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Title: Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty

Authors:
 [1];  [2];  [1];  [1];  [3];  [3];  [3];  [3]
  1. University of Pennsylvania, Philadelphia
  2. University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia
  3. University of Alabama at Birmingham
Publication Date:
Sponsoring Org.:
USDOE Office of Electricity Delivery and Energy Reliability (OE), Power Systems Engineering Research and Development (R&D) (OE-10)
OSTI Identifier:
1407816
Grant/Contract Number:
IK2-CX-000955
Resource Type:
Journal Article: Publisher's Accepted Manuscript
Journal Name:
Arthritis Care & Research
Additional Journal Information:
Journal Volume: 69; Journal Issue: 12; Related Information: CHORUS Timestamp: 2017-12-01 10:22:55; Journal ID: ISSN 2151-464X
Publisher:
Wiley Blackwell (John Wiley & Sons)
Country of Publication:
Country unknown/Code not available
Language:
English

Citation Formats

George, Michael D., Baker, Joshua F., Hsu, Jesse Yenchih, Wu, Qufei, Xie, Fenglong, Chen, Lang, Yun, Huifeng, and Curtis, Jeffrey R. Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty. Country unknown/Code not available: N. p., 2017. Web. doi:10.1002/acr.23209.
George, Michael D., Baker, Joshua F., Hsu, Jesse Yenchih, Wu, Qufei, Xie, Fenglong, Chen, Lang, Yun, Huifeng, & Curtis, Jeffrey R. Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty. Country unknown/Code not available. doi:10.1002/acr.23209.
George, Michael D., Baker, Joshua F., Hsu, Jesse Yenchih, Wu, Qufei, Xie, Fenglong, Chen, Lang, Yun, Huifeng, and Curtis, Jeffrey R. 2017. "Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty". Country unknown/Code not available. doi:10.1002/acr.23209.
@article{osti_1407816,
title = {Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty},
author = {George, Michael D. and Baker, Joshua F. and Hsu, Jesse Yenchih and Wu, Qufei and Xie, Fenglong and Chen, Lang and Yun, Huifeng and Curtis, Jeffrey R.},
abstractNote = {},
doi = {10.1002/acr.23209},
journal = {Arthritis Care & Research},
number = 12,
volume = 69,
place = {Country unknown/Code not available},
year = 2017,
month =
}

Journal Article:
Free Publicly Available Full Text
This content will become publicly available on November 2, 2018
Publisher's Accepted Manuscript

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  • Forty-eight patients treated by primary bilateral simultaneous total knee arthroplasty, in which one knee had a lateral release and the other did not, were evaluated clinically and roentgenographically from one to 12 years postoperatively. Thirty of these patients also had a technetium-99 bone scan. Mean clinical scores at the last follow-up examination were 90 for both groups. Roentgenographically, there were no subluxations, dislocations, or fractures in either group. There were two metal-backed patellae (one in each group) with signs of polyethylene wear and developed debris. Bone scans showed no difference between the two groups and no signs of osteonecrosis ofmore » the patella.« less
  • The natural history of bone scans after total knee arthroplasty (TKA) was studied in 26 patients with 28 cemented TKAs and 29 patients with 31 cementless TKAs. The bone scans were examined at specified postoperative intervals. Radionuclide activity of the femoral, tibial, and patellar regions was measured. Six patients who developed pain postoperatively were excluded. Bone scans immediately postoperative and at three months demonstrated increased uptake, which gradually decreased to baseline levels at ten to 12 months. Radioisotope uptake was comparable in the cemented and cementless groups, but was highly variable in individual patients and in each of the follow-upmore » periods. A single postoperative bone scan cannot differentiate component loosening from early bone remodeling. Sequential bone scans, as a supplement to the clinical examination and conventional radiography, may prove useful in the diagnosis of TKA failure.« less
  • Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included withinmore » the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4–146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 × 10{sup −5} to 837.4 × 10{sup −5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2–541.0) × 10{sup −5}. The probability of bladder cancer development was more than 113.7 × 10{sup −5} and 110.3 × 10{sup −5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003–68.5) × 10{sup −5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the treatment parameters, organ site in respect to treatment volume and patient's gender and age. The presented risk estimates may be useful in the follow-up studies of irradiated patients.« less
  • The objective of this study was to determine if consistent posterior femoral rollback of an asymmetrical posterior cruciate retaining (PCR) total knee arthroplasty was mostly influenced by the implant design, surgical technique, or presence of a well-functioning posterior cruciate ligament (PCL). Three-dimensional femorotibial kinematics was determined for 80 subjects implanted by 3 surgeons, and each subject was evaluated under fluoroscopic surveillance during a deep knee bend. All subjects in this present study having an intact PCL had a well-functioning PCR knee and experienced normal kinematic patterns, although less in magnitude than the normal knee. In addition, a surprising finding wasmore » that, on average, subjects without a PCL still achieved posterior femoral rollback from full extension to maximum knee flexion. The findings in this study revealed that implant design did contribute to the normal kinematics demonstrated by subjects having this asymmetrical PCR total knee arthroplasty.« less
  • Pain after total knee arthroplasty is a common clinical problem in orthopedics, and prosthetic loosening, often requiring surgical revision, is usually the etiology. Since standard clinical and radiographic diagnostic measures have not proven totally satisfactory, a study of the utility of bone scintigraphy to assess stability of the knee prosthesis was done. Thirty-five patients with 39 prostheses were studied. Seventeen patients with 21 total knee arthroplasties served as controls and were asymptomatic, were stable at surgery, or improved with conservative management. Eighteen knees in 18 symptomatic patients composed the experimental group. Of these, 11 knees were loose at surgery andmore » seven have had surgery recommended. Scintigrams of the knees were obtained using /sup 99m/Tc-MDP, and ranked 0-3 corresponding to increasingly abnormal localization by three observers. Highly significant differences were observed between the abnormal and control groups (p<0.001). Reciprocal changes in sensitivity and specificity with increasingly stringent criteria were shown. While it is apparent that the bone scan cannot be used as the sole diagnostic method for evaluation of prosthetic stability, it does seem to be a useful adjunct along with clinical criteria and radiographic studies.« less