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Biomedical subjects

Javad Parvizi

Publications and source records attributed to Javad Parvizi.

At least 19 recordsLinked to original sources
PubMed2007

Can epidural anesthesia and warfarin be coadministered?

Epidural hypotensive anesthesia can, in addition to imparting numerous intraoperative benefits, provide excellent postoperative pain control for patients having joint arthroplasties. However, because of the risk of epidural hematoma, epidural anesthesia is not coadministered with anticoagulation in some centers. We retrospectively ascertained, by chart review, the incidence of epidural hematoma in 11,235 patients having 12,991 knee arthroplasties at our institution who received oral anticoagulation and epidural anesthesia for their surgery. Warfarin was administered on the day of surgery. With the exception of 212 patients, the epidural catheter was removed within 48 hours of surgery. Based on clinical examinations, we detected no epidural hematomas. For 1030 patients (1038 knees) whose charts were reviewed in detail, the mean international normalized ratio at the time of removal of the epidural catheter was 1.54 (range, 0.93-4.25). We identified no other complications related to the coadministration of epidural anesthesia and warfarin. Although administration of epidural anesthesia in patients with coagulopathy can be detrimental, we recognized no cases of epidural hematoma causing neurologic symptoms in patients receiving controlled oral anticoagulation after total knee arthroplasty.

Anesthesia, Epidural↗
PubMed2007

Selfprotective smart orthopedic implants.

In this review, we discuss current advances leading to an exciting change in implant design for orthopedic surgery. The initial biomaterial approaches in implant design are being replaced by cellular-molecular interactions and nanoscale chemistry. New designs address implant complications, particularly loosening and infection. For infection, local delivery systems are an important first step in the process. Selfprotective 'smart' devices are an example of the next generation of orthopedic implants. If proven to be effective, antibiotics or other active molecules that are tethered to the implant surface through a permanent covalent bond and tethering of antibiotics or other biofactors are likely to transform the practice of orthopedic surgery and other medical specialties. This new technology has the potential to eliminate periprosthetic infection, a major and growing problem in orthopedic practice.

Antibiotic Prophylaxis↗
PubMed2007

Total joint arthroplasty: When do fatal or near-fatal complications occur?

BACKGROUND: With the recent trend toward minimally invasive total joint arthroplasty and the increased emphasis on faster recovery and shorter hospital stays, it has become increasingly important to recognize the timing and severity of the various complications associated with elective total joint arthroplasty to ensure that early patient discharge is a safe practice. METHODS: We evaluated the systemic and local complications associated with primary unilateral lower-extremity arthroplasties performed during one year in 1636 patients. A total of 966 patients had a primary total hip arthroplasty, and 670 had a primary total knee arthroplasty. All complications that occurred in the hospital and for six weeks following the index surgery were recorded. The circumstances leading to the complications and the details of the therapeutic intervention for each complication were recorded. Analyses were performed to predict the factors that predispose patients to serious complications. RESULTS: One patient (0.06%) in the cohort died during the hospital stay. There were a total of 104 major (life-threatening) complications, including cardiac arrest (one), tachyarrhythmia (thirty-three), pulmonary edema or congestive heart failure (ten), myocardial infarction (six), hypotensive crisis (four), pulmonary embolus (twenty-five), acute renal failure (fourteen), stroke (six), bowel obstruction or perforation (three), and pneumothorax (one). There were seventeen major local complications. Ninety-four (90%) of the major complications occurred within four days after the index surgery. Although older age, increased body mass, and preexistent comorbidities were important predisposing factors for serious medical complications, 58% of the patients who had life-threatening complications develop had no identifiable predisposing factors. CONCLUSIONS: This study demonstrated that most of the complications of lower-extremity total joint replacement occur within the time-frame of the typical hospital stay. Given the serious nature of some of these complications and the inability to identify many of the patients who may be at risk, we caution against early discharge of patients from the hospital after elective total joint arthroplasty in the lower extremity.

Adolescent↗
PubMed2006

Femoral perforation complicating contemporary uncemented hip arthroplasty.

This case series reports on 4 patients in whom intraoperative penetration of the femoral cortex occurred and went unrecognized on routine postoperative radiographs. This case series highlights some important points. Femoral cortex penetration can and does occur with uncemented hip arthroplasty and is likely to occur when surgical exposure is difficult and inadequate (such as in patients with severe obesity) or some form of proximal femoral deformity exists (such as patients with achondroplasia). Extra diligence should be exercised to avoid this complication in the high-risk patients, and adequate 2-plain radiographs may need to be ordered intraoperatively if such complication is suspected.

Achondroplasia↗
PubMed2006

Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients.

This study analyzed the outcome of total hip arthroplasty (THA) from a single institution of patients with renal failure, including renal dialysis patients (9 patients, 9 hips) and renal transplant patients (28 patients, 36 hips). There were 12 revisions and a 61% complication rate in the transplant group. In the dialysis group, 1 patient was revised, and there was a 33% complication rate. Transplant patients were younger, more active, and lived longer, but had higher cumulative rates of revision and complications with longer follow-up. Dialysis patients, in contrast, had a short survival but a lower rate of complications and revisions. These data differ from previous reports of acceptable outcomes with low complication rates of THA in transplant patients. Efforts to minimize complications in these patients are justified.

Adolescent↗
PubMed2006

Total hip arthroplasty: is small incision better?

Outcome data are eagerly awaited at present time to evaluate the role of minimally invasive surgery in orthopedic surgery. This matched-pair study reports the outcome of total hip arthroplasty (THA) performed through regular or small incision technique by a single surgeon. There were 120 patients in this cohort with a mean age of 66.8 years (range, 39-90 years). There was no detectable difference in outcome between the two groups with regard to blood loss, analgesia requirement, functional recovery, length of hospital stay, or disposition at discharge. One patient in the small incision group with undersized femoral component required revision of the femoral stem 8 months later. The recent extensive interest for minimally invasive THA has been attributed to market-driven and patient-driven demand for this procedure. We were not able to detect any difference in outcome parameters for THA performed through small incision compared with the conventional techniques.

Acetabulum↗
PubMed2006

Simultaneous primary total hip arthroplasty and contralateral revision hip arthroplasty: role for use of femoral head autograft.

We report the outcome of revision hip arthroplasty for patients with acetabular bone loss in whom the femoral head retrieved from arthritic contralateral hip during the same anesthesia was used as autograft for acetabular reconstruction. Thirty-two hips in 16 patients with a mean age of 63.8 years (range, 43-79 years) were followed for an average of 3.5 years. All primary arthroplasties were successful. Evidence of autograft incorporation was found in all except 2 patients. The acetabular component failed and required revision in the latter 2 patients. The use of femoral head autograft in a select group of patients with symptomatic arthritis of hip and a failed prosthetic hip with severe bone loss in the contralateral side is a viable option. However, this technique should not be applied to acetabular reconstructions in which protected weight-bearing in the postoperative period may be necessary.

Adult↗
PubMed2006

Total hip arthroplasty for acute femoral neck fractures using a cementless tapered femoral stem.

The purpose of this study was to evaluate the osseointegration potential and implant-related complications of cementless total hip arthroplasty with a titanium alloy collarless, tapered, wedge-shaped femoral stem with a proximal circumferential plasma-spray coating in patients with acute hip fractures. The cohort consists of 85 patients with a mean age of 78.1 years. The mean duration of follow-up was 3.8 years. Total hip arthroplasty conferred significant improvement in function for all patients. All femoral components were stable with evidence of bone ingrowth (84 hips) or fibrous fixation (1 hip). Mild thigh pain was present in 3 patients. The complications included dislocation (3 cases), intraoperative femoral fracture (2 cases), and periprosthetic femoral fracture in the postoperative period (1 case). There was one reoperation for revision of the femoral component in the patient with a periprosthetic fracture. There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis.

Aged↗
PubMed2006

Ninety-day mortality after bilateral hip arthroplasty.

Despite lack of any studies, to our knowledge, bilateral total hip arthroplasty (THA) is believed to carry higher perioperative mortality. The purpose of this study is to investigate the incidence of mortality within 90 days of bilateral THA in a major urban medical center. The incidence of 90-day mortality after 1-stage bilateral THA performed in 707 patients between 1995 and 2004 was evaluated. A detailed analysis of our database was performed to determine which bilateral THA patients died within 90 days of surgery. Every living patient who had undergone bilateral hip arthroplasty was contacted. One patient (0.14%, 1/707) died within 90 days of 1-stage bilateral THA. The patient developed spontaneous retroperitoneal hematoma requiring massive transfusion. The patient died of multisystem failure 35 days after undergoing bilateral THA. One-stage bilateral uncemented THA performed in a select group of healthy and young patients carries an acceptable risk.

Adolescent↗
PubMed2006

One-stage bilateral total hip arthroplasty compared with unilateral total hip arthroplasty: a prospective study.

It is believed that patients undergoing 1-stage bilateral joint arthroplasty are at higher risk for developing cardiopulmonary and possibly other complications. The aim of this prospective matched study was to evaluate and compare the morbidity profile of patients undergoing 1-stage bilateral uncemented total hip arthroplasty (BTHA) vs unilateral uncemented THA (UTHA). One hundred consecutive patients undergoing 1-stage bilateral THA (50 patients, 100 hips) and unilateral THA (50 patients) were recruited and prospectively followed. There were no statistically significant differences in 90-day mortality, individual major (BTHA, 8%; UTHA, 10%) or minor (BTHA, 20%; UTHA, 26%) complications between the 2 groups. Bilateral THA patients required more autologous and allogenic blood transfusion and had lower hemoglobin at discharge than UTHA patients. Patients undergoing BTHA should expect a slightly higher incidence of complications related to postoperative anemia.

Adolescent↗
PubMed2006

Hip arthroplasty with minimally invasive surgery: a survey comparing the opinion of highly qualified experts vs patients.

In recent years, there has been an increasing debate regarding the possible role of minimally invasive (MIS) total hip arthroplasty (THA). We conducted a questionnaire survey of the Hip Society members and compared the responses of the surgeons with those of patients who were being considered for THA. 80% of surgeons who completed the survey admitted to performing MIS THA, of whom two thirds defined MIS as small incision. Of surgeons, 74% had encountered some complication related to MIS THA; 67% of patients had not heard of MIS THA. The knowledge regarding MIS THA expressed by 80% of patients was either inaccurate or not substantiated by any studies. This survey highlights the inadequacy of our current understanding of MIS THA and lack of education on the part of the patients.

Arthroplasty, Replacement, Hip↗
PubMed2006

Ninety-day mortality after hip arthroplasty: a comparison between unilateral and simultaneous bilateral procedures.

This study compares the 90-day mortality of unilateral total hip arthroplasty (THA) with simultaneous bilateral THA. Patient demographics, cause of death, and risk factors for mortality after THA were investigated. A total of 6258 patients (6791 hips) received primary THA using uncemented prostheses from 1995 to 2002. There were 5725 (91%) patients who received unilateral THA, whereas 533 (9%) patients underwent simultaneous bilateral THA. Of 6258 patients, 10 (0.16%) died within 90 days of THA, none of whom underwent simultaneous bilateral THA (0%, 0/533). Simultaneous bilateral uncemented THA performed in a select group of patients carries no greater perioperative mortality rate than unilateral THA.

Adolescent↗
PubMed2006

Comparison of fluorodeoxyglucose positron emission tomography and (111)indium-white blood cell imaging in the diagnosis of periprosthetic infection of the hip.

We aimed to compare the accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) with technetium-99m sulfur colloid (111)indium-labeled white blood cell scintigraphy (TcSC-Ind BM/WBC) in diagnosis of periprosthetic infection. Eighty-nine patients with 92 painful hip prostheses were recruited prospectively and given the option of undergoing either combined FDG-PET and TcSC-Ind BM/WBC or FDG-PET only. FDG-PET correctly diagnosed 20 of the 21 infected cases (sensitivity, 95.2%) and ruled out infection in 66 of the 71 aseptic hips (specificity, 93%) corresponding to a positive predictive value of 80% (20/25) and a negative predictive value of 98.5% (66/67). TcSC-Ind BM/WBC correctly identified 5 of the 10 infected cases (sensitivity, 50%) and 39 of 41 aseptic cases (specificity, 95.1%) corresponding to a positive and negative predictive values of 41.7% (5/12 cases) and 88.6% (39/44 cases), respectively. Based on these preliminary results, FDG-PET appears to be a promising diagnostic tool for distinguishing septic from aseptic painful hip prostheses.

Adult↗
PubMed2006

Socioeconomic issues and demographics of total knee arthroplasty revision.

UNLABELLED: Despite rising numbers of total knee arthroplasty revision (TKAR) procedures there remains a paucity of information regarding the relationships between total knee arthroplasty failure and socioeconomic and educational status, demographics, general health and functional disability. We performed a multicenter prospective study of 290 consecutive TKAR patients in order to determine whether they differed from the population they were drawn from in terms of socioeconomic or educational status, race or gender. Secondary aims were to establish the relative comorbid status of this population, social supports and their general health status compared to national norms and their modes of failure. Our cohort consisted of 137 males and 153 females with a mean age of 68.6 years (range, 34-85 years), substantial overall functional disability according to the SF-36 and a large average number of comorbidities at baseline. We found a relative overrepresentation of patients of comparatively low socioeconomic and educational status and also of Caucasian patients in the TKAR population. This large prospective investigation demonstrates demographic features associated with TKA failure and provides a platform for further investigations on the effect demographic characteristics have on the outcomes of TKAR. LEVEL OF EVIDENCE: Prognostic Study, Level II (Lesser quality prospective study). See Guidelines for Authors for a complete description of the Levels of Evidence.

Adult↗
PubMed2006

Periprosthetic fractures after total knee arthroplasties.

UNLABELLED: The management of periprosthetic fracture around the knee remains a challenging problem. The objective of this article was to review the general concepts, treatment algorithms, and the overall treatment outcomes of femoral and tibial periprosthetic fractures after total knee arthroplasty. This article aimed to highlight the deficiencies of the current classification systems that fail to provide a guideline for selection of appropriate treatment options. We proposed a new classification system for periprosthetic femoral fractures that takes into account the status of the prosthesis, the quality of distal bone stock, and the reducibility of the fracture. Type I fractures are those occurring in patients with good bone stock with the prosthesis being fixed and well positioned. Type IA fractures are either nondisplaced or easily reducible and can be treated conservatively. Type IB fractures are irreducible and require reduction and internal fixation. Type II fractures are defined as those occurring also in patients with good bone stock and being reducible, but either the components are loose or malpositioned. These fractures are treated by revision arthroplasty. Type III fractures are reducible or irreducible fractures that occur in patients with poor bone stock and in the vicinity of loose or malpositioned components. These fractures are treated by distal femoral replacement. LEVEL OF EVIDENCE: Therapeutic study, level V (expert opinion). See Guidelines for Authors for a complete description of levels of evidence.

Arthroplasty, Replacement, Knee↗
PubMed2006

Periprosthetic patellar fractures.

UNLABELLED: Patellar fracture after total knee arthroplasty is a rare yet challenging complication. Patellar fracture can occur as a result of trauma or it may be atraumatic. A multitude of factors can lead to periprosthetic patellar fracture including patient related factors, surgical technique related factors, and implant specific factors. Understanding the etiologic factors leading to atraumatic patellar fractures could result in minimizing complications. We present the results of peri-prosthetic patellar fractures in 12 patients. All type I non-displaced fractures (7 cases) were treated nonoperatively. Surgical treatment was selected for the remaining 5 cases which included resection arthroplasty combined with open reduction and internal fixation of the fracture (3 knees), partial patellectomy (1 knee), and total patellectomy (1 knee). The outcome was excellent in 1 knee, good in 8 knees, and fair in the remaining 3 knees at the latest follow-up. There were 2 reoperations; 1 for disruption of the extensor mechanism and 1 for refracture. One patient developed a superficial wound infection. We reviewed the available literature regarding the etiology, surgical strategies, and outcomes for periprosthetic patellar fracture. LEVEL OF EVIDENCE: Therapeutic studies, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗
PubMed2006

Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning.

Most patients exhibiting instability after total hip arthroplasty can be treated nonoperatively. However, instability may become recurrent and require surgical intervention. Abductor insufficiency and component malpositioning constitute two of the most important causes of recurrent instability, although the exact cause may not be identifiable in some patients. There is relative scarcity of reports in the literature regarding the outcome of surgical intervention for recurrent instability; however, it is known that surgical intervention is likely to have a better outcome in patients for whom the cause of recurrent instability can be identified. We hypothesized that component malpositioning, which may be subtle in some cases, is the cause of recurrent instability for many patients. The outcomes of revision arthroplasty in 93 patients who were treated at our institution for recurrent instability were reviewed. Component malpositioning was found to be the major cause of recurrent instability in this successfully treated cohort.

Adult↗