scholarly journals Extracellular Vesicle Isolation and Characterization from Periprosthetic Joint Synovial Fluid in Revision Total Joint Arthroplasty

2020 ◽  
Vol 9 (2) ◽  
pp. 516 ◽  
Author(s):  
Julian M. Rüwald ◽  
Thomas M. Randau ◽  
Cäcilia Hilgers ◽  
Werner Masson ◽  
Stephan Irsen ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Total Joint Arthroplasty ◽  
Joint Infection ◽  
Extracellular Vesicle ◽  
Joint Arthroplasty ◽  
Surface Markers ◽  
Multiplex Analysis ◽  
Isolation And Characterization ◽  
New Research ◽  
Revision Total Joint Arthroplasty

Extracellular vesicles (EVs) comprise an as yet insufficiently investigated intercellular communication pathway in the field of revision total joint arthroplasty (RTJA). This study examined whether periprosthetic joint synovial fluid contains EVs, developed a protocol for their isolation and characterized them with respect to quantity, size, surface markers as well as documented their differences between aseptic implant failure (AIF) and periprosthetic joint infection (PJI). EV isolation was accomplished using ultracentrifugation, electron microscopy (EM) and nanoparticle tracking analysis evaluated EV presence as well as particle size and quantity. EV surface markers were studied by a bead-based multiplex analysis. Using our protocol, EM confirmed the presence of EVs in periprosthetic joint synovial fluid. Higher EV particle concentrations and decreased particle sizes were apparent for PJI. Multiplex analysis confirmed EV-typical surface epitopes and revealed upregulated CD44 and HLA-DR/DP/DQ for AIF, as well as increased CD40 and CD105. Our protocol achieved isolation of EVs from periprosthetic joint synovial fluid, confirmed by EM and multiplex analysis. Characterization was documented with respect to size, concentration and epitope surface signature. Our results indicate various differences between PJI and AIF EVs. This pilot study enables new research approaches and rising diagnostic opportunities in the field of RTJA.

Are current DRG-based bundled payment models for revision total joint arthroplasty risk-adjusting adequately?

2020 ◽  
Vol 102-B (7) ◽  
pp. 959-964
Author(s):  
Azeem T. Malik ◽  
Mengnai Li ◽  
Safdar N. Khan ◽  
John H. Alexander ◽  
Daniel Li ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
Marginal Cost ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Prosthetic Joint ◽  
Revision Total Joint Arthroplasty ◽  
Payment Models

Aims Currently, the US Center for Medicaid and Medicare Services (CMS) has been testing bundled payments for revision total joint arthroplasty (TJA) through the Bundled Payment for Care Improvement (BPCI) programme. Under the BPCI, bundled payments for revision TJAs are defined on the basis of diagnosis-related groups (DRGs). However, these DRG-based bundled payment models may not be adequate to account appropriately for the varying case-complexity seen in revision TJAs. Methods The 2008-2014 Medicare 5% Standard Analytical Files (SAF5) were used to identify patients undergoing revision TJA under DRG codes 466, 467, or 468. Generalized linear regression models were built to assess the independent marginal cost-impact of patient, procedural, and geographic characteristics on 90-day costs. Results A total of 9,263 patients (DRG-466 = 838, DRG-467 = 4,573, and DRG-468 = 3,842) undergoing revision TJA from 2008 to 2014 were included in the study. Undergoing revision for a dislocation (+$1,221), periprosthetic fracture (+$4,454), and prosthetic joint infection (+$5,268) were associated with higher 90-day costs. Among comorbidities, malnutrition (+$10,927), chronic liver disease (+$3,894), congestive heart failure (+$3,292), anaemia (+$3,149), and coagulopathy (+$2,997) had the highest marginal cost-increase. The five US states with the highest 90-day costs were Alaska (+$14,751), Maryland (+$13,343), New York (+$7,428), Nevada (+$6,775), and California (+$6,731). Conclusion Under the proposed DRG-based bundled payment methodology, surgeons would be reimbursed the same amount of money for revision TJAs, regardless of the indication (periprosthetic fracture, prosthetic joint infection, mechanical loosening) and/or patient complexity. Cite this article: Bone Joint J 2020;102-B(7):959–964.

scholarly journals The bactericidal effect of vancomycin is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christiane Schwerdt ◽  
Eric Röhner ◽  
Sabrina Böhle ◽  
Benjamin Jacob ◽  
Georg Matziolis
Keyword(s):  
Staphylococcus Aureus ◽  
Tranexamic Acid ◽  
Total Joint Arthroplasty ◽  
Staphylococcus Epidermidis ◽  
Joint Infection ◽  
Bactericidal Effect ◽  
Joint Arthroplasty ◽  
Zone Of Inhibition ◽  
Agar Diffusion Test

AbstractOne of the most challenging complications of total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). There is growing evidence of a good anti-infective effect of intrawound vancomycin powder in total joint arthroplasty. At the same time, various different locally applied substances have become popular in total joint arthroplasty. The objective of this study was therefore to investigate a possible inhibition of the bactericidal effect of vancomycin by tranexamic acid, adrenalin, lidocaine, or dexamethasone. The bactericidal effect of vancomycin was quantified using the established method of the agar diffusion test. The plates were incubated with Staphylococcus aureus or Staphylococcus epidermidis and four wells were stamped out. The wells were filled with vancomycin alone, the tested substance alone or a mixture of the two. The fourth well remained empty as a control. The plates were incubated overnight at 37 °C and the zone of inhibition in each field was measured on the next day. All tests were run three times for each pathogen and mean values and standard deviations of the measurements were calculated. Differences between the substances were tested using the t-test at a level of significance of 0.05. The bacterial growth was homogeneous on all plates. The baseline value for the zone of inhibition of vancomycin was on average 6.2 ± 0.4 mm for Staphylococcus aureus and 12 ± 0.3 mm for Staphylococcus epidermidis. In all other substances, no inhibition was detected around the well. The combination of vancomycin and each other substance did not show any different result compared to vancomycin alone. The bactericidal effect of vancomycin on staphylococci is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro.

scholarly journals Efficacy of hydrofibre dressing following total joint arthroplasty: a meta-analysis of randomised controlled trials

2021 ◽  
pp. 112070002110126
Author(s):  
Raman Mundi ◽  
Harman Chaudhry ◽  
Seper Ekhtiari ◽  
Prabjit Ajrawat ◽  
Daniel M Tushinski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Joint Infection ◽  
The United States ◽  
Joint Arthroplasty ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Observable Effect ◽  
The Impact

Introduction: In the United States, over 1,000,000 total joint arthroplasty (TJA) surgeries are performed annually and has been forecasted that this number will exceed 4,000,000 by the year 2030. Many different types of dressing exist for use in TJA surgery, and it is unclear if any of the newer, hydrofibre dressings are superior to traditional dressings at reducing rates of infections or improving wound healing. Thus, the aim of this systematic review and meta-analysis was to assess the impact of hydrofiber dressings on reducing complications. Methods: A systematic review and meta-analysis was performed using the online databases MEDLINE and the Cochrane Library. Randomized controlled trials (RCTs) comparing hydrofibre dressings to a standard dressing were included. Summary measures are reported as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Our primary outcome was prosthetic joint infection (PJI). Secondary outcomes included blisters, dressing changes and wound irritation. Results: 5 RCTs were included. Hydrofibre dressing had no observable effect on PJI or wound irritation (OR 0.53; 95% CI, 0.14–1.98; p = 0.35). Hydrofibre dressings reduced the rate of blisters (OR 0.36; 95% CI, 0.14–0.90; p = 0.03) and number of dressing changes (MD -1.89; 95% CI, -2.68 to -1.11). Conclusions: In conclusion, evidence suggests hydrofibre dressings have no observable effect on PJI and wound irritation. Evidence for reduction in blisters and number of dressings is modest given wide CIs and biased trial methodologies. Use of hydrofibre dressings should be considered inconclusive for mitigating major complications in light of current best evidence.

scholarly journals Performance Characteristics of Broth-only Cultures After Revision Total Joint Arthroplasty

2014 ◽  
Vol 472 (11) ◽  
pp. 3285-3290 ◽  
Author(s):  
Eric B. Smith ◽  
Jenny Cai ◽  
Rachael Wynne ◽  
Mitchell Maltenfort ◽  
Robert P. Good
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Performance Characteristics ◽  
Revision Total Joint Arthroplasty

scholarly journals 7 Management of Periprosthetic Joint Infection

2021 ◽  
Keyword(s):  
Decision Making ◽  
Periprosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Orthopaedic Surgeon ◽  
Systemic Complications ◽  
Surgical Decision ◽  
Surgical Options ◽  
Surgical Decision Making

Periprosthetic joint infection (PJI) continues to be a devastating problem in the field of total joint arthroplasty. There are a number of surgical options to decide from and management decisions are based upon the interplay between host, pathogen, and surgeon characteristics. The goal of management is to maximize function, prevent systemic complications, and eradicate infection. Throughout this chapter we will discuss the most relevant recent literature and guiding theories to assist the treating orthopaedic surgeon in the surgical decision-making process.

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