.com
Abstract
Anemia has emerged as a significant healthcare crisis in India and often remains undiagnosed, with broad implications across all age groups. Iron deficiency remains the most important and correctable cause of anemia in our country. It often leads to significant morbidity during major operative procedures such as hip and knee arthroplasties, due to the substantial intraoperative bleeding associated with these procedures. To address this challenge and mitigate complications related to blood transfusions, peri-operative iron therapy, notably parenteral iron therapy, has become common practice. Nevertheless, there is a lack of consensus on managing peri-operative anemia and the role of ferric carboxymaltose (FCM) in pre-operative and post-operative orthopedic surgeries in India. A group of 14 experts, primarily orthopedic surgeons and an hematologist in India, convened an in-person expert group meeting. Their primary focus was on the approach of FCM in managing anemia in elective orthopedic surgeries within the diverse landscape of the Indian healthcare system. The consensus strongly advocated using FCM as a rapid and adequate source of iron replacement, especially in cases of significant pre-operative and post-operative anemia in patients undergoing elective orthopedic surgery. Keywords: Pre-operative, post-operative, orthopedic surgery, anemia, ferric carboxymaltose.
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31. Bailie GR. Efficacy and safety of ferric carboxymaltose in correcting iron-deficiency anemia: A review of randomized controlled trials across different indications. Arzneimittelforschung 2010;60:386-98.
32. Friedrisch JR, Cançado RD. Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia. Rev Bras Hematol Hemoter 2015;37:400-5.
33. Geisser P, Banké-Bochita J. Pharmacokinetics, safety and tolerability of intravenous ferric carboxymaltose: A dose-escalation study in volunteers with mild iron-deficiency anaemia. Arzneimittelforschung 2010;60:362-72.
34. Vikrant S, Parashar A. The safety and efficacy of high dose ferric carboxymaltose in patients with chronic kidney disease: A single center study. Indian J Nephrol 2015;25:213-21.
35. Bailie GR, Mason NA, Valaoras TG. Safety and tolerability of intravenous ferric carboxymaltose in patients with iron deficiency anemia. Hemodial Int 2010;14:47-54.
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43. Choi KY, Koh IJ, Kim MS, Kim C, In Y. Intravenous ferric carboxymaltose improves response to postoperative anemia following total knee arthroplasty: A prospective randomized controlled trial in Asian cohort. J Clin Med 2022;11:2357.
44. Jones JJ, Mundy LM, Blackman N, Shwarz M. Ferric carboxymaltose for anemic peri-operative populations: A systematic literature review of randomized controlled trials. J Blood Med 2021;12:337-59.
45. Suh YS, Nho JH, Seo J, Jang BW, Park JS. Hip fracture surgery without transfusion in patients with hemoglobin less than 10 g/dL. Clin Orthop Surg 2021;13:30-6.
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How to Cite this article: Desai M, Jain P, Bava S, Samanta S, Kumar KRP, Galagali A, Shetty S, Panghate A, Arbat A, Sonar S, Vasdev A, Tonape P, Sheth M, Shaikh A, Suryawanshi S, Kulkarni K. Expert Consensus on the Significance of Intravenous Iron using Ferric Carboxymaltose Perioperatively and in Elective Major Orthopedic Surgeries. Journal of Clinical Orthopaedics 2024 January-June;9(1):42-51.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-06-30 09:05:002024-06-30 09:25:29Expert Consensus on the Significance of Intravenous Iron using Ferric Carboxymaltose Perioperatively and in Elective Major Orthopedic Surgeries
[1] Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
Address of Correspondence
Dr. Mohd Danish,
Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
Introduction: Osteoporosis and diabetes are both common human diseases. The prevalence of both is increasing individually and in combination, due to better detection methods and changing definitions. Due to the different pathogenesis of Type 1 and Type 2 diabetes mellitus (T2DM), one of which is a predominant autoimmune process while the other mainly a metabolic disorder, it is not surprising that there is no uniform entity of diabetic bone disease as such, although such term has been proposed in the past but never gained momentum. Paradoxically, an increased risk of osteoporotic fracture in T2DM has been repeatedly demonstrated and this was independent of bone mineral density (BMD). This association with fracture adds uncertainty around the actual association between diabetes mellitus and BMD.
This study aims to study the population of diabetes at tertiary care center when they are compared with non-diabetics in terms of BMD.
Aims of Study: The aim of this study was to determine the prevalence of osteopenia and osteoporosis in T2DM and non-diabetic male patients using Dual Energy X-ray absorptiometry (DEXA scan). Materials and Methods: Patients for the study included male patients between 40 and 60 years of age group attending outpatient department, health checkup, and admitted in the ward of Saifee Hospital, Department of Medicine. In 200 (100 type 2 diabetic males and 100 non-diabetic males), DEXA Scan was performed in the Department of Imaging, Saifee Hospital from June 2017 to April 2019. Results: Type 2 diabetics were significantly associated with the presence of osteoporosis compared to non-diabetics (P = 0.001). Type 2 diabetics were significantly associated with body mass index (BMI) >25 (P = 0.0) and diabetics had a significantly higher BMI compared to non-diabetics (P = 0.0001). Type 2 diabetics above 50 years of age were significantly associated with osteoporosis (P = 0.000) and diabetics with osteoporosis were significantly older compared to diabetics without osteoporosis (P = 0.0018). Conclusion: The study concluded that there is a correlation between T2DM, increasing age, glycemic control, increased BMI, increased calcium levels, and decreased BMD. Thus, physician treating diabetes must anticipate decreased BMD and rule out or correct all of these factors in patients of diabetes to prevent the complications of decreased BMD in these groups of patients. Therefore, early detection and treatment of osteoporosis/osteopenia by estimation of BMD in Type 2 diabetic males, strict diabetic control with target hemoglobin A1c <6.5, weight control with target BMI <25, supplementation with Vitamin D3 should be advocated. Keywords: Diabetes, osteoporosis, dual-energy X-ray absorptiometry scan.
References
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2. Barrett-Connor E, Holbrook TL. Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus. JAMA 1992;268:3333-7.
3. Gregorio F, Cristallini S, Santeusanio F, Filipponi P, Fumelli P. Osteopenia associated with non-insulin-dependent diabetes mellitus: What are the causes? Diabetes Res Clin Pract 1994;23:43-54.
4. Asokan AG, Jaganathan J, Philip R, Soman RR, Sebastian ST, Pullishery F. Evaluation of bone mineral density among type 2 diabetes mellitus patients in South Karnataka. J Nat Sci Biol Med 2017;8:94-8.
5. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007;92:2017-29.
6. Rucker D, Tonelli M, Coles MG, Yoo S, Young K, McMahon AW. Vitamin D insufficiency and treatment with oral vitamin D3 in northern-dwelling patients with chronic kidney disease. J Nephrol 2009;22:75-82.
7. Nicodemus KK, Folsom AR, Iowa Women’s Health Study. Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 2001;24:1192-7.
8. Strotmeyer ES, Cauley JA, Orchard TJ, Steenkiste AR, Dorman JS. Middle-aged premenopausal women with type 1 diabetes have lower bone mineral density and calcaneal quantitative ultrasound than nondiabetic women. Diabetes Care 2006;29:306-11.
9. Kayath MJ, Tavares EF, Dib SA, Vieria JG. Prospective bone mineral density evaluation in patients with insulin-dependent diabetes mellitus. J Diabetes Complications 1998;12:133-9.
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11. Yamagishi S, Nakamura K, Inoue H. Possible participation of advanced glycation end products in the pathogenesis of osteoporosis in diabetic patients. Med Hypotheses 2005;65:1013-5
12. Vestergaard P, Rejnmark L, Mosekilde L. Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 2005;48:1292-9.
13. Paul RG, Bailey AJ. Glycation of collagen: The basis of its central role in the late complications of ageing and diabetes. Int J Biochem Cell Biol 1996;28:1297-310.
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17. Miyata T, Notoya K, Yoshida K, Horie K, Maeda K, Kurokawa K, et al. Advanced glycation end products enhance osteoclast-induced bone resorption in cultured mouse unfractionated bone cells and in rats implanted subcutaneously with devitalized bone particles. J Am Soc Nephrol 1997;8:260-70.
18. Hein G, Wiegand R, Lehmann G, Stein G, Franke S. Advanced glycation end-products pentosidine and N epsilon-carboxymethyllysine are elevated in serum of patients with osteoporosis. Rheumatology (Oxford) 2003;42:1242-6.
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How to Cite this article: Kumar JS, Danish M, Singh V. Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients. Journal of Clinical Orthopaedics 2024 January-June;9(1):28-34.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-06-30 09:01:312024-06-30 09:26:00Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients
Open Reduction with Collateral Ligaments Reconstruction in Neglected Elbow Dislocation – A Case Report
/in Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 57-60 | Made Winatra Satya Putra, Anak Agung Gde Yuda Asmara
DOI: https://doi.org/10.13107/jcorth.2024.v09i01.636
Author: Made Winatra Satya Putra [1], Anak Agung Gde Yuda Asmara [1]
[1] Department of Orthopaedics and Traumatology, General Hospital Prof. IGNG Ngoerah, Faculty of Medicine Udayana University, Bali, Indonesia
Address of Correspondence
Dr. Made Winatra Satya Putra,
JL. Diponegoro, Dauh Puri Klod, Bali, Indonesia.
E-mail: borthopaedi@gmail.com
Abstract
Neglected elbow dislocations pose a challenge to orthopedic surgeons, leading to contracture and functional limitations. This case involves a 51-year-old female patient experiencing pain and stiffness in her left elbow for the past 5 months due to neglected dislocation. Previous traditional treatment showed no improvement. Disuse atrophy was suspected, prompting open reduction, ligament reconstruction, and a 3-week temporary pinning. The intervention aimed to address the late-presenting unreduced elbow, utilizing autograft for ligament reconstruction. The subsequent supervised physiotherapy played a crucial role in restoring functional, stable, and painless elbow movement. This case underscores the importance of timely intervention in neglected elbow dislocations to prevent disability and enhance the quality of life for affected individuals.
Keywords: Neglected elbow dislocation, ligament reconstruction, autograft.
References
1. Kone SG, Bana A, Dogba EG. Neglected elbow dislocation with conservation of elbow function, concerning a case in Abidjan (Ivory Coast). Open J Orthop 2018;8:127-31.
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3. Agarwal S, Patel RK. A prospective study of 9 cases of neglected posterior dislocation of elbow treated by open reduction and V-Y tricepsplasty of speed. J Bone Jt Dis 2016;31:26-9.
4. Mehta S, Sud A, Tiwari A, Kapoor SK. Open reduction for late-presenting posterior dislocation of the elbow. J Orthop Surg (Hong Kong) 2007;15:15-21.
5. Coulibaly NF, Tiemdjo H, Sane AD, Sarr YF, Ndiaye A, Seye S. Posterior approach for surgical treatment of neglected elbow dislocation. Orthop Traumatol Surg Res 2012;98:552-8.
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Surgical Duration Increases the Risk of Infection Following Total Knee Arthroplasty
/in Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 22-27 | Jamie C Heimroth, Max L Willinger, Nipun Sodhi, B A Ariel Henig, Alain E Sherman, Jonathan R Danoff
DOI: https://doi.org/10.13107/jcorth.2024.v09i01.626
Author: Jamie C Heimroth [1], Max L Willinger [1], Nipun Sodhi1, B A Ariel Henig [2], Alain E Sherman [3], Jonathan R Danoff [1]
[1] Department of Orthopedic Surgery, Long Island Jewish Medical Center, New York, USA,
[2] Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra, New York, USA,
[3] Department of Orthopedic Surgery, Lenox Hill Hospital, New York, USA.
Address of Correspondence
Dr. Jonathan Danoff,
Department of Orthopedic Surgery, Long Island Jewish Medical Center, New York, USA.
Email: jdanoff@northwell.edu
Abstract
Introduction: Risk stratification is used in total joint arthroplasty (TKA) to optimize outcomes and minimize complications. Modifiable risk factors such as surgical duration can be influenced by surgeons; however, under certain circumstances, prolonged surgery cannot be avoided. While previous studies have investigated the impact of surgical duration on post-operative complications, we felt that research was lacking in comparing both surgical duration and tourniquet time and the rate of infection following a TKA. Our learning objective was to investigate the risk of surgical site infections (SSIs) and periprosthetic joint infections (PJIs) from prolonged (1) surgical duration or (2) tourniquet time during primary TKAs.
Materials and Methods: A multicenter health-care system database consisting of 15 hospitals was queried for all patients undergoing TKA between March 2020 and December 2020. Patient demographics, comorbidities, and infection data were collected. The surgical duration and tourniquet time were calculated for each patient undergoing a TKA and compared against the rate of PJI or SSI rate. PJI was defined based on the 2018 musculoskeletal infection society (MSIS) criteria, and superficial SSI was defined as any infection that did not meet MSIS criteria.
Results: Of the 2511 patients who underwent primary TKA, 19 were found to have an infection. Average surgical duration of 126.17 min for patients with an infection compared to 103.44 min without infection (P = 0.02). There was a significantly increased infection rate with increased surgical duration after univariate analysis. Patients who developed any infection had an average tourniquet time of 78.5 min, whereas those without infections had an average of 62.14 min (P = 0.004). Infection rate began to increase once the surgical duration reached 70 min; however, the infection rate increase per 10-min increments was not statistically significant (P = 0.09). The infection rate began to increase at 50 min of tourniquet time and significantly increased as tourniquet time increased (P = 0.004).
Conclusion: Surgical duration is associated with an increased risk of infection following TKA. Our study demonstrated tourniquet time had a greater impact on infection. There are many circumstances that lead to increased surgical and tourniquet duration, including increased body mass index, and severe deformity. Surgeons should consider deflating the tourniquet as soon as the critical parts of the surgery are complete to decrease the risk of post-operative infections.
Keywords: Total knee replacement, infection, knee joint, tourniquets.
References
1. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: Current concepts and outlook. EFORT Open Rev 2019;4:482-94.
2. Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014;29:929-32.
3. Colston J, Atkins B. Bone and joint infection. Clin Med (Lond) 2018;18:150-4.
4. Eka A, Chen AF. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med 2015;3:233.
5. Gold PA, Garbarino LJ, Anis HK, Neufeld EV, Sodhi N, Danoff JR, et al. The cumulative effect of substance abuse disorders and depression on postoperative complications after primary total knee arthroplasty. J Arthroplasty 2020;35:S151-7.
6. Naranje S, Lendway L, Mehle S, Gioe TJ. Does operative time affect infection rate in primary total knee arthroplasty? Clin Orthop Relat Res 2015;473:64-9.
7. Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative time and risk of surgical site infection and periprosthetic joint infection: A systematic review and meta-analysis. Iowa Orthop J 2022;42:155-61.
8. Anis HK, Sodhi N, Klika AK, Mont MA, Barsoum WK, Higuera CA, et al. Is operative time a predictor for post-operative infection in primary total knee arthroplasty? J Arthroplasty 2019;34:S331-6.
9. Badawy M, Espehaug B, Fenstad AM, Indrekvam K, Dale H, Havelin LI, et al. Patient and surgical factors affecting procedure duration and revision risk due to deep infection in primary total knee arthroplasty. BMC Musculoskelet Disord 2017;18:544.
10. Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, della Valle CJ. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty 2018;33:2256-62.e4.
11. Duchman KR, Pugely AJ, Martin CT, Gao Y, Bedard NA, Callaghan JJ. Operative time affects short-term complications in total joint arthroplasty. J Arthroplasty 2017;32:1285-91.
12. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplasty 2019;34:947-53.
13. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 1995;77:250-3.
14. Arthur JR, Spangehl MJ. Tourniquet use in total knee arthroplasty. J Knee Surg 2019;32:719-29.
15. Li X, Yin L, Chen ZY, Zhu L, Wang HL, Chen W, et al. The effect of tourniquet use in total knee arthroplasty: Grading the evidence through an updated meta-analysis of randomized, controlled trials. Eur J Orthop Surg Traumatol 2014;24:973-86.
16. Zak SG, Yeroushalmi D, Long WJ, Meftah M, Schnaser E, Schwarzkopf R. Does the use of a tourniquet influence outcomes in total knee arthroplasty: A randomized controlled trial. J Arthroplasty 2021;36:2492-6.
17. Parvizi J, Tan TL, Goswami K, Higuera C, della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty 2018;33:1309-14.e2.
18. Anis HK, Rothfusz CA, Eskildsen SM, Klika AK, Piuzzi NS, Higuera CA, et al. Does surgical trainee participation affect infection outcomes in primary total knee arthroplasty? J Surg Educ 2022;79:993-9.
19. Hegde V, Bracey DN, Johnson RM, Dennis DA, Jennings JM. Tourniquet use improves cement penetration and reduces radiolucent line progression at 5 years after total knee arthroplasty. J Arthroplasty 2021;36:S209-14.
20. Ahmed I, Chawla A, Underwood M, Price AJ, Metcalfe A, Hutchinson CE, et al. Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery. Bone Joint J 2021;103-B:830-9.
21. Magan AA, Dunseath O, Armonis P, Fontalis A, Kayani B, Haddad FS. Tourniquet use in total knee arthroplasty and the risk of infection: A meta-analysis of randomised controlled trials. J Exp Orthop 2022;9:62.
22. Pinsornsak P, Pinitchanon P, Boontanapibul K. Effect of different tourniquet pressure on postoperative pain and complications after total knee arthroplasty: A prospective, randomized controlled trial. J Arthroplasty 2021;36:1638-44.
23. Silver R, de la Garza J, Rang M, Koreska J. Limb swelling after release of a tourniquet. Clin Orthop Relat Res 1986;206:86-9.
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Bacterial Spectrum Analysis of Pediatric Septic Arthritis in Sanglah General Hospital (2019-2021): A Case Series
/in Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 61-69 | Ida Bagus Anom Krishna Caitanya, Made Agus Maharjana, Nyoman Gede Grenata Nanda Ustriyana
DOI: https://doi.org/10.13107/jcorth.2024.v09i01.638
Author: Ida Bagus Anom Krishna Caitanya [1], Made Agus Maharjana [1], Nyoman Gede Grenata Nanda Ustriyana [1]
[1] Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Denpasar, Indonesia
Address of Correspondence
Dr. Ida Bagus Anom Krishna Caitanya,
Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Denpasar, Indonesia.
E-mail: borthopaedi@gmail.com
Abstract
This case series presents five pediatric patients diagnosed with septic arthritis in Sanglah General Hospital from 2019 to 2021. The most common infecting organism was Staphylococcus aureus, comprising 66.7% of all infections. Other organisms described in literatures are Salmonella, Staphylococcus epidermidis, Enterobacter cloacae, and Mycobacterium tuberculosis. Antibiotic treatment should be started as soon as the diagnosis is suspected and modified once the organism isolated from the synovial fluid (SF) has been characterized. Unfortunately, in many cases, despite a high clinical suspicion of SA, the diagnosis cannot be confirmed because the SF is sterile on bacterial culture. This may lead to difficulties in patient management. The case series also analyzed the possible causes of negative culture results. The data showed three cases with no pathogen organism detected, which can be turned to false negative that ruled out the infection cause of the arthritis. The study suggests that in the future, other techniques might prove useful in increasing the sensitivity of the detection of bacterial infection, such as Polymerase chain reaction and detection of antibodies against the teichoic acid staphylococcal cell wall component. The detection and identification of Kingela kingae in synovial fluid have improved significantly since the development of PCR. The specificity of these assays relies on the ability of the PCR to generate only the expected amplification product. The duration of the laboratory to process is also a factor that affects the result. The study concludes that early diagnosis and prompt treatment are crucial in achieving good functional outcomes in pediatric septic arthritis.
Keywords: septic arthritis, pediatric patients, bacterial spectrum, diagnosis, culture methods
References
1. Al Arfaj AS. A prospective study of the incidence and characteristics of septic arthritis in a teaching hospital in Riyadh, Saudi Arabia. Clin Rheumatol 2008;27:1403-10.
2. Erkilinc M, Gilmore A, Weber M, Mistovich RJ. Current concepts in pediatric septic arthritis. J Am Acad Orthop Surg 2021;29:196-206.
3. Hoswell RL, Johns BP, Loewenthal MR, Dewar DC. Outcomes of paediatric septic arthritis of the hip and knee at 1-20 years in an Australian urban centre. ANZ J Surg 2019;89:562-66.
4. Montgomery NI, Rosenfeld S. Pediatric osteoarticular infection update. J Pediatr Orthop 2015;35:74-81.
5. Castellazzi L, Mantero M, Esposito S. Update on the management of pediatric acute osteomyelitis and septic arthritis. Int J Mol Sci 2016;17:855.
6. Whiting ZG, Doerre T. Diagnosis of culture-negative septic arthritis with polymerase chain reaction in an immunosuppressed patient: A case report. JBJS Case Connect 2020;10:e20.00057.
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8. Slinger R, Moldovan I, Bowes J, Chan F. Polymerase chain reaction detection of Kingella kingae in children with culture-negative septic arthritis in eastern Ontario. Paediatr Child Health 2016;21:79-82.
9. Spyridakis E, Gerber JS, Schriver E, Grundmeier RW, Porsch EA, St Geme JW, et al. Clinical Features and outcomes of children with culture-negative septic arthritis. J Pediatric Infect Dis Soc 2019;8:228-34.
10. Anino-Fernández J, Ramírez-Huaranga MA, Mínguez-Sanchez MD. False negatives of synovial fluid in septic arthritis. Reumatol Clin 2016;12:114-5.
11. Hujazi I, Oni D, Arora A, Muniz G, Khanduja V. The fate of acutely inflamed joints with a negative synovial fluid culture. Int Orthop 2012;36:1487-92.
12. Chan MM, Tse TS, Wan YC, Wah Hung Y, Fan JC. A rare and uncommon complication after use of hydrogen peroxide (H2O2): A review of use of H2O2 in orthopaedics. J Orthop Trauma Rehabil 2020;27:247-51.
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Current Concept Update on Robotic Technology in Arthroplasty- A Narrative review
/in Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 35-41 | Shobit Deshmukh, Vaibhav Bagaria
DOI: https://doi.org/10.13107/jcorth.2024.v09i01.630
Author: Shobit Deshmukh [1], Vaibhav Bagaria [1]
[1] Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Vaibhav Bagaria,
Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.
E-mail: drbagaria@gmail.com
Abstract
Ensuring precise prosthesis positioning is one of the key elements for improving long-term survival rates in knee arthroplasty. The evolution of Total knee arthroplasty surgeries from Computer assisted navigation to robotic assisted techniques has improved the precision of bone preparation, component positioning and has reduced alignment outliers and surgeon-related errors. The present article gives an overview of the existing robotic arthroplasty systems available.
The present review describes the types of robots, their classification system, comparisons between various robotic assisted devices available in the market. This review highlights the key steps involved in using various systems, current concepts and the future scope of development in this field. This review also proposes the concept of intelligent alignment philosophy which is more patient specific combining different philosophies.
Keywords– Robotic Assisted techniques, current updates, intelligent alignment, total knee arthroplasty
References
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Expert Consensus on the Significance of Intravenous Iron using Ferric Carboxymaltose Perioperatively and in Elective Major Orthopedic Surgeries
/in Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 42-51 | Mohan Desai, Punit Jain, Surendar Singh Bava, Swarnendu Samanta, K R Prathap Kumar, Anand Galagali, Santhosh Shetty, Atul Panghate, Ashish Arbat, Satish Sonar, Attique Vasdev, Prashant Tonape, Miten Sheth, Ashraf Shaikh, Sachin Suryawanshi, Ketan Kulkarni
DOI: https://doi.org/10.13107/jcorth.2024.v09i01.000
Author: Mohan Desai [1], Punit Jain [2,3], Surendar Singh Bava [1], Swarnendu Samanta [4], K R Prathap Kumar [5], Anand Galagali [6], Santhosh Shetty [7], Atul Panghate [1], Ashish Arbat [8,9], Satish Sonar [10], Attique Vasdev [11], Prashant Tonape [12], Miten Sheth [13], Ashraf Shaikh [1], Sachin Suryawanshi [14], Ketan Kulkarni [15]
[1] Department of Orthopedics, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India,
[2] Department of Hematology Oncology and Stem Cell Transplant, Apollo Hospitals, Navi Mumbai, Maharashtra, India,
[3] HematCare-Speciality Hematology Clinic, Powai, Mumbai, India,
[4] Department of Orthopedics, Peerless Hospital, Kolkata, West Bengal, India,
[5] Department of Orthopedics, Sunrise Group of Hospitals, Kochi, Kerala, India,
[6] Department of Orthopedics Surgery Manipal Hospital, Bengaluru, Karnataka, India,
[7] Department of Arthroplasty and Joint Replacement, Surana Group of Hospitals, Malad, Mumbai, Maharashtra, India,
[8] Department of Joint Replacement Surgery, Jehangir Hospital, Pune, Maharashtra, India,
[9] Department of Orthopedics, Oyster and Pearl Hospital, Pune, Maharashtra, India,
[10] SportsMed Arthroscopy and Shoulder Surgery Centre, Nagpur, Maharashtra, India,
[11] Department of Orthopaedics, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta – The Medicity, Gurugram, Haryana, India,
[12] Department ofArthroscopy and Joint Replacement Surgery, Sterling Multispeciality Hospital, Nigadi, Pradhikaran, Pune, Maharashtra, India,
[13] The Knee Clinic, Mumbai, Maharashtra, India,
[14] Medical Services, Emcure Pharmaceuticals Ltd, Mumbai, Maharashtra, India,
[15] Medical Services, Emcure Pharmaceuticals Ltd, Pune, Maharashtra, India.
Address of Correspondence
Dr. Ketan Kulkarni,
Medical Services, Emcure Pharmaceuticals Ltd, Pune, Maharashtra, India.
E-mail: Ketan.Kulkarni@emcure.com
Abstract
Anemia has emerged as a significant healthcare crisis in India and often remains undiagnosed, with broad implications across all age groups. Iron deficiency remains the most important and correctable cause of anemia in our country. It often leads to significant morbidity during major operative procedures such as hip and knee arthroplasties, due to the substantial intraoperative bleeding associated with these procedures. To address this challenge and mitigate complications related to blood transfusions, peri-operative iron therapy, notably parenteral iron therapy, has become common practice. Nevertheless, there is a lack of consensus on managing peri-operative anemia and the role of ferric carboxymaltose (FCM) in pre-operative and post-operative orthopedic surgeries in India. A group of 14 experts, primarily orthopedic surgeons and an hematologist in India, convened an in-person expert group meeting. Their primary focus was on the approach of FCM in managing anemia in elective orthopedic surgeries within the diverse landscape of the Indian healthcare system. The consensus strongly advocated using FCM as a rapid and adequate source of iron replacement, especially in cases of significant pre-operative and post-operative anemia in patients undergoing elective orthopedic surgery.
Keywords: Pre-operative, post-operative, orthopedic surgery, anemia, ferric carboxymaltose.
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Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients
/in Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 1 | January-June 2024 | page: 28-34 | Jata Shankar Kumar, Mohd Danish, Vikash Singh
DOI: https://doi.org/10.13107/jcorth.2024.v09i01.628
Author: Jata Shankar Kumar [1], Mohd Danish [1], Vikash Singh [1]
[1] Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
Address of Correspondence
Dr. Mohd Danish,
Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com
Abstract
Introduction: Osteoporosis and diabetes are both common human diseases. The prevalence of both is increasing individually and in combination, due to better detection methods and changing definitions. Due to the different pathogenesis of Type 1 and Type 2 diabetes mellitus (T2DM), one of which is a predominant autoimmune process while the other mainly a metabolic disorder, it is not surprising that there is no uniform entity of diabetic bone disease as such, although such term has been proposed in the past but never gained momentum. Paradoxically, an increased risk of osteoporotic fracture in T2DM has been repeatedly demonstrated and this was independent of bone mineral density (BMD). This association with fracture adds uncertainty around the actual association between diabetes mellitus and BMD.
This study aims to study the population of diabetes at tertiary care center when they are compared with non-diabetics in terms of BMD.
Aims of Study: The aim of this study was to determine the prevalence of osteopenia and osteoporosis in T2DM and non-diabetic male patients using Dual Energy X-ray absorptiometry (DEXA scan).
Materials and Methods: Patients for the study included male patients between 40 and 60 years of age group attending outpatient department, health checkup, and admitted in the ward of Saifee Hospital, Department of Medicine. In 200 (100 type 2 diabetic males and 100 non-diabetic males), DEXA Scan was performed in the Department of Imaging, Saifee Hospital from June 2017 to April 2019.
Results: Type 2 diabetics were significantly associated with the presence of osteoporosis compared to non-diabetics (P = 0.001). Type 2 diabetics were significantly associated with body mass index (BMI) >25 (P = 0.0) and diabetics had a significantly higher BMI compared to non-diabetics (P = 0.0001). Type 2 diabetics above 50 years of age were significantly associated with osteoporosis (P = 0.000) and diabetics with osteoporosis were significantly older compared to diabetics without osteoporosis (P = 0.0018).
Conclusion: The study concluded that there is a correlation between T2DM, increasing age, glycemic control, increased BMI, increased calcium levels, and decreased BMD. Thus, physician treating diabetes must anticipate decreased BMD and rule out or correct all of these factors in patients of diabetes to prevent the complications of decreased BMD in these groups of patients. Therefore, early detection and treatment of osteoporosis/osteopenia by estimation of BMD in Type 2 diabetic males, strict diabetic control with target hemoglobin A1c <6.5, weight control with target BMI <25, supplementation with Vitamin D3 should be advocated.
Keywords: Diabetes, osteoporosis, dual-energy X-ray absorptiometry scan.
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