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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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ICM document update: Russian translation completed

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

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2018 ICM book updates

Dear Delegates many of you are still waiting to receive a hard copy of the ICM book. The 5000 copies we had are all accounted for at this point. We are planning to have 300-400 copies of the book for distribution at the AAOS either in some of our industry partners’ booth or during off-site activities like the ICM symposium that will be held on Thursday evening at Venetian. In addition, some copies will be distributed in European meetings this month. We hope you will be able to get your hands on a copy soon.

Very sorry if we were unable to get you a copy. We distributed the books on first come first served basis and have ran out of the hard copies at this point. We may consider a second print run in the future.

Please note that the entire document (and the soon to come translations) are available on the App (ICMPhilly) and also the website (www.icmphilly.com).

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Paper of the week: Reconsidering Strategies for Managing Chronic Periprosthetic Joint Infection in Total Knee Arthroplasty: Using Decision Analytics to Find the Optimal Strategy Between One-Stage and Two-Stage Total Knee Revision

Paper of the Week: Reconsidering Strategies for Managing Chronic Periprosthetic Joint Infection in Total Knee Arthroplasty: Using Decision Analytics to Find the Optimal Strategy Between One-Stage and Two-Stage Total Knee Revision. Srivastava K, Bozic KJ, Silverton C, Nelson AJ, Makhni EC, Davis JJ.J Bone Joint Surg Am. 2019 Jan 2;101(1):14-24. doi: 10.2106/JBJS.17.00874.

Summary and Editorial by Sreeram Penna

In this study, researchers used decision analysis to determine the optimal decision for the management of chronic periprosthetic infection (PJI) following total knee arthroplasty (TKA). Researchers constructed an expected-value decision tree to estimate the quality-adjusted-life-years (QALYs) and costs associated with 1-stage and 2-stage revision. Two decision trees were created one was for all pathogens, a second decision tree was constructed for difficult to treat organisms including methicillin-resistant. A Markov model was used to calculate the QALYs over a 15-year period. The model input was based on values such as mortality rates and reinfection rates published in original studies since 2000. Cost data were obtained from Medicare data.

Results showed that 1-stage revision was the optimal decision in producing greater health utility in both decision trees in the analysis. Some of the issues with research are that there is limited data on infection eradication 1-stage revisions for PJI. Seven studies included in the above simulation for 1-stage revision showed reinfection rates of 7% compared to 15% for 2-stage revision. Researchers contend that even if we assume reinfection rate for 2-stage revision to be around 10% infection rates of 1-stage be more than 30% to be considered non-optimal strategy compared to 2-stage revision as decision model captures significant morbidity and mortality associated with a 2-stage procedure. The simulation also captures cost savings of around $19,000 to $27,000 per infection (depending on pathogen) for 1-stage revision.

Normally in PJI treatment 2 stage revision procedure is considered the gold standard for infection eradication. However, it is known that such strategy place significant morbidity on the patient. In addition, a significant number of patients does not complete the reimplantation procedure in 2-stage operation.[1] This study gives an opportunity for orthopaedic community to rethink options in managing patients with PJI and further research is required.

References
[1] Gomez MM, Tan TL, Manrique J, Deirmengian GK, Parvizi J. The Fate of Spacers in the Treatment of Periprosthetic Joint Infection. J Bone Joint Surg Am 2015;97:1495–502. doi:10.2106/JBJS.N.00958.