Camilo Restrepo - Academia.edu (original) (raw)

Papers by Camilo Restrepo

Background: In the absence of positive cultures and draining sinuses, the diagnosis of periprosth... more Background: In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI. Questions/purposes The purpose of this study was to investigate the correlation of antibiotic administration with (1) fluctuations in the synovial fluid and serology laboratory values; and (2) sensitivity of the diagnostic tests in patients with late PJI (per Musculoskeletal Infection Society [MSIS] criteria). Methods: Synovial white blood cell (WBC) count, polymorphonuclear neutrophil (PMN) percentage, and serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as culture results were investigated in 161 patients undergoing total knee arthroplasty with late PJI diagnosed with the MSIS criteria. Depending on whether presampling antibiotics were used, patients were divided in...

The Journal of bone and joint surgery. British volume, 2011

We performed a retrospective examination of the anteroposterior pelvic CT scout views of 419 rand... more We performed a retrospective examination of the anteroposterior pelvic CT scout views of 419 randomly selected patients between April 2004 and August 2009 in order to determine the prevalence of cam-type femoroacetabular deformity in the asymptomatic population. The CT scans had all been undertaken for conditions unrelated to disorders of the hip. The frequency of cam-type femoroacetabular deformity was assessed by measuring the α-angle of each hip on the anteroposterior images. The α-angles were classified according to the Copenhagen Osteoarthritis Study. Among 215 male hips (108 patients) the mean α-angle was 59.12° (37.75° to 103.50°). Of these, a total of 30 hips (13.95%) were defined as pathological, 32 (14.88%) as borderline and 153 (71.16%) as normal. Among 540 female hips (272 patients) the mean α-angle was 45.47° (34.75° to 87.00°), with 30 hips (5.56%) defined as pathological, 33 (6.11%) as borderline and 477 (88.33%) as normal. It appears that the cam-type femoroacetabula...

Seminars in Arthroplasty, 2005

Total hip arthroplasty (THA) of a developmental dysplasia of the hip (DDH) is a challenging recon... more Total hip arthroplasty (THA) of a developmental dysplasia of the hip (DDH) is a challenging reconstructive procedure. 50% of all THA may be due to DDH. An adequate classification like Crowe's is necessary so surgical planning can be established. In order to evaluate ...

Clinical Orthopaedics and Related Research®, 2015

Background There is concern that neuraxial anesthesia in patients undergoing surgery for treatmen... more Background There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory.

The Journal of Arthroplasty, 2015

Skin blisters occur in up to 20% of patients after total knee arthroplasty (TKA). Tourniquet rele... more Skin blisters occur in up to 20% of patients after total knee arthroplasty (TKA). Tourniquet release results in a limb volume increase of 10%. We hypothesized that releasing tourniquet before application of circumferential dressing will decrease blister formation. A prospective study was conducted on 135 consecutive primary TKAs. The tourniquet was released immediately after wound closure to allow for re-perfusion and then a dressing was applied. These patients were compared to a historical cohort of 200 primary TKAs, where the tourniquet was released after application of dressing. There was a significant difference in the incidence of blisters between the two groups [Late 7.5% (15/200) vs early release 2.2% (3/135) P=0.028]. Releasing the tourniquet prior to dressing application has reduced the incidence of blistering following TKA.

Acta orthopaedica Belgica, 2008

A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, t... more A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, total hip arthroplasty may occasionally be necessary for treatment of end-stage disabling arthritis of the hip in the young. There is paucity of information documenting the outcome of uncemented total hip arthroplasty in adolescents. We report our experience with total hip arthroplasty in patients under the age of twenty years. The results of 35 consecutive total hip arthroplasties performed at our institution in 25 patients between 1993 and 2003 were reviewed. There were 17 females and 8 males with a mean age of 17.6 years (range: 13.5 to 20). All patients received a Hydroxyapatite (HA) plasma sprayed Titanium acetabular component and a tapered femoral stem proximally coated with HA. Follow-up averaged 6.6 years (range: 4.2 to 10). The underlying diagnosis was avascular necrosis (16 hips), juvenile rheumatoid arthritis (9 hips), sequelae of DDH (2 hips), spondyloepiphyseal dysplasia (2 h...

Techniques in Orthopaedics, 2010

... Mortazavi, S M. Javad MD*; Fertala, Kasia BA†; Restrepo, Camilo MD†; Parmar, Raviinder BS†; H... more ... Mortazavi, S M. Javad MD*; Fertala, Kasia BA†; Restrepo, Camilo MD†; Parmar, Raviinder BS†; Hozack, William J. MD†. ... cementless femoral components (Accolade 37, Secure-Fit 5). The bearing surface was either metal or ceramic on highly crossed-linked PE bearing, ceramic ...

The Journal of Arthroplasty, 2014

Clinical Orthopaedics and Related Research®, 2015

Background In the absence of positive cultures and draining sinuses, the diagnosis of periprosthe... more Background In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI. Questions/purposes The purpose of this study was to investigate the correlation of antibiotic administration with (1) fluctuations in the synovial fluid and serology laboratory values; and (2) sensitivity of the diagnostic tests in patients with late PJI (per Musculoskeletal Infection Society [MSIS] criteria). Methods Synovial white blood cell (WBC) count, polymorphonuclear neutrophil (PMN) percentage, and serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as culture results were investigated in 161 patients undergoing total knee arthroplasty with late PJI diagnosed with the MSIS criteria. Depending on whether presampling antibiotics were used, patients were divided in two groups (53 [33%] patients were on antibiotics). The median laboratory values and the false-negative rates were compared between the two groups. Results The median of all variables were lower in the antibiotic group compared with the other group: ESR (mm/hr): 70 versus 85, difference of medians (DOM) = 15 mm/hr, p = 0.018; CRP (mg/L): 72 versus 130, DOM = 58 mg/L, p = 0.038; synovial WBC (cells/lL): 29,170 versus 46,900, DOM = 17,730, p = 0.022; and synovial PMN%: 88.5% versus 92.5%, DOM = 4%, p = 0.012. Furthermore, using the MSIS cutoffs, the false-negative rates of several parameters were higher in the antibiotic group; ESR: 19.2% (nine of 47) versus 6.1% (six of 99) (relative risk, 3.1; 95% confidence interval [CI], 1.2-8.3; p = 0.020); CRP: 14.9%

The Journal of Arthroplasty, 2015

Computer Aided Surgery, 2008

Proper rotational alignment of components is crucial for the success of total knee arthroplasty (... more Proper rotational alignment of components is crucial for the success of total knee arthroplasty (TKA). The traditional reference guides for assessment of femoral rotation include the posterior condylar axis, the anteroposterior axis, also known as Whiteside's line, and the transepicondylar axis (TEA). The fixed-angle posterior referencing system recommends that the rotational femoral cut be made at 3 degrees of external rotation. In a consecutive series of 100 patients undergoing TKA at our institution, the accuracy of these reference guides in determining the rotation of the femoral component was compared with that of a computerized navigation system. Although differences between the three reference methods were not statistically significant, the possibility of finding an outlier leading to excessive external or internal rotation of the femoral component when using a fixed posterior condyle reference guide mandates the use of other referencing methods to avoid this error. Using fixed posterior referencing, up to 17% of femoral components would have differed by more than 5 degrees from the anatomic reference landmarks (TEA, Whiteside's line). This degree of rotational malalignment could lead to knee instability and early failure.

The Journal of Arthroplasty, 2014

We report our experience with 215 recalled neck modular stems due to corrosion. Among the 195 hip... more We report our experience with 215 recalled neck modular stems due to corrosion. Among the 195 hips with 2 years follow-up, 56% had no clinical symptoms, 26% had groin pain (typical of corrosion), and 17% had other symptoms. Cobalt levels were comparable between asymptomatic (3.4 μg/L, range 0.7-7.3 μg/L) and symptomatic patients (4.0 μg/L range 0-13.2 μg/L). Abnormal imaging findings were seen in 46% of symptomatic and 11% of asymptomatic hips (P=0.001). Twenty-six hips (13%) have either undergone revision surgery or have been scheduled. Evidence of corrosion was seen at revision surgery in all patients. Despite modest elevations in serum cobalt levels, abnormal imaging studies were seen in 36%, clinical symptoms were seen in 44%, and revision for corrosion was undertaken or scheduled in 13% of the hips.

Journal of Arthroplasty, 2007

Thromboembolic disease is a relatively common and potentially devastating complication of joint a... more Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and/or migration of venous emboli into the pulmonary circulation. This article reports on a cohort of joint arthroplasty patients either with confirmed

Quality of Life Research, 2013

Purpose Despite the interest in surgical treatment of femoroacetabular impingement (FAI), its imp... more Purpose Despite the interest in surgical treatment of femoroacetabular impingement (FAI), its impact upon health-related quality of life (HRQoL) has not been established. The objectives of this study were twofold: (a) to describe the pattern of impact of FAI on HRQoL and (b) to assess how articular and extra-articular factors influence HRQoL in this group of patients. Methods A total of 108 patients [55 females (50.9 %); age 36.0 ± 12.4 years] with intraoperatively confirmed FAI and no evidence of secondary hip osteoarthritis were studied. The pattern of impact on HRQoL was studied using SF-36 V.2 TM and then contrasted with other medical conditions employing the SF-36 spydergram. The best model explaining the influence of ''articular'' and ''extraarticular'' factors over the SF-36 physical and mental component scores (PCS/MCS) was selected using the Akaike information criterion. Results The PCS was 53.2 ± 19.2 and MCS was 68.94 ± 17.15. The SF-36 spydergram depicted an impact pattern distinguishable from other conditions. A linear model predicted PCS would increase by 8.9 points in male patients and 3.7 points per point

The Journal of Bone and Joint Surgery (American), 2010

Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citatio... more Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to

The Journal of Bone and Joint Surgery (American), 2010

Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citatio... more Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to Background: The ceramic-on-ceramic bearing for total hip arthroplasty has an extremely low wear rate and demonstrates minimal inflammatory response in comparison with other bearing choices. However, acoustic emissions such as squeaking and clicking are being reported as annoying complications related to its use. The cause or causes of this phenomenon have not been determined. The purpose of the present study was to evaluate the possibility that design aspects of the femoral component may be a contributing factor to the etiology of squeaking associated with the ceramicon-ceramic bearing total hip arthroplasty.

The Journal of Bone and Joint Surgery (American), 2013

Background: There has been a major and alarming increase in readmission rates following total joi... more Background: There has been a major and alarming increase in readmission rates following total joint arthroplasty. With proposed changes in reimbursement policy, increased rates of unplanned readmission following arthroplasty will penalize providers. In particular, it has been proposed that specific complications-so-called ''zero-tolerance'' complications-are unacceptable and that their treatment will not qualify for reimbursement. The purpose of this study was to identify the incidence, causes, and risk factors for readmission following total joint arthroplasty.

The Journal of Bone and Joint Surgery (American), 2007

BACKGROUND: The safety of simultaneous bilateral total knee replacement remains controversial. So... more BACKGROUND: The safety of simultaneous bilateral total knee replacement remains controversial. Some studies have demonstrated a higher rate of serious complications, including death, following bilateral procedures, whereas others have suggested no increase in the complication rate. The objective of this meta-analysis was to compare the safety of simultaneous bilateral total knee replacement with that of staged bilateral and unilateral total knee replacements. METHODS: A computerized literature search was conducted to identify all citations, from 1966 to 2005, concerning bilateral total knee replacement. All of the English-language abstracts were obtained. A multistage assessment was then performed to identify articles fulfilling the inclusion criteria for the study. All randomized, prospective studies reporting the outcome of bilateral total knee replacement were included. The details of the reported data were extracted, and an extensive analysis of relevant variables was carried out. RESULTS: One hundred and fifty published articles were identified, and eighteen that included a total of 27,807 patients (44,684 knees) were included in the meta-analysis. There were 10,930 unilateral total knee replacements, 16,419 simultaneous bilateral total knee replacements, and 458 staged bilateral total knee replacements with at least three months between the operative procedures. The prevalence's of pulmonary embolism (odds ratio = 1.8), cardiac complications (odds ratio = 2.49), and mortality (odds ratio = 2.2) were higher after simultaneous bilateral total knee replacement. The prevalence of deep venous thrombosis was lower after simultaneous bilateral total knee replacement, but this difference was not significant. The complication rates after the staged bilateral total knee replacements were similar to those in the patients who had undergone unilateral total knee replacement only. CONCLUSIONS: Compared with staged bilateral or unilateral total knee replacement, simultaneous bilateral total knee replacement carries a higher risk of serious cardiac complications, pulmonary complications, and mortality. The period of time between staged procedures that would eliminate these increased risks could not be determined from this study. LEVEL OF EVIDENCE: Therapeutic Level III.

The Journal of Bone and Joint Surgery (American), 2013

Background: Common peroneal nerve palsy, although rare, is a serious complication of total hip ar... more Background: Common peroneal nerve palsy, although rare, is a serious complication of total hip arthroplasty. Although several publications have dealt with the risk factors for peroneal nerve palsy, there is little literature regarding the time it takes for the nerve to recover and the factors that influence its recovery. The purpose of this study was to elucidate the clinical course of this injury and identify prognostic factors for recovery. , 7969 primary and 1601 revision total hip arthroplasties were performed at our institution. Common peroneal nerve palsy developed following thirty-one (0.32%) of these procedures. Thirty of these patients were evaluated by a neurologist at the time of diagnosis and at regular intervals thereafter. Univariate and multivariate regression analyses were performed to identify risk factors and prognostic factors for recovery.

The Journal of Arthroplasty, 2013

Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (T... more Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03).

Background: In the absence of positive cultures and draining sinuses, the diagnosis of periprosth... more Background: In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI. Questions/purposes The purpose of this study was to investigate the correlation of antibiotic administration with (1) fluctuations in the synovial fluid and serology laboratory values; and (2) sensitivity of the diagnostic tests in patients with late PJI (per Musculoskeletal Infection Society [MSIS] criteria). Methods: Synovial white blood cell (WBC) count, polymorphonuclear neutrophil (PMN) percentage, and serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as culture results were investigated in 161 patients undergoing total knee arthroplasty with late PJI diagnosed with the MSIS criteria. Depending on whether presampling antibiotics were used, patients were divided in...

The Journal of bone and joint surgery. British volume, 2011

We performed a retrospective examination of the anteroposterior pelvic CT scout views of 419 rand... more We performed a retrospective examination of the anteroposterior pelvic CT scout views of 419 randomly selected patients between April 2004 and August 2009 in order to determine the prevalence of cam-type femoroacetabular deformity in the asymptomatic population. The CT scans had all been undertaken for conditions unrelated to disorders of the hip. The frequency of cam-type femoroacetabular deformity was assessed by measuring the α-angle of each hip on the anteroposterior images. The α-angles were classified according to the Copenhagen Osteoarthritis Study. Among 215 male hips (108 patients) the mean α-angle was 59.12° (37.75° to 103.50°). Of these, a total of 30 hips (13.95%) were defined as pathological, 32 (14.88%) as borderline and 153 (71.16%) as normal. Among 540 female hips (272 patients) the mean α-angle was 45.47° (34.75° to 87.00°), with 30 hips (5.56%) defined as pathological, 33 (6.11%) as borderline and 477 (88.33%) as normal. It appears that the cam-type femoroacetabula...

Seminars in Arthroplasty, 2005

Total hip arthroplasty (THA) of a developmental dysplasia of the hip (DDH) is a challenging recon... more Total hip arthroplasty (THA) of a developmental dysplasia of the hip (DDH) is a challenging reconstructive procedure. 50% of all THA may be due to DDH. An adequate classification like Crowe's is necessary so surgical planning can be established. In order to evaluate ...

Clinical Orthopaedics and Related Research®, 2015

Background There is concern that neuraxial anesthesia in patients undergoing surgery for treatmen... more Background There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory.

The Journal of Arthroplasty, 2015

Skin blisters occur in up to 20% of patients after total knee arthroplasty (TKA). Tourniquet rele... more Skin blisters occur in up to 20% of patients after total knee arthroplasty (TKA). Tourniquet release results in a limb volume increase of 10%. We hypothesized that releasing tourniquet before application of circumferential dressing will decrease blister formation. A prospective study was conducted on 135 consecutive primary TKAs. The tourniquet was released immediately after wound closure to allow for re-perfusion and then a dressing was applied. These patients were compared to a historical cohort of 200 primary TKAs, where the tourniquet was released after application of dressing. There was a significant difference in the incidence of blisters between the two groups [Late 7.5% (15/200) vs early release 2.2% (3/135) P=0.028]. Releasing the tourniquet prior to dressing application has reduced the incidence of blistering following TKA.

Acta orthopaedica Belgica, 2008

A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, t... more A variety of conditions may lead to arthritis of the hip during adolescence. Although uncommon, total hip arthroplasty may occasionally be necessary for treatment of end-stage disabling arthritis of the hip in the young. There is paucity of information documenting the outcome of uncemented total hip arthroplasty in adolescents. We report our experience with total hip arthroplasty in patients under the age of twenty years. The results of 35 consecutive total hip arthroplasties performed at our institution in 25 patients between 1993 and 2003 were reviewed. There were 17 females and 8 males with a mean age of 17.6 years (range: 13.5 to 20). All patients received a Hydroxyapatite (HA) plasma sprayed Titanium acetabular component and a tapered femoral stem proximally coated with HA. Follow-up averaged 6.6 years (range: 4.2 to 10). The underlying diagnosis was avascular necrosis (16 hips), juvenile rheumatoid arthritis (9 hips), sequelae of DDH (2 hips), spondyloepiphyseal dysplasia (2 h...

Techniques in Orthopaedics, 2010

... Mortazavi, S M. Javad MD*; Fertala, Kasia BA†; Restrepo, Camilo MD†; Parmar, Raviinder BS†; H... more ... Mortazavi, S M. Javad MD*; Fertala, Kasia BA†; Restrepo, Camilo MD†; Parmar, Raviinder BS†; Hozack, William J. MD†. ... cementless femoral components (Accolade 37, Secure-Fit 5). The bearing surface was either metal or ceramic on highly crossed-linked PE bearing, ceramic ...

The Journal of Arthroplasty, 2014

Clinical Orthopaedics and Related Research®, 2015

Background In the absence of positive cultures and draining sinuses, the diagnosis of periprosthe... more Background In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI. Questions/purposes The purpose of this study was to investigate the correlation of antibiotic administration with (1) fluctuations in the synovial fluid and serology laboratory values; and (2) sensitivity of the diagnostic tests in patients with late PJI (per Musculoskeletal Infection Society [MSIS] criteria). Methods Synovial white blood cell (WBC) count, polymorphonuclear neutrophil (PMN) percentage, and serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as culture results were investigated in 161 patients undergoing total knee arthroplasty with late PJI diagnosed with the MSIS criteria. Depending on whether presampling antibiotics were used, patients were divided in two groups (53 [33%] patients were on antibiotics). The median laboratory values and the false-negative rates were compared between the two groups. Results The median of all variables were lower in the antibiotic group compared with the other group: ESR (mm/hr): 70 versus 85, difference of medians (DOM) = 15 mm/hr, p = 0.018; CRP (mg/L): 72 versus 130, DOM = 58 mg/L, p = 0.038; synovial WBC (cells/lL): 29,170 versus 46,900, DOM = 17,730, p = 0.022; and synovial PMN%: 88.5% versus 92.5%, DOM = 4%, p = 0.012. Furthermore, using the MSIS cutoffs, the false-negative rates of several parameters were higher in the antibiotic group; ESR: 19.2% (nine of 47) versus 6.1% (six of 99) (relative risk, 3.1; 95% confidence interval [CI], 1.2-8.3; p = 0.020); CRP: 14.9%

The Journal of Arthroplasty, 2015

Computer Aided Surgery, 2008

Proper rotational alignment of components is crucial for the success of total knee arthroplasty (... more Proper rotational alignment of components is crucial for the success of total knee arthroplasty (TKA). The traditional reference guides for assessment of femoral rotation include the posterior condylar axis, the anteroposterior axis, also known as Whiteside's line, and the transepicondylar axis (TEA). The fixed-angle posterior referencing system recommends that the rotational femoral cut be made at 3 degrees of external rotation. In a consecutive series of 100 patients undergoing TKA at our institution, the accuracy of these reference guides in determining the rotation of the femoral component was compared with that of a computerized navigation system. Although differences between the three reference methods were not statistically significant, the possibility of finding an outlier leading to excessive external or internal rotation of the femoral component when using a fixed posterior condyle reference guide mandates the use of other referencing methods to avoid this error. Using fixed posterior referencing, up to 17% of femoral components would have differed by more than 5 degrees from the anatomic reference landmarks (TEA, Whiteside's line). This degree of rotational malalignment could lead to knee instability and early failure.

The Journal of Arthroplasty, 2014

We report our experience with 215 recalled neck modular stems due to corrosion. Among the 195 hip... more We report our experience with 215 recalled neck modular stems due to corrosion. Among the 195 hips with 2 years follow-up, 56% had no clinical symptoms, 26% had groin pain (typical of corrosion), and 17% had other symptoms. Cobalt levels were comparable between asymptomatic (3.4 μg/L, range 0.7-7.3 μg/L) and symptomatic patients (4.0 μg/L range 0-13.2 μg/L). Abnormal imaging findings were seen in 46% of symptomatic and 11% of asymptomatic hips (P=0.001). Twenty-six hips (13%) have either undergone revision surgery or have been scheduled. Evidence of corrosion was seen at revision surgery in all patients. Despite modest elevations in serum cobalt levels, abnormal imaging studies were seen in 36%, clinical symptoms were seen in 44%, and revision for corrosion was undertaken or scheduled in 13% of the hips.

Journal of Arthroplasty, 2007

Thromboembolic disease is a relatively common and potentially devastating complication of joint a... more Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and/or migration of venous emboli into the pulmonary circulation. This article reports on a cohort of joint arthroplasty patients either with confirmed

Quality of Life Research, 2013

Purpose Despite the interest in surgical treatment of femoroacetabular impingement (FAI), its imp... more Purpose Despite the interest in surgical treatment of femoroacetabular impingement (FAI), its impact upon health-related quality of life (HRQoL) has not been established. The objectives of this study were twofold: (a) to describe the pattern of impact of FAI on HRQoL and (b) to assess how articular and extra-articular factors influence HRQoL in this group of patients. Methods A total of 108 patients [55 females (50.9 %); age 36.0 ± 12.4 years] with intraoperatively confirmed FAI and no evidence of secondary hip osteoarthritis were studied. The pattern of impact on HRQoL was studied using SF-36 V.2 TM and then contrasted with other medical conditions employing the SF-36 spydergram. The best model explaining the influence of ''articular'' and ''extraarticular'' factors over the SF-36 physical and mental component scores (PCS/MCS) was selected using the Akaike information criterion. Results The PCS was 53.2 ± 19.2 and MCS was 68.94 ± 17.15. The SF-36 spydergram depicted an impact pattern distinguishable from other conditions. A linear model predicted PCS would increase by 8.9 points in male patients and 3.7 points per point

The Journal of Bone and Joint Surgery (American), 2010

Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citatio... more Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to

The Journal of Bone and Joint Surgery (American), 2010

Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citatio... more Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to Background: The ceramic-on-ceramic bearing for total hip arthroplasty has an extremely low wear rate and demonstrates minimal inflammatory response in comparison with other bearing choices. However, acoustic emissions such as squeaking and clicking are being reported as annoying complications related to its use. The cause or causes of this phenomenon have not been determined. The purpose of the present study was to evaluate the possibility that design aspects of the femoral component may be a contributing factor to the etiology of squeaking associated with the ceramicon-ceramic bearing total hip arthroplasty.

The Journal of Bone and Joint Surgery (American), 2013

Background: There has been a major and alarming increase in readmission rates following total joi... more Background: There has been a major and alarming increase in readmission rates following total joint arthroplasty. With proposed changes in reimbursement policy, increased rates of unplanned readmission following arthroplasty will penalize providers. In particular, it has been proposed that specific complications-so-called ''zero-tolerance'' complications-are unacceptable and that their treatment will not qualify for reimbursement. The purpose of this study was to identify the incidence, causes, and risk factors for readmission following total joint arthroplasty.

The Journal of Bone and Joint Surgery (American), 2007

BACKGROUND: The safety of simultaneous bilateral total knee replacement remains controversial. So... more BACKGROUND: The safety of simultaneous bilateral total knee replacement remains controversial. Some studies have demonstrated a higher rate of serious complications, including death, following bilateral procedures, whereas others have suggested no increase in the complication rate. The objective of this meta-analysis was to compare the safety of simultaneous bilateral total knee replacement with that of staged bilateral and unilateral total knee replacements. METHODS: A computerized literature search was conducted to identify all citations, from 1966 to 2005, concerning bilateral total knee replacement. All of the English-language abstracts were obtained. A multistage assessment was then performed to identify articles fulfilling the inclusion criteria for the study. All randomized, prospective studies reporting the outcome of bilateral total knee replacement were included. The details of the reported data were extracted, and an extensive analysis of relevant variables was carried out. RESULTS: One hundred and fifty published articles were identified, and eighteen that included a total of 27,807 patients (44,684 knees) were included in the meta-analysis. There were 10,930 unilateral total knee replacements, 16,419 simultaneous bilateral total knee replacements, and 458 staged bilateral total knee replacements with at least three months between the operative procedures. The prevalence's of pulmonary embolism (odds ratio = 1.8), cardiac complications (odds ratio = 2.49), and mortality (odds ratio = 2.2) were higher after simultaneous bilateral total knee replacement. The prevalence of deep venous thrombosis was lower after simultaneous bilateral total knee replacement, but this difference was not significant. The complication rates after the staged bilateral total knee replacements were similar to those in the patients who had undergone unilateral total knee replacement only. CONCLUSIONS: Compared with staged bilateral or unilateral total knee replacement, simultaneous bilateral total knee replacement carries a higher risk of serious cardiac complications, pulmonary complications, and mortality. The period of time between staged procedures that would eliminate these increased risks could not be determined from this study. LEVEL OF EVIDENCE: Therapeutic Level III.

The Journal of Bone and Joint Surgery (American), 2013

Background: Common peroneal nerve palsy, although rare, is a serious complication of total hip ar... more Background: Common peroneal nerve palsy, although rare, is a serious complication of total hip arthroplasty. Although several publications have dealt with the risk factors for peroneal nerve palsy, there is little literature regarding the time it takes for the nerve to recover and the factors that influence its recovery. The purpose of this study was to elucidate the clinical course of this injury and identify prognostic factors for recovery. , 7969 primary and 1601 revision total hip arthroplasties were performed at our institution. Common peroneal nerve palsy developed following thirty-one (0.32%) of these procedures. Thirty of these patients were evaluated by a neurologist at the time of diagnosis and at regular intervals thereafter. Univariate and multivariate regression analyses were performed to identify risk factors and prognostic factors for recovery.

The Journal of Arthroplasty, 2013

Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (T... more Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. Regression analysis was performed to identify prognostic factors for recovery. A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03).