Povidone-Iodine-Based Solutions for Decolonization of Nasal Staphylococcus aureus: A Randomized, Prospective, Placebo-Controlled Study.

BACKGROUND: Nasal Staphylococcus aureus decolonization reduces the risk of surgical site infections after orthopedic procedures. Povidone-iodine (PI)-based solutions have shown promising results in bacteria decolonization. The unique physiology of the nose may pose challenges for the bioactivity profiles of PI solutions. This study compared the antibacterial efficacy of an off-the-shelf PI product with a specifically manufactured PI-based skin and nasal antiseptic (SNA). METHODS: This randomized, placebo-controlled study was conducted at a single institution between April 2014 and July 2015. Four hundred and twenty-nine patients undergoing primary or revision total joint arthroplasty, femoroacetabular osteoplasty, pelvic osteotomy, or total shoulder arthroplasty were included. 10% off-the-shelf PI, 5% PI-based SNA, or saline (placebo) were used for nasal decolonization. Baseline cultures were taken immediately preoperatively, followed by treatment of both nares twice for 2 minutes with 4 applicators. Reculturing of the right nostril occurred at 4 hours and the left at 24 hours. RESULTS: Ninety-five of the 429 patients (22.1%) had a positive culture result for S. aureus; 13 (3.03%) were methicillin-resistant S. aureus. Of these 95, 29 were treated with off-the-shelf PI, 34 with SNA, and 32 with saline swabs. At 4 hours post-treatment, S. aureus culture was positive in 52% off-the-shelf PI patients, 21% SNA patients, and 59% saline patients. After 24 hours posttreatment, S. aureus culture was positive in 72% off-the-shelf PI patients, 59% SNA patients, and 69% saline group. SNA was significantly more effective at decolonizing S. aureus over the 4-hour time interval (P = .003); no significant difference was observed over the 24-hour time interval between the 3 groups. CONCLUSION: A single application of PI-based SNA before surgery may be effective in eliminating nasal S. aureus in over two-thirds of patients. Off-the-shelf PI swabs were not as effective at 4 hours as the specifically manufactured product for S. aureus decolonization.

Coronary revascularization and adverse events in joint arthroplasty.

BACKGROUND: There is a paucity of literature about outcome of total joint arthroplasty in patients with the history of angioplasty and/or stent or coronary artery bypass graft (CABG). The present study aimed to evaluate perioperative complications and mortality in these patients. METHODS: We used the Nationwide Inpatient Sample data from 2002-2011. Using the Ninth Revision of the International Classification of Disease, Clinical Modification codes for disorders and procedures, we identified patients with a history of coronary revascularization (angioplasty and/or stent or CABG) and compared the inhospital adverse events in these patients with patients without a history of coronary revascularization. RESULTS: Cardiac complications occurred in 1.06% patients with a history of CABG; 0.95% of patients with a coronary angioplasty and/or stent and 0.82% of the control patients. In the multivariate analysis, neither the history of CABG (P = 0.07) nor the history of angioplasty and/or stenting (P = 0.86) was associated with a higher risk of cardiac complications. However, myocardial infarction occurred in a significantly higher proportion of patients with the history of CABG (0.66%, odds ratio, 1.24, P = 0.001) and coronary angioplasty and/or stenting (0.67%, odds ratio, 1.96, P < 0.001) compared with that in the controls (0.27%). History of coronary revascularization did not increase the risk of respiratory, renal, and wound complications, surgical site infection, and mortality. CONCLUSIONS: Based on the findings of this study, it appears that there is no increased risk of inhospital mortality and complications (except for myocardial infarction) in patients with a history of coronary artery revascularization undergoing total joint arthroplasty. We also found perioperative cardiac arrhythmia, particularly atrial fibrillation, to be an independent predictor of inhospital adverse events.

Combining Concentrated Autologous Bone Marrow Stem Cells Injection With Core Decompression Improves Outcome for Patients with Early-Stage Osteonecrosis of the Femoral Head: A Comparative Study.

The management of early-stage osteonecrosis of the femoral head (ONFH) remains challenging. This study aimed to evaluate the effects of core decompression and concentrated bone marrow implantation on ONFH. The study recruited 28 hips with early ONFH randomly assigned into two groups of core decompression with (group A) and without (group B) bone marrow injection. Patients were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Visual Analogue Scale (VAS) pain index, and MRI. The mean WOMAC and VAS scores in all patients improved significantly (P<0.001). MRI showed a significant improvement in group A (P=0.046) and significant worsening in group B (P<0.001). Bone marrow stem cell injection with core decompression can be effective in early ONFH.

In-Hospital Morbidity and Mortality Following Total Joint Arthroplasty in Patients with Hemoglobinopathies.

Given the growing patient population with hemoglobinopathies needing total joint arthroplasty (TJA) and paucity of literature addressing this cohort, we examined the in-hospital complications in patients with hemoglobinopathies undergoing TJA. International Classification of Diseases, Ninth Revision codes were used to search the Nationwide Inpatient Sample database for hemoglobinopathy patients undergoing primary or revision TJA. Hemoglobinopathy patients had a significant increase in cardiac, respiratory, and wound complications; blood product transfusion; pulmonary embolism; surgical site infection; and systemic infection events, while there was no significant effect on deaths, deep vein thrombosis, and renal complications. It may be prudent to implement blood conservation strategies as well as diligent postoperative protocols to minimize the need for transfusion and related complications in this patient population.

Transpetrosal approach: an anatomical study of temporal bone.

Resection of the petrous temporal bone to various degrees provides different levels of access to lesions of the posterior fossa. However, regarding the numerous variations, precise distances of petrosal bone are not still clearly described. This may lead to serious complications during transpetrosal surgeries. Our objective was to evaluate different distances of temporal bone landmarks in order to assess their variations and the possible correlations between them. This anatomical study was performed on 60 temporal bones from 60 human cadavers in the years 2006 and 2007. All the bones contained an adequate portion of the petrous apex and attached fossa dura. Twelve landmarks were defined and 27 different distances were measured for each temporal bone using two-point caliper. Less variation was observed in the superoinferior diameter of horizontal carotid canal with the less coefficient of variation (CV) of 9.29; whereas, the most variation was detected in the inferior (axial) plane of posterior semicircular canal to superior plane of jugular bulb (CV = 57.65). There was a significant correlation between vertical intratemporal diameter of carotid in pyramidal direction, and superior-inferior diameter of horizontal carotid canal (r (Pearson) = 0.500, P < 0.001). Other significant correlations were also found between other distances. The variations of different distances and landmarks were evaluated and many significant correlations were demonstrated between them which could potentially aid ENT specialists and neurosurgeons in order to approach anatomical landmarks and cranial fossas more safely during otologic and neurotologic surgeries. It could also help the design of middle ear prosthesis.

Acute stroke after total joint arthroplasty: a population-based trend analysis.

STUDY OBJECTIVES: This study aims to determine trends and predictors of acute stroke among total joint arthroplasty (TJA) patients using nationally representative data. DESIGN: Retrospective database review. SETTING: Nationwide Inpatient Sample database. PATIENTS: A total of 1,762,496 TJAs from 2002 to 2011. INTERVENTIONS: Patients underwent primary or revision total hip or total knee arthroplasty. MEASUREMENTS: Development of perioperative acute stroke. MAIN RESULTS: Among 1,762,496 TJAs, 2414 patients (0.14%) developed stroke; 1918 (79.45%) cases were ischemic and the remaining 496 (20.55%) cases were hemorrhagic stroke. The incidence of stroke decreased steadily from 0.17% in 2002 to 0.14% in 2011, which was statistically significant (P<.0001). The in-hospital mortality rate was much higher after stroke at 9% vs 0.15% for general TJA patients. Logistic regression analysis showed that stroke is a strong predictor of in-hospital mortality (odds ratio [OR], 27.73; 95% confidence interval [CI], 23.06-33.05; P<.001). Independent predictors of stroke were presence of pulmonary circulation disorders (including pulmonary embolism; OR, 2.23; 95% CI, 1.73-2.87), advanced diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), cardiac arrhythmia (OR, 2.05; 95% CI, 1.83-2.29), peripheral vascular disease (OR, 1.74; 95% CI, 1.42-2.12), valvular heart disease (OR, 1.67; 95% CI, 1.43-1.95), renal disease (OR, 1.66; 95% CI, 1.38-1.99), and revision hip (OR, 1.39; 95% CI, 1.18-1.65). History of stroke or ischemic heart disease was not an independent predictor of stroke. CONCLUSIONS: Despite a decline in the rate of stroke and stroke-related mortality after TJA, stroke still seems to be a major cause of in-hospital mortality. The present study outlines some risk factors for stroke after TJA. Recognition of these factors and identification of the at-risk patients may allow for appropriate allocation of resources and ability to minimize this complication after TJA.