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Despite numerous advancements in orthopedics, surgical site infection remains one of the most common and serious complications. Infection involving a joint arthroplasty portends a poor prognosis and usually requires revision [...], Background: Periprosthetic joint infections (PJI) following joint arthroplasty are now the leading cause of reoperation and are associated with serious morbidity to the patient, often requiring several staged operations and a prolonged course of parenteral antibiotics. Prophylactic administration of intravenous antibiotics before skin incision is arguably the most important measure to prevent PJI; however, the dose effectiveness of cefazolin in target tissue is not well known. We aimed to identify parameters affecting local tissue concentration (LTC) of cefazolin. Methods: We performed a literature search using the following keywords: "orthopaedics," "orthopedic," "arthroplasty" and "cefazolin." We included studies that measured LTC of cefazolin from samples obtained during either a total knee or total hip arthroplasty. Results: Of the 332 records screened, we included 10 studies that described LTC of cefazolin. The included studies evaluated dosing (n = 7), procedure type (n = 3), body mass index (n = 1) and tourniquet utilization (n = 1). Conclusion: Few studies have measured LTC levels of antibiotics (or levels of cefazolin) to validate current recommendations for antibiotic prophylaxis in orthopedic surgery. With infection as the leading reason for early reoperation or revision surgery, the parameters affecting LTC during orthopedic procedures need to be further assessed. Contexte : Les infections de prothèse articulaire (IPA) suivant une arthroplastie de la hanche sont aujourd&apos;hui la principale cause de réopération; elles sont associées à une grave morbidité chez le patient et nécessitent souvent plusieurs interventions en séquence et une antibiothérapie prolongée administrée par voie parentérale. L&apos;administration prophylactique d&apos;antibiotiques intraveineux avant l&apos;incision cutanée est sans doute la mesure la plus importante pour prévenir les IPA; la dose efficace de céfazoline dans le tissu ciblé n&apos;est toutefois pas connue avec précision. Nous avons voulu déterminer les paramètres modulant la concentration locale tissulaire de la céfazoline. Méthodes : Nous avons effectué une recherche documentaire à l&apos;aide des mots-clés suivants : << orthopaedics >> [orthopédie], << orthopedic >> [orthopédique], << arthroplasty >> [arthroplastie] et << cefazolin >> [céfazoline]. Nous avons aussi inclus des études ayant mesuré la concentration locale de la céfazoline dans des échantillons obtenus dans le cadre d&apos;arthroplasties totales du genou ou de la hanche. Résultats : Après examen de 332 articles, nous avons inclus 10 études décrivant la concentration locale tissulaire de céfazoline, qui évaluaient la dose (n = 7), le type d&apos;intervention (n = 3), l&apos;indice de masse corporelle (n = 1) et l&apos;utilisation d&apos;un garrot (n = 1). Conclusion : Peu d&apos;études ont mesuré les concentrations locales tissulaires d&apos;antibiotiques (ou de céfazoline) afin de valider les recommandations actuelles sur l&apos;antibioprophylaxie en chirurgie orthopédique. Les infections étant la principale cause de réopérations ou chirurgies de révision hâtives, les paramètres modulant la concentration locale tissulaire au cours des interventions orthopédiques doivent faire l&apos;objet d&apos;une évaluation plus poussée.

Patients with end-stage hip osteoarthritis are commonly treated with total hip arthroplasty (THA). This operation has become one of the most successful and common orthopedic procedures, restoring function to more [...], Background: Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways. Methods: We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020. Patient demographic and clinical data were recorded, as were preoperative diagnosis, type of anesthesia, type of implant used, surgical time and estimated blood loss. We determined direct and indirect costs from time of arrival at the presurgical unit to hospital discharge. We determined the EOCCs using an ABC method. Results: The study included 50 patients who underwent THA (25 DS, 25 SDA). The mean length of stay in the SDA group was 45.1 (standard deviation [SD] 21.4) hours. Differences were observed between the 2 groups in mean age, mean Charlson Comorbidity Index score, surgical technique and mean surgical time (p [inférieur ou égal à] 0.001). The mean total EOCC for SDA THA was $10 911 (SD $706.12, range $9944.07-$12 871.95), compared to $9672 (SD $546.55, range $8838.30-$11 058.07) for DS THA, a difference of 11.4%, mostly attributable to hospital resources such as laboratory tests, radiologic studies and cost of the surgical admission. Conclusion: Day surgery THA is cost-effective in selected patient populations. With the savings identified in this study, every 10 additional DS THA procedures would save sufficient resources to perform an additional THA operation. Contexte : Si l&apos;arthroplastie totale de la hanche (ATH) en chirurgie d&apos;un jour est associée à un taux de satisfaction élevé des patients et à un bon profil d&apos;innocuité, il existe peu de calculs précis du coût de la période de traitement (CPT) pour cette intervention par rapport au coût des interventions avec hospitalisation. Nous avons déterminé le CPT des patients ayant subi une ATH pour ensuite comparer les interventions en chirurgie d&apos;un jour à celles avec hospitalisation. Méthodes : Nous avons évalué le CPT de patients consécutifs ayant subi une ATH en chirurgie d&apos;un jour ou avec hospitalisation pour cause d&apos;arthrose ou d&apos;ostéonécrose auprès d&apos;un même chirurgien dans un centre universitaire entre juillet 2018 et janvier 2020. Les caractéristiques démographiques et les données cliniques des patients ont été notées, de même que le diagnostic préopératoire, le type d&apos;anesthésie, le type d&apos;implant utilisé, le temps de chirurgie et la perte sanguine estimée. Nous avons déterminé les coûts directs et indirects, de l&apos;admission à l&apos;unité préopératoire jusqu&apos;au congé de l&apos;hôpital, et calculé le CPT avec la méthode des coûts par activités. Résultats : L&apos;étude comprenait 50 patients ayant subi une ATH (25 en chirurgie d&apos;un jour, 25 avec hospitalisation). La durée de séjour moyenne pour le groupe en chirurgie d&apos;un jour était de 45,1 heures (écart type [?‰.T.] 21,4 heures). Des différences ont été notées entre les 2 groupes pour l&apos;âge moyen, l&apos;indice de comorbidités de Charlson moyen, la technique chirurgicale et le temps de chirurgie moyen (p [inférieur ou égal à] 0,001). Le CPT total moyen était de 10 911 $ pour les interventions avec hospitalisation (?‰.T. 706,12 $, plage 9944,07 $-12 871,95 $), comparativement à 9672 $ pour les chirurgies d&apos;un jour (?‰.T. 546,55 $, plage 8838,30 $-11 058,07 $), une différence de 11,4 % attribuable principalement aux ressources hospitalières telles que les analyses de laboratoire, les examens radiologiques et les coûts d&apos;admission au bloc opératoire. Conclusion : L&apos;ATH en chirurgie d&apos;un jour est rentable lorsqu&apos;on cible des populations de patients précises. Selon les économies quantifiées dans cette étude, les ressources économisées en réalisant 10 ATH en chirurgie d&apos;un jour seraient suffisantes pour une intervention de plus.

Background: Advancements in musculoskeletal oncologic treatment have allowed for longer survival of patients with malignant bone tumors and the associated longer use of tumor endoprostheses in those who have had such reconstructions. Several studies have reported on increased serum metal ions with the use of such implants. Modularity in these implants introduces the risk of taper junction corrosion and subsidence resulting in metal wear particle release that may cause an adverse local tissue reaction or systemic toxicity. Additionally, these implants contain a large surface area of cobalt and chromium. It is unclear whether the source of the increased serum ion levels was due to the taper junction corrosion or the implant itself. To our knowledge, no prior study has reported on taper junction subsidence. Questions/purposes: In this study we sought (1) to determine survivorship free from radiographic taper junction subsidence in a femoral modular tumor endoprosthesis, and (2) to identify the implant characteristics in the endoprostheses associated with taper subsidence. Methods: Between January 1996 and February 2020, the senior author performed 150 proximal or distal femur replacements following resections of soft tissue or bone tumors of the thigh and femur. Of those, 6% (9 of 150) of patients were lost to follow-up before 2 years, 25% (37 of 150) could not be analyzed due to absence of plain radiographs during follow-up, and 13% (20 of 150) died before 2 years follow-up, leaving 56% (84 of 150) for analysis in this retrospective study, with a median time for analysis of 14 years (range 2 to 31 years) after the index resection and endoprosthetic reconstruction for patients with distal femur replacements and 5 years (range 2 to 19 years) for patients with proximal femur replacement. Radiographs involving the entire implant were evaluated for the presence or absence of subsidence of the taper junction that was evident and clear to see if present. The association between the number of taper junctions, the length of resection, the number of collapsed junctions, and the time to collapse from the initial surgery were examined using regression analysis. Results: Overall, 14% (12 of 84) patients with a distal femur replacement had radiographic collapse of at least one of the modular tapers. Survivorship free from taper subsidence was 91% (95% CI 86% to 96%) at 10 years and 84% (95% CI 78% to 90%) at 20 years. All patients were in the distal femur replacement group. The median follow-up of patients with subsidence was 15 years (range 5 to 26). Fifty-eight percent (7 of 12) of patients had two junctions involved, 25% (3 of 12) had three junctions, and 17% (2 of 12) had one junction involved. All but one patient had subsidence in a single junction. The median time to subsidence was 15 years (range 4.5 to 24.0 years). The subsidence was progressive in all patients who demonstrated it. The taper junction subsidence was complete in 75% (9 of 12) of patients and partial in 25% (3 of 12). Univariate and multivariable regression analyses did not show that the risk factors we studied were associated with subsidence. Two patients with junction subsidence were revised, one for taper fracture and one during busing exchange for distal junction subsidence. Conclusion: Taper damage with late and progressive subsidence of the intervening junction is not uncommon after distal femur replacement. The impact of such a complication is still unknown. Further studies should examine the long-term outcomes and correlate them with metal ion levels. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Bioactive surface coatings have retained the attention of researchers and physicians due to their versatility and range of applications in orthopedics, particularly in infection prevention. Antibacterial metal nanoparticles (mNPs) are a promising therapeutic, with vast application opportunities on orthopedic implants. The current research aimed to construct a polyelectrolyte multilayer on a highly porous titanium implant using alternating thin film coatings of chitosan and alginate via the layer-by-layer (LbL) self-assembly technique, along with the incorporation of silver nanoparticles (AgNPs) or titanium dioxide nanoparticles (TiO2NPs), for antibacterial and osteoconductive activity. These mNPs were characterized for their physicochemical properties using quartz crystal microgravimetry with a dissipation system, nanoparticle tracking analysis, scanning electron microscopy, and atomic force microscopy. Their cytotoxicity and osteogenic differentiation capabilities were assessed using AlamarBlue and alkaline phosphatase (ALP) activity assays, respectively. The antibiofilm efficacy of the mNPs was tested against Staphylococcus aureus. The LbL polyelectrolyte coating was successfully applied to the porous titanium substrate. A dose-dependent relationship between nanoparticle concentration and ALP as well as antibacterial effects was observed. TiO2NP samples were also less cytotoxic than their AgNP counterparts, although similarly antimicrobial. Together, these data serve as a proof-of-concept for a novel coating approach for orthopedic implants with antimicrobial and osteoconductive properties. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic resulted in the abrupt cessation of elective operating time as hospitals prepared for a surge of critically ill patients. While emergency surgeries proceeded, the [...], With the closure of most operating rooms (ORs) during the coronavirus disease 2019 (COVID-19) pandemic, the traditional allocation of block OR time needed to be redesigned. An important factor permitting the treatment of patients in a prioritized fashion was our pre-existing centralized OR booking (CORB) framework, which already required surgeons to categorize the priority level for each patient. The CORB, in conjunction with the multidisciplinary OR oversight committee that was formed during COVID-19 to review and triage the urgent cases, allowed for prioritization of cases among surgical services. Centralized OR booking provided opportunities that were essential in OR planning during the pandemic, including the ability to plan surgeries to maximize OR efficiency, minimize the number of admissions on any given day to the wards and the intensive care unit, flatten the number of admissions over the week and provide the flexibility to ramp up or down the number of ORs as the crisis changed.

This study investigated whether decreasing the femoral head size, in addition to performing a posterior capsular closure and short external rotator repair, influences the historical rate of dislocation after conversion of a failed hemiarthroplasty (HA) to a total hip arthroplasty (THA) through a posterior approach. We reviewed 15 patients from our prospective arthroplasty database who underwent a conversion from an HA to a THA with closure of the posterior capsule, had downsizing of the femoral head, and had at least a 2-year follow-up. Patients were clinically observed to determine whether their hip dislocated postoperatively or required re-revision. Radiographs were evaluated to assess for known risk factors for dislocation, including component position and restoration of hip biomechanics. The femoral head size was downsized from a mean of 45 mm (range, 42–57 mm) preoperatively to a mean of 32 mm (range, 28–36 mm) postoperatively (P<.001). Femoral heads sized 36, 32, and 28 mm were used in the revision of 4, 5, and 6 hips, respectively. At the mean 84-month follow-up (range, 24–156 months), there were no dislocations. Attention to surgical technique and closing the posterior capsule can decrease the historically high dislocation rate associated with converting an HA to a total hip replacement using the posterolateral approach. Despite substantial reduction in size of the prosthetic femoral head, there were no postoperative dislocations with closure of the posterior capsule. Downsizing the femoral head during revision THA should be avoided; however, if not feasible, closure of the posterior capsule can offset the otherwise increased risk of dislocation. [Orthopedics. 2023;46(3):175–179.] [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO) is a common complication after total hip arthroplasty (THA) and can result in pain and loss of motion of the hip. This is the first study in the literature to determine if a short course of Celecoxib is effective in the prevention of HO in patients undergoing cementless THA. In this retrospective study of prospectively collected data, consecutive patients undergoing a primary cementless THA were reviewed at a 2-year follow-up. The Control group consisted of 104 hips that did not receive Celecoxib (Control group), while the 208 hips in the Celecoxib group received 100 mg twice daily for 10 days. Radiographs, patient-recorded outcome measures and range of motion (ROM) were evaluated. Overall, there was a significantly decreased incidence of HO in the Celecoxib group (18.7%) than in the Control group (31.7%) (p = 0.01). The odds that a patient developed HO using Celecoxib were 0.4965 times the odds that a patient developed HO without treatment. Clinically, the Celecoxib group demonstrated significantly greater improvement in their mean WOMAC stiffness (0.35 vs. 0.17, p = 0.02) and physical function scores (3.26 vs. 1.83, p = 0.03) compared to those in the Control group, but there was no difference in the ROM between the two groups. This study is the first to demonstrate that the lowest dose of Celecoxib for a short course of only 10 days is a simple and effective prophylactic treatment option that can significantly reduce the incidence of HO following cementless THA. [ABSTRACT FROM AUTHOR]

Objectives: In 2020, Canada spent 12.9 percent of its GDP on healthcare, of which 3 percent was on medical devices. Early adoption of innovative surgical devices is mostly driven by physicians and delaying adoption can deprive patients of important medical treatments. This study aimed to identify the criteria in Canada used to decide on the adoption of a surgical device and identify challenges and opportunities. Methods: This scoping review was guided by the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA-ScR reporting guidelines. The search strategy included Canada’s provinces, different surgical fields, and adoption. Embase, Medline, and provincial databases were searched. Grey literature was also searched. Data were analyzed by reporting the criteria that were used for technology adoption. Finally, a thematic analysis by subthematic categorization was conducted to arrange the criteria found. Results: Overall, 155 studies were found. Seven were hospital-specific studies and 148 studies were from four provinces with publicly available Web sites for technology assessment committees (Alberta, British Columbia, Ontario, and Quebec). Seven main themes of criteria were identified: economic, hospital-specific, technology-specific, patients/public, clinical outcomes, policies and procedures, and physician specific. However, standardization and specific weighted criteria for decision making in the early adoption stage of novel technologies are lacking in Canada. Conclusions: Specific criteria for decision making in the early adoption stage of novel surgical technologies are lacking. These criteria need to be identified, standardized, and applied in order to provide innovative, and the most effective healthcare to Canadians. [ABSTRACT FROM AUTHOR]