Lazaros Poultsides - Academia.edu (original) (raw)

Papers by Lazaros Poultsides

Research paper thumbnail of Clinical and epidemiological features of upper-extremity infections caused by Staphylococcus aureus carrying the PVL gene: A four-year study in Greece

Medical science monitor: international medical journal of experimental and clinical research

All Staphylococcus aureus isolated during 2003-2006 at a university hospital in Thessalia, centra... more All Staphylococcus aureus isolated during 2003-2006 at a university hospital in Thessalia, central Greece, from ulcerative upper-extremity infections were tested for the presence of PVL gene and for possible clonal relationship to validate the role of PVL toxin in the clinical features of these infections and also to establish preventive measures towards limiting the spread of such strains among close contacts. Of 305 bacterial cultures obtained from consecutive patients suffering from purulent musculoskeletal infections of an upper extremity, 207 revealed the presence of S. aureus (81 methicillin-resistant and 126 methicillin-sensitive). Seventy of the 207 cultures were found to be positive for the PVL gene. The PVL gene was detected in 12.1% (2003), 46.7% (2004), 34% (2005), and 53% (2006) of upper-extremity staphylococcal infections, indicating a statistically significant increase between 2003 and 2004-2006. However, there was a significant decrease in readmissions during 2005 and 2006 and also in the number of relatives diagnosed with PVL-positive infections during the same period of time. The localization of these infections, their higher incidence during summer, and the transmission to family members indicated that contact was the means of spread of PVL-positive S. aureus. Most isolates belonged to the ST-80 clone, predominant in Europe. The emergence of new MRSA and also MSSA clones carrying the PVL gene and the decreases in readmissions and number of infected "close contacts" emphasizes the need for closer systematic surveillance and the implementation of preventive measures.

Research paper thumbnail of Do steroids, conventional non-steroidal anti-inflammatory drugs and selective COX-2 inhibitors adversely affect fracture healing

Journal of musculoskeletal & neuronal interactions

Research paper thumbnail of Choosing Implant for Total Hip Arthroplasty

Research paper thumbnail of Radiological Planning of Total Hip Arthroplasty

Research paper thumbnail of Tips and Pearls in Total Hip Arthroplasty

Research paper thumbnail of Multiple Irrigation and Debridements for Periprosthetic Joint Infections: Facing a Necessity or Just Prolonging the Inevitable?

The Journal of arthroplasty, Jan 2, 2015

Irrigation and debridement (I&D) may be a viable option in selected cases of periprosthetic joint... more Irrigation and debridement (I&D) may be a viable option in selected cases of periprosthetic joint infections (PJI). Our aim was to investigate the role of multiple I&Ds. Among 141 patients with PJI treated with I&D in our institution, 19 were subjected to additional procedures. Their clinical characteristics were retrospectively reviewed and compared to the remaining patients treated with a single I&D. The probability of treatment failure (removal of implants) was not significantly different among the two groups. The interval between serial I&Ds was a significant factor determining outcomes. Patients treated with multiple I&Ds had a significantly higher prevalence of peripheral vascular disease. The decision to proceed with repeat of I&D should be made with caution.

Research paper thumbnail of Perioperative Outcomes in Orthopedic Surgery

The Scientific World Journal, 2015

Research paper thumbnail of Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty

The Scientific World Journal, 2015

Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly advers... more Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA. These can be classified into patient-related factors (age, gender, obesity, comorbidities, history of infection, primary diagnosis, and socioeconomic profile), surgery-related factors (allogeneic blood transfusion, DVT prophylaxis and coagulopathy, duration of surgery, antibiotic prophylaxis, bearing surface and fixation, bilateral procedures, NNIS index score, and anesthesia type), and hospital-related factors (duration of hospitalization, institution and surgeon volume, and admission from a healthcare facility). All these factors are discussed with respect to potential measures that can be taken to reduce their effect and consequently the overall risk for infection.

Research paper thumbnail of Medial Unicondylar Knee Arthroplasty Improves Patellofemoral Congruence: a possible mechanistic explanation for poor association between patellofemoral degeneration and clinical outcome

The Journal of Arthroplasty, 2015

The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UK... more The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UKA) on postoperative patellofemoral joint (PFJ) congruence and analyze the relationship of preoperative PFJ degeneration on clinical outcome. We retrospectively reviewed 110 patients (113 knees) who underwent medial UKA. Radiographs were evaluated to ascertain PFJ degenerative changes and congruence. Clinical outcomes were assessed preoperatively and postoperatively. The postoperative absolute patellar congruence angle (10.05±10.28) was significantly improved compared with the preoperative value (14.23±11.22) (P=0.0038). No correlation was found between preoperative PFJ congruence or degeneration severity, and WOMAC scores at two-year follow up. Pre-operative PFJ congruence and degenerative changes do not affect UKA clinical outcomes. This finding may be explained by the post-op PFJ congruence improvement.

Research paper thumbnail of Risk Factors for Recurrence of Periprosthetic Knee Infection

The Journal of arthroplasty, Jan 8, 2015

We retrospectively reviewed 110 patients who underwent two-stage revision surgery in order to ide... more We retrospectively reviewed 110 patients who underwent two-stage revision surgery in order to identify potential risk factors for recurrence of periprosthetic infection. We found that patients with inflammatory arthritis (P=0.0125), perioperative hematoma formation (P=0.0422), wound dehiscence (P=0.042), and those who are chronic Staphylococcus carriers (P=0.0177) were associated with an increased incidence of re-infection. The duration of intravenous antibiotic therapy less than 6weeks was associated with a reduced risk of reinfection to greater than 6weeks (P=0.03). Multivariate analysis indicated that wound dehiscence (odds ratio [OR], 5.119; 95% confidence interval [CI], 1.367-19.17), and Staphylococcus carriers (OR, 11.419; 95% CI, 1.376-94.727) are significant predictors of recurrence (P=0.0153 and 0.0241, respectively).

Research paper thumbnail of Perioperative Morbidity and Mortality of Same-day Bilateral TKAs Incidence and Risk Factors

Clinical Orthopaedics and Related Research

Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilat... more Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA). We compared (1) 30-day mortality; (2) rates of in-hospital complications; and (3) blood transfusion rates between patients undergoing same-admission staged BTKA and patients undergoing BTKA staged within 1 year in a highly specialized center where specific guidelines have been implemented for same-day BTKA patient selection. We analyzed institutional data for 149 patients undergoing same-admission staged and 1557 patients undergoing staged BTKA diagnosed with bilateral knee idiopathic osteoarthritis from 1998 to 2011. Although patients in both groups presented with bilateral knee disease, same-admission staged patients had more medical comorbidities and did not qualify for same-day BTKA. Specifically, patients with coronary artery disease with inducible ischemia, congestive heart failure, advanced chronic obstructive pulmonary disease, uncontrolled diabetes, peripheral vascular disease, renal failure, morbid obesity, history of venous thromboembolism, or those who were older than 75 years were not considered eligible for same-day BTKA. Patient demographics and Deyo comorbidity index were tabulated. The groups were similar in age, but same-admission staged patients were more likely to be male and had a higher overall comorbidity burden. The complications were categorized into systemic (medical) and local (orthopaedic). Furthermore, the systemic complications were subcategorized into major (required complex surgical or medical intervention or were deemed life-threatening) and minor (necessitated additional observation or required medical treatment), depending on their severity. Regression models were conducted to examine the association between surgery type and development of complications. There was no difference in 30-day mortality between the groups (0% versus 0.06%; p=0.754). There was no difference in the local complication rates (0.7% versus 0.8%; p=1.000). However, multivariable regression analysis adjusting for age, sex, and Deyo comorbidity index showed that same-admission staged patients were three and two times more likely than staged to develop a minor (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.25-3.25; p=0.004) and major (OR, 2.02; 95% CI, 2.09-4.37; p<0.001) complication, respectively. The same-admission group experienced more acute postoperative anemia (11% versus 3%; p<0.001) and blood transfusions (93% versus 54%; p<0.001). These results suggest that patients who are not appropriate candidates for same-day BTKA as a result of increased overall comorbidity burden may be better served by undergoing staged BTKA…

Research paper thumbnail of Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome

International orthopaedics, Jan 31, 2015

Our purpose was to identify the success rate and factors predicting outcome of irrigation and deb... more Our purpose was to identify the success rate and factors predicting outcome of irrigation and debridement (I&D) in patients with deep periprosthetic joint infection (PJI) of the hip. We retrospectively reviewed clinical characteristics of patients with deep PJI after primary/revision total hip arthroplasty (THA) between January 2000 and May 2013 treated with I&D. Implant retention was the outcome of interest. Sixty patients (29 men and 31 women; mean age 64.9 years) were identified. Mean follow-up was 59 months (range, 12-168). The implants were retained in 42 patients (70%). Failure of I&D treatment correlated with duration of symptoms >five days (p <0.001) and obesity [body mass index (BMI) ≥ 30)] (p = 0.0289). Treatment outcome was affected by the type of pathogen (p = 0.0482), with patients with methicillin-resistant staphylococci having significantly lower odds of success.…

Research paper thumbnail of Staging Bilateral Total Knee Arthroplasty During the Same Hospitalization: The Impact of Timing

The Journal of arthroplasty, Jan 17, 2015

The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTK... more The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTKA) has emerged as a practice to minimize perioperative risks, although with few data providing an evidence base. A total of 41,664 BTKA patients from Nationwide Inpatient Sample data between 1998 and 2010 were identified, and categorized into three groups, same day, staging 1-3 days, and staging 4-7 days BTKA. Staging BTKA 1-3 days apart was associated with increased rates for complications compared to same day BTKA, while staging 4-7 days BTKA was associated with similar complication profiles compared to same day BTKA. Our study suggests that same day BTKA for selective patient population is preferable, and staging BTKA either 1-3 days or 4-7 days apart should be discouraged.

Research paper thumbnail of Report from the first European Bone and Joint Infection Society Travelling Fellowship 2009

European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2013

Research paper thumbnail of Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study

Psychosomatics

Depression and anxiety are highly prevalent psychiatric disorders. However, little is known about... more Depression and anxiety are highly prevalent psychiatric disorders. However, little is known about their impact on outcomes in the perioperative setting. This study is intended to gain insight into epidemiology and effects on perioperative morbidity, mortality, length of hospital stay, discharge and cost. We obtained the National Inpatient Sample from the Hospital Cost and Utilization Project for each year between 2000 and 2008. Entries indicating the performance of primary total hip and knee arthroplasty were identified and separated into four groups: (1) those with concomitant diagnosis of depression or (2) anxiety, (3) both, and (4) none of these diagnoses. The incidence of major complications, non-routine discharge, length, and cost of hospitalization were assessed. Regression analysis was performed to identify if psychiatric comorbidity was an independent risk factor for each outcome. We identified 1,212,493 patients undergoing arthroplasty between 2000 and 2008. The prevalence ...

Research paper thumbnail of Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens

The Journal of bone and joint surgery. British volume, 2012

We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operat... more We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operative mortality and the cause of death using different thromboprophylactic regimens as follows: 1) no routine chemothromboprophylaxis (NRC); 2) Potent anticoagulation (PA) (unfractionated or low-molecular-weight heparin, ximelagatran, fondaparinux or rivaroxaban); 3) Potent anticoagulation combined (PAC) with regional anaesthesia and/or pneumatic compression devices (PCDs); 4) Warfarin (W); 5) Warfarin combined (WAC) with regional anaesthesia and/or PCD; and 6) Multimodal (MM) prophylaxis, including regional anaesthesia, PCDs and aspirin in low-risk patients. Cause of death was classified as autopsy proven, clinically certain or unknown. Deaths were grouped into cardiopulmonary excluding pulmonary embolism (PE), PE, bleeding-related, gastrointestinal, central nervous system, and others (miscellaneous). Meta-analysis based on fixed effects or random effects models was used for pooling incid...

Research paper thumbnail of Current concepts and controversies in the management of radial head fractures

Orthopedics, 2006

1. Orthopedics. 2006 Oct;29(10):904-16; quiz 917-8. Current concepts and controversies in the man... more 1. Orthopedics. 2006 Oct;29(10):904-16; quiz 917-8. Current concepts and controversies in the management of radial head fractures. Roidis NT, Papadakis SA, Rigopoulos N, Basdekis G, Poultsides L, Karachalios T, Malizos K, Itamura J. ...

Research paper thumbnail of Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

The Scientific World Journal, 2014

Background. Various studies have raised concern of worse outcomes in patients receiving blood tra... more Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12-9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.

Research paper thumbnail of Periprosthetic Knee Infections Treated with Irrigation and Debridement: Outcomes and Preoperative Predictive Factors

The Journal of arthroplasty, Jan 25, 2014

The role of irrigation and debridement (I&D) in the treatment of periprosthetic joint infections ... more The role of irrigation and debridement (I&D) in the treatment of periprosthetic joint infections (PJI) of the knee remains controversial. Our purpose was to identify the success rate and factors determining outcome of I&D in those patients. Clinical characteristics of 78 patients with PJI of the knee treated with I&D were retrospectively reviewed. Implant retention at final follow-up was achieved in 43 patients (55.1%). Logistic regression analysis revealed that duration of symptoms >5days and thyroid disease were independent predictors of I&D failure. Patients with methicillin-resistant staphylococcal infections had a success rate of 45.5% and significantly lower odds of success compared to patients with negative cultures. In selected patients,…

Research paper thumbnail of Central Role of SREBP-2 in the Pathogenesis of Osteoarthritis

Background: Recent studies have implied that osteoarthritis (OA) is a metabolic disease linked to... more Background: Recent studies have implied that osteoarthritis (OA) is a metabolic disease linked to deregulation of genes involved in lipid metabolism and cholesterol efflux. Sterol Regulatory Element Binding Proteins (SREBPs) are transcription factors regulating lipid metabolism with so far no association with OA. Our aim was to test the hypothesis that SREBP-2, a gene that plays a key role in cholesterol homeostasis, is crucially involved in OA pathogenesis and to identify possible mechanisms of action.

Research paper thumbnail of Clinical and epidemiological features of upper-extremity infections caused by Staphylococcus aureus carrying the PVL gene: A four-year study in Greece

Medical science monitor: international medical journal of experimental and clinical research

All Staphylococcus aureus isolated during 2003-2006 at a university hospital in Thessalia, centra... more All Staphylococcus aureus isolated during 2003-2006 at a university hospital in Thessalia, central Greece, from ulcerative upper-extremity infections were tested for the presence of PVL gene and for possible clonal relationship to validate the role of PVL toxin in the clinical features of these infections and also to establish preventive measures towards limiting the spread of such strains among close contacts. Of 305 bacterial cultures obtained from consecutive patients suffering from purulent musculoskeletal infections of an upper extremity, 207 revealed the presence of S. aureus (81 methicillin-resistant and 126 methicillin-sensitive). Seventy of the 207 cultures were found to be positive for the PVL gene. The PVL gene was detected in 12.1% (2003), 46.7% (2004), 34% (2005), and 53% (2006) of upper-extremity staphylococcal infections, indicating a statistically significant increase between 2003 and 2004-2006. However, there was a significant decrease in readmissions during 2005 and 2006 and also in the number of relatives diagnosed with PVL-positive infections during the same period of time. The localization of these infections, their higher incidence during summer, and the transmission to family members indicated that contact was the means of spread of PVL-positive S. aureus. Most isolates belonged to the ST-80 clone, predominant in Europe. The emergence of new MRSA and also MSSA clones carrying the PVL gene and the decreases in readmissions and number of infected &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;close contacts&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; emphasizes the need for closer systematic surveillance and the implementation of preventive measures.

Research paper thumbnail of Do steroids, conventional non-steroidal anti-inflammatory drugs and selective COX-2 inhibitors adversely affect fracture healing

Journal of musculoskeletal & neuronal interactions

Research paper thumbnail of Choosing Implant for Total Hip Arthroplasty

Research paper thumbnail of Radiological Planning of Total Hip Arthroplasty

Research paper thumbnail of Tips and Pearls in Total Hip Arthroplasty

Research paper thumbnail of Multiple Irrigation and Debridements for Periprosthetic Joint Infections: Facing a Necessity or Just Prolonging the Inevitable?

The Journal of arthroplasty, Jan 2, 2015

Irrigation and debridement (I&D) may be a viable option in selected cases of periprosthetic joint... more Irrigation and debridement (I&D) may be a viable option in selected cases of periprosthetic joint infections (PJI). Our aim was to investigate the role of multiple I&Ds. Among 141 patients with PJI treated with I&D in our institution, 19 were subjected to additional procedures. Their clinical characteristics were retrospectively reviewed and compared to the remaining patients treated with a single I&D. The probability of treatment failure (removal of implants) was not significantly different among the two groups. The interval between serial I&Ds was a significant factor determining outcomes. Patients treated with multiple I&Ds had a significantly higher prevalence of peripheral vascular disease. The decision to proceed with repeat of I&D should be made with caution.

Research paper thumbnail of Perioperative Outcomes in Orthopedic Surgery

The Scientific World Journal, 2015

Research paper thumbnail of Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty

The Scientific World Journal, 2015

Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly advers... more Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA. These can be classified into patient-related factors (age, gender, obesity, comorbidities, history of infection, primary diagnosis, and socioeconomic profile), surgery-related factors (allogeneic blood transfusion, DVT prophylaxis and coagulopathy, duration of surgery, antibiotic prophylaxis, bearing surface and fixation, bilateral procedures, NNIS index score, and anesthesia type), and hospital-related factors (duration of hospitalization, institution and surgeon volume, and admission from a healthcare facility). All these factors are discussed with respect to potential measures that can be taken to reduce their effect and consequently the overall risk for infection.

Research paper thumbnail of Medial Unicondylar Knee Arthroplasty Improves Patellofemoral Congruence: a possible mechanistic explanation for poor association between patellofemoral degeneration and clinical outcome

The Journal of Arthroplasty, 2015

The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UK... more The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UKA) on postoperative patellofemoral joint (PFJ) congruence and analyze the relationship of preoperative PFJ degeneration on clinical outcome. We retrospectively reviewed 110 patients (113 knees) who underwent medial UKA. Radiographs were evaluated to ascertain PFJ degenerative changes and congruence. Clinical outcomes were assessed preoperatively and postoperatively. The postoperative absolute patellar congruence angle (10.05±10.28) was significantly improved compared with the preoperative value (14.23±11.22) (P=0.0038). No correlation was found between preoperative PFJ congruence or degeneration severity, and WOMAC scores at two-year follow up. Pre-operative PFJ congruence and degenerative changes do not affect UKA clinical outcomes. This finding may be explained by the post-op PFJ congruence improvement.

Research paper thumbnail of Risk Factors for Recurrence of Periprosthetic Knee Infection

The Journal of arthroplasty, Jan 8, 2015

We retrospectively reviewed 110 patients who underwent two-stage revision surgery in order to ide... more We retrospectively reviewed 110 patients who underwent two-stage revision surgery in order to identify potential risk factors for recurrence of periprosthetic infection. We found that patients with inflammatory arthritis (P=0.0125), perioperative hematoma formation (P=0.0422), wound dehiscence (P=0.042), and those who are chronic Staphylococcus carriers (P=0.0177) were associated with an increased incidence of re-infection. The duration of intravenous antibiotic therapy less than 6weeks was associated with a reduced risk of reinfection to greater than 6weeks (P=0.03). Multivariate analysis indicated that wound dehiscence (odds ratio [OR], 5.119; 95% confidence interval [CI], 1.367-19.17), and Staphylococcus carriers (OR, 11.419; 95% CI, 1.376-94.727) are significant predictors of recurrence (P=0.0153 and 0.0241, respectively).

Research paper thumbnail of Perioperative Morbidity and Mortality of Same-day Bilateral TKAs Incidence and Risk Factors

Clinical Orthopaedics and Related Research

Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilat... more Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA). We compared (1) 30-day mortality; (2) rates of in-hospital complications; and (3) blood transfusion rates between patients undergoing same-admission staged BTKA and patients undergoing BTKA staged within 1 year in a highly specialized center where specific guidelines have been implemented for same-day BTKA patient selection. We analyzed institutional data for 149 patients undergoing same-admission staged and 1557 patients undergoing staged BTKA diagnosed with bilateral knee idiopathic osteoarthritis from 1998 to 2011. Although patients in both groups presented with bilateral knee disease, same-admission staged patients had more medical comorbidities and did not qualify for same-day BTKA. Specifically, patients with coronary artery disease with inducible ischemia, congestive heart failure, advanced chronic obstructive pulmonary disease, uncontrolled diabetes, peripheral vascular disease, renal failure, morbid obesity, history of venous thromboembolism, or those who were older than 75 years were not considered eligible for same-day BTKA. Patient demographics and Deyo comorbidity index were tabulated. The groups were similar in age, but same-admission staged patients were more likely to be male and had a higher overall comorbidity burden. The complications were categorized into systemic (medical) and local (orthopaedic). Furthermore, the systemic complications were subcategorized into major (required complex surgical or medical intervention or were deemed life-threatening) and minor (necessitated additional observation or required medical treatment), depending on their severity. Regression models were conducted to examine the association between surgery type and development of complications. There was no difference in 30-day mortality between the groups (0% versus 0.06%; p=0.754). There was no difference in the local complication rates (0.7% versus 0.8%; p=1.000). However, multivariable regression analysis adjusting for age, sex, and Deyo comorbidity index showed that same-admission staged patients were three and two times more likely than staged to develop a minor (odds ratio [OR], 3.02; 95% confidence interval [CI], 1.25-3.25; p=0.004) and major (OR, 2.02; 95% CI, 2.09-4.37; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) complication, respectively. The same-admission group experienced more acute postoperative anemia (11% versus 3%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and blood transfusions (93% versus 54%; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). These results suggest that patients who are not appropriate candidates for same-day BTKA as a result of increased overall comorbidity burden may be better served by undergoing staged BTKA…

Research paper thumbnail of Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome

International orthopaedics, Jan 31, 2015

Our purpose was to identify the success rate and factors predicting outcome of irrigation and deb... more Our purpose was to identify the success rate and factors predicting outcome of irrigation and debridement (I&D) in patients with deep periprosthetic joint infection (PJI) of the hip. We retrospectively reviewed clinical characteristics of patients with deep PJI after primary/revision total hip arthroplasty (THA) between January 2000 and May 2013 treated with I&D. Implant retention was the outcome of interest. Sixty patients (29 men and 31 women; mean age 64.9 years) were identified. Mean follow-up was 59 months (range, 12-168). The implants were retained in 42 patients (70%). Failure of I&D treatment correlated with duration of symptoms >five days (p <0.001) and obesity [body mass index (BMI) ≥ 30)] (p = 0.0289). Treatment outcome was affected by the type of pathogen (p = 0.0482), with patients with methicillin-resistant staphylococci having significantly lower odds of success.…

Research paper thumbnail of Staging Bilateral Total Knee Arthroplasty During the Same Hospitalization: The Impact of Timing

The Journal of arthroplasty, Jan 17, 2015

The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTK... more The concept of staging during the same hospitalization for bilateral total knee arthroplasty (BTKA) has emerged as a practice to minimize perioperative risks, although with few data providing an evidence base. A total of 41,664 BTKA patients from Nationwide Inpatient Sample data between 1998 and 2010 were identified, and categorized into three groups, same day, staging 1-3 days, and staging 4-7 days BTKA. Staging BTKA 1-3 days apart was associated with increased rates for complications compared to same day BTKA, while staging 4-7 days BTKA was associated with similar complication profiles compared to same day BTKA. Our study suggests that same day BTKA for selective patient population is preferable, and staging BTKA either 1-3 days or 4-7 days apart should be discouraged.

Research paper thumbnail of Report from the first European Bone and Joint Infection Society Travelling Fellowship 2009

European journal of orthopaedic surgery & traumatology : orthopédie traumatologie, 2013

Research paper thumbnail of Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study

Psychosomatics

Depression and anxiety are highly prevalent psychiatric disorders. However, little is known about... more Depression and anxiety are highly prevalent psychiatric disorders. However, little is known about their impact on outcomes in the perioperative setting. This study is intended to gain insight into epidemiology and effects on perioperative morbidity, mortality, length of hospital stay, discharge and cost. We obtained the National Inpatient Sample from the Hospital Cost and Utilization Project for each year between 2000 and 2008. Entries indicating the performance of primary total hip and knee arthroplasty were identified and separated into four groups: (1) those with concomitant diagnosis of depression or (2) anxiety, (3) both, and (4) none of these diagnoses. The incidence of major complications, non-routine discharge, length, and cost of hospitalization were assessed. Regression analysis was performed to identify if psychiatric comorbidity was an independent risk factor for each outcome. We identified 1,212,493 patients undergoing arthroplasty between 2000 and 2008. The prevalence ...

Research paper thumbnail of Meta-analysis of cause of death following total joint replacement using different thromboprophylaxis regimens

The Journal of bone and joint surgery. British volume, 2012

We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operat... more We performed a meta-analysis of modern total joint replacement (TJR) to determine the post-operative mortality and the cause of death using different thromboprophylactic regimens as follows: 1) no routine chemothromboprophylaxis (NRC); 2) Potent anticoagulation (PA) (unfractionated or low-molecular-weight heparin, ximelagatran, fondaparinux or rivaroxaban); 3) Potent anticoagulation combined (PAC) with regional anaesthesia and/or pneumatic compression devices (PCDs); 4) Warfarin (W); 5) Warfarin combined (WAC) with regional anaesthesia and/or PCD; and 6) Multimodal (MM) prophylaxis, including regional anaesthesia, PCDs and aspirin in low-risk patients. Cause of death was classified as autopsy proven, clinically certain or unknown. Deaths were grouped into cardiopulmonary excluding pulmonary embolism (PE), PE, bleeding-related, gastrointestinal, central nervous system, and others (miscellaneous). Meta-analysis based on fixed effects or random effects models was used for pooling incid...

Research paper thumbnail of Current concepts and controversies in the management of radial head fractures

Orthopedics, 2006

1. Orthopedics. 2006 Oct;29(10):904-16; quiz 917-8. Current concepts and controversies in the man... more 1. Orthopedics. 2006 Oct;29(10):904-16; quiz 917-8. Current concepts and controversies in the management of radial head fractures. Roidis NT, Papadakis SA, Rigopoulos N, Basdekis G, Poultsides L, Karachalios T, Malizos K, Itamura J. ...

Research paper thumbnail of Blood Transfusions in Total Hip and Knee Arthroplasty: An Analysis of Outcomes

The Scientific World Journal, 2014

Background. Various studies have raised concern of worse outcomes in patients receiving blood tra... more Background. Various studies have raised concern of worse outcomes in patients receiving blood transfusions perioperatively compared to those who do not. In this study we attempted to determine the proportion of perioperative complications in the orthopedic population attributable to the use of a blood transfusion. Methods. Data from 400 hospitals in the United States were used to identify patients undergoing total hip or knee arthroplasty (THA and TKA) from 2006 to 2010. Patient and health care demographics, as well as comorbidities and perioperative outcomes were compared. Multivariable logistic regression models were fitted to determine associations between transfusion, age, and comorbidities and various perioperative outcomes. Population attributable fraction (PAF) was determined to measure the proportion of outcome attributable to transfusion and other risk factors. Results. Of 530,089 patients, 18.93% received a blood transfusion during their hospitalization. Patients requiring blood transfusion were significantly older and showed a higher comorbidity burden. In addition, these patients had significantly higher rates of major complications and a longer length of hospitalization. The logistic regression models showed that transfused patients were more likely to have adverse health outcomes than nontransfused patients. However, patients who were older or had preexisting diseases carried a higher risk than use of a transfusion for these outcomes. The need for a blood transfusion explained 9.51% (95% CI 9.12-9.90) of all major complications. Conclusions. Advanced age and high comorbidity may be responsible for a higher proportion of adverse outcomes in THA and TKA patients than blood transfusions.

Research paper thumbnail of Periprosthetic Knee Infections Treated with Irrigation and Debridement: Outcomes and Preoperative Predictive Factors

The Journal of arthroplasty, Jan 25, 2014

The role of irrigation and debridement (I&D) in the treatment of periprosthetic joint infections ... more The role of irrigation and debridement (I&D) in the treatment of periprosthetic joint infections (PJI) of the knee remains controversial. Our purpose was to identify the success rate and factors determining outcome of I&D in those patients. Clinical characteristics of 78 patients with PJI of the knee treated with I&D were retrospectively reviewed. Implant retention at final follow-up was achieved in 43 patients (55.1%). Logistic regression analysis revealed that duration of symptoms >5days and thyroid disease were independent predictors of I&D failure. Patients with methicillin-resistant staphylococcal infections had a success rate of 45.5% and significantly lower odds of success compared to patients with negative cultures. In selected patients,…

Research paper thumbnail of Central Role of SREBP-2 in the Pathogenesis of Osteoarthritis

Background: Recent studies have implied that osteoarthritis (OA) is a metabolic disease linked to... more Background: Recent studies have implied that osteoarthritis (OA) is a metabolic disease linked to deregulation of genes involved in lipid metabolism and cholesterol efflux. Sterol Regulatory Element Binding Proteins (SREBPs) are transcription factors regulating lipid metabolism with so far no association with OA. Our aim was to test the hypothesis that SREBP-2, a gene that plays a key role in cholesterol homeostasis, is crucially involved in OA pathogenesis and to identify possible mechanisms of action.