Scott Sporer - Academia.edu (original) (raw)
Papers by Scott Sporer
Current Orthopaedics, Jun 1, 2006
ABSTRACT
Journal of Arthroplasty, Jun 1, 2010
Journal of Bone and Joint Surgery, American Volume, Apr 1, 2005
The bone & joint journal, Jul 1, 2018
Journal of Arthroplasty, Jul 1, 2018
Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded ... more Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded cement spacer (ACS). The risk for acute kidney injury (AKI) related to use of antibiotic spacers has not been well defined. We aimed to identify the incidence of and risk factors for AKI after placement of an ACS. We performed a prospective cohort study of patients with an infected primary total hip or knee arthroplasty treated with ACSs with vancomycin, gentamicin, and tobramycin. Serum creatinine and glomerular filtration rate data were collected at baseline and weekly intervals for 8 weeks. Patients were classified into Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) stages to determine incidence of AKI. Risk factors for kidney injury were identified via regression analysis. A total of 37 patients (20 total knee arthroplasty and 17 total hip arthroplasty) were included. During the 8 weeks after ACS placement, 10 patients (27%) fit RIFLE criteria for kidney injury and 2 patients (5%) fit RIFLE criteria for kidney failure. No baseline patient characteristics were associated with development of AKI. Patients should be monitored closely for development of AKI after placement of ACSs for the treatment of periprosthetic joint infection. Further research into minimizing risk for AKI is warranted.
Journal of Arthroplasty, Nov 1, 2016
Multimodal pain protocols have been proposed to achieve improved long-acting postoperative analge... more Multimodal pain protocols have been proposed to achieve improved long-acting postoperative analgesia. Controlling postoperative pain after joint arthroplasty is especially important as it relates to patient satisfaction and outcomes. The purpose of this study was to compare the postoperative pain, time to ambulation, and overall narcotic usage between patients who received either a femoral nerve block with a periarticular bupivacaine injection or a periarticular bupivacaine and extended-release liposomal bupivacaine injection after primary total knee arthroplasty. A total of 597 consecutive primary total knee arthroplasties performed between September 1, 2012 and August 31, 2014 received preoperative celecoxib, oxycodone, and transdermal scopolamine. Intraoperatively, patients either received a single-dose bupivacaine femoral nerve block along with 30-mL 0.25% bupivacaine periarticular injection (group A) or a 60-mL periarticular injection alone (20-mL liposomal bupivacaine, 30-mL 0.25% bupivacaine, and 10-mL saline; group B). The postoperative pain scores, narcotic usage, and time to ambulation were retrospectively collected from the electronic medical record. These outcomes were compared between treatment groups. There were 325 patients in group A compared with 272 in group B during the time frame. There was no difference among age, gender, race, and body mass index between the groups. Group B demonstrated a decreased need for breakthrough pain medication (16.9% vs 36.3% P < .001), decreased pain 12 hours postoperatively (3.2 vs 3.6 P < .003), and an earlier time to ambulation (29.5 hours vs 32.2 hours, P < .017). There was no difference in hospital length of stay (2.8 vs 2.6 days, P = .123). On controlling for demographic factors, patients in group B were able to ambulate 2.3 hours earlier than those in group A (coefficient = -2.3, P = .049). Liposomal bupivacaine resulted in a decrease need for breakthrough pain medication, improved pain scores at 12 hours, and an earlier time to ambulation compared to a combined femoral nerve block and periarticular bupivacaine injection.
The bone & joint journal, Nov 1, 2014
Clinical Orthopaedics and Related Research, Dec 1, 2003
Femoral revision with a 7-inch or 8-inch fully porous-coated stem may not provide reliable long-t... more Femoral revision with a 7-inch or 8-inch fully porous-coated stem may not provide reliable long-term results in patients with moderate bone loss. The purpose of this study was to evaluate the limits of fully porous-coated stems and to create a treatment algorithm for femoral deficiencies. Fifty-one patients with either a 10-inch or 9-inch calcar fully porous-coated stem, 10 patients with impaction bone grafting, and 10 patients with a modular tapered stem were evaluated at an average 4.2 years postoperatively. The mechanical failure rate among the 9-inch and 10-inch fully porous-coated stems was 0% in Type III B defects with femoral canals less than 19 mm (15 patients), 18% in Type IIIB defects with femoral canals greater than 19 mm (2 of 11 patients) and 37.5% in Type IV defects (three of eight patients). There were no mechanical failures observed among the bone packing or modular tapered stems. Patients with Type IIIB defects and a femoral canal less than 19 mm can be treated successfully with either a 10-inch or 9-inch calcar fully porous-coated stem. However, patients with Type IIIB defect and an endosteal canal greater than 19 mm or a Type IV defect require alternative methods of reconstruction such as a modular tapered stem or a bone packing procedure.
Clinical Orthopaedics and Related Research, Dec 1, 2004
Journal of Bone and Joint Surgery, American Volume, Sep 1, 2008
While multiple tests are used to determine the presence of infection at the site of a total hip a... more While multiple tests are used to determine the presence of infection at the site of a total hip arthroplasty, few studies have applied a consistent algorithm to determine the utility of the various tests that are available. The purpose of the present study was to evaluate the utility of commonly available tests for determining the presence of periprosthetic infection in patients undergoing revision total hip arthroplasty. Two hundred and thirty-five consecutive total hip arthroplasties in 220 patients were evaluated by one of two surgeons using a consistent algorithm to identify infection and were treated with reoperation. Receiver-operating-characteristic curve analysis was used to determine the optimal cut-point values for the white blood-cell count and the percentage of polymorphonuclear cells of intraoperatively aspirated hip synovial fluid. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were determined. Patients were considered to have an infection if two of three criteria were met; the three criteria were a positive intraoperative culture, gross purulence at the time of reoperation, and positive histopathological findings. Thirty-four arthroplasties were excluded because of the presence of a draining sinus, incomplete data, or a preoperative diagnosis of inflammatory arthritis, leaving 201 total hip arthroplasties available for evaluation. Fifty-five hips were judged to be infected. No hip in a patient with a preoperative erythrocyte sedimentation rate of <30 mm/hr and a C-reactive protein level of <10 mg/dL was determined to be infected. Receiver-operating-characteristic curve analysis of the synovial fluid illustrated optimal cut-points to be >4200 white blood cells/mL for the white blood-cell count and >80% polymorphonuclear cells for the differential count. However, when combined with an elevated erythrocyte sedimentation rate and C-reactive protein level, the optimal cut-point for the synovial fluid cell count was >3000 white blood cells/mL, which yielded the highest combined sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the tests studied. A synovial fluid cell count of >3000 white blood cells/mL was the most predictive perioperative testing modality in our study for determining the presence of periprosthetic infection when combined with an elevated preoperative erythrocyte sedimentation rate and C-reactive protein level in patients undergoing revision total hip arthroplasty.
Journal of Arthroplasty, Apr 1, 2010
JBJS case connector, Mar 25, 2015
Case: We present two patients with dual-mobility total hip arthroplasty components who underwent ... more Case: We present two patients with dual-mobility total hip arthroplasty components who underwent closed reduction of posterior dislocations with conscious sedation in the emergency room. Following closed reduction, both patients had immediate pain, clicking, and grinding of the hip. Radiographs identified intraprosthetic dislocation of the dual-mobility components, and revision surgery was required. Conclusion: When dislocation of a dual-mobility bearing occurs, the surgeon should consider performing a careful closed reduction with muscle paralysis and use of fluoroscopic guidance in the operating room to avoid intraprosthetic dislocation.
Journal of Arthroplasty, Jun 1, 2005
Journal of Arthroplasty, Oct 1, 2008
Journal of Arthroplasty, Apr 1, 2010
Journal of Arthroplasty, Feb 1, 2007
Orthopedics, Sep 7, 2010
The majority of acetabular defects can be reconstructed with a hemispherical acetabular component... more The majority of acetabular defects can be reconstructed with a hemispherical acetabular component alone. However, severe bone loss encountered at the time of revision acetabular surgery can result in compromised initial fixation leading to component micromotion, failure of bone ingrowth, and mechanical failure. Porous acetabular augments offer a potential solution to enhance initial component fixation while maximizing the area for biologic ingrowth. Premanufactured metal augments can be placed independent of the acetabular component. This feature provides surgeons the flexibility to place the hemispherical acetabular component in the optimal orientation at the anatomic hip center. The augment is initially secured to the hemipelvis with multiple screws before it is then secured to the hemispherical acetabular component with the use of polymethylmethacrylate bone cement. The modularity of the augments effectively allows a custom implant to be designed intraoperatively. Porous acetabular augments offer the potential advantages of a nonresorbable material that can be inserted without extensive soft tissue stripping. Additionally, these metal augments do not carry the risk of disease transmission associated with bulk structural allograft and are manufactured in a variety of shapes and sizes. The early clinical and radiographic results of porous acetabular augments are promising, yet there remains a paucity of long-term data.
Journal of the American Academy of Orthopaedic Surgeons, Apr 15, 2018
Arthroplasty today, Dec 1, 2017
Current Orthopaedics, Jun 1, 2006
ABSTRACT
Journal of Arthroplasty, Jun 1, 2010
Journal of Bone and Joint Surgery, American Volume, Apr 1, 2005
The bone & joint journal, Jul 1, 2018
Journal of Arthroplasty, Jul 1, 2018
Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded ... more Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded cement spacer (ACS). The risk for acute kidney injury (AKI) related to use of antibiotic spacers has not been well defined. We aimed to identify the incidence of and risk factors for AKI after placement of an ACS. We performed a prospective cohort study of patients with an infected primary total hip or knee arthroplasty treated with ACSs with vancomycin, gentamicin, and tobramycin. Serum creatinine and glomerular filtration rate data were collected at baseline and weekly intervals for 8 weeks. Patients were classified into Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) stages to determine incidence of AKI. Risk factors for kidney injury were identified via regression analysis. A total of 37 patients (20 total knee arthroplasty and 17 total hip arthroplasty) were included. During the 8 weeks after ACS placement, 10 patients (27%) fit RIFLE criteria for kidney injury and 2 patients (5%) fit RIFLE criteria for kidney failure. No baseline patient characteristics were associated with development of AKI. Patients should be monitored closely for development of AKI after placement of ACSs for the treatment of periprosthetic joint infection. Further research into minimizing risk for AKI is warranted.
Journal of Arthroplasty, Nov 1, 2016
Multimodal pain protocols have been proposed to achieve improved long-acting postoperative analge... more Multimodal pain protocols have been proposed to achieve improved long-acting postoperative analgesia. Controlling postoperative pain after joint arthroplasty is especially important as it relates to patient satisfaction and outcomes. The purpose of this study was to compare the postoperative pain, time to ambulation, and overall narcotic usage between patients who received either a femoral nerve block with a periarticular bupivacaine injection or a periarticular bupivacaine and extended-release liposomal bupivacaine injection after primary total knee arthroplasty. A total of 597 consecutive primary total knee arthroplasties performed between September 1, 2012 and August 31, 2014 received preoperative celecoxib, oxycodone, and transdermal scopolamine. Intraoperatively, patients either received a single-dose bupivacaine femoral nerve block along with 30-mL 0.25% bupivacaine periarticular injection (group A) or a 60-mL periarticular injection alone (20-mL liposomal bupivacaine, 30-mL 0.25% bupivacaine, and 10-mL saline; group B). The postoperative pain scores, narcotic usage, and time to ambulation were retrospectively collected from the electronic medical record. These outcomes were compared between treatment groups. There were 325 patients in group A compared with 272 in group B during the time frame. There was no difference among age, gender, race, and body mass index between the groups. Group B demonstrated a decreased need for breakthrough pain medication (16.9% vs 36.3% P < .001), decreased pain 12 hours postoperatively (3.2 vs 3.6 P < .003), and an earlier time to ambulation (29.5 hours vs 32.2 hours, P < .017). There was no difference in hospital length of stay (2.8 vs 2.6 days, P = .123). On controlling for demographic factors, patients in group B were able to ambulate 2.3 hours earlier than those in group A (coefficient = -2.3, P = .049). Liposomal bupivacaine resulted in a decrease need for breakthrough pain medication, improved pain scores at 12 hours, and an earlier time to ambulation compared to a combined femoral nerve block and periarticular bupivacaine injection.
The bone & joint journal, Nov 1, 2014
Clinical Orthopaedics and Related Research, Dec 1, 2003
Femoral revision with a 7-inch or 8-inch fully porous-coated stem may not provide reliable long-t... more Femoral revision with a 7-inch or 8-inch fully porous-coated stem may not provide reliable long-term results in patients with moderate bone loss. The purpose of this study was to evaluate the limits of fully porous-coated stems and to create a treatment algorithm for femoral deficiencies. Fifty-one patients with either a 10-inch or 9-inch calcar fully porous-coated stem, 10 patients with impaction bone grafting, and 10 patients with a modular tapered stem were evaluated at an average 4.2 years postoperatively. The mechanical failure rate among the 9-inch and 10-inch fully porous-coated stems was 0% in Type III B defects with femoral canals less than 19 mm (15 patients), 18% in Type IIIB defects with femoral canals greater than 19 mm (2 of 11 patients) and 37.5% in Type IV defects (three of eight patients). There were no mechanical failures observed among the bone packing or modular tapered stems. Patients with Type IIIB defects and a femoral canal less than 19 mm can be treated successfully with either a 10-inch or 9-inch calcar fully porous-coated stem. However, patients with Type IIIB defect and an endosteal canal greater than 19 mm or a Type IV defect require alternative methods of reconstruction such as a modular tapered stem or a bone packing procedure.
Clinical Orthopaedics and Related Research, Dec 1, 2004
Journal of Bone and Joint Surgery, American Volume, Sep 1, 2008
While multiple tests are used to determine the presence of infection at the site of a total hip a... more While multiple tests are used to determine the presence of infection at the site of a total hip arthroplasty, few studies have applied a consistent algorithm to determine the utility of the various tests that are available. The purpose of the present study was to evaluate the utility of commonly available tests for determining the presence of periprosthetic infection in patients undergoing revision total hip arthroplasty. Two hundred and thirty-five consecutive total hip arthroplasties in 220 patients were evaluated by one of two surgeons using a consistent algorithm to identify infection and were treated with reoperation. Receiver-operating-characteristic curve analysis was used to determine the optimal cut-point values for the white blood-cell count and the percentage of polymorphonuclear cells of intraoperatively aspirated hip synovial fluid. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were determined. Patients were considered to have an infection if two of three criteria were met; the three criteria were a positive intraoperative culture, gross purulence at the time of reoperation, and positive histopathological findings. Thirty-four arthroplasties were excluded because of the presence of a draining sinus, incomplete data, or a preoperative diagnosis of inflammatory arthritis, leaving 201 total hip arthroplasties available for evaluation. Fifty-five hips were judged to be infected. No hip in a patient with a preoperative erythrocyte sedimentation rate of <30 mm/hr and a C-reactive protein level of <10 mg/dL was determined to be infected. Receiver-operating-characteristic curve analysis of the synovial fluid illustrated optimal cut-points to be >4200 white blood cells/mL for the white blood-cell count and >80% polymorphonuclear cells for the differential count. However, when combined with an elevated erythrocyte sedimentation rate and C-reactive protein level, the optimal cut-point for the synovial fluid cell count was >3000 white blood cells/mL, which yielded the highest combined sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the tests studied. A synovial fluid cell count of >3000 white blood cells/mL was the most predictive perioperative testing modality in our study for determining the presence of periprosthetic infection when combined with an elevated preoperative erythrocyte sedimentation rate and C-reactive protein level in patients undergoing revision total hip arthroplasty.
Journal of Arthroplasty, Apr 1, 2010
JBJS case connector, Mar 25, 2015
Case: We present two patients with dual-mobility total hip arthroplasty components who underwent ... more Case: We present two patients with dual-mobility total hip arthroplasty components who underwent closed reduction of posterior dislocations with conscious sedation in the emergency room. Following closed reduction, both patients had immediate pain, clicking, and grinding of the hip. Radiographs identified intraprosthetic dislocation of the dual-mobility components, and revision surgery was required. Conclusion: When dislocation of a dual-mobility bearing occurs, the surgeon should consider performing a careful closed reduction with muscle paralysis and use of fluoroscopic guidance in the operating room to avoid intraprosthetic dislocation.
Journal of Arthroplasty, Jun 1, 2005
Journal of Arthroplasty, Oct 1, 2008
Journal of Arthroplasty, Apr 1, 2010
Journal of Arthroplasty, Feb 1, 2007
Orthopedics, Sep 7, 2010
The majority of acetabular defects can be reconstructed with a hemispherical acetabular component... more The majority of acetabular defects can be reconstructed with a hemispherical acetabular component alone. However, severe bone loss encountered at the time of revision acetabular surgery can result in compromised initial fixation leading to component micromotion, failure of bone ingrowth, and mechanical failure. Porous acetabular augments offer a potential solution to enhance initial component fixation while maximizing the area for biologic ingrowth. Premanufactured metal augments can be placed independent of the acetabular component. This feature provides surgeons the flexibility to place the hemispherical acetabular component in the optimal orientation at the anatomic hip center. The augment is initially secured to the hemipelvis with multiple screws before it is then secured to the hemispherical acetabular component with the use of polymethylmethacrylate bone cement. The modularity of the augments effectively allows a custom implant to be designed intraoperatively. Porous acetabular augments offer the potential advantages of a nonresorbable material that can be inserted without extensive soft tissue stripping. Additionally, these metal augments do not carry the risk of disease transmission associated with bulk structural allograft and are manufactured in a variety of shapes and sizes. The early clinical and radiographic results of porous acetabular augments are promising, yet there remains a paucity of long-term data.
Journal of the American Academy of Orthopaedic Surgeons, Apr 15, 2018
Arthroplasty today, Dec 1, 2017