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Russell Wagner, MD

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NCBI: db=pubmed; Term=(wagner ra[Author]) AND (John Peter Smith[Affiliation] OR JPS Health Network[Affiliation] OR JPS [Affiliation] NOT Japan Pancreas Society[Affiliation])
Updated: 13 hours 34 min ago

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Thu, 05/02/2019 - 07:44
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Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Arthroplast Today. 2019 Mar;5(1):26-31

Authors: Neal DC, Sambhariya V, Tran A, Rahman SK, Dean TJ, Wagner RA, Sanchez HB

Abstract
Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic distal femur fracture and closed right intraarticular distal femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.

PMID: 31020017 [PubMed]

The Radiographic Prepatellar Fat Thickness Ratio Correlates With Infection Risk After Total Knee Arthroplasty.

Wed, 01/30/2019 - 08:34
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The Radiographic Prepatellar Fat Thickness Ratio Correlates With Infection Risk After Total Knee Arthroplasty.

J Arthroplasty. 2018 Jul;33(7):2251-2255

Authors: Wagner RA, Hogan SP, Burge JR, Bates CM, Sanchez HB

Abstract
BACKGROUND: Obesity has been associated with complications after a total knee arthroplasty (TKA). Surgical site infection (SSI) after TKA is one of the feared complications as it increases revision rates, costs, and stress to the patient. There is conflicting evidence in the literature regarding body mass index (BMI) and risk of infection after TKA, and some studies have suggested that site-specific fat distribution may be a better metric for determining risk of postoperative infections. Here, we investigate the correlation of soft tissue distribution about the knee to SSI after TKA.
METHODS: We retrospectively review 572 patients who underwent primary TKA at a single institution from 2006 to 2010. We introduce the prepatellar fat thickness ratio (PFTR) as a radiographic means to quantitatively assess fat distribution about the knee and evaluate this measurement's ability to assess the risk of developing an SSI after TKA.
RESULTS: The PFTR was shown to be a better predictor of SSI than BMI in both the univariate (P = .05) and multivariate (P = .01) analyses.
CONCLUSION: Although BMI cannot fully account for variations in adipose distribution, the PFTR may account for this variability and may be a helpful tool for assessing a patient's preoperative risk of SSI after TKA.

PMID: 29555491 [PubMed - in process]

Protecting the PCL During Total Knee Arthroplasty Using a Bone Island Technique.

Wed, 01/30/2019 - 08:34
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Protecting the PCL During Total Knee Arthroplasty Using a Bone Island Technique.

J Arthroplasty. 2018 Jan;33(1):102-106

Authors: Wood AR, Rabbani TA, Sheffer B, Wagner RA, Sanchez HB

Abstract
BACKGROUND: Prior studies have shown that the posterior cruciate ligament (PCL) may be partially resected during cruciate retaining (CR) total knee arthroplasty (TKA) using highly experienced hands and standard surgical technique; therefore, proper surgical technique is aimed at preservation and balance of the PCL during CR TKA. The central objective of this study is to evaluate the effectiveness of a simple surgical technique to prevent PCL damage during performance of a CR TKA.
METHODS: Sixty embalmed cadaver specimens were randomized into 2 groups, experimental and control. The control group consisted of standard tibial resection without the use of an osteotome. The experimental group utilized an osteotome in addition to standard technique to preserve a bone island anterior to the tibial attachment of the PCL.
RESULTS: In the control group, PCL damage was noted in 73% (22/30) of specimens. In the experimental group, where an osteotome was used, PCL damage was found in 23% (7/30) of specimens. The use of an osteotome was found to have an absolute risk reduction of 50% when compared to the control group which did not use an osteotome to protect the PCL.
CONCLUSION: In the setting of minimal surgical experience, the use of an osteotome to preserve the PCL during CR TKA by forming a bone island was found to be an effective means of protecting the PCL over standard technique. In addition, standard technique with the use of a Y-shaped PCL retractor was found to provide questionable protection to the PCL.

PMID: 28927647 [PubMed - indexed for MEDLINE]

Effect of Posterior Tibial Slope on Flexion and Anterior-Posterior Tibial Translation in Posterior Cruciate-Retaining Total Knee Arthroplasty.

Wed, 01/30/2019 - 08:34
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Effect of Posterior Tibial Slope on Flexion and Anterior-Posterior Tibial Translation in Posterior Cruciate-Retaining Total Knee Arthroplasty.

J Arthroplasty. 2016 Jan;31(1):103-6

Authors: Chambers AW, Wood AR, Kosmopoulos V, Sanchez HB, Wagner RA

Abstract
Reduced posterior tibial slope (PTS) and posterior tibiofemoral translation (PTFT) in posterior cruciate-retaining (PCR) total knee arthroplasty (TKA) may result in suboptimal flexion. We evaluated the relationship between PTS, PTFT, and total knee flexion after PCR TKA in a cadaveric model. We performed a balanced PCR TKA using 9 transfemoral cadaver specimens and changed postoperative PTS in 1° increments. We measured maximal flexion and relative PTFT at maximal flexion. We determined significant changes in flexion and PTFT as a function of PTS. Findings showed an average increase in flexion of 2.3° and average PTFT increase of 1mm per degree of PTS increase when increasing PTS from 1° to 4° (P<.05). Small initial increases in PTS appear to significantly increase knee flexion and PTFT.

PMID: 26476469 [PubMed - indexed for MEDLINE]

Shortening femoral osteotomy with stemmed resurfacing total knee arthroplasty for severe flexion contracture in Juvenile Rheumatoid Arthritis.

Wed, 01/30/2019 - 08:34
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Shortening femoral osteotomy with stemmed resurfacing total knee arthroplasty for severe flexion contracture in Juvenile Rheumatoid Arthritis.

J Orthop. 2015 Jun;12(2):118-21

Authors: Kitchen B, Sanchez HB, Wagner RA

Abstract
Juvenile Rheumatoid Arthritis (JRA) is a progressive disease characterized by pain, swelling, and loss of motion in the joints of adolescents. Total knee arthroplasty (TKA) can be indicated, during the adolescent years, in patients with advanced JRA to alleviate pain and improve function. Because of the relative infrequency of TKA in patients with JRA, evaluation of the type of TKA performed and the results merit review. This case report present two distinct operations performed to obtain full extension. 1. Distal femoral resection with conversion to hinged arthroplasty. 2. Femoral shortening osteotomy with resurfacing TKA.

PMID: 25972704 [PubMed]

Efficacy of skin preparation in eradicating organisms before total knee arthroplasty.

Wed, 01/30/2019 - 08:34
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Efficacy of skin preparation in eradicating organisms before total knee arthroplasty.

Am J Orthop (Belle Mead NJ). 2014 Dec;43(12):E309-12

Authors: Boe E, Sanchez HB, Kazenske FM, Wagner RA

Abstract
The solution of 2% chlorhexidine gluconate and 70% isopropyl alcohol (Chloraprep) is commonly used for antiseptic skin preparation before surgery. We conducted a study to evaluate the efficacy of this solution in eradicating organisms during skin preparation for total knee arthroplasty (TKA), to isolate the organism type, and to evaluate possible contributing factors leading to infection. Ninety-nine patients who were undergoing TKA were swabbed for cultures in the popliteal fossa before and after solution application. Swabs were collected, cultured, and read. Culture isolates grew in 20 (20%) of the 99 patients before solution application and in 5 (5%) of the 99 after application. Mean presolution body mass index (BMI) was 38 for patients with bacterial isolates and 34 for patients without isolates (P<.03). Mean postsolution BMI was 40 for patients with bacterial isolates and 35 for patients without isolates. BMI was a statistically significant factor in predicting presence of isolates after solution application. In addition, presence of bacteria in presolution cultures was predictive of isolation in postsolution cultures. Diabetic patients were 3.6 times more likely than nondiabetic patients to have a bacterial isolate. Other factors did not predict organism isolation. No patient developed a postoperative infection.

PMID: 25490018 [PubMed - indexed for MEDLINE]

Displaced ischial stress fracture following revision total hip arthroplasty.

Wed, 01/30/2019 - 08:34
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Displaced ischial stress fracture following revision total hip arthroplasty.

Am J Orthop (Belle Mead NJ). 2014 Sep;43(9):E214-6

Authors: Merchant AM, Wagner RA

Abstract
Stress fractures of the ischium are uncommon and are most likely caused by excessive stretching or contracture of the hamstring muscles. In addition, revision total hip arthroplasty (THA) may weaken the ilium, and metabolic bone disease may also contribute to a fracture. Treatment is usually conservative and prognosis is favorable. We present a rare case of spontaneous displaced fracture of the entire ischium following revision THA that healed without requiring operative intervention.

PMID: 25251536 [PubMed - indexed for MEDLINE]

Quadriceps and patellar tendon pie-crusting as a treatment for limited flexion in total knee arthroplasty.

Wed, 01/30/2019 - 08:34
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Quadriceps and patellar tendon pie-crusting as a treatment for limited flexion in total knee arthroplasty.

Am J Orthop (Belle Mead NJ). 2014 Apr;43(4):E83-8

Authors: Burge JR, Sanchez HB, Wagner RA

Abstract
The pie-crusting method of ligament and tendon lengthening has been used successfully in various tissues but is not reported in the literature as an option for patellar or quadriceps tendons to address flexion limitation. Our case report discusses a patient with longstanding flexion limitation who underwent primary total knee arthroplasty. The report reviews the literature on intraoperative treatments, which primarily pertains to the condition of patella baja, and demonstrates that the pie-crusting technique should be included as a treatment option for a tight extensor mechanism while having some advantages over tibial tubercle osteotomy or Z-plasty.

PMID: 24730010 [PubMed - indexed for MEDLINE]

Evaluating factors affecting patellar component fixation strength in total knee arthroplasty.

Wed, 01/30/2019 - 08:34
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Evaluating factors affecting patellar component fixation strength in total knee arthroplasty.

Am J Orthop (Belle Mead NJ). 2013 Sep;42(9):416-9

Authors: Wagner RA, Lesley NE, Coté RE, Tayag TJ

Abstract
Complications related to the patellofemoral joint after total knee arthroplasty (TKA) represent up to 50% of TKA reoperations. Shear forces across the knee produce wear and occasionally result in failure of fixation of all-polyethylene patellar components. We conducted a study to evaluate the effect of 2 factors on the shear strength of patellar component fixation: time between cement mixing and application of the patellar component, and amount of pressure applied during implantation. Fifty-four patellae were harvested from 27 cadavers and were prepared as for a TKA, allowing 3 different amounts of time for the cement to set or cure before application, and using 3 different pressures. The patellae were mounted and tested for fixation strength with a materials testing machine. Fixation was significantly stronger (P = .006) at 42 pounds of pressure after curing the cement for 8 minutes (compared with 2 minutes) and was significantly stronger (P = .005) after 2 minutes of curing at 42 pounds of pressure (compared with 62 pounds of pressure). We concluded that allowing the cement to cure while cementing the femoral and tibial components does not jeopardize fixation of the patellar component and that excessive compression of a patellar clamp may weaken fixation.

PMID: 24078966 [PubMed - indexed for MEDLINE]

Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds.

Wed, 01/30/2019 - 08:34
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Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds.

Orthopedics. 2008 May;31(5):445

Authors: Webb BG, Lichtman DM, Wagner RA

Abstract
Infection after total joint arthroplasty is a serious complication. Several risk factors have been shown to increase the risk of total joint infections. The purpose of this study was to evaluate whether socioeconomic background was a risk factor for infection in primary total joint arthroplasty. A retrospective chart review was conducted over a 4-year period on a single surgeon's split practice between private patients with mostly private insurance and Medicare and county based patients with predominately indigent county health coverage and Medicaid. An infection rate was calculated for each population in both primary total knee and hip arthroplasty. The two populations were statistically analyzed for differences in age, preoperative diagnoses, and socioeconomic background. To our knowledge, this is the first study showing an increased risk of infection in total joint arthroplasty based on socioeconomic background.

PMID: 19292321 [PubMed - indexed for MEDLINE]

Failed closed reduction of hip arthroplasty secondary to prosthetic incarceration in the pelvis.

Wed, 01/30/2019 - 08:34
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Failed closed reduction of hip arthroplasty secondary to prosthetic incarceration in the pelvis.

J Arthroplasty. 2004 Jun;19(4):513-5

Authors: Weight MA, Wagner RA

Abstract
This report describes a patient with dislocation of a unipolar hemiarthroplasty that could not be reduced by closed reduction methods because of perforation of the prosthesis through the ileum.

PMID: 15188115 [PubMed - indexed for MEDLINE]