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Thomas Thornhill, MD
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Second Session
Moderator: Thomas Thornhill, MD
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| Jennifer Cook, MD |
Dennis Burke, MD |
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Early Acute and Late Metastatic Infections after Total Knee Arthroplasty: A single surgeon’s experience after 3013 consecutive total knee arthroplasties
Jennifer Cook, MD
Advisor: Richard Scott, MD
Discussor: Dennis Burke, MD
Total knee arthroplasty techniques have gradually become refined enough that mechanical causes of failure do not dominate the discussion as they once did. As techniques have become more reliable, postoperative infection has taken on a larger role in the discussion. In her work, Dr. Cook reviewed the preoperative, intraoperative, postoperative and rehabilitation protocol of Dr. Scott over the past 19 years – an experience encompassing 3013 total knee arthroplasties. In this she draws several conclusions with respect to minimizing both early and late infections. Of the more than three thousand knees studied there were no early infections (less than 4 weeks postoperative) and only 15 late infections – a 0.5% infection rate. Given the small numbers it was difficult to draw many general conclusions, but it was clear that consistency, sterile technique and proper tissue handling were felt to be paramount in obtaining such excellent results.
Dr. Burke provided an excellent review of the current state of surgical infections in the US – as many as 500,000 per year—to help illustrate both what a large problem this is and how a 0.5% infection rate is truly remarkable. He provided some levity by tracing Dr. Cook’s surgical genealogy through Dr. Scott back to both Pasteur and Lister. He did question whether the new move toward smaller incisions stood to give more problems with infection given the need to handle the tissue with more force. Dr. Cook agreed that there was likely some increased risk, but that properly placed incisions allowed adequate visualization and hence proper tissue handling.
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| Travis Matheney, MD |
Young-Jo Kim, MD |
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Long-term Outcomes of Periacetabular Osteotomy
Travis Matheney, MD
Advisor: Michael B. Millis, MD
Discussor: Young-Jo Kim, MD
Hip dysplasia can lead to osteoarthritis and arthrosis of the hip. This is a particularly vexing problem in the young population, as it is not desirable to perform a total hip arthroplasty (THA) that will almost certainly one day need revision. One potential solution to this is the periacetabular osteotomy (PAO). Unfortunately, even when everything with the operation goes well, some hips progress to THA. In this work, Dr. Matheney sought to identify the factors that could determine which hips would not do well with a PAO. He looked at several factors in 160 PAO operations performed at the Children’s Hospital including gender, BMI, the presence of a labral tear, and various radiographic metrics. Ultimately he found that decreased preoperative joint space width and joint congruency were most likely to indicate failure of a PAO. This work represented a unique model in the prediction of PAO failure.
Dr. Kim congratulated Dr. Matheney on this model. He cautioned that the model will need to be verified on other patient populations prior to wide acceptance. Dr. Matheney agreed that further verification would be needed.
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| Samantha Spencer, MD |
Michael B. Millis, MD |
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Surgical Dislocation of the Hip
Samantha A. Spencer, MD
Advisor: Young-Jo Kim, MD
Discussor: Michael B. Millis, MD
Intra-articular lesions of the hip are notoriously difficult to treat. For example, the impingement syndrome seen in slipped capital femoral epiphysis (SCFE) can sometimes lead to other problems such as labral tears, chondral injury, rim fractures and OA. Many times this can be treated with observation, NSAIDs, or even hip arthroscopy. In her work, Dr. Spencer suggests the next step in this progression, namely the use of surgical hip dislocations to treat these lesions. She examined 19 patients who had undergone surgical hip dislocation for SCFE or idiopathic pistol grip deformity. The use of surgical dislocation allows for assessment of the anatomy as well as the dynamics of the hip. Ultimately it was shown that use of a greater trochanteric osteotomy and osteoplasty in SCFE patients had the most overall improvement in their function. It was suggested that surgical dislocation was an effective treatment given one’s ability to repair labral tears, the option for osteotomy and the ability to perform osteoplasty.
Dr. Millis congratulated Dr. Spencer for her interesting and very relevant work. He inquired as to whether arthroscopy of the hip would grow to be a more effective tool in the assessment of hip pathology. Dr. Spencer answered that hip arthroscopy was still in its early stages and that it was unclear how effective it would be. For example, one may be limited in the ability to perform adequate osteoplasty or fix labral tears.
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