This study supports the hypothesis that hip arthroscopy in professional athletes is associated with excellent rates of return at the professional level. However, postoperative performance outcomes varied based on sport and position.
Abstract. Introduction: A synovial cell count greater than 50,000/mm3 is the threshold most commonly used to diagnose septic arthritis. This lab value may be nonspecific in the setting of crystalline arthropathy. The purpose of this study was to evaluate the accuracy of diagnosing septic arthritis using a synovial cell count cut-off of 50,000/mm3 in the setting of crystalline arthropathy.Methods: This was a retrospective review of joint aspirations performed between July 1st, 2013 and June 30th, 2016. Synovial fluid samples were evaluated for cell count, crystals, Gram stain, and culture. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the synovial markers were calculated.Results: During the study period, 738 joint aspirations were sent for testing, of which 358 aspirations in 348 patients met inclusion criteria. There were 49 (13.7%) cases of culture-positive septic arthritis, and 47 patients underwent surgical irrigation and debridement. Gout and pseudogout crystals were present in 163 aspirates (45.5%). Three joints (0.8% overall rate) had concomitant crystalline arthropathy and septic arthritis, each of which had a synovial WBC ≥85,000/mm3. Increasing the WBC count cutoff to 85,000/mm3 demonstrated a specificity of 100%, but a PPV of 12.0%.Conclusions: A cut-off of 85,000/mm3 may be more appropriate to diagnose concomitant septic arthritis and crystalline arthropathy. We recommend medical management and observation in patients with crystal-positive joint aspirations unless the synovial cell count is elevated above 85,000/mm3. Prospective studies using this treatment guideline are needed to evaluate its validity and accuracy.
Case:
This report describes a case of prolonged neurologic deficit of primarily the nonoperative lower extremity in a patient with sickle cell disease (SCD) who received spinal anesthesia during revision total hip arthroplasty (THA). The patient initially showed bilateral lower extremity neurologic deficits localized to the L5/S1 nerve root, with the eventual persistence of symptoms in the nonoperative extremity for >1 year.
Conclusions:
This report describes an unusual complication after THA and spinal anesthesia. This case highlights the rare occurrence of nerve root injury after spinal anesthesia and emphasizes the importance of close perioperative monitoring in patients with SCD undergoing orthopaedic surgery.
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