No abstract

In North America, two-stage revision arthroplasty is the treatment of choice for chronic periprosthetic infection of the hip and knee. Controversy exists regarding the diagnosis of persistent infection, cement spacer design, and duration of antibiotic therapy. Erythrocyte sedimentation rate and C-reactive protein tests have no clear cutoff values for detecting infection before reimplantation of hardware, and aspiration for microbial culture can yield false-negative results. Mobile spacers are as effective as static spacers for eradicating infection, but mobile spacers provide better interim function and may help to make the second stage of surgery technically easier. Some articulating spacer designs have fewer reports of spacer dislocation and fracture than do others. Although prolonged antibiotic therapy has been the standard of care for two-stage procedures, some have suggested that a short course of antibiotics is just as effective. When infection persists despite antibiotic therapy, the second stage of revision arthroplasty should be delayed until the first stage of the procedure is repeated.

No abstract

Optimal prophylaxis for prevention of venous thromboembolism (VTE) after total joint arthroplasty (TJA) remains debated. The purpose of this study was to compare postoperative complications in patients receiving different VTE chemoprophylactic regimens. Using a nationwide healthcare database, 72,670 THA patients without a history of VTE were identified. Study cohorts received VTE prophylaxis within 30 days postoperatively. Odds ratios and 95% confidence intervals were used to assess 30-day and 90-day postoperative complications (hematoma, hemorrhage, transfusion, pulmonary embolism (PE), VTE, prosthetic joint infection (PJI), and incision/drainage (I&D)). Of the 72,670 THA patients, 25,966 received single medication VTE prophylaxis; 551 (2.12%) aspirin, 6791 (26.15%) enoxaparin, 12,008 (46.25%) warfarin, 5403 (20.81%) rivaroxaban, 876 (3.37%) fondaparinux and 337 (1.30%) apixaban. 30-day complications included; aspirin: I&D; warfarin: I&D, hematoma, hemorrhage, transfusion, PJI, PE and DVT; apixaban: hematoma and hemorrhage. 90-day complications included; aspirin: I&D; warfarin: I&D, hematoma, hemorrhage, transfusion, PJI, PE and DVT. Warfarin was the only anticoagulant associated with a higher risk for DVT, and the highest risk for 30-day and 90-day complications. Aspirin had the highest risk for I&D. Despite three times increased 30-day risk for bleeding, apixaban was effective in preventing VTE during the high-risk 3-month-period. Enoxaparin had the lowest risk for PE and DVT while rivaroxaban had the lowest risk for PJI, hematoma, I&D, hemorrhage and transfusion.