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Coronary Revascularization in Chronic and End-Stage Renal Disease: A Systematic Review and Meta-analysis.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Coronary Revascularization in Chronic and End-Stage Renal Disease: A Systematic Review and Meta-analysis.

Am J Ther. 2016 Jan-Feb;23(1):e16-28

Authors: Kannan A, Poongkunran C, Medina R, Ramanujam V, Poongkunran M, Balamuthusamy S

Abstract
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) on dialysis have an increased risk for cardiovascular mortality and morbidity secondary to occlusive coronary artery disease. Optimal revascularization strategy is unclear in this high-risk population. We have performed a meta-analysis to compare coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with ESRD and CKD. We searched PubMed, Ovid, MEDLINE, CINAHL, and EMBASE (1980-2013) and found 17 trials (N = 33,584) in the ESRD arm and 6 studies (n = 15,493) in the CKD arm. Two investigators independently collected the data. All the studies were retrospective trials. In the ESRD and CKD groups, we found significantly reduced early mortality with the PCI group with the odds ratio of 2.08 (1.90-2.26; P < 0.00001) and 2.55 (1.45-4.51; P = 0.001), respectively. Contrary to the early mortality results, we found decreased late mortality with the CABG group when compared with the PCI group [odds ratio: 0.86 (0.83-0.89; P < 0.000001) and 0.82 (0.76-0.88; P < 0.00001)] in the ESRD and CKD arm, respectively. When compared with PCI, there was decreased cardiovascular mortality with an odds ratio of 0.61 (0.40-0.92; P = 0.02) in patients who underwent CABG in ESRD population. Similar trends were observed in the incidence of myocardial infarction and repeat revascularization. There is a strong trend for decreased risk of stroke with PCI when compared with CABG in ESRD and CKD populations.

PMID: 24999748 [PubMed - indexed for MEDLINE]

Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Mild Renal Artery Stenosis Can Induce Renovascular Hypertension and is Associated with Elevated Renal Vein Renin Secretion.

Semin Dial. 2015 May-Jun;28(3):293-8

Authors: Balamuthusamy S, Kannan A, Thajudeen B, Ottley D, Jalandhara N

Abstract
Renovascular hypertension is a syndrome which encompasses the physiological response of the kidney to changes in renal blood flow and renal perfusion pressure. Such physiological changes can occur with renal artery occlusion irrespective of the severity of the lesion. We have analyzed hypertensive patients with mild renal artery stenosis and compared them to patients with no stenosis. Renal vein renin sampling from catheterization of the renal vein was performed in all these patients. Patients with mild stenosis had higher renal vein renin ratio (3.01 ± 1.5) than the patients with no stenosis (1.10 ± 0.29; p = 0.002). Patients with mild stenosis were also found to have higher diastolic blood pressure and renal artery resistive indices when compared to patients with no stenosis. We therefore conclude that mild stenosis can precipitate renin-mediated hypertension in renovascular stenosis and also emphasis that parameters pertinent to renal physiology need to be evaluated before considering treatment options in patients with renal artery stenosis and medical management with RAAS blockade is the preferred modality of therapy for patients with renin-mediated hypertension.

PMID: 24943669 [PubMed - indexed for MEDLINE]

Prognostic value of myocardial scar in atrial fibrillation.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Prognostic value of myocardial scar in atrial fibrillation.

J Am Coll Cardiol. 2014 May 20;63(19):2055

Authors: Kannan A, Balamuthusamy S

PMID: 24561137 [PubMed - indexed for MEDLINE]

Self-centering, split-tip catheter has better patency than symmetric-tip tunneled hemodialysis catheter: single-center retrospective analysis.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Self-centering, split-tip catheter has better patency than symmetric-tip tunneled hemodialysis catheter: single-center retrospective analysis.

Semin Dial. 2014 Sep-Oct;27(5):522-8

Authors: Balamuthusamy S

Abstract
The performance and safety of a new self-centering, split-tip hemodialysis tunneled catheter was compared with a symmetric-tip catheter. The new catheter has a greater separation between the arterial and venous tips, with dual apertures designed to permanently face the center of the blood vessel. The design is intended to improve dialysis efficiency by increasing flow rates while decreasing recirculation, fibrin sheath formation, thrombosis, and vessel wall occlusions. The study results indicated that the self-centering, split-tip catheter had statistically greater patency after 3 months with similar clearance, blood flow, and safety.

PMID: 24438081 [PubMed - indexed for MEDLINE]

Circulating adipocytokines and chronic kidney disease.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Circulating adipocytokines and chronic kidney disease.

PLoS One. 2013;8(10):e76902

Authors: Mills KT, Hamm LL, Alper AB, Miller C, Hudaihed A, Balamuthusamy S, Chen CS, Liu Y, Tarsia J, Rifai N, Kleinpeter M, He J, Chen J

Abstract
BACKGROUND: Adipokines have been associated with atherosclerotic heart disease, which shares many common risk factors with chronic kidney disease (CKD), but their relationship with CKD has not been well characterized.
METHODS: We investigated the association of plasma leptin, resistin and adiponectin with CKD in 201 patients with CKD and 201 controls without. CKD was defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) or presence of albuminuria. Quantile regression and logistic regression models were used to examine the association between adipokines and CKD adjusting for multiple confounding factors.
RESULTS: Compared to controls, adjusted median leptin (38.2 vs. 17.2 ng/mL, p<0.0001) and adjusted mean resistin (16.2 vs 9.0 ng/mL, p<0.0001) were significantly higher in CKD cases. The multiple-adjusted odds ratio (95% confidence interval) of CKD comparing the highest tertile to the lower two tertiles was 2.3 (1.1, 4.9) for leptin and 12.7 (6.5, 24.6) for resistin. Median adiponectin was not significantly different in cases and controls, but the odds ratio comparing the highest tertile to the lower two tertiles was significant (1.9; 95% CI, 1.1, 3.6). In addition, higher leptin, resistin, and adiponectin were independently associated with lower eGFR and higher urinary albumin levels.
CONCLUSIONS: These findings suggest that adipocytokines are independently and significantly associated with the risk and severity of CKD. Longitudinal studies are warranted to evaluate the prospective relationship of adipocytokines to the development and progression of CKD.

PMID: 24116180 [PubMed - indexed for MEDLINE]

Myeloma light chain-induced renal injury in mice.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Myeloma light chain-induced renal injury in mice.

Nephron Exp Nephrol. 2010;116(2):e32-41

Authors: Khan AM, Li M, Balamuthusamy S, Maderdrut JL, Simon EE, Batuman V

Abstract
We investigated the effects of human light chain (LC) protein-overload in mice kidney to gain further insights into the molecular mechanisms involved in the pathogenesis of myeloma kidney. Intact male C57BL/6, 10- to 12-week-old mice were given daily intraperitoneal (i.p.) injections of 1 ml of human κ-LCs (1.5 mg/ml, low dose), or (100 mg/ml, high dose) to uninephrectomized mice for 2 weeks. Intact, sham-operated or uninephrectomized control animals were given the same volume (1 ml/day) of saline, human serum albumin (10 mg/ml) or bovine serum albumin (100 mg/ml) i.p. for 2 weeks in place of LCs. The low-dose LC-treated mice had human LCs in their urine and a significant increase in monocyte chemoattractant protein-1 (MCP-1) mRNA in the kidneys. Uninephrectomized mice treated with high-dose κ-LCs showed tubule casts, and foci of intracytoplasmic rhomboid crystals within the proximal tubules, along with cytoskeletal disruptions and alterations in the brush-border membrane, and high concentrations of human κ-LC were present in their sera. High-dose LC treatment also led to increases in serum creatinine and tumor necrosis factor-α levels, and marked increases in interleukin-6 and MCP-1 expression as well as cellular apoptosis in the kidneys. These studies demonstrate that myeloma LC overload over a range of LC concentrations in mice causes significant functional and morphological kidney injury. The model should be helpful in investigating pathophysiologic mechanisms and exploring therapeutic interventions for myeloma kidney and other LC-associated renal disorders.

PMID: 20588062 [PubMed - indexed for MEDLINE]

Pituitary adenylate cyclase-activating polypeptide prevents cisplatin-induced renal failure.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
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Pituitary adenylate cyclase-activating polypeptide prevents cisplatin-induced renal failure.

J Mol Neurosci. 2011 Jan;43(1):58-66

Authors: Li M, Balamuthusamy S, Khan AM, Maderdrut JL, Simon EE, Batuman V

Abstract
Cisplatin is widely used for cancer chemotherapy, but nephrotoxicity is a major dose-limiting side effect. Our recent studies in vitro have shown that pituitary adenylate cyclase-activating polypeptide (PACAP) ameliorated cisplatin nephrotoxicity and that the renoprotection with PACAP38 was mediated by the PAC(1) receptor and through the p53-dependent and -independent suppression of apoptosis of human renal proximal tubular epithelial cells. In the present studies, PACAP38 prevented the rise in blood urea nitrogen and serum creatinine in mice treated with cisplatin. Cisplatin-exposed mice treated with PACAP38 had relatively well-preserved tubular integrity, even when the treatment started 24 h after cisplatin exposure. PACAP38 also reduced plasma and kidney levels of tumor necrosis factor-α and restored collagen IV levels. The damage to mouse kidney tubules caused by cisplatin involved p53 accumulation and was partially reversed by treatment with PACAP38. PACAP38 ameliorates cisplatin-induced acute kidney injury even when treatment started 24 h after the onset of injury and increases tubular regeneration, which further facilitates restoration of kidney function in addition to its anti-apoptotic effects.

PMID: 20514524 [PubMed - indexed for MEDLINE]

Pituitary adenylate cyclase-activating polypeptide ameliorates cisplatin-induced acute kidney injury.

Saravanan Balamuthusamy, MD - Wed, 01/30/2019 - 08:36
Related Articles

Pituitary adenylate cyclase-activating polypeptide ameliorates cisplatin-induced acute kidney injury.

Peptides. 2010 Apr;31(4):592-602

Authors: Li M, Balamuthusamy S, Khan AM, Maderdrut JL, Simon EE, Batuman V

Abstract
Cisplatin nephrotoxicity involves DNA damage, proinflammatory responses and apoptosis/necrosis of renal proximal tubular epithelial cells. Pituitary adenylate cyclase-activating polypeptide (PACAP) has been shown to protect kidneys from ischemic injury and light chain-induced damage by modulating inflammation. Confluent monolayer of HK-2 human renal cells were exposed to 50 microM cisplatin in the presence or absence of either PACAP38 or p53 siRNA. Mice injected with cisplatin were also treated with PACAP38 daily for 3 days. The damage to HK-2 cells caused by cisplatin involved the activation of p53, caspase-7, and poly (ADP-ribose) polymerase-1 (PARP-1). PACAP38 prevented the decrease in the apurinic/apyrimidinic endonuclease-1 by suppressing p53 activation and blocked the cleavage of caspase-7 and PARP-1 in cisplatin-exposed cells. PACAP also markedly inhibited cisplatin-induced apoptotic tubule cell death. Exposure to cisplatin significantly suppressed the expression of fibronectin and collagens I and IV, and altered the integrin repertoire of human renal tubule cells, while PACAP partially reversed the reduction of fibronectin, collagen IV, and the integrin subunits in cells exposed to cisplatin. Experiments with PACAP receptor antagonists and siRNA silencing of p53 showed that the renoprotection with PACAP was mediated by the PAC(1) receptor and through both p53-dependent and -independent suppression of apoptosis. PACAP was renoprotective in vivo and prevented the rise in blood urea nitrogen and creatinine in mice treated with cisplatin. These results suggest that p53 plays a pivotal role in decreased integrin-mediated extracellular matrix component expression in cisplatin-induced tubule cell apoptosis, and reveal a novel aspect of PACAP-mediated renoprotection.

PMID: 20034524 [PubMed - indexed for MEDLINE]

Levels of acculturation and effect on glycemic control in Mexicans and Mexican Americans with type 2 diabetes.

Sarah Ross, DO - Wed, 01/30/2019 - 08:35
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Levels of acculturation and effect on glycemic control in Mexicans and Mexican Americans with type 2 diabetes.

Postgrad Med. 2011 Jan;123(1):66-72

Authors: Ross SE, Franks SF, Hall J, Young R, Cardarelli R

Abstract
BACKGROUND: Acculturation of Mexican Americans toward the predominant American culture has been shown to influence health outcomes. Little is known about the role of acculturation in diabetes control.
OBJECTIVE: To measure the association between acculturation and diabetes control in Mexicans and Mexican Americans with type 2 diabetes mellitus (T2DM).
DESIGN: Cross-sectional survey and chart review.
SETTING: Ambulatory family medicine clinics.
PATIENTS: Sixty-six Mexican and Mexican American adults with T2DM for ≥ 1 year. INSTRUMENT AND OUTCOMES: A survey tool was developed that included the General Acculturation Index developed by Balcazar et al to measure acculturation. Basic demographics, psychosocial factors, patient satisfaction, and patients' most recent hemoglobin A(1c) (HbA(1c)) levels were also obtained.
RESULTS: There was no significant correlation between acculturation score and HbA(1c) levels. On binary logistic regression, HbA(1c) levels were associated with patient satisfaction in having their questions answered (odds ratio [OR], 0.44; P < 0.05), interference of diabetes with daily life (OR, 1.4; P < 0.05), male gender (OR, 3.93; P < 0.01), and number of diabetes complications (OR, 1.81; P < 0.05). In the multivariate linear regression model, age (beta, -0.348; P < 0.05) and frequency of physician visits (beta, -0.403; P < 0.05) were the only variables significantly associated with glycemic control. Variables included in the model that were not associated with glycemic control include family history of diabetes and confidence in diabetes treatment efficacy.
CONCLUSIONS: Acculturation was not associated with glycemic control in this population. Family physicians should not assume that acculturation difficulties explain poor glycemic control in their Mexican American patients with T2DM.

PMID: 21293085 [PubMed - indexed for MEDLINE]

Financial planning and satisfaction across life domains among retired emergency physicians in the United States.

Sandra Schneider, MD - Wed, 01/30/2019 - 08:35
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Financial planning and satisfaction across life domains among retired emergency physicians in the United States.

Am J Emerg Med. 2018 Mar;36(3):508-510

Authors: Kuhn GJ, Marco CA, Mallory MNS, Blanda M, Kaplan JA, Schneider SM, Joldersma KB, Martin SI, Choo EK

PMID: 28784258 [PubMed - indexed for MEDLINE]

Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit.

Ryan Krech, MD - Wed, 01/30/2019 - 08:34
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Chest Pain Risk Scores Can Reduce Emergent Cardiac Imaging Test Needs With Low Major Adverse Cardiac Events Occurrence in an Emergency Department Observation Unit.

Crit Pathw Cardiol. 2016 12;15(4):145-151

Authors: Wang H, Watson K, Robinson RD, Domanski KH, Umejiego J, Hamblin L, Overstreet SE, Akin AM, Hoang S, Shrivastav M, Collyer M, Krech RN, Schrader CD, Zenarosa NR

Abstract
OBJECTIVE: To compare and evaluate the performance of the HEART, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) scores to predict major adverse cardiac event (MACE) rates after index placement in an emergency department observation unit (EDOU) and to determine the need for observation unit initiation of emergent cardiac imaging tests, that is, noninvasive cardiac stress tests and invasive coronary angiography.
METHODS: A prospective observational single center study was conducted from January 2014 through June 2015. EDOU chest pain patients were included. HEART, GRACE, and TIMI scores were categorized as low (HEART ≤ 3, GRACE ≤ 108, and TIMI ≤1) versus elevated based on thresholds suggested in prior studies. Patients were followed for 6 months postdischarge. The results of emergent cardiac imaging tests, EDOU length of stay (LOS), and MACE occurrences were compared. Student t test was used to compare groups with continuous data, and χ testing was used for categorical data analysis.
RESULTS: Of 986 patients, emergent cardiac imaging tests were performed on 62%. A majority of patients were scored as low risk by all tools (85% by HEART, 81% by GRACE, and 80% by TIMI, P < 0.05). The low-risk patients had few abnormal cardiac imaging test results as compared with patients scored as intermediate to high risk (1% vs. 11% in HEART, 1% vs. 9% in TIMI, and 2% vs. 4% in GRACE, P < 0.05). The average LOS was 33 hours for patients with emergent cardiac imaging tests performed and 25 hours for patients without (P < 0.05). MACE occurrence rate demonstrated no significant difference regardless of whether tests were performed emergently (0.31% vs. 0.97% in HEART, 0.27% vs. 0.95% in TIMI, and 0% vs. 0.81% in GRACE, P > 0.05).
CONCLUSIONS: Chest pain risk stratification via clinical decision tool scores can minimize the need for emergent cardiac imaging tests with less than 1% MACE occurrence, especially when the HEART score is used.

PMID: 27846006 [PubMed - indexed for MEDLINE]

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

Russell Wagner, MD - 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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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.

Russell Wagner, MD - 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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

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]

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