OKOJ, Volume 14, No. 7

Prevention and Diagnosis of Periprosthetic Knee Infection

Total knee arthroplasty (TKA) has become an increasingly common treatment option for patients who have debilitating knee arthritis. TKA is a relatively safe and efficient procedure that results in promising outcomes and has a positive effect on a patient's quality of life. More TKAs are being performed annually because the procedure substantially reduces pain and improves functionality; however, as the number of TKAs continues to rise, there is concern for potential complications that may result in prosthetic joint failure. Primary TKA failure may result in revision procedures that have high costs and an increased risk for additional complications. Infection is the second most common cause of primary TKA failure and the single most common cause of revision TKA failure. Surgeons who have a better understanding of the epidemiology, risk factors, and diagnostic modalities associated with periprosthetic knee infection will be able to implement preventive measures and manage patients in whom such a complication occurs.

    • Keywords:
    • arthroplasty

    • diagnosis

    • infection

    • periprosthetic knee infection

    • prevention

    • revision

    • total knee replacement

    Malignant Tumors of Bone and Soft Tissue

    For both the patient and clinician, the evaluation of an aggressive musculoskeletal lesion is an anxiety-producing process. By understanding principles of biopsy, staging, typical presentation, and treatment of malignant bone and soft-tissue lesions, the clinician can help inform the patient, expedite the workup, and refer to a specialty center expeditiously when a primary sarcoma is suspected. The prognosis for patients with bone and soft-tissue sarcomas has not changed substantially in the past 35 years and remains approximately 60% to 70% survival at 5 years following treatment. Abundant research activity has focused on improving systemic management for patients with recurrent and/or metastatic sarcoma. The ability to completely evaluate a patient with suspected metastatic disease of unknown primary source and assess fracture risk are two skill sets that most orthopaedic surgeons should have in their armamentarium.

      • Keywords:
      • biopsy

      • staging

      • bone sarcoma

      • soft-tissue sarcoma

      • metastatic bone disease

      • myeloma

      • lymphoma

      • treatment of malignant lesions

      Diagnosis and Treatment of the Biceps-Labral Complex

      The long head of the biceps tendon (LHBT) is a common source of pathology. The biceps-labral complex (BLC) is the collective anatomic and clinical features shared by the biceps tendon and the superior labrum. LHBT pathology can be caused by inflammation, instability, or trauma. Numerous tests can be performed to determine the existence of biceps tendon and superior labrum anterior to posterior (SLAP) lesions; however, many of these tests do not have high sensitivity and specificity, which limits their clinical utility. Because it is difficult to diagnose both LHBT and SLAP pathology, management strategies are best guided by a strong clinical suspicion and imaging findings on either MRI or ultrasonography. Initial nonsurgical treatment of LHBT and SLAP pathology includes focused physical therapy, anti-inflammatory medications, and corticosteroid injections. If nonsurgical management fails, surgical techniques for the treatment of LHBT pathology include biceps anchor reattachment (SLAP repair), biceps tenotomy, and biceps tenodesis. Techniques for biceps tenodesis, which can be performed in either an arthroscopic or open manner, include soft-tissue tenodesis, suprapectoral tenodesis, and subpectoral tenodesis. If appropriately managed, patients with LHBT pathology often have excellent clinical outcomes.

        • Keywords:
        • baseball

        • biceps tendinitis

        • biceps tenodesis

        • overhead athletes

        • SLAP tear