Publications by authors named "C A Higuera"

204 Publications

What Is the Optimal Irrigation Solution in the Management of Periprosthetic Hip and Knee Joint Infections?

J Arthroplasty 2021 May 26. Epub 2021 May 26.

Department of Orthopedics, Rothman Orthopedics, Philadelphia, PA.

Background: Thorough irrigation and debridement using an irrigation solution is a well-established treatment for both acute and chronic periprosthetic joint infections (PJIs). In the absence of concrete data, identifying the optimal irrigation agent and protocol remains challenging.

Methods: A thorough review of the current literature on the various forms of irrigations and their additives was performed to evaluate the efficacy and limitations of each solution as pertaining to pathogen eradication in the treatment of PJI. As there is an overall paucity of high-quality literature comparing irrigation additives to each other and to any control, no meta-analyses could be performed. The literature was therefore summarized in this review article to give readers concise information on current irrigation options and their known risks and benefits.

Results: Antiseptic solutions include povidone-iodine, chlorhexidine gluconate, acetic acid, hydrogen peroxide, sodium hypochlorite, hypochlorous acid, and preformulated commercially available combination solutions. The current literature suggests that intraoperative use of antiseptic irrigants may play a role in treating PJI, but definitive clinical studies comparing antiseptic to no antiseptic irrigation are lacking. Furthermore, no clinical head-to-head comparisons of different antiseptic irrigants have identified an optimal irrigation solution.

Conclusion: Further high-quality studies on the optimal irrigation additive and protocol for the management of PJI are warranted to guide future evidence-based decisions.
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http://dx.doi.org/10.1016/j.arth.2021.05.032DOI Listing
May 2021

When Total Joint Arthroplasty After Septic Arthritis Can Be Safely Performed.

JB JS Open Access 2021 Apr-Jun;6(2). Epub 2021 May 13.

Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.

Background: Patients undergoing total joint arthroplasty (TJA) following septic arthritis are at higher risk for developing periprosthetic joint infection (PJI). Minimal literature is available to guide surgeons on the optimal timing of TJA after completing treatment for prior native joint septic arthritis. This multicenter study aimed to determine the optimal timing of TJA after prior septic arthritis and to examine the role of preoperative serology in predicting patients at risk for developing PJI.

Methods: A total of 207 TJAs were performed after prior septic arthritis from 2000 to 2017 at 5 institutions. Laboratory values, prior treatment, time from the initial infection, and other variables were recorded. Bivariate analyses were performed to identify the association between the time from septic arthritis to TJA and the risk of developing subsequent PJI. A subanalysis was performed between patients who underwent TJA in 1 setting (n = 97) compared with those who underwent 2-stage arthroplasties (n = 110). Receiver operating characteristic (ROC) curve analysis was performed for serum markers prior to TJA in predicting the risk of a subsequent PJI.

Results: The overall PJI rate was 12.1%. Increasing time from septic arthritis treatment to TJA was not associated with a reduction of PJI, whether considering time as a continuous or categorical variable, for both surgical treatment cohorts (all p > 0.05). Although the ROC curve analysis found that the optimal threshold for timing of TJA from the initial treatment was 5.9 months, there was no difference in the PJI rate when the overall cohort was dichotomized by this threshold and when stratified by 1-stage compared with 2-stage TJA. There was no significant difference in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level prior to conversion TJA between patients who subsequently developed PJI and those who did not.

Conclusions: Serum markers have limited value in predicting subsequent PJI in patients who undergo TJA after prior septic arthritis. There was no optimal interim period between septic arthritis treatment and subsequent TJA; thus, delaying a surgical procedure does not appear to reduce the risk of PJI.

Level Of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.OA.20.00146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154388PMC
May 2021

What's New in Musculoskeletal Infection.

J Bone Joint Surg Am 2021 May 28. Epub 2021 May 28.

Mayo Clinic, Rochester, Minnesota.

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http://dx.doi.org/10.2106/JBJS.21.00311DOI Listing
May 2021

Orthopaedic clinical research: building a team that lasts.

EFORT Open Rev 2021 Apr 1;6(4):245-251. Epub 2021 Apr 1.

Cleveland Clinic Department of Orthopaedic Surgery, Cleveland, Ohio, USA.

Medical progress, including in the orthopaedic surgery field, depends on the interaction and collaboration between: physicians, with their expertise on the clinical setting; scientists, with their expertise on the research setting; and professionals who are skilled in both settings (clinical scientists). This leads to the need to develop research approaches which involves people who are committed and support the process, strategic planning, and a cohesive team that can execute the tasks. All these interactions must be supported financially in order to maintain the long-term viability of such team.Time management is crucial for the clinical research team. To ensure success, the research team must be flexible in order to adapt to dynamic clinical and surgical schedules. It is especially important that surgeons have regular, dedicated quality research time to maintain a consistent interaction with the team.Building a successful and productive orthopaedic clinical research programme involves many challenges in creating proper leadership, obtaining funding, setting proper resources, establishing necessary training, and providing guidance and insight around the importance of each role that every member plays on the team. Cite this article: 2021;6:245-251. DOI: 10.1302/2058-5241.6.200058.
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http://dx.doi.org/10.1302/2058-5241.6.200058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142594PMC
April 2021

Variability and Interpretation of Synovial Cell Count and Differential: A Perspective in Hip and Knee Arthroplasty.

Orthopedics 2021 May-Jun;44(3):e320-e325. Epub 2021 May 1.

Multiple threshold values have been proposed for synovial leukocyte count (white blood cell count) and synovial neutrophil percentage (percent polymorphonuclear neutrophils) in the diagnosis of periprosthetic joint infection (PJI). The objective of this study was to elucidate the variability of these criteria under diverse patient/surgical settings. Hip PJIs yield higher synovial white blood cell counts and percent polymorphonuclear neutrophils than knee PJIs. Periprosthetic joint infection of failed unicompartmental knee arthroplasty produces a higher white blood cell count than that of failed total knee arthroplasty. Synovial white blood cell count and percent polymorpho-nuclear neutrophils PJI thresholds also vary in patients with antibiotic cement spacers and depend on the timing from primary arthroplasty (<6 weeks vs >6 weeks). Similarly, test results should be carefully interpreted for patients with comorbidities so that PJI is not missed or falsely identified. [. 2021;44(3):e320-e325.].
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http://dx.doi.org/10.3928/01477447-20210508-01DOI Listing
May 2021