Incidence and risk factors for periprosthetic joint infection: A common data model analysis.

OBJECTIVES: The aim of this study was to determine the incidence of periprosthetic joint infection (PJI) following primary total joint arthroplasty (TJA) and to investigate risk factors in a large cohort utilizing common data model (CDM). PATIENTS AND METHODS: The entire cohort of primary and revision hip or knee TJA between January 2003 and December 2017 was retrospectively analyzed utilizing the CDM database. We detected patients who had revision TJA as a consequence of PJI. We determined the incidence of PJI and examined risk factors, including demographic features, comorbidities, prior corticosteroid usage, and preoperative laboratory values. RESULTS: There were 34 revision TJAs as a consequence of PJI (hip, 16; knee, 18) among 12,320 primary TJAs (hip, 4,758; knee 7,562), representing 0.27% incidence of PJI (hip, 0.33%; knee 0.23%). Of the patients, 15 were males and 19 were females. The mean age at the time of primary TJA was 59.8±17.5 (range, 31 to 85) years in hip PJI patients and 71.4±7.2 (range, 56 to 80) years in knee PJI patients. Hypertension and urinary tract infection were both associated with PJI following primary hip TJA. Age between 70 and 79 years, male sex, urinary tract infection, anemia, and prior corticosteroid usage were all associated with PJI following primary knee TJA. CONCLUSION: This study indicates the viability of employing CDM to undertake research on PJI and serves as a reference for future CDM-based risk factor analysis. Preoperative screening and mitigating identified risk factors can aid in the reduction of PJI following TJA.

Wrist Arthrodesis in Athetoid Type Cerebral Palsy: A Case Study of 2 Patients.

Wrist arthrodesis has been used successfully for the management of severe wrist flexion deformity when soft tissue procedures would not provide adequate correction. However, in athetoid type cerebral palsy which has a component of involuntary movement, the outcome of wrist arthrodesis has not been discussed much. We present our experience in 2 athetoid type cerebral palsy patients who underwent wrist arthrodesis due to severe involuntary movement of the wrist. One patient had a nonunion and both patients had unexpected aggravation of involuntary movement in the adjacent joints. Secure fixation using a pre-contoured plate is necessary and preparation for iliac bone grafting should be considered as proximal row carpectomy is usually not necessary in these patients. In addition, although single-event, multi-level surgery is advocated for patients with cerebral palsy, potential additional procedures for the adjacent joints should be discussed preoperatively because unexpected aggravation of involuntary movement of adjacent joints can occur after stabilization of the wrist.

Evaluation and Management of Osteoporosis and Sarcopenia in Patients with Distal Radius Fractures.

Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.

Comparison of the osteogenic potential of bone dust and iliac bone chip.

BACKGROUND CONTEXT: There is no comparative study of the in vitro and in vivo osteogenic potential of iliac bone chips (autogenous iliac cancellous bone chips) compared with bone dusts generated during the decortication process with a high-speed burr in spine fracture or fusion surgery. PURPOSE: To compare the osteogenic potential of three sizes of bone dusts with iliac bone chips and to determine whether bone dusts can be used as a bone graft substitute. STUDY DESIGN: In vitro and in vivo study. METHODS: Bone chips were harvested from the posterior superior iliac spine and bone dusts from the vertebrae of 15 patients who underwent spinal fracture surgery. Bone dust was divided into three groups: small (3 mm), middle (4 mm), and large (5 mm) according to the size of the burr tip. A comparison was made using a cell proliferation assay, alkaline phosphatase (ALP) activity, the degree of mineralization in an in vitro model, and radiographic and histologic studies (the change of absorbable area and tissue density) after implantation of the various materials into back muscles of nude mice. RESULTS: Although all three bone dust groups were less active with regard to cell proliferation, ALP activity, and the degree of mineralization, than were bone chips, they still exhibited osteogenic potential. Furthermore, there was no significant difference among the three bone dust groups. The three bone dust groups did show greater absorbable area and change of the tissue density than did the iliac bone chip group. Again, there was no significant difference among the three bone dust groups in this regard. Histologically, specimens from the bone dust groups had a higher osteoclast cell number than specimens from the iliac bone chip group. CONCLUSIONS: The osteogenic potential of bone dusts is lower than that of iliac bone chips, and the absorption speed of bone dusts in vivo is faster than that of iliac bone chips. The increased resorption speed appeared to result from an increase in osteoclast cell number. Therefore, caution needs to be used when surgeons employ bone dust as a bone graft substitute.