scholarly journals Wound Complications after 2-Octyl Skin Closure Systems for Total Joint Arthroplasty

2020 ◽  
Vol 5 (2) ◽  
pp. 101-105
Author(s):  
Andrew Michalowitz ◽  
Robert Comrie ◽  
Christopher Nicholas ◽  
Michael Wagner ◽  
James Kehoe
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Secondary Outcome ◽  
Wound Complications ◽  
Skin Closure ◽  
Closure Systems ◽  
Large Numbers ◽  
Deep Wound ◽  
Superficial Wound ◽  
Future Randomized Control Trial

Abstract. Introduction: Total joint arthroplasty is projected to expand rapidly by 2030. With large numbers of patients undergoing TJA, the choice of incisional closure has come into question. We compared the 2-Ocyl cyanoacrylate closure system of Dermabond ® Prineo ® with Exofin Fusion ® to compare rates of adverse wound outcomes after total joint arthroplasty. Secondary outcome measures were age, sex, and medical comorbidities between groups.Methods: We retrospectively reviewed adverse wound outcomes with skin closure in TJA in 281 patients (160 Dermabond Prineo and 121 Exofin Fusion). Clinical charts were analyzed out to the 6-week post-op visit.Results: The rate of overall adverse superficial wound outcomes was similar between the two groups with Dermabond Prineo (N=20) and Exofin Fusion (N=19). The rate of cellulitis was significantly higher for Dermabond Prineo when compared to Exofin Fusion (P=0.033). No other significant differences were found for rate of superficial or deep wound complications or for secondary outcomes.Conclusions: The two 2-octyl wound closure systems had similar adverse superficial wound complications. Except for Dermabond Prineo having a higher rate of post-operative cellulitis, there were no statistically significant differences for other superficial or deep adverse wound outcomes or secondary outcomes. A future randomized control trial or prospective cohort study is needed for a more robust analysis.

Increased Incidence of Bleeding and Wound Complications With Factor-Xa Inhibitors After Total Joint Arthroplasty

2018 ◽  
Vol 33 (2) ◽  
pp. 533-536 ◽  
Author(s):  
Jonathan H. Garfinkel ◽  
Brian P. Gladnick ◽  
Niama Roland ◽  
David W. Romness
Keyword(s):  
Total Joint Arthroplasty ◽  
Factor Xa ◽  
Joint Arthroplasty ◽  
Factor Xa Inhibitors ◽  
Wound Complications

Neuraxial anesthesia is associated with improved survival after total joint arthroplasty depending on frailty: a cohort study

2020 ◽  
Vol 45 (6) ◽  
pp. 405-411 ◽  
Author(s):  
Rebecca L Johnson ◽  
Ryan D Frank ◽  
Elizabeth B Habermann ◽  
Alanna M Chamberlain ◽  
Matthew P Abdel ◽  
...  
Keyword(s):  
Cohort Study ◽  
Total Joint Arthroplasty ◽  
Cox Regression ◽  
Joint Arthroplasty ◽  
Neuraxial Anesthesia ◽  
Wound Complications ◽  
Neuraxial Block ◽  
Frailty Status ◽  
Vulnerable Patients ◽  
Selection Of

BackgroundFrailty increases risk for complications after total joint arthroplasty (TJA). Whether this association is influenced by anesthetic administered is unknown. We hypothesized that use of neuraxial (spinal or epidural) anesthesia is associated with better outcomes compared with general anesthesia, and that the effect of anesthesia type on outcomes differs by frailty status.MethodsThis single-institution cohort study included all patients (≥50 years) from January 2005 through December 2016 undergoing unilateral, primary and revision TJA. Using multivariable Cox regression, we assessed relationships between anesthesia type, a preoperative frailty deficit index (FI) categorized as non-frail (FI <0.11), vulnerable (FI 0.11 to 0.20), and frail (FI >0.20), and complications (mortality, infection, wound complications/hematoma, reoperation, dislocation, and periprosthetic fracture) within 1 year after surgery. Interactions between anesthesia type and frailty were tested, and stratified models were presented when an interaction (p<0.1) was observed.ResultsAmong 18 458 patients undergoing TJA, more patients were classified as frail (21.5%) and vulnerable (36.2%) than non-frail (42.3%). Anesthesia type was not associated with complications after adjusting for age, joint, and revision type. However, in analyzes stratified by frailty, vulnerable patients under neuraxial block had less mortality (HR=0.49; 95% CI 0.27 to 0.89) and wound complications/hematoma (HR=0.71; 95% CI 0.55 to 0.90), whereas no difference in risk by anesthesia type was observed among patients found non-frail or frail.ConclusionsNeuraxial anesthesia use among vulnerable patients was associated with improved survival and less wound complications. Calculating preoperative frailty prior to TJA informs perioperative risk and enhances shared-decision making for selection of anesthesia type.

scholarly journals Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

Geriatrics ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 18
Author(s):  
Jordan Etscheidt ◽  
Amir Shahien ◽  
Monique Gainey ◽  
Daniel Kronenfeld ◽  
Ruijia Niu ◽  
...  
Keyword(s):  
High Risk ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Therapeutic Options ◽  
Wound Complications ◽  
Specific Patient ◽  
Standards Of Practice ◽  
Venous Thromboembolic Events ◽  
Risk Patients ◽  
Oral Aspirin

Hip and knee arthroplasty patients are at high risk of perioperative venous thromboembolic events (VTE). VTE has been well studied in this population and it is recommended that total joint arthroplasty recipients receive chemoprophylactic anticoagulation due to risk factors inherent to the surgical intervention. There are few concise resources for the orthopedic surgeon that summarize data regarding post-operative anticoagulation in the context of currently available therapeutic options and perioperative standards of practice. The periodic reexamination of literature is essential as conclusions drawn from studies predating perioperative protocols that include early mobilization and sequential compression devices as standards of practice in total joint arthroplasty are no longer generalizable to modern-day practice. We reviewed a large number of recently published research studies related to post-operative anticoagulation in total joint arthroplasty populations that received a high Level of Evidence grade. Current literature supports the use of oral aspirin regimens in place of more aggressive anticoagulants, particularly among low risk patients. Oral aspirin regimens appear to have the additional benefit of lower rates of bleeding and wound complications. Less consensus exists among high risk patients and more potent anticoagulants may be indicated. However, available evidence does not demonstrate clear superiority among current options, all of which may place patients at a higher risk of bleeding and wound complications. In this situation, chemoprophylactic selection should reflect specific patient needs and characteristics.

Wound Complications in Joint Arthroplasty: Comparing Traditional and Modern Methods of Skin Closure

Orthopedics ◽  
2012 ◽  
Vol 35 (5) ◽  
pp. e641-e646 ◽  
Author(s):  
Ronak M. Patel ◽  
Max Cayo ◽  
Arpan Patel ◽  
Marie Albarillo ◽  
Lalit Puri
Keyword(s):  
Joint Arthroplasty ◽  
Wound Complications ◽  
Skin Closure ◽  
Modern Methods

scholarly journals Surgical site peptidylarginine deaminase 4 (PAD4), a biomarker of NETosis, correlates with insulin resistance in total joint arthroplasty patients: A preliminary report

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245594
Author(s):  
Vitor F. Martins ◽  
Christopher R. Dobson ◽  
Maedha Begur ◽  
Jesal Parekh ◽  
Scott T. Ball ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Skeletal Muscle ◽  
Wound Healing ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Neutrophil Extracellular Trap ◽  
Wound Complications ◽  
Model Assessment ◽  
Insulin Resistant ◽  
Homeostatic Model Assessment

While obesity and insulin resistance are known risk factors for wound complications after total joint arthroplasty (TJA), the biologic causes remain to be elucidated. Recently, neutrophil extracellular trap formation (NETosis) was identified as a mediator of delayed wound healing in insulin resistant states. Herein, we explored the relationship between obesity, insulin resistance and biomarkers of NET formation in TJA subjects. We enrolled 14 obese (body mass index [BMI]≥30 kg/m2), and 15 lean (BMI<30 kg/m2) subjects undergoing primary knee or hip TJA. On the day of surgery, skeletal muscle proximal to the operated joint and plasma were collected. Protein abundance of NETosis biomarkers, peptidylarginine deaminase 4 (PAD4) and neutrophil elastase (NE) were assessed in skeletal muscle by immunoblotting and metabolic parameters (glucose, insulin, triglycerides, free fatty acids) and cell-free double-stranded DNA (cf-dsDNA) were assessed in plasma and were correlated with obesity and insulin resistance (as measured by the homeostatic model assessment for insulin resistance). When comparing lean and obese subjects, there were no significant differences in plasma cf-dsDNA or skeletal muscle NE or PAD4 abundance. In contrast, skeletal muscle PAD4 abundance, but not NE or plasma cf-dsDNA, was positively correlated with insulin resistance. Compared to insulin sensitive subjects, insulin resistant TJA subjects have higher expression of PAD4 at the surgical site and therefore may have higher rates of NET formation, which may lead to delayed surgical site wound healing.

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