What Determines the Type and Dose of Antibiotic That Is Needed to Be Added to the Cement Spacer in Patients With Infected Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 48S-52S
Author(s):  
Rachel Shakked ◽  
Ferdinando Da Rin de Lorenzo
Keyword(s):  
Renal Function ◽  
Hip Arthroplasty ◽  
Broad Spectrum ◽  
Total Ankle Arthroplasty ◽  
Cement Spacer ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Medical Comorbidities ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

Recommendation:We recommend tailoring the antibiotic in cement spacers to the infecting organism if it has been identified, as is typically done in total knee and hip arthroplasty. Otherwise, broad-spectrum antibiotics may be utilized. Medical comorbidities should always be considered, especially with regard to renal function and allergy profile. A thermostable antibiotic should be added to cement.Level of Evidence:Consensus.Delegate Vote:Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

scholarly journals Diagnostic Criteria and Treatment of Acute and Chronic Periprosthetic Joint Infection of Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984100
Author(s):  
Kempland C. Walley ◽  
Christopher B. Arena ◽  
Paul J. Juliano ◽  
Michael C. Aynardi
Keyword(s):  
Diagnostic Criteria ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Prosthetic Joint ◽  
Ankle Replacement ◽  
Knee And Hip Arthroplasty

Background: Prosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a serious complication that results in significant consequences to the patient and threatens the survival of the ankle replacement. PJI in TAA may require debridement, placement of antibiotic spacer, revision arthroplasty, conversion to arthrodesis, or potentially below the knee amputation. While the practice of TAA has gained popularity in recent years, there is some minimal data regarding wound complications in acute or chronic PJI of TAA. However, of the limited studies that describe complications of PJI of TAA, even fewer studies describe the criteria used in diagnosing PJI. This review will cover the current available literature regarding total ankle arthroplasty infection and will propose a model for treatment options for acute and chronic PJI in TAA. Methods: A review of the current literature was conducted to identify clinical investigations in which prosthetic joint infections occurred in total ankle arthroplasty with associated clinical findings, radiographic imaging, and functional outcomes. The electronic databases for all peer-reviewed published works available through January 31, 2018, of the Cochrane Library, PubMed MEDLINE, and Google Scholar were explored using the following search terms and Boolean operators: “total ankle replacement” OR “total ankle arthroplasty” AND “periprosthetic joint infection” AND “diagnosis” OR “diagnostic criteria.” An article was considered eligible for inclusion if it concerned diagnostic criteria of acute or chronic periprosthetic joint infection of total ankle arthroplasty regardless of the number of patients treated, type of TAA utilized, conclusion, or level of evidence of study. Results: No studies were found in the review of the literature describing criteria for diagnosing PJI specific to TAA. Conclusions: Literature describing the diagnosis and treatment of PJI in TAA is entirely reliant on the literature surrounding knee and hip arthroplasty. Because of the limited volume of total ankle arthroplasty in comparison to knee and hip arthroplasty, no studies to our knowledge exist describing diagnostic criteria specific to total ankle arthroplasty with associated reliability. Large multicenter trials may be required to obtain the volume necessary to accurately describe diagnostic criteria of PJI specific to TAA. Level of Evidence: Level III, systematic review.

What Is the Definition of Acute and Chronic Periprosthetic Joint Infection (PJI) of Total Ankle Arthroplasty (TAA)?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 19S-21S ◽  
Author(s):  
Michael C. Aynardi ◽  
Milena M. Plöger ◽  
Kempland C. Walley ◽  
Christopher B. Arena
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Definition Of ◽  
Knee And Hip Arthroplasty

Recommendation: There is a paucity of data for defining acute or chronic periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA) in the literature. Any discussion of PJI after ankle replacement is entirely reliant on the literature surrounding knee and hip arthroplasty. Level of Evidence: Consensus. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

Crystal-Induced Arthritis After Total Ankle Arthroplasty

2019 ◽  
Vol 109 (2) ◽  
pp. 159-161
Author(s):  
Le Hoang Nam Dang ◽  
Jong-Kil Kim ◽  
Kwang-Bok Lee
Keyword(s):  
Synovial Tissue ◽  
Hip Arthroplasty ◽  
Late Onset ◽  
Total Ankle Replacement ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Ankle Replacement ◽  
Total Knee ◽  
Knee And Hip Arthroplasty ◽  
Crystal Induced Arthritis

The causes of late-onset pain after total ankle replacement (TAR) are various, and include infection, subsidence, polyethylene spacer failure, osteolysis, and wear. There are few reports of late-onset pain caused by gouty attacks after total knee and hip arthroplasty. In addition, no research has reported gouty attacks after total ankle arthroplasty. Therefore, we report a case of a gouty attack after total ankle replacement. A 43-year-old man presented with pain after total ankle arthroplasty performed 5 years previously. We found a white-yellow crystalline deposit within the synovial tissue during ankle arthroscopy, confirmed by histologic examination.

Effect of Tranexamic Acid on Wound Complications and Blood Loss in Total Ankle Arthroplasty

2020 ◽  
Vol 41 (9) ◽  
pp. 1117-1121
Author(s):  
R. Garrett Steinmetz ◽  
Laura Luick ◽  
Shaun Tkach ◽  
Spencer Falcon ◽  
Julie Stoner ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hip Arthroplasty ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Intraoperative Blood Loss ◽  
Ankle Arthroplasty ◽  
Total Hip ◽  
Total Knee

Background: Tranexamic acid (TXA) is a medication that has been shown to decrease blood loss and risk of blood transfusion in total knee and total hip arthroplasty. The purpose of this study was to evaluate the use of TXA in patients undergoing total ankle arthroplasty (TAA). We hypothesized there would be less blood loss and wound complications in patients receiving TXA. Methods: A retrospective review of 2 patient cohorts operated on by 2 surgeons was performed from 2010 to 2018. We compared a group of TAA patients that did not receive TXA vs a subsequent group that received TXA. Patients received 1g intravenous TXA before the tourniquet was inflated followed by another 1 g after release of the tourniquet. Intraoperative blood loss was recorded and preoperative hemoglobin and hematocrit levels were compared to postoperative levels. Intraoperative and postoperative complications were compared between the 2 groups. A total of 119 patients were included in the study, of whom 55 received TXA. No significant difference existed between the 2 groups in gender, age, body mass index, or Charlson comorbidity index. Results: There was no difference in estimated blood loss, postoperative hemoglobin/hematocrit values or preoperative to postoperative change in hemoglobin/hematocrit values. Additionally, there was no difference in wound complications or overall complication rate between the groups. Conclusion: TXA has been shown to be effective in total knee and total hip arthroplasty in decreasing blood loss and transfusion risk. We did not find it to be effective in reducing intraoperative blood loss, perioperative blood loss, or wound complications in TAA. Level of Evidence: Level III, comparative study.

Does Intra-articular Injection of the Ankle With Corticosteroids Increase the Risk of Subsequent Periprosthetic Joint Infection (PJI) Following Total Ankle Arthroplasty (TAA)? If So, How Long After a Prior Intra-articular Injection Can TAA Be Safely Performed?

2019 ◽  
Vol 40 (1_suppl) ◽  
pp. 3S-4S
Author(s):  
Ilker Uçkay ◽  
Christopher B. Hirose ◽  
Mathieu Assal
Keyword(s):  
Periprosthetic Joint Infection ◽  
Corticosteroid Injection ◽  
Joint Infection ◽  
Invasive Procedure ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Strong Consensus ◽  
Healthcare Associated ◽  
The Ideal

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

Possible Implications for Bundled Payment Models of Comorbidities and Complications as Drivers of Cost in Total Ankle Arthroplasty

2018 ◽  
Vol 40 (2) ◽  
pp. 210-217 ◽  
Author(s):  
Daniel Cunningham ◽  
Vasili Karas ◽  
James K. DeOrio ◽  
James A. Nunley ◽  
Mark E. Easley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Patient Factors ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Bundled Payment ◽  
Significance Threshold ◽  
Ed Visits

Background: The Comprehensive Care for Joint Replacement (CJR) model provides bundled payments for in-hospital and 90-day postdischarge care of patients undergoing total ankle arthroplasty (TAA). Defining patient factors associated with increased costs during TAA could help identify modifiable preoperative patient factors that could be addressed prior to the patient entering the bundle, as well as determine targets for cost reduction in postoperative care. Methods: This study is part of an institutional review board–approved single-center observational study of patients undergoing TAA from January 1, 2012, to December 15, 2016. Patients were included if they met CJR criteria for inclusion into the bundled payment model. All Medicare payments beginning at the index procedure through 90 days postoperatively were identified. Patient, operative, and postoperative characteristics were associated with costs in adjusted, multivariable analyses. One hundred thirty-seven patients met inclusion criteria for the study. Results: Cerebrovascular disease (intracranial hemorrhages, strokes, or transient ischemic attacks) was initially associated with increased costs (mean, $5595.25; 95% CI, $1710.22-$9480.28) in adjusted analyses ( P = .005), though this variable did not meet a significance threshold adjusted for multiple comparisons. Increased length of stay, discharge to a skilled nursing facility (SNF), admissions, emergency department (ED) visits, and wound complications were significant postoperative drivers of payment. Conclusion: Common comorbidities did not reliably predict increased costs. Increased length of stay, discharge to an SNF, readmission, ED visits, and wound complications were postoperative factors that considerably increased costs. Lastly, reducing the rates of SNF placement, readmission, ED visitation, and wound complications are targets for reducing costs for patients undergoing TAA. Level of Evidence: Level II, prognostic prospective cohort study.

scholarly journals Computer assisted navigation in total knee and hip arthroplasty

SICOT-J ◽  
2017 ◽  
Vol 3 ◽  
pp. 50 ◽  
Author(s):  
Kamal Deep ◽  
Shivakumar Shankar ◽  
Ashish Mahendra
Keyword(s):  
Hip Arthroplasty ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Total Knee ◽  
Knee And Hip Arthroplasty

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

2018 ◽  
Vol 32 (06) ◽  
pp. 475-482 ◽  
Author(s):  
Karim G. Sabeh ◽  
Samuel Rosas ◽  
Leonard T. Buller ◽  
Andrew A. Freiberg ◽  
Cynthia L. Emory ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Primary Total Knee Arthroplasty ◽  
Cost Of Care ◽  
Chronic Obstructive ◽  
Level Of Evidence ◽  
Medical Comorbidities ◽  
Total Knee ◽  
The Impact

AbstractMedical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294–26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost.

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