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Purpose: The purpose of this study is to determine if there is a relationship between clinical outcomes and nickel allergy by evaluating asymptomatic total knee arthroplasty (TKA) patients with well-functioning implants through quantitative metal allergy (MA) testing., Methods: A prospective case series was performed on 50 patients with well-functioning TKA of various implant types. Inclusion criteria included primary TKA with a minimum 12-month follow-up and Oxford knee score (OKS) ≥ 40. A commercially available Lymphocyte Transformation Test measured the amount of a hypersensitivity lymphocyte immune response after exposure to a particular antigen. MA results were stratified based on the stimulation index (SI). The Cochran-Mantel-Haenzel test was used to test the homogeneity of metal reactivities. The Wilcoxon-Mann-Whitney test was used to compare individual metal SI by gender and the association of OKS and metal SI was ascertained with the Spearman correlation., Results: Nickel, cobalt, and chromium do not have the same reactivity scores (p < 0.001), and only nickel showed reactive/highly reactive scores. Females were found to have 3.41 times the odds of males for higher Ni reactivity (p = 0.0295, odds ratio [OR], 95% confidence interval [CI] = 3.41 [1.13-10.3]) only. Clinically, there was no correlation between metal SI and OKS score by metal (Ni rho = -0.1779; Co rho = -0.0036; Cr rho = -0.1748)., Conclusion: This is the first study looking at MA in well-functioning TKA. There is no correlation between clinical results and nickel reactivity. Surgeons should exercise caution when revising a painful or poorly functioning TKA based solely on a 'positive' Nickel Allergy test and look for other possible reasons for failure., Level of Evidence: Level II., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: In 2010, a recall was issued for a specific monoblock large head metal-on-metal (MoM) hip prosthesis due to short-term revision rates of 12%-13% (articular surface replacement, DePuy Orthopaedics, Inc., Warsaw, IN). High complication, infection, and rerevision rates for revised MoM implants have been reported. The purpose of the study is to report long-term outcomes and trend metal ion levels of this recalled MoM prosthesis from a single surgeon series., Methods: Retrospective chart review was performed on all patients that underwent revision of large MoM hip replacements between 2010 and 2015. Pre- and post-revision Harris Hip Score (HHS), cup abduction angles, anteversion angles, and cup sizes were compared. Survivorship and HHS were the primary outcomes measured; serum cobalt and chromium levels were secondary outcomes. Multivariate linear regression was used to examine the correlation between prerevision serum metal ion levels and HHS., Results: A total of 24 hips (21 patients) met inclusion criteria. Mean time to revision was 4.12 years ± 1.1. Mean follow-up was 10.0 years (7-11.9 years). Mean HHS increased significantly after revision from 48.5 to 89.5 ( P < .001). Higher prerevision cobalt levels were correlated with lower prerevision HHS (cobalt R  = 0.25; chromium R  = 0.3160). There was no correlation with prerevision cobalt ( P  = .2671) or chromium ( P  = .3160) with postrevision HHS. Most recent metal ion testing revealed a significant decrease in both cobalt ( P  = .0084) and chromium ( P  = .0115). Survival rate is 100%., Conclusions: Our study showed excellent survivorship and outcomes at 10 years. There were no failures for any reason including infection. This differs from previous studies and confirms excellent long-term results are possible with revision of this recalled MoM implant., (© 2023 The Authors.)

Background: One devastating complication that leads to increased morbidity and mortality rates after total joint arthroplasty (TJA) is prosthetic joint infection (PJI). Evidence on the relationship between climate, seasonality, and the risk of developing a PJI conflicts. The objective of this study was to investigate the effect of seasonality and climate change on the rate of PJI. Methods: We retrospectively reviewed data of patients undergoing primary TJA at a single institution in a subtropical climate location from 2012 to 2015. Only primary TJAs with a minimum of 1-year follow-up were included in the analysis. Patient demographics and complications were extracted from the database, and monthly average temperature, humidity, and precipitation were obtained. The primary endpoint was PJI requiring revision surgery within 1 year of the index procedure. Results: A total of 3,696 TJAs met the inclusion criteria, with 28 PJIs requiring a second surgery within 1 year (0.76%). We found no significant difference in age, sex, or body mass index in patients who developed a PJI ( P =0.9450, P =0.0989, and P =0.7942, respectively). The highest incidence of PJI occurred in August (1.49%), but the incidence of PJI by month was not significant ( P =0.8996). July and August were the hottest (91 °F) and most humid (79%) months, and June had the most average precipitation (8.06 inches); however, these climate variables were not significant contributors to the incidence of PJI ( P =0.4996, P =0.4999, and P =0.4957, respectively). Conclusion: We found no association between temperature, humidity, and development of PJI in a North American subtropical climate. Surgeons can use this information to counsel patients when planning for TJA., (©2022 by the author(s); Creative Commons Attribution License (CC BY).)

Background: Postoperative total joint arthroplasty complications place a tremendous burden on the health care system. The purpose of this study was to compare 30-day postoperative complication rates for surgeries in patients who received preoperative antiplatelet agents and/or anticoagulants to surgeries in a control group that did not receive antiplatelet agents and/or anticoagulants in the 90 days prior to undergoing a total joint arthroplasty. Methods: We retrospectively reviewed total hip or knee arthroplasties from November 2012 to March 2016. Surgeries were categorized into 4 groups depending on their preoperative antiplatelet and anticoagulant status. Complications between the groups were compared using chi-square analysis and Fisher exact test. Results: In this study, 1,726 arthroplasties in 1,544 patients were included. Superficial wound complications were the most common complication in all 4 groups (3.8% of surgeries), with no significant difference between the groups. A statistically significant difference was found in the number of prosthetic joint infections in the group of surgeries with no antiplatelets or anticoagulants compared to surgeries with both medications administered during the 90 days preoperatively (0.82% vs 5.13%, P =0.0003). No significant difference was found between the groups with regard to stroke, myocardial infarction, pulmonary embolism, or deep venous thrombosis. Conclusion: Surgeries for which both antiplatelets and anticoagulants were administered in the 90 days preoperatively had a statistically significantly higher rate of prosthetic joint infections compared to surgeries with neither medication administered preoperatively. Surgeons can use this information to better inform and risk-stratify patients prior to surgery., (©2021 by the author(s); Creative Commons Attribution License (CC BY).)