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Paper of the week: Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery.

Paper of the week: Modifiable Factors as Current Smoking, Hypoalbumin, and Elevated Fasting Blood Glucose Level Increased the SSI Risk Following Elderly Hip Fracture Surgery. Ma T, Lu K, Song L, Wang D, Ning S, Chen Z, Wu Z. J Invest Surg. 2019 Mar 19:1-9. doi: 10.1080/08941939.2018.1556364.

Summary by Dr Sreeram Penna

Aim of this retrospective study was to find incidence of infection post hip fracture surgery in elderly population. In addition, researchers were also looking for independent risk factors associated with infection in this cohort. Infections were classified in to superficial and deep infections based on combination of clinical findings of persistent wound discharge, wound dehiscence, gangrene and abscess development, need for surgical intervention and positive cultures. 611 patients were included in the final study. Over all infection incidence was 4.4% (27/611), superficial infection was 3.1% (21/611) and deep infection was 1.3% (6/611). Multivariate analysis showed that body mass index, current smoking, surgical duration of more than 2 hours, preoperative hospital stay more than 7 days, ASA class of III and IV, albumin levels less than 35 gram per liter, and fasting blood glucose more than 110 mg/dl were know to be independent risk factors for development of infection following hip fracture surgery.

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Paper of the week: Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single Dose Is as Effective as Multiple Doses.

Paper of the week: Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single Dose Is as Effective as Multiple Doses. Tan TL, Shohat N, Rondon AJ, Foltz C, Goswami K, Ryan SP, Seyler TM, Parvizi J. J Bone Joint Surg Am. 2019 Mar 6;101(5):429-437. doi: 10.2106/JBJS.18.00336.

Summary by Dr. Sreeram Penna

This study is a retrospective study comparing the incidence of periprosthetic joint infection (PJI) in primary joint arthroplasty who had a single dose of prophylactic antibiotic versus multiple doses at the time of surgery. A total of 20,682 patients were included in the study. Of these 4523 had a single dose and 16159 had multiple doses. All patients who had an infection within 1 year were identified and confirmed with MSIS criteria. In addition, researchers calculated and recorded the patient’s preoperative infection risk score.

The results showed that overall rates of PJI were 0.60% (27/4523) in patients receiving a single dose and 0.88% (142/16159) in patients receiving multiple prophylactic antibiotic doses. Researchers also noted that both patient groups were significantly different in various demographics (age, sex, BMI, comorbidities, ASA score, length of stay). Researchers then performed multivariate analysis after controlling for potential confounders and found no significant difference between the PJI rate between both groups. They have also used propensity score matching with preoperative risk score and found no increase in PJI rate in patients with a single dose of prophylactic antibiotic at the primary procedure.

Although this study has limitations of being retrospective study and statistically significant differences between two groups, it provides the necessary evidence to support the use of single-dose prophylactic antibiotic during primary joint arthroplasty.

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ICM document update: Spanish translation completed

ICM document Spanish translation is completed. It is available online at the following link.

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ICM symposium at AAOS info and ICM book availability updates

Dear Delegates, For those of you who may be attending the AAOS next week, we wanted to let you know that copies of the ICM book will be distributed during the ICM symposium to be held on Thursday 6-7:30 PM at Titan Room Venetian(sponsored by Convatec) and also another symposium on the same day from 9-10:30 PM at Tao, Venetian(Sponsored by Heraeus). In addition, our industry partners Aerobiotix, Acelity, and MicrogenDx, have agreed to have copies of the book for distribution in their booth.

See you in Vegas

Have you checked out the new version of the PJIDx on the App?

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Paper of the week: Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in diagnosing chronic periprosthetic shoulder joint infection.

Paper of the week: Labeled white blood cell/bone marrow single-photon emission computed tomography with computed tomography fails in diagnosing chronic periprosthetic shoulder joint infection. Falstie-Jensen T, Daugaard H, Søballe K, Ovesen J, Arveschoug AK, Lange J; ROSA study group. J Shoulder Elbow Surg. 2019 Jan 31. pii: S1058-2746(18)30782-1. doi: 10.1016/j.jse.2018.10.024.

Summary by Dr. Sreeram Penna

This prospective cohort study assessed the diagnostic accuracy of combined labeled leukocyte (WBC) and technetium 99m sulfur colloid bone marrow imaging (WBC/BM) single-photon emission computed tomography-computed tomography in chronic shoulder prosthetic joint infection (PJI). Researchers reviewed patients with a failed shoulder arthroplasty, which was defined as any unsatisfactory result of any cause. Researchers considered shoulder infected if 3 positive tissue cultures with the same bacteria or if a sinus tract communicating to the prosthesis was present. The final cohort of 29 patients was included in the study. Of these 11 were considered positive based on infection definition criteria used. Only 2 patients in the infected group had positive WBC/BM single-photon emission computed tomography (2/11, 18.2%). There were no false positive cases in the study. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of detecting chronic shoulder PJI using this test was 0.18, 1.00, 1.00, 0.67, and 0.69 respectively. Although the study had a low sample size it has shown a lack of utility of bone scan in improving the diagnostic accuracy of chronic shoulder PJI.