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2. Recommendations from the ICM-VTE: General

Author

Parvizi, J., Abbas, A. A., Abcha, O., Abdelaal, M. S., Ackermann, P. W., Acuna, A. J., Ageno, W., Aguilar Ramirez, J. J., Akkaya, M., Alameddine, D., Alfaro, D. O., Alvand, A., Alzeedi, M., Andrade, A. J., Arnold, W. V., Arish, A., Austin, M. S., Ay, C., Azboy, I., Babis, G. C., Baker, C. M., Barrack, R. L., Barragan, E., Beaton-Comulada, D., Bedair, H. S., Bell, J. A., Beverland, D. E., Bhatia, N., Bialecki, J., Bondarenko, S., Bonilla, G., River Boschert, S. O., Bracho, C., Brooks, D., Buttaro, M., Cacan Daniel Caldeira, M. A., Callaghan, J., Campbell, D. G., Cancienne, J. M., Cannegieter, S. C., Canseco, J. A., Caprini, J. A., Carrier, M., Castro Bejarano, J. C., Catani, F., Ceylan, H. H., Cha, Y. -H., Chan, C. K., Chan, N., Cheung, M. H., Chisari, E., Cimminiello, C., Citak, M., Colon-Miranda, R. G., Colwell, C., Combs, K., Cordeiro, M., Corvi, J. J., Courtney Crispiana Cozowicz, P. M., Crawford, R. W., Cruz, E., D'Amore, T., Dantas, P., Della Valle, A. G., Deltour, C., Demanes, A. C., Djaja, Y. P., Dunbar, M. J., Egoavil, M. S., Egol, K. A., Eichinger, S., Elias, L. F., Emmerson, B. R., Ettema, H. B., Al Farii, H., Fernandez-Rodriguez, D., Fillingham, Y. A., Fu, H., Gallagher, N., Gary, J. L., Geerts, W. H., Ghazavi, M. T., Gleason, B., Goh, G. S., Goncalves, S., Goriainov, V., Goswami, K., Goyal, L., Granqvist, M., Grenho, A., Griffin, X., Hafez, M. A., Hakyemez, O. S., Hamdi, S., Hansen, E. N., Hansen, H., Hasegawa, M., Higuera, C. A., Hobohm, L. M. A., Holc, F., Hollingsworth, N., Hozack, W. J., Hughes, A. J., Humphrey, T. J., Huo, M. H., Inaba, Y., Jenny, J. -Y., Jiranek, W., Kaila, R., Kallel, S., Kamath, A. F., Karachalios, T., Karas, V., Kelkar, A. H., Keller, K., Kenanidis, E., Khan, I. A., Khan, Y., Kim, J. -H., Kim, K. -I., Klein, G. R., Kleiner, J. E., Komnos, G., Konstantinides, S. V., Koo, K. -H., Kopenitz, J., Krasinski, Z., Krueger, C. A., Kuo, A., Kvederas, G., Kwong, L. M., Lachiewicz, P. F., De Ladoucette, A., Larco, E., Larkin, J. A., Levine, B. R., W. T., Li, Lieberman, J. R., Lip, G. Y. H., Lizarraga, M. M., Llinas, A., Lobastov, K., Lobo, C. A., Ludwick, L., Julian, F., Maempel, Magnuson, J., Maini, L., Maltseva, V., Mamczak, C. N., Garcia-Mansilla, A., Manzaneda, M. E., Martino, V., Al Maskari, S., Matharu, G. S., Mead, M., Meghpara, M. M., Mehta, S., Memtsoudis, S. G., Menon, D., Merli Nikolaos Milonakis, G. J., Mirkazemi, C., Mojica, J. J., Moka, E., Moncman, T. G., Monsalvo, D., Mortazavi, S. M. J., Morton, J., Mulcahey, M. K., Najafi, F., Nam, D., Namdari, S., Navarro, R., Nazarian, D. G., Niikura, T., Noyez, J. F., Ochoa Chaar, C. I., Ong, C. B., Otero-Lopez, A., Ozaki, T., Pandit, H., Pannu, T. S., Parvizi, N., Poeran, J., Poolman, R. W., Purtill, J. J., Radoicic, D. K., Rajasekaran, R. B., Rajasekhar, A., Randelli, F., Reed, M., Restrepo, C., Riva, N., Romanini, E., Sadek, M., Saglam, Y., Salazar, G., Salazar, M., Salvati, E. A., Samama, C. M., Sanchez-Osorio, J. S., Santoso, A., Sattarzadeh, R., Saxena, A., Schemitsch, E., Schulman, S., Schwenk, E. S., Shahi, A., Sharkey, P. F., Sharrock, N., Shivakumar, S., Shohat, N., Siegel, N. M., Sievers, D. A., Smailys, A., Smith, E. B., Somers, J. F. A., Souissi, M., Sousa, P., Sousa, R., Spyropoulos, A. C., Squizzato, A., Srivastava, A., Suarez, C., Suresh, S., Tannoury, T., Tarabichi, M., Tarabichi, S., Taylor, J., Terhune, E. B., Thienpont, E., Thomas, T. L., Top, A. C., Tornetta, P., Torres, A., Torres-Lugo, N. J., Tort-Saade, P., Tresgallo-Pares, R., Tsiridis, E., Tuncay, I., Urbanek, T., Urish, K. L., Vendittoli, P. -A., Victor, K., Vilchez, F., Villa, J. M., Viscusi, E. R., Volk, T., Vosooghi, F., Vysotskyi, O., Walsh, M., Warren, J., Werner, B. C., Westrich, G., Whitehouse, M. R., Whitehouse, S. L., Winters, B. S., Wouthuyzen-Bakker, M., Yamada, K., Yates, A. J., Yoo, J. -I., Yoon, U., Zambianchi, F., UCL - SSS/IREC/NMSK - Neuro-musculo-skeletal Lab, UCL - (SLuc) Service d'orthopédie et de traumatologie de l'appareil locomoteur, and Delegates, ICM-VTE General

Subjects
Risk Factors, Anticoagulants, Humans, Orthopedics and Sports Medicine, Surgery, General Medicine, Venous Thromboembolism
Published
2022

11. Intra-operative digital imaging

Author

Hambright, D., Hellman, M., and Barrack, R.

Subjects
Adult, Aged, 80 and over, Male, Intraoperative Care, Arthroplasty, Replacement, Hip, Operative Time, Hip Arthroplasty: Management Factorials, Acetabulum, Total Hip Arthroplasty, Middle Aged, Hip Arthroplasty, Arthroplasty, Leg Length Inequality, Radiographic Image Enhancement, Bone Anteversion, Postoperative Complications, Treatment Outcome, Humans, Female, Femur, Hip Prosthesis, Intra-Operative Digital Imaging, Aged, Retrospective Studies
Abstract

Aims The aims of this study were to examine the rate at which the positioning of the acetabular component, leg length discrepancy and femoral offset are outside an acceptable range in total hip arthroplasties (THAs) which either do or do not involve the use of intra-operative digital imaging. Patients and Methods A retrospective case-control study was undertaken with 50 patients before and 50 patients after the integration of an intra-operative digital imaging system in THA. The demographics of the two groups were comparable for body mass index, age, laterality and the indication for surgery. The digital imaging group had more men than the group without. Surgical data and radiographic parameters, including the inclination and anteversion of the acetabular component, leg length discrepancy, and the difference in femoral offset compared with the contralateral hip were collected and compared, as well as the incidence of altering the position of a component based on the intra-operative image. Results Digital imaging took a mean of five minutes (2.3 to 14.6) to perform. Intra-operative changes with the use of digital imaging were made for 43 patients (86%), most commonly to adjust leg length and femoral offset. There was a decrease in the incidence of outliers when using intra-operative imaging compared with not using it in regard to leg length discrepancy (20% versus 52%, p = 0.001) and femoral offset inequality (18% versus 44%, p = 0.004). There was also a difference in the incidence of outliers in acetabular inclination (0% versus 7%, p = 0.023) and version (0% versus 4%, p = 0.114) compared with historical results of a high-volume surgeon at the same centre. Conclusion The use of intra-operative digital imaging in THA improves the accuracy of the positioning of the components at THA without adding a substantial amount of time to the operation. Cite this article: Bone Joint J 2018;100B(1 Supple A):36–43.

Published
2018

27. Alfred Cox

Author

Barrack, R H

Published
1999

30. Tranexamic acid

Author

Sassoon, A., primary, Nam, D., additional, Jackups, R., additional, Johnson, S. R., additional, Nunley, R. M., additional, and Barrack, R. L., additional

Published
2016
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31. Changes in acetabular orientation during total hip arthroplasty

Author

Schloemann, D. T., Edelstein, A. I., and Barrack, R. L.

Abstract

AimsThe aims of this study were to determine the change in pelvic sagittal alignment before, during, and after total hip arthroplasty (THA) undertaken with the patient in the lateral decubitus position, and to determine the impact of these changes on acetabular component position.Patients and MethodsWe retrospectively compared the radiological pelvic ratio among 91 patients undergoing THA. In total, 41 patients (46%) were female. The mean age was 61.6 years (sd10.7) and the mean body mass index (BMI) was 20.0 kg/m2(sd5.5). Anteroposterior radiographs were obtained: in the standing position preoperatively and at six weeks postoperatively; in the lateral decubitus position after trial reduction intraoperatively; and in the supine position in the post-anaesthesia care unit. Pelvic ratio was defined as the ratio between the vertical distance from the inferior aspect of the sacroiliac (SI) joints to the superior pubic symphysis and the horizontal distance between the inferior aspect of the SI joints. Changes in the apparent component position based on changes in pelvic ratio were determined, with a change of > 5° considered clinically significant. Analyses were performed using Wilcoxon’s signed-rank test, with p < 0.05 considered significant.ResultsIntraoperatively, in the lateral decubitus position, the pelvic ratio increased (anterior tilt) in 69.4% of cases, did not change significantly in 20.4%, and decreased (posterior tilt) in 10.2% of cases. When six-week postoperative radiographs were compared with preoperative radiographs, the pelvic ratio decreased in 44.9% of cases, did not change significantly in 42.3%, and increased in 12.8% of cases. This change in alignment correlated with a change in acetabular component version of > 5° in 79.6% of cases intraoperatively and 57.7% of cases at six weeks postoperatively.ConclusionChanges in pelvic sagittal pelvic position occur throughout THA that, if unaccounted for, introduce errors in acetabular component placement. The use of intraoperative imaging may help the appropriate placement of the acetabular component.Cite this article: Bone Joint J2019;101-B(6 Supple B):45–50.

Published
2019
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34. Pharmacogenetic warfarin dose refinements remain significantly influenced by genetic factors after one week of therapy

Author

Horne, B D, Lenzini, P A, Wadelius, Mia, Jorgensen, A L, Kimmel, S E, Ridker, P M, Eriksson, Niclas, Anderson, J L, Pirmohamed, M, Limdi, N A, Pendleton, R C, McMillin, G A, Burmester, J K, Kurnik, D, Stein, C M, Caldwell, M D, Eby, C S, Rane, A, Lindh, J D, Shin, J-G, Kim, H-S, Angchaisuksiri, P, Glynn, R J, Kronquist, K E, Carlquist, J F, Grice, G R, Barrack, R L, Li, J, Gage, B F, Horne, B D, Lenzini, P A, Wadelius, Mia, Jorgensen, A L, Kimmel, S E, Ridker, P M, Eriksson, Niclas, Anderson, J L, Pirmohamed, M, Limdi, N A, Pendleton, R C, McMillin, G A, Burmester, J K, Kurnik, D, Stein, C M, Caldwell, M D, Eby, C S, Rane, A, Lindh, J D, Shin, J-G, Kim, H-S, Angchaisuksiri, P, Glynn, R J, Kronquist, K E, Carlquist, J F, Grice, G R, Barrack, R L, Li, J, and Gage, B F

Abstract

By guiding initial warfarin dose, pharmacogenetic (PGx) algorithms may improve the safety of warfarin initiation. However, once international normalised ratio (INR) response is known, the contribution of PGx to dose refinements is uncertain. This study sought to develop and validate clinical and PGx dosing algorithms for warfarin dose refinement on days 6-11 after therapy initiation. An international sample of 2,022 patients at 13 medical centres on three continents provided clinical, INR, and genetic data at treatment days 6-11 to predict therapeutic warfarin dose. Independent derivation and retrospective validation samples were composed by randomly dividing the population (80%/20%). Prior warfarin doses were weighted by their expected effect on S-warfarin concentrations using an exponential-decay pharmacokinetic model. The INR divided by that "effective" dose constituted a treatment response index . Treatment response index, age, amiodarone, body surface area, warfarin indication, and target INR were associated with dose in the derivation sample. A clinical algorithm based on these factors was remarkably accurate: in the retrospective validation cohort its R2 was 61.2% and median absolute error (MAE) was 5.0 mg/week. Accuracy and safety was confirmed in a prospective cohort (N=43). CYP2C9 variants and VKORC1-1639 G→A were significant dose predictors in both the derivation and validation samples. In the retrospective validation cohort, the PGx algorithm had: R2= 69.1% (p<0.05 vs. clinical algorithm), MAE= 4.7 mg/week. In conclusion, a pharmacogenetic warfarin dose-refinement algorithm based on clinical, INR, and genetic factors can explain at least 69.1% of therapeutic warfarin dose variability after about one week of therapy.

Published
2012
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36. Cement Spacers in Periprosthetic Joint Infection

Author

Barrack, R. L., primary, Berend, K. R., additional, Cui, Q., additional, Fehring, T. K., additional, Della Valle, C. J., additional, Gehrke, T., additional, Lombardi, A. V., additional, Mont, M. A., additional, Parvizi, J., additional, and Springer, B. D., additional

Published
2013
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37. The Hip Society

Author

Lombardi, Jr, A. V., primary, Barrack, R. L., additional, Berend, K. R., additional, Cuckler, J. M., additional, Jacobs, J. J., additional, Mont, M. A., additional, and Schmalzried, T. P., additional

Published
2012
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41. The cost of implanting a cemented versuscementless total knee arthroplasty

Author

Lawrie, C. M., Schwabe, M., Pierce, A., Nunley, R. M., and Barrack, R. L.

Abstract

AimsThe aim of this study was to compare the actual cost of a cemented and cementless total knee arthroplasty (TKA) procedure.Materials and MethodsThe cost of operative time, implants, cement, and cementing accessories were included in the overall cost of the TKA procedure. Operative time was determined from a previously published study comparing cemented and cementless implants of the same design. The cost of operative time, implants, cement, and cementing accessories was determined from market and institutional data.ResultsMean operative time for cemented TKA was 11.6 minutes longer for cemented TKA than cementless TKA (93.7 minutes (sd16.7) vs82.1 minutes (sd16.6); p = 0.001). Using a conservative published standard of $36 per minute for operating theatre time cost, the total time cost was $418 higher for cementing TKA. The cost of cement and accessories ranged from $170 to $625. Overall, the calculated cost of cemented TKA is $588 to $1043, depending on technique. The general increased charge for cementless TKA implants over cemented TKA implants was $366.ConclusionThe overall procedural cost of implanting a cementless TKA is less than implanting a cemented TKA. Cost alone should not be a barrier to using cementless TKA.Cite this article: Bone Joint J2019;101-B(7 Supple C):61–63

Published
2019
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45. Antibiotic Cement Spacers in Total Hip and Total Knee Arthroplasty: Problems, Pitfalls, and Avoiding Complications.

Author

Meani, Enzo, Romanò, Carlo, Crosby, Lynn, Hofmann, Gunther, Calonego, Giovanni, Burnett, R. S. J., Clohisy, J. C., and Barrack, R. L.

Abstract

With the increasing number of total hip (THA) and knee arthroplasties (TKA) performed with expanding indications and at a younger age, there continues to be a low risk of periprosthetic sepsis in association with these surgeries. The incidence of infection in THA/TKA ranges for 0.3% to 3 %. While sepsis is a rare complication, the management from both patient and surgeon perspective are challenging, often require a prolonged course of treatment, and may lead to complications. The diagnosis and management of periprosthetic sepsis has evolved with the current standard of care and management based upon the useful classification of Gustilo et al [21, 25]. The use of antibiotic impregnated cement beads [19] and spacers as local delivery devices to treat periprosthetic infections in either a single stage [3] or two-stage surgery [12, 17, 18] has evolved and become popular over recent years. Frequently, reports of periprosthetic sepsis do not address antibiotic spacer complications. [ABSTRACT FROM AUTHOR]

Published
2007
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48. Patellar resurfacing in total knee arthroplasty. A prospective, randomized, double-blind study with five to seven years of follow-up.

Author

Barrack RL, Bertot AJ, Wolfe MW, Waldman DA, Milicic M, Myers L, Barrack, R L, Bertot, A J, Wolfe, M W, Waldman, D A, Milicic, M, and Myers, L

Abstract

Background: Whether to resurface the patella during a primary total knee arthroplasty performed for the treatment of degenerative osteoarthritis remains a controversial issue. Parameters that have been suggested as being useful in guiding this decision include patient height and weight, the presence of anterior knee pain preoperatively, and the grade of chondromalacia encountered intraoperatively. The purpose of this study was to determine whether these parameters were predictive of the clinical result following total knee arthroplasty with or without patellar resurfacing.Methods: Eighty-six patients (118 knees) undergoing primary total knee arthroplasty for the treatment of osteoarthritis were enrolled in a prospective, randomized, double-blind study. All patients received the same posterior-cruciate-sparing total knee prosthetic components. Patients were randomized to treatment with or without resurfacing of the patella. Evaluations consisted of the determination of a Knee Society clinical score, the completion of a patient satisfaction questionnaire, specific questions relating to patellofemoral symptoms, and radiographs. Sixty-seven patients (ninety-three knees) were followed for a minimum of five years (range, sixty to eighty-four months; average, 70.5 months).Results: With the numbers available, there was no significant difference between the groups treated with and without resurfacing with regard to the overall Knee Society score or the pain and function subscores. Obesity, the degree of patellar chondromalacia, and the presence of preoperative anterior knee pain did not predict postoperative clinical scores or the presence of postoperative anterior knee pain.Conclusions: The occurrence of anterior knee pain could not be predicted with any clinical or radiographic parameter studied. On the basis of these results, it seems likely that postoperative anterior knee pain is related either to the component design or to the details of the surgical technique, such as component rotation, rather than to whether or not the patella is resurfaced. [ABSTRACT FROM AUTHOR]

Published
2001

49. The effect of weight-bearing on the radiographic measurement of the position of the femoral head after total hip arthroplasty.

Author

Moore, K. David, Barrack, Robert L., Sychterz, Christi J., Sawhney, Jaswin, Yang, Anthony M., Engh, Charles A., Moore, K D, Barrack, R L, Sychterz, C J, Sawhney, J, Yang, A M, and Engh, C A

Subjects
FEMUR radiography, TOTAL hip replacement, POLYETHYLENE, HIP joint, RESEARCH evaluation, SUPINE position, FEMUR head, WEIGHT-bearing (Orthopedics)
Abstract

Background: In most radiographic studies of polyethylene wear, investigators have used routine annual radiographs made with the patient in the supine position in order to measure penetration by the femoral head into the polyethylene liner. However, researchers have begun to question the effect of weight-bearing on the position of the head within the acetabular cup and, consequently, the effect of weight-bearing on measurements of penetration by the head. The purpose of the current study was to determine the effect of weight-bearing on the two-dimensional radiographic position of the femoral head within the acetabular cup. Methods: Thirty-seven patients (forty-seven hips) who had had a total hip arthroplasty had radiographs made at one of two separate institutions. A set of anteroposterior radiographs was made for each patient: one radiograph was made with the patient supine and one was made with the patient upright bearing full weight on the replaced hip. At one of the institutions, a third anteroposterior radiograph was made with the patient in the same upright position but not bearing weight on the replaced hip. All measurements of the two-dimensional position of the head were performed by a single observer with use of a previously published computerized measurement system. Results: Data from both institutions revealed that measurements of the position of the head on radiographs made with the patient supine were strongly and significantly correlated with measurements of the position of the head on radiographs made with the patient bearing weight (r2>0.93, p<0.001 for both regressions). Examination of the differences between the measurements revealed no bias for one set of measurements to consistently underestimate or overestimate the values derived with use of the other method. Moreover, we found a nearly perfect relationship between the measurements of the position of the head on radiographs made with the patient standing and bearing weight and those on radiographs made with the patient standing but not bearing weight (r2 = 0.97, p<0.001, slope = 0.99, intercept = 0.02 millimeter). Conclusions: On the basis of these findings, there is no evidence that radiographs must be made with the patient bearing weight in order to accurately measure the position of the femoral head within the polyethylene liner. [ABSTRACT FROM AUTHOR]

Published
2000
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