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Seigerman D.A.,Rothman Institute | Rivlin M.,Rothman Institute | Bianchini J.,Drexel University | Liss F.E.,Rothman Institute | And 2 more authors.
Journal of Hand Surgery | Year: 2016

Purpose The purpose of this study was to determine the extent of skin coverage during surgical preparation of the hand when preparation is done by 2 different methods. We hypothesized that hand preparation with commercially available prep-stick applicators (PS) would lead to more unprepared areas (UPAs) of skin compared with immersed 4 × 4 inch sterile gauze sponges (GS) used as controls. Methods Sixty upper extremities of 30 healthy volunteers were used for this study. The hands were prepped by 2 fellowship trained orthopedic hand surgeons as 30 matched pairs. The experimental group was prepped using a commercially available PS (ChloraPrep, Carefusion, San Diego, CA), whereas the control group was prepared with GS immersed in the prep solution and applied manually using sterile gloves. The number and location of UPAs in the hands and wrists of volunteers after preparation were recorded. In addition, the sum of UPAs relative to the total surface area of the skin was quantified with image analysis software. Results There were a total of 77 UPAs when prepping the volunteers with PS, compared with 14 in the control hands. This difference was statistically significant. Similarly, the average percentage area of UPAs relative to the total skin surface was 0.76% (range, 0.006% to 2.15%) when using PS compared with 0.15% (range, 0.005% to 0.56%) in the controls. This difference was statistically significant. Conclusions We identified a larger numbers of UPAs with commercially available applicator sticks compared with a control using sterile GS. Clinical relevance The clinical implications of these findings are unknown. © 2016 American Society for Surgery of the Hand.

Miller A.G.,Thomas Jefferson University | Bercik M.J.,Thomas Jefferson University | Ong A.,Rothman Institute of Orthopedics
Journal of Trauma and Acute Care Surgery | Year: 2012

BACKGROUND: Hip fracture is a common yet serious injury sustained by the elderly patient and represents one of the major healthcare challenges today. The aim of this study was to better define the unique characteristics of treating nonagenarian peritrochanteric hip fractures and their subsequent complications during hospital stay. METHODS: Seven hundred twenty-two patients underwent surgery for isolated fracture around the femoral neck. These patients were divided into one of three age groups: A, <50 years; B, 51-89 years; and C, >90 years. We performed a retrospective chart review to compare these groups in terms of patient characteristics, comorbidities, postoperative complications, fracture type, type of surgery performed, and mortality rate. RESULTS: There was no difference in time to surgery between groups. Comorbidities were similar in groups B and C but were higher than group A. Nonagenarians received a significantly greater percentage of hemiarthroplasties compared with those aged 51 years to 89 years. Cardiac complications were significantly higher in group C. In patients with sustained cardiac complications, the odds ratio for mortality was 15.88. CONCLUSIONS: Our results suggest that groups B and C were not significantly different pre- or intraoperatively. Nevertheless, there is an increase in cardiac complications and mortality in nonagenarians postoperatively. Nonagenarians should undergo similar treatment in the operating room compared with less elderly patients with the caveat that older patients, especially those with cardiac disease, may be more at risk for complication. The surgeon must evaluate the elderly patient with a hip fracture on a case-by-case basis, while ignoring chronological age. Copyright © 2012 by Lippincott Williams & Wilkins.

Springer B.D.,OrthoCarolina Hip and Knee Center | Parvizi J.,Rothman Institute of Orthopedics
Periprosthetic Joint Infection of the Hip and Knee | Year: 2014

Periprosthetic Joint Infection of the Hip and Knee is a practical reference for the diagnosis and treatment of total joint infections following hip and knee arthroplasty. In addition to useful chapters presenting common tests and algorithms used for diagnosis, the book gives background on the epidemiology, risk factors, and prevention strategies of periprosthetic joint infection. Additionally, practical clinical information is given, including antibiotic treatment strategies and delivery methods and medical optimization techniques for physicians to follow for patient care and follow-up. Covering a topic that is currently underrepresented in the medical literature, Periprosthetic Joint Infection of the Hip and Knee will be useful to orthopedic surgeons, rheumatologists, and other physicians involved in the care of patients with hip and knee prosthetic implants. © 2014 Springer Science+Business Media New York. All rights are reserved.

Kavanagh E.C.,Materials Misericordiae Hospital | Read P.,Thomas Jefferson University | Carty F.,Thomas Jefferson University | Zoga A.C.,Thomas Jefferson University | And 2 more authors.
Clinical Radiology | Year: 2011

Aim: To determine a possible association between femoral-acetabular impingement (FAI) volume and the development of labral tear using a three-dimensional (3D) model reconstruction of the acetabulum and the femoral head. Materials and methods: Magnetic resonance arthrography images of the hip in 42 patients with pain and suspected labral tear were acquired using a 1.5 T MRI machine. Using 3D analysis software, outlines of the acetabular cup and femoral head were drawn and 3D reconstruction obtained. To control for differences in patient size, ratios of acetabulum : femoral head volume (AFV) and acetabulum : femoral head surface area (AFA) were used for analysis. The association between volume of acetabulum : femoral head and FAI was investigated using ANOVA analysis. Results: There were 19 men and 23 women with a mean age of 39 years (range 18-78 years). The average AFV was 0.64 (range 0.37-1.05, SD 0.16) and AFA was 0.73 (range 0.36-1.26, SD 0.23). Herniation pit was significantly associated with a small AFV. Conclusion: Femoral neck herniation pits are associated with a low AFV. Gross volume and surface area ratios do not appear to correlate with labral tears or cartilage loss. This technique will enable more advanced analysis of morphological variations associated with FAI. © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Alijanipour P.,Rothman Institute of Orthopedics | Bakhshi H.,Rothman Institute of Orthopedics | Parvizi J.,Rothman Institute of Orthopedics
Clinical Orthopaedics and Related Research | Year: 2013

Background: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. Questions/purposes: Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. Methods: We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. Results: ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. Conclusions: The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. Level of Evidence: Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence. © 2013 The Association of Bone and Joint Surgeons®.

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