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英文中文

Dalbavancin Use in Bone and Joint Infections 达尔巴万星在骨与关节感染中的应用

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101505

Liam P. Alderson BS , Srivani Sanikommu MD , Simon C. Mears MD, PhD , C. Lowry Barnes MD , Benjamin M. Stronach MD , Jeffrey B. Stambough MD , Jennifer McDonald RPh , Traci Motes APRN , Brett Bailey PharmD , Ryan K. Dare MD

Background

Dalbavancin (DAL) off-label use for treating bone and joint infections has increased especially as long-term intravenous access is not needed. Little is known about the effectiveness and safety of its use.

Methods

This retrospective, single-center, descriptive study included adults treated with DAL for bone or joint infections over a 4-year period (2019-2023). Patient demographics, infection type and location, pre-DAL antibiotic and surgical treatments, indication for DAL, and clinical outcomes were collected. Risk factor analysis for 1-year infection recurrence was performed.

Results

There were 58 patient encounters of bone and/or joint infections treated with DAL. The majority of patients were treated for osteomyelitis (81.0%) followed by native (8.6%) and peri-prosthetic (10.4%) joint infection. Fifty (86.2%) patients underwent surgical intervention, and 17 (68%) of the 25 patients with infected hardware had full hardware removal. The most common pathogen identified was Staphylococcus aureus (41; 70.7%), with methicillin-resistant Staphylococcus aureus isolated in 23 (40.0%) cases. Ten (17.2%) patients had recurrence within 1 year. Hardware removal was found to significantly decrease the risk of infection recurrence (P = .026). None of the peri-prosthetic joint infection patients had infection recurrence within 1 year.

Conclusions

Our findings support DAL as an effective treatment for bone and joint infection when combined with surgical debridement and hardware removal. Failure to remove infected hardware significantly increased the risk of infection recurrence within 1 year. Randomized controlled trials are needed to further support DAL as a novel treatment for orthopedic infections.

背景达巴万星（DAL）用于治疗骨和关节感染的标示外使用有所增加，尤其是在不需要长期静脉注射的情况下。这项回顾性、单中心、描述性研究纳入了在 4 年内（2019-2023 年）使用 DAL 治疗骨或关节感染的成人患者。研究收集了患者的人口统计学特征、感染类型和部位、DAL 前的抗生素和手术治疗、DAL 的适应症以及临床结果。结果共有58例患者接受了DAL治疗后发生骨和/或关节感染。大多数患者接受治疗的原因是骨髓炎（81.0%），其次是本关节感染（8.6%）和假体周围关节感染（10.4%）。50例（86.2%）患者接受了手术治疗，25例硬件感染患者中有17例（68%）完全切除了硬件。最常见的病原体是金黄色葡萄球菌（41；70.7%），其中 23 例（40.0%）分离出耐甲氧西林金黄色葡萄球菌。10例（17.2%）患者在一年内复发。研究发现，移除假体能明显降低感染复发的风险（P = .026）。结论：我们的研究结果表明，在结合手术清创和硬件移除的情况下，DAL是治疗骨关节感染的有效方法。未移除受感染的硬件会显著增加一年内感染复发的风险。需要进行随机对照试验，以进一步支持 DAL 作为骨科感染的新型治疗方法。

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引用次数: 0

Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes 2 型糖尿病患者使用胰高血糖素样肽-1 受体激动剂与全膝关节置换术后并发症增加无关

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101506

Kevin Y. Heo BS , Rahul K. Goel MD , Andrew Fuqua BS , Jeffrey S. Holmes MD , Brian T. Muffly MD , Greg A. Erens MD , Jacob M. Wilson MD , Ajay Premkumar MD, MPH

Background

Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, its effects on outcomes following total knee arthroplasty (TKA) are not well known. The purpose of this study was to compare the risk of complications after TKA in patients with type-2 diabetes who were on GLP-1 agonists with those who were not.

Methods

In total, 34,696 type 2 diabetes patients undergoing primary TKA between 2016 and 2021 were retrospectively reviewed utilizing a large national database. Propensity score matching was employed to match patients on GLP-1 agonists to controls at a 1:1 ratio (n = 2388 each). Multivariable logistic regression was utilized to examine 90-day and 1-year TKA outcomes between cohorts.

Results

Controls had higher odds of extended hospital stays (≥3 days) (odds ratio 1.29, P < .001). However, surgical complication rates at 90-days including surgical site infection and prosthetic joint infection were not significantly different. Similarly, no differences were seen in medical complications. There were also no significant differences in rates of all-cause revision TKA and aseptic revision TKA at 1 year postoperatively.

Conclusions

This study found that GLP-1 agonist use was not associated with increased medical or surgical complication rates in patients with diabetes undergoing TKA and was associated with lower rates of extended hospital stays after surgery. Given the potential for increased glycemic control and weight loss in patients using GLP-1 agonists, more data are needed to delineate the potential role of GLP-1 agonists in preoperative optimization of patients with diabetes prior to joint arthroplasty to minimize postoperative complications.

背景胰高血糖素样肽-1（GLP-1）激动剂已成为一种强有力的糖尿病辅助治疗药物；然而，它对全膝关节置换术（TKA）术后效果的影响却不甚了解。本研究旨在比较服用 GLP-1 激动剂和未服用 GLP-1 激动剂的 2 型糖尿病患者在 TKA 术后出现并发症的风险。方法利用大型国家数据库对 2016 年至 2021 年间接受初级 TKA 手术的 34,696 名 2 型糖尿病患者进行了回顾性研究。采用倾向得分匹配法，将使用 GLP-1 激动剂的患者与对照组按 1:1 的比例进行匹配（各为 2388 人）。结果对照组延长住院时间（≥3 天）的几率更高（几率比 1.29，P < .001）。然而，90 天后的手术并发症发生率（包括手术部位感染和假体关节感染）并无显著差异。同样，内科并发症也无差异。结论这项研究发现，在接受 TKA 手术的糖尿病患者中，GLP-1 促效剂的使用与内科或外科并发症发生率的增加无关，而且与术后住院时间延长率的降低有关。鉴于使用 GLP-1 激动剂的患者有可能增加血糖控制和减轻体重，因此需要更多的数据来界定 GLP-1 激动剂在糖尿病患者关节置换术前的术前优化中的潜在作用，以最大限度地减少术后并发症。

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引用次数: 0

Acetabular Hydatid Cyst in a Teenage Girl: A Rare Manifestation and Successful Long-Term Management With Combined Surgical and Anthelmintic Approaches 一名少女的髋臼包虫囊肿：罕见病例和手术与驱虫药联合疗法的长期成功治疗

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101521

Mohammadreza Razzaghof MD, MPH , Mohammad Soleimani MD, MPH , Mohammad Poursalehian MD , Mohammadreza Barzegar MD , Sirous Jafari MD , Seyed Mohammad Javad Mortazavi MD

Hydatid disease is a zoonotic infestation caused by the Echinococcus, with extremely rare bone involvement. We present a case of acetabular hydatid cyst in a 16-year-old girl who initially underwent wide surgical excision, adjuvant ablation, and local administration of anthelminthic agent followed by systemic anthelmintic therapy. After 5 years, due to the development of degenerative joint disease and as infection was suspected intraoperatively, a 2-stage total hip arthroplasty was performed. The patient’s prosthesis remained stable and well fixed, and she is now fully functional at the 12-year follow-up. The consideration of hydatid disease in the differential diagnosis of destructive bone lesions, particularly in endemic areas, is crucial for timely detection and effective treatment. This case report highlights the challenges in the surgical treatment of periacetabular bone hydatidosis.

包虫病是由棘球蚴引起的人畜共患传染病，骨骼受累极为罕见。我们报告了一例髋臼包虫囊肿病例，患者是一名 16 岁的女孩，最初接受了大范围手术切除、辅助消融、局部使用驱虫药和全身驱虫药治疗。5 年后，由于出现关节退行性病变，且术中怀疑感染，患者接受了两阶段全髋关节置换术。患者的假体保持稳定，固定良好，随访 12 年后已完全恢复功能。在破坏性骨病变的鉴别诊断中考虑包虫病，尤其是在流行地区，对于及时发现和有效治疗至关重要。本病例报告强调了手术治疗髋臼周围骨水包虫病的挑战。

引用次数: 0

Recurrent Guillain-Barré Syndrome After Subsequent Total Knee Arthroplasties 全膝关节置换术后复发吉兰-巴雷综合征

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101518

Laith Z. Abwini DO , Dhara Rana DO , Joanna Crincoli DO , Firth G. Bowden PharmD , Fred McAlpin III DO

Guillain-Barré syndrome (GBS) is an acute immune-mediated inflammatory demyelinating polyneuropathy characterized by symmetrical limb weakness and areflexia. GBS is typically monophasic but may recur in 1%-7% of patients. Many etiologies exist for GBS; one rare associated etiology is surgery, most notably orthopaedic, abdominal, and cardiac surgery. Here, we present a 76-year-old male who developed postsurgical GBS after a right total knee arthroplasty (TKA), 11 years after developing GBS following a left TKA. The patient developed worsening ascending paralysis and, ultimately, respiratory failure requiring tracheostomy. This study reports a rare case of recurrent postsurgical GBS after TKA, possibly triggered by general anesthesia or tourniquet use. Early recognition of postsurgical GBS is imperative to avoid patient mortality.

吉兰-巴雷综合征（Guillain-Barré syndrome，GBS）是一种急性免疫介导的炎症性脱髓鞘多发性神经病，以对称性肢体无力和肢体瘫痪为特征。GBS 通常是单相的，但有 1%-7%的患者可能会复发。GBS 的病因很多，其中一种罕见的相关病因是外科手术，尤其是骨科、腹部和心脏手术。在此，我们介绍一名 76 岁的男性患者，他在接受右侧全膝关节置换术（TKA）后出现了手术后 GBS，而这距离他在接受左侧全膝关节置换术后出现 GBS 已经过去了 11 年。患者的升麻不断加重，最终导致呼吸衰竭，需要进行气管造口术。本研究报告了一例罕见的 TKA 术后 GBS 复发病例，可能是由全身麻醉或使用止血带引发的。要避免患者死亡，必须及早识别手术后 GBS。

引用次数: 0

Accelerometer-Navigated Revision Total Knee Arthroplasty: A Technique for Successful Gap Balancing 加速度计导航的翻修全膝关节置换术：成功平衡间隙的技术

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-11 DOI: 10.1016/j.artd.2024.101510

Matthew E. Wells DO , Richard L. Purcell MD

Accelerometer-based navigation (OrthAlign) is the first computer-assisted surgical navigation system approved for use in the setting of revision total knee arthroplasty (TKA) in the United States. The senior author has used this technology in the revision setting for several years and developed the individualized, reproducible technique. The 4 goals during revision TKA are to (1) gain adequate exposure for the safe explanation of prior implants, (2) address any resultant bone loss, (3) restore the joint line via distal femur metal augmentation, and (4) ensure adequate stability through gap-balancing techniques and increasing the constraint of the revision implants as needed. This technique guide illustrates how accelerometer-based navigation (OrthAlign) can achieve these goals in the revision TKA setting.

基于加速度计的导航（OrthAlign）是美国第一个获准用于翻修全膝关节置换术（TKA）的计算机辅助手术导航系统。资深作者已在翻修手术中使用该技术数年，并开发出了个性化、可重复的技术。翻修全膝关节置换术的四个目标是：（1）获得足够的暴露，以便安全地解释先前植入的假体；（2）解决由此造成的骨质流失；（3）通过股骨远端金属增量恢复关节线；以及（4）通过间隙平衡技术确保足够的稳定性，并根据需要增加翻修假体的约束。本技术指南说明了基于加速度计的导航（OrthAlign）如何在翻修 TKA 中实现这些目标。

引用次数: 0

Surgical Tips and Tricks for the Anterior-Based Muscle-Sparing Approach During Total Hip Arthroplasty 全髋关节置换术中基于前路的肌肉切除方法的手术技巧和窍门

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-10 DOI: 10.1016/j.artd.2024.101514

Gideon Jia Wei Cheok MBBCh, BAO (Ire), MRCS (Eng), GDSM (S’pore), Ing How Moo MBBS, MRCS (Ire), MMed (Ortho), FRCS Ortho (Edin)

In orthopaedic surgery, the advancement of surgical techniques aims to enhance patient outcomes and minimize postoperative complications. A notable innovation in this field is the anterior-based muscle-sparing (ABMS) approach to total hip arthroplasty, also known as ABLE or Rottinger approach. ABMS modifies the Watson-Jones approach, using the intermuscular plane between the tensor fascia lata and the gluteus medius to access the hip joint without detaching abductor muscles. This technique offers several benefits including muscle preservation, decreased pain, faster recovery, and lower dislocation rates, similar to the direct anterior approach. However, ABMS distinguishes itself by its lower infection rate, reduced nerve injury risk, easier femoral exposure, and compatibility with various implants. Large-scale studies have confirmed its safety and effectiveness. While mastering the ABMS technique requires some learning, this article provides a concise description of the technique, along with practical insights gained from surgical experience to support safe and effective execution.

在骨科手术中，手术技术的进步旨在提高患者的治疗效果，最大限度地减少术后并发症。全髋关节置换术中的前路肌肉保留（ABMS）方法（也称 ABLE 或 Rottinger 方法）是这一领域的一项显著创新。ABMS 方法对 Watson-Jones 方法进行了修改，利用张肌筋膜和臀中肌之间的肌间平面进入髋关节，而不分离内收肌。这种技术与直接前入路相似，具有保留肌肉、减轻疼痛、恢复更快、脱位率更低等优点。不过，ABMS 的与众不同之处在于感染率更低、神经损伤风险更小、股骨暴露更容易以及与各种植入物兼容。大规模研究已证实其安全性和有效性。虽然掌握 ABMS 技术需要一定的学习，但本文对该技术进行了简明扼要的描述，并提供了从手术经验中获得的实用见解，以支持安全有效地实施该技术。

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引用次数: 0

Robotic Arm–Assisted Total Knee Arthroplasty Results in Smaller Femoral Components and Larger Tibial Baseplates Than the Manual Technique 与手动技术相比，机器人手臂辅助全膝关节置换术可获得更小的股骨组件和更大的胫骨基板

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-01 DOI: 10.1016/j.artd.2024.101414

Jenna Bernstein MD , Matthew Hepinstall MD , Claire Donnelley MD , Vinaya Rajahraman BS , Daniel Waren MSPH , Ran Schwarzkopf MD , Daniel Wiznia MD

Background

Robotic systems for total knee arthroplasty (TKA) may utilize computed tomography three-dimensional modeling and intraoperative ligamentous balancing data to assist surgeons with implant size and position. This study evaluated the effect of such robotic systems on implant selection.

Methods

We reviewed 645 TKAs performed with a single prosthetic design at 2 academic medical centers between 2016 and 2022. A robotic system was utilized in 304 TKAs, 341 were conventionally instrumented. Implant sizing was compared between cohorts. Multivariate analyses assessed for confounding and effect modification on the basis of demographics.

Results

The 2 cohorts exhibited no significant differences in age (P = .33), weight (P = .29), or race (P = .24). The robotic-arm cohort had fewer women (58.9% vs 66.7% P = .04) and was taller on average (66.3 in vs 65.0 in P < .001). Mean polyethylene liner thickness was larger in the manual cohort (10.3 robotic and 10.6 manual; P < .00). On multivariate analysis, robotic-arm TKAs had larger tibial components (P < .001) and smaller femoral components (P = .017).

Conclusions

Robotic-arm assisted TKA with computed tomography–based three-dimensional planning was associated with a larger mean tibial component size and a smaller mean femoral component size when compared to conventionally instrumented TKAs. Observed differences likely reflect differences in the data informing implant size selection; effects on clinical outcomes warrant further study.

背景用于全膝关节置换术（TKA）的机器人系统可利用计算机断层三维建模和术中韧带平衡数据来协助外科医生确定植入物的大小和位置。本研究评估了此类机器人系统对植入物选择的影响。方法我们回顾了2016年至2022年期间在两家学术医疗中心使用单一假体设计进行的645例TKA手术。304例TKAs使用了机器人系统，341例使用了传统器械。对不同组群的假体尺寸进行了比较。结果两个队列在年龄（P = .33）、体重（P = .29）或种族（P = .24）方面无显著差异。机器人手臂队列中女性较少（58.9% vs 66.7% P = .04），平均身高较高（66.3 英寸 vs 65.0 英寸 P < .001）。手动组的平均聚乙烯衬垫厚度更大（机器人为 10.3 英寸，手动为 10.6 英寸；P < .00）。结论与传统的器械辅助 TKA 相比，基于计算机断层扫描三维规划的机器人臂辅助 TKA 的胫骨组件平均尺寸较大，股骨组件平均尺寸较小。观察到的差异可能反映了选择植入物尺寸的数据差异；对临床结果的影响值得进一步研究。

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引用次数: 0

Total Hip Arthroplasty Outcomes are Improved When Cement is Used for Femoral Fixation in Elderly Patients? 老年患者使用水泥固定股骨时，全髋关节置换术的疗效如何？

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-01 DOI: 10.1016/j.artd.2024.101570

Hari P. Bezwada MD, Nicholas A. Bedard MD

引用次数: 0

Penultimate 倒数第二

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-10-01 DOI: 10.1016/j.artd.2024.101572

Gregory J. Golladay MD (Editor-in-Chief)

引用次数: 0

Possible Transformation of Pseudotumor to Synovial Sarcoma in a Failed Metal-on-Metal Total Hip Arthroplasty 金属对金属全髋关节置换术失败者的假瘤可能转变为滑膜肉瘤

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2024-09-26 DOI: 10.1016/j.artd.2024.101408

Victor Shen BS , Reed Andrews MD , Odion Binitie MD , Brian T. Palumbo MD

Adverse local tissue reaction (ALTR) from the release of chromium and cobalt ions in metal-on-metal total hip arthroplasty (MoM THA) is a well-reported complication, but there is little evidence suggesting that this inflammatory reaction causes malignancy. We present a 69-year-old female with MoM THA who developed synovial sarcoma (SS). She underwent mass resection and revision THA. Postoperative pathologic analysis revealed the unanticipated diagnosis of SS. She subsequently underwent chemotherapy, sarcoma resection, and endoprosthetic reconstruction. We hypothesize that the SS developed from an ALTR in the setting of failed MoM THA. Given the paucity of data on possible malignant transformation of an ALTR to SS, we advise surgeons to consider potential malignancies when diagnosing ALTR in the setting of failed MoM THA bearings.

金属全髋关节置换术（MoM THA）中铬和钴离子的释放引起的局部组织不良反应（ALTR）是一种报道较多的并发症，但很少有证据表明这种炎症反应会导致恶性肿瘤。我们为您介绍一位 69 岁的女性患者，她曾接受过金属全髋关节置换术（MoM THA），但后来患上了滑膜肉瘤（SS）。她接受了肿块切除术和翻修型 THA。术后病理分析表明，她被意外诊断为滑膜肉瘤。她随后接受了化疗、肉瘤切除和假体内重建。我们推测，SS是在MoM THA失败的情况下由ALTR发展而来的。鉴于有关 ALTR 可能恶变为 SS 的数据较少，我们建议外科医生在确诊 ALTR 和 MoM THA 支架植入失败时考虑潜在的恶性肿瘤。

引用次数: 0

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