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Sacher SE, Baral EC, Wright TM, Bauer TW, Li Q, Padgett DE, Potter HG, Koff MF. Association of Total Hip Arthroplasty Flexural Rigidity With Magnetic Resonance Imaging and Histological Findings. J Arthroplasty 2024:S0883-5403(24)00192-X. [PMID: 38428693 DOI: 10.1016/j.arth.2024.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA. METHODS Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes. RESULTS A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity. CONCLUSIONS Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Elexis C Baral
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Timothy M Wright
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qian Li
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Douglas E Padgett
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Hollis G Potter
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Matthew F Koff
- Hospital for Special Surgery, Department of Radiology, New York, New York
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Mazzella FM, Zhang Y, Bauer TW. Update on the role of pathology and laboratory medicine in diagnosing periprosthetic infection. Hum Pathol 2024:S0046-8177(24)00009-1. [PMID: 38280657 DOI: 10.1016/j.humpath.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/22/2024] [Indexed: 01/29/2024]
Abstract
Technological and implant design advances have helped reduce the frequency of aseptic total joint arthroplasty failure, but periprosthetic joint infections (PJI) remain a clinical important problem with high patient morbidity. Misinterpreting PJI as aseptic mechanical loosening commonly leads to unsatisfactory revision arthroplasty, persistent infection, and poor long-term results. While there is no single "gold standard" diagnostic test for PJI, recent collaborative efforts by Orthopaedic and Infectious Disease Societies have developed algorithms for diagnosing PJI. However, the efficacy of individual tests as well as diagnostic thresholds are controversial. We review the recommended thresholds for commonly used screening tests as well as tissue histopathology and confirmatory tests to diagnose periprosthetic infection. We also update lesser-known laboratory tests, and we briefly summarize rapidly evolving molecular tests to diagnose periprosthetic infection. Pathologists hold a critical role in assisting with PJI diagnosis, maintaining laboratory test quality and interpreting test results. Collaboration between clinicians and pathologists is essential to provide optimal patient care and reduce the burden of PJI.
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Affiliation(s)
- Fermina M Mazzella
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, USA
| | - Yaxia Zhang
- Department of Pathology and Laboratory Medicine, Hospital for Sprecial Surgery, Weill Cornell College of Medicine, USA
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th St, New York, NY, 10021, USA.
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3
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Esteban J, Salar-Vidal L, Schmitt BH, Waggoner A, Laurent F, Abad L, Bauer TW, Mazariegos I, Balada-Llasat JM, Horn J, Wolk DM, Jefferis A, Hermans M, Verhoofstad I, Butler-Wu SM, Umali-Wilcox M, Murphy C, Cabrera B, Craft D, von Bredow B, Leber A, Everhart K, Dien Bard J, Flores II, Daly J, Barr R, Holmberg K, Graue C, Kensinger B. Multicenter evaluation of the BIOFIRE Joint Infection Panel for the detection of bacteria, yeast, and AMR genes in synovial fluid samples. J Clin Microbiol 2023; 61:e0035723. [PMID: 37877730 PMCID: PMC10662359 DOI: 10.1128/jcm.00357-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/07/2023] [Indexed: 10/26/2023] Open
Abstract
The bioMérieux BIOFIRE Joint Infection (JI) Panel is a multiplex in vitro diagnostic test for the simultaneous and rapid (~1 h) detection of 39 potential pathogens and antimicrobial resistance (AMR) genes directly from synovial fluid (SF) samples. Thirty-one species or groups of microorganisms are included in the kit, as well as several AMR genes. This study, performed to evaluate the BIOFIRE JI Panel for regulatory clearance, provides data from a multicenter evaluation of 1,544 prospectively collected residual SF samples with performance compared to standard-of-care (SOC) culture for organisms or polymerase chain reaction (PCR) and sequencing for AMR genes. The BIOFIRE JI Panel demonstrated a sensitivity of 90.9% or greater for all but six organisms and a positive percent agreement (PPA) of 100% for all AMR genes. The BIOFIRE JI Panel demonstrated a specificity of 98.5% or greater for detection of all organisms and a negative percent agreement (NPA) of 95.7% or greater for all AMR genes. The BIOFIRE JI Panel provides an improvement over SOC culture, with a substantially shorter time to result for both organisms and AMR genes with excellent sensitivity/PPA and specificity/NPA, and is anticipated to provide timely and actionable diagnostic information for joint infections in a variety of clinical scenarios.
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Affiliation(s)
- Jaime Esteban
- IIS-Fundacion Jimenez Diaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Llanos Salar-Vidal
- IIS-Fundacion Jimenez Diaz, CIBERINFEC-CIBER de Enfermedades Infecciosas, Madrid, Spain
| | - Bryan H. Schmitt
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy Waggoner
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | | | | | | | - Jared Horn
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | | | | | | | - Caitlin Murphy
- University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
| | - Barbara Cabrera
- University of Nebraska Medical Center Omaha, Omaha, Nebraska, USA
| | - David Craft
- The Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Amy Leber
- Nationwide Children’s Hospital, Columbus, Ohio, USA
| | | | | | | | - Judy Daly
- Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Rebecca Barr
- Primary Children’s Hospital, Salt Lake City, Utah, USA
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Ramirez DC, Ren R, Burge AJ, Potter HG, Su E, Bauer TW. Exuberant Rice Body Formation Associated with Adverse Local Tissue Reaction After Hip Resurfacing Arthroplasty: A Case Report and Review of the Literature. JBJS Case Connect 2023; 13:01709767-202306000-00006. [PMID: 37053362 DOI: 10.2106/jbjs.cc.22.00524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
CASE A 65-year-old man with osteoarthritis of the hip developed a soft-tissue mass of the inferior gluteal region 3 years after metal-on-metal resurfacing hip arthroplasty. Clinical and imaging findings suggested an adverse local tissue reaction. Intraoperatively, nearly 1 liter of intra-articular fibrinous loose bodies (rice bodies) was removed, and histology showed features of an adaptive immune response. The patient had no evidence of an autoimmune disease or mycobacterial infection. CONCLUSION To our knowledge, this is the first reported case of florid rice bodies associated with a metal-on-metal hip arthroplasty and adverse local tissue reaction.
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Affiliation(s)
- Daniel C Ramirez
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Alissa J Burge
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Edwin Su
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement (ARJR), Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
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Clohisy JCF, Abjornson C, Bauer TW, Baral E, Albert TJ. Delayed Failure of M6-C Cervical Disc Arthroplasty After Conversion of Adjacent Cervical Disc Arthroplasty to Fusion: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00013. [PMID: 37071739 DOI: 10.2106/jbjs.cc.22.00788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
CASE We present a delayed failure of an M6-C cervical disc arthroplasty after conversion of a subjacent failed cervical disc arthroplasty to fusion. The annular component had failed, and the core had been ejected. Histology demonstrated a giant cell reaction to polyethylene debris, and tissue cultures were positive for Cutibacterium acnes. CONCLUSION This is the first report of M6-C failure after conversion of an adjacent arthroplasty to fusion. A growing number of reports surrounding the M6-C failure rate and mechanisms raise concern about the device's durability and underscore the importance of routine clinical and radiographic surveillance for these patients.
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Affiliation(s)
- John C F Clohisy
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Celeste Abjornson
- Integrated Spine Research Program, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Elexis Baral
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Todd J Albert
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
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Fury MS, Cirino CM, White AE, Bauer TW, Taylor SA. Rice-Body Synovitis, Foreign Body Reaction, and Rotator Cuff Failure After Subacromial Balloon Spacer Augmentation of a Rotator Cuff Repair: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00040. [PMID: 37235697 DOI: 10.2106/jbjs.cc.23.00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CASE A 66-year-old woman presented with shoulder pain and weakness 4 months after augmentation of a rotator cuff repair with a Stryker InSpace subacromial balloon spacer. A magnetic resonance imaging (MRI) demonstrated a failed rotator cuff repair, large effusion with rice bodies, synovitis, axillary lymphadenopathy, loose anchors, and erosive changes to the greater tuberosity. Arthroscopy revealed balloon fragmentation surrounded by diffusely hyperemic synovium without repairable cuff tissue. Final cultures proved negative for infection. Histologic evaluation revealed ulcerated synovium with diffuse chronic and focal acute inflammation. CONCLUSION Despite promising early results, augmentation of a rotator cuff repair with a subacromial balloon spacer introduces a risk of inflammatory reaction that may mimic a deep infection and compromise rotator cuff healing.
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Affiliation(s)
- Matthew S Fury
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Carl M Cirino
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Alex E White
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Samuel A Taylor
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
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Malahias MA, Bauer TW, Manolopoulos PP, Sculco PK, Westrich GH. Allergy Testing Has No Correlation with Intraoperative Histopathology from Revision Total Knee Arthroplasty for Implant-Related Metal Allergy. J Knee Surg 2023; 36:6-17. [PMID: 33932947 DOI: 10.1055/s-0041-1729618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lymphocyte transformation testing (LTT) is often used in the workup for possible metal allergy after total knee arthroplasty (TKA) but the correlation of this test with other diagnostic metal-allergy findings in patients undergoing revision TKA for suspected metal allergy has not been established. A single-center, single-surgeon cohort of 19 TKAs in which both components were revised for presumed implant-related metal allergy based on history, physical, and LTT testing, to nonnickel-containing implants were retrospectively identified. Histopathologic samples obtained intraoperatively were semiquantitatively analyzed using both the Hospital for Special Surgery (HSS) synovial pathology score and the Campbell aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL) score. As histopathology control group, we included in the study an additional cohort of 17 patients who received aseptic revision TKA and had no history of reported or tested metal sensitivity. All preoperative LTT results were highly reactive to nickel. However, this did not correlate with local periarticular tissue response in 18 of 19 cases which demonstrated a low HSS synovial score (mean: 3.8 ± 2.8, of a maximum score of 28) and the low Campbell ALVAL scores (mean: 2.5/10 ± 1.3, of a maximum score of 10). There were not any significant differences between the study group (suspected implant-related metal allergy) and the control group (nonsuspected implant-related metal allergy) in regard to (1) the Campbell score and (2) the HSS synovial inflammatory score. Knee Society Clinical Rating System (KSCRS) function score improved significantly after revision (mean postoperative increase: 34.0 ± 17. 2; p < 0.001), as well as mean visual analog scale (VAS) pain (mean postoperative decrease: 33.3 ± 26.4; p < 0.01) score. The short-term survival rate (at mean follow-up of 26.1 months) of this patient cohort was 100%. In this cohort of revised TKA patients with suspected nickel allergy based on clinical presentation and LTT positive results, intraoperative histopathology was essentially normal. However, all patients with suspected nickel allergy showed a significant clinical and functional improvement with excellent short-term survival rates. The clinical significance of a positive LTT needs further study.
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Affiliation(s)
- Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Philip P Manolopoulos
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
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8
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Zhang Y, Bauer TW, Rodeo SA. Pseudotumor Associated with a Bioabsorbable Screw in a Patient with Reconstructed Congenital Absence of the Anterior Cruciate Ligament: a Case report. J Clin Transl Pathol 2022; 000:000-000. [DOI: 10.14218/jctp.2022.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
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9
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Kheir MM, Bauer TW, Westrich GH. Diagnosis of Prostate Adenocarcinoma on Routine Pathology After a Primary Total Hip Arthroplasty. Arthroplast Today 2022; 15:19-23. [PMID: 35368851 PMCID: PMC8964817 DOI: 10.1016/j.artd.2022.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022] Open
Abstract
We present a 67-year-old male patient who presented with insidious worsening of right hip pain over a 6-month period with clinical and radiographic evidence of severe osteoarthritis. The patient underwent a primary total hip arthroplasty where the femoral head specimen was sent to pathology as a routine specimen. Pathology results demonstrated metastatic adenocarcinoma of prostate origin. The present case emphasizes the importance of routine pathologic examination of femoral head specimens retrieved during total hip arthroplasty, particularly since this was a clinically unsuspected finding. Although cases like these are rare and the process of routine pathologic examination raises a concern for economic implications, a timely diagnosis of adenocarcinoma provides benefits for the patient, for which cost-benefit ratios are difficult to quantify.
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11
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Bauer TW, Zhang Y, Gao MA, Lin BQ, Koff MF. Reproducibility of pathologic scoring systems for periprosthetic adverse local tissue reactions: A cross-sectional study. Pathol Res Pract 2021; 228:153685. [PMID: 34781211 DOI: 10.1016/j.prp.2021.153685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Several previous studies have described broad histologic classifications of peri-prosthetic reactions that likely reflect the underlying mechanism of arthroplasty failure; however, a consensus has not yet been reached about the relative importance of individual observations. QUESTION/PURPOSE The purpose of this study was to evaluate the inter-examiner repeatability of commonly used histopathologic grading methods, and to determine the utility of assigning a more simple, global categorization in patients undergoing revision THA surgery of implants with a variety of bearing combinations. METHODS Between March 2013 and February 2020, a total of 2131 patients underwent revision hip arthroplasty surgery at a one center, of which 12% (248 of 2131) of patients were enrolled. Two pathologists independently reviewed microscope slides of periprosthetic tissue from these patients, of which 425 slides (229 hips, 222 subjects) were reviewed by both pathologists. Separate slides were used for a priori training of the pathologists. Slides were evaluated with the Campbell Aseptic Lymphocyte-dominant Vasculitis-Associated Lesion (ALVAL) score, the Oxford ALVAL score as modified by Grammatopolous, the Fujishiro and Natu scores, and a proposed simplified pattern classification, similar to that of Krenn et al., that incorporates individual factors of these existing scoring methods and was previously shown to correspond to Magnetic Resonance Imaging findings. Inter-rater agreement was assessed using Gwet's AC1 and AC2 coefficients and correspondence analysis was used to examine associations between individual factors of prior scoring methods with the proposed major pattern. RESULTS Almost perfect inter-rater repeatability (Gwet's AC2 > 0.8) was found for 71% (15/21) of the individual factors, and substantial interrater agreement was found for the proposed major overall pattern (Gwet's AC1: 0.80, 95%CI: 0.72-0.85). Correspondence analysis was able to explain 89-91% of data variability and was able to identify individual features not commonly associated with a major pattern, but discriminatory of the major pattern, such as "Lymph Cuff Thickness 0.25-0.5″ with ALVAL. CONCLUSION In contrast to prior examinations, excellent interrater agreement was found that may be attributable to a priori training of raters with a test set of slides or difficulty of interpreting grading criteria. The proposed simplified major pattern classification may facilitate evaluation of histopathologic tissue samples.
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Affiliation(s)
- Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, 535 East 70th Street, New York, NY, USA.
| | - Yaxia Zhang
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, 535 East 70th Street, New York, NY, USA.
| | - Madeleine A Gao
- Hospital for Special Surgery, MRI Research Laboratory, 535 East 70th Street, New York, NY, USA.
| | - Bin Q Lin
- Hospital for Special Surgery, MRI Research Laboratory, 535 East 70th Street, New York, NY, USA.
| | - Matthew F Koff
- Hospital for Special Surgery, MRI Research Laboratory, 535 East 70th Street, New York, NY, USA.
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Echeverria AP, Cohn IS, Danko DC, Shanaj S, Blair L, Hollemon D, Carli AV, Sculco PK, Ho C, Meshulam-Simon G, Mironenko C, Ivashkiv LB, Goodman SM, Grizas A, Westrich GH, Padgett DE, Figgie MP, Bostrom MP, Sculco TP, Hong DK, Hepinstall MS, Bauer TW, Blauwkamp TA, Brause BD, Miller AO, Henry MW, Ahmed AA, Cross MB, Mason CE, Donlin LT. Sequencing of Circulating Microbial Cell-Free DNA Can Identify Pathogens in Periprosthetic Joint Infections. J Bone Joint Surg Am 2021; 103:1705-1712. [PMID: 34293751 DOI: 10.2106/jbjs.20.02229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Over 1 million Americans undergo joint replacement each year, and approximately 1 in 75 will incur a periprosthetic joint infection. Effective treatment necessitates pathogen identification, yet standard-of-care cultures fail to detect organisms in 10% to 20% of cases and require invasive sampling. We hypothesized that cell-free DNA (cfDNA) fragments from microorganisms in a periprosthetic joint infection can be found in the bloodstream and utilized to accurately identify pathogens via next-generation sequencing. METHODS In this prospective observational study performed at a musculoskeletal specialty hospital in the U.S., we enrolled 53 adults with validated hip or knee periprosthetic joint infections. Participants had peripheral blood drawn immediately prior to surgical treatment. Microbial cfDNA from plasma was sequenced and aligned to a genome database with >1,000 microbial species. Intraoperative tissue and synovial fluid cultures were performed per the standard of care. The primary outcome was accuracy in organism identification with use of blood cfDNA sequencing, as measured by agreement with tissue-culture results. RESULTS Intraoperative and preoperative joint cultures identified an organism in 46 (87%) of 53 patients. Microbial cfDNA sequencing identified the joint pathogen in 35 cases, including 4 of 7 culture-negative cases (57%). Thus, as an adjunct to cultures, cfDNA sequencing increased pathogen detection from 87% to 94%. The median time to species identification for cases with genus-only culture results was 3 days less than standard-of-care methods. Circulating cfDNA sequencing in 14 cases detected additional microorganisms not grown in cultures. At postoperative encounters, cfDNA sequencing demonstrated no detection or reduced levels of the infectious pathogen. CONCLUSIONS Microbial cfDNA from pathogens causing local periprosthetic joint infections can be detected in peripheral blood. These circulating biomarkers can be sequenced from noninvasive venipuncture, providing a novel source for joint pathogen identification. Further development as an adjunct to tissue cultures holds promise to increase the number of cases with accurate pathogen identification and improve time-to-speciation. This test may also offer a novel method to monitor infection clearance during the treatment period. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Ian S Cohn
- Hospital for Special Surgery Research Institute, New York, NY
| | - David C Danko
- Tri-Institutional Computational Biology and Medicine Program, Weill Cornell Medicine of Cornell University, New York, NY
| | - Sara Shanaj
- Hospital for Special Surgery Research Institute, New York, NY
| | | | | | - Alberto V Carli
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Carine Ho
- Karius, Inc., Redwood City, California
| | | | - Christine Mironenko
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Lionel B Ivashkiv
- Hospital for Special Surgery Research Institute, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Susan M Goodman
- Department of Medicine, Weill Cornell Medical College, New York, NY.,Department of Rheumatology, Hospital for Special Surgery, New York, NY
| | - Alexandra Grizas
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Douglas E Padgett
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mark P Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Mathias P Bostrom
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Thomas P Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Matthew S Hepinstall
- Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY.,Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Thomas W Bauer
- Department of Medicine, Weill Cornell Medical College, New York, NY.,Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | | | - Barry D Brause
- Department of Medicine, Weill Cornell Medical College, New York, NY.,Infectious Diseases, Department of Medicine, Hospital for Special Surgery, New York, NY
| | - Andy O Miller
- Department of Medicine, Weill Cornell Medical College, New York, NY.,Infectious Diseases, Department of Medicine, Hospital for Special Surgery, New York, NY
| | - Michael W Henry
- Department of Medicine, Weill Cornell Medical College, New York, NY.,Infectious Diseases, Department of Medicine, Hospital for Special Surgery, New York, NY
| | | | - Michael B Cross
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Christopher E Mason
- Tri-Institutional Computational Biology and Medicine Program, Weill Cornell Medicine of Cornell University, New York, NY.,Department of Physiology and Biophysics and the Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY.,The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY.,The WorldQuant Initiative for Quantitative Prediction, Weill Cornell Medicine, New York, NY.,The Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Laura T Donlin
- Hospital for Special Surgery Research Institute, New York, NY.,Department of Medicine, Weill Cornell Medical College, New York, NY.,Department of Physiology and Biophysics and the Institute for Computational Biomedicine, Weill Cornell Medical College, New York, NY
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Tarity TD, Vigdorchik JM, Westrich GH, Gonzalez Della Valle A, Cerrito P, Baral EC, Bromage TG, Bauer TW. Adaptive Immune Response Associated with a Zirconium-Containing, Cemented, Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00092. [PMID: 34449449 DOI: 10.2106/jbjs.cc.21.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE A 69-year-old woman underwent revision total knee arthroplasty for patellar component aseptic loosening. The periprosthetic tissue demonstrated histologic features of an adaptive immune response (aseptic lymphocyte-dominant vasculitis-associated lesion [ALVAL]). No particles of corrosion debris were identified. The inflammation seemed to be associated with zirconium oxide (ZrO2) particles added as a bone cement radio-opacifier. CONCLUSION The factors responsible for the adaptive immune response cannot be determined with certainty; however, this is the first reported case of ALVAL associated with ZrO2-containing bone cement. Previous reports describing ALVAL around failed total knee prostheses have not included observations about the type of contrast material added to cement.
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Affiliation(s)
- T David Tarity
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Geoffrey H Westrich
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | | | - Paola Cerrito
- Departments of Anthropology and Molecular Pathobiology, New York University College of Dentistry, New York, New York
| | - Elexis C Baral
- Department of Biomedical Engineering, Hospital for Special Surgery, New York, New York
| | - Timothy G Bromage
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
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15
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Abstract
AIMS Dual mobility implants in total hip arthroplasty are designed to increase the functional head size, thus decreasing the potential for dislocation. Modular dual mobility (MDM) implants incorporate a metal liner (e.g. cobalt-chromium alloy) in a metal shell (e.g. titanium alloy), raising concern for mechanically assisted crevice corrosion at the modular liner-shell connection. We sought to examine fretting and corrosion on MDM liners, to analyze the corrosion products, and to examine histologically the periprosthetic tissues. METHODS A total of 60 retrieved liners were subjectively scored for fretting and corrosion. The corrosion products from the three most severely corroded implants were removed from the implant surface, imaged using scanning electron microscopy, and analyzed using Fourier-transform infrared spectroscopy. RESULTS Fretting was present on 88% (53/60) of the retrieved liners, and corrosion was present on 97% (58/60). Fretting was most often found on the lip of the taper at the transition between the lip and the dome regions. Macrophages and particles reflecting an innate inflammatory reaction to corrosion debris were noted in six of the 48 cases for which periprosthetic tissues were examined, and all were associated with retrieved components that had high corrosion scores. CONCLUSION Our results show that corrosion occurs at the interface between MDM liners and shells and that it can be associated with reactions in the local tissues, suggesting continued concern that this problem may become clinically important with longer-term use of these implants. Cite this article: Bone Joint J 2021;103-B(7):1238-1246.
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Affiliation(s)
| | - Lydia Weitzler
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
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16
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Dowdell J, Cong GT, Verma R, Gang CH, Bauer TW, Qureshi SA. Inferior Articular Process Fracture in a Collegiate Athlete Causing Back Pain: A Case Report of Surgical Treatment. JBJS Case Connect 2021; 11:01709767-202106000-00036. [PMID: 33979830 DOI: 10.2106/jbjs.cc.20.00173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CASE A 20-year-old male athlete presented with 8 months of low back pain. Conservative management had been unsuccessful. He noted lumbar spine pain with extension, and imaging showed features of an L4-5 inferior articular facet tip fracture. The fragment was excised, he returned to college lacrosse and is without symptoms at the 9-month follow-up. CONCLUSION In similar cases with facet fragments, we would recommend a full workup and attempt nonoperative therapy. If not improved and a diagnostic injection provides near-complete relief, then resection of the facet fragment can be discussed as a potentially effective and conservative surgical option.
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Affiliation(s)
| | | | - Ravi Verma
- Hospital for Special Surgery, New York, New York
| | | | - Thomas W Bauer
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medical College, New York, New York
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, New York.,Weill Cornell Medical College, New York, New York
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17
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Carli AV, Gkiatas I, Bauer TW, Wright TM, Gonzalez FQ, Sculco PK. Sister, Sister! Siblings With Simultaneous Early Femoral Insufficiency Fractures After Total Knee Arthroplasty. Arthroplast Today 2021; 7:188-193. [PMID: 33553548 PMCID: PMC7856391 DOI: 10.1016/j.artd.2020.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/06/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022] Open
Abstract
Early periprosthetic fractures after total knee arthroplasty are rare but devastating complications which require revision surgery and lead to poor patient satisfaction. We present 2 siblings who underwent primary total knee arthroplasty on the same day and then both presented 2 weeks after surgery with atraumatic periprosthetic femur fractures. The first patient underwent revision for a cemented distal femoral replacement with stemmed tibial fixation. The second patient underwent an isolated femoral component revision with a stemmed femoral component and distal augment. Histological evaluation identified significant peri-implant osteoporosis. The variation in complexity associated with early periprosthetic femoral insufficiency fractures is highlighted by these 2 cases. Surgeons may consider using stemmed femoral components in similar patients if poor distal femoral bone stock is encountered intraoperatively.
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Affiliation(s)
- Alberto V Carli
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | | | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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18
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Saeed K, Sendi P, Arnold WV, Bauer TW, Coraça-Huber DC, Chen AF, Choe H, Daiss JL, Ghert M, Hickok NJ, Nishitani K, Springer BD, Stoodley P, Sculco TP, Brause BD, Parvizi J, McLaren AC, Schwarz EM. Bacterial toxins in musculoskeletal infections. J Orthop Res 2021; 39:240-250. [PMID: 32255540 PMCID: PMC7541548 DOI: 10.1002/jor.24683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/27/2020] [Accepted: 04/01/2020] [Indexed: 02/04/2023]
Abstract
Musculoskeletal infections (MSKIs) remain a major health burden in orthopaedics. Bacterial toxins are foundational to pathogenesis in MSKI, but poorly understood by the community of providers that care for patients with MSKI, inducing an international group of microbiologists, infectious diseases specialists, orthopaedic surgeons and biofilm scientists to review the literature in this field to identify key topics and compile the current knowledge on the role of toxins in MSKI, with the goal of illuminating potential impact on biofilm formation and dispersal as well as therapeutic strategies. The group concluded that further research is needed to maximize our understanding of the effect of toxins on MSKIs, including: (i) further research to identify the roles of bacterial toxins in MSKIs, (ii) establish the understanding of the importance of environmental and host factors and in vivo expression of toxins throughout the course of an infection, (iii) establish the principles of drug-ability of antitoxins as antimicrobial agents in MSKIs, (iv) have well-defined metrics of success for antitoxins as antiinfective drugs, (v) design a cocktail of antitoxins against specific pathogens to (a) inhibit biofilm formation and (b) inhibit toxin release. The applicability of antitoxins as potential antimicrobials in the era of rising antibiotic resistance could meet the needs of day-to-day clinicians.
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Affiliation(s)
- Kordo Saeed
- University Hospital Southampton NHS Foundation Trust, Department of Microbiology, Microbiology Innovation and Research Unit (MIRU), Southampton, UK; and University of Southampton, School of Medicine, Southampton UK
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology/ Department of Orthopaedics and Traumatology, University Hospital Basel, University Basel, Basel, Switzerland
| | - William V. Arnold
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Hospital for Special Surgery, New York, NY, USA
| | - Débora C. Coraça-Huber
- Research Laboratory for Implant Associated Infections (Biofilm Lab), Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Antonia F. Chen
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - John L. Daiss
- Center for Musculoskeletal Research, School of Medicine and Dentistry University of Rochester, Rochester, NY, USA
| | - Michelle Ghert
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Noreen J. Hickok
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan
| | - Bryan D. Springer
- OrthoCarolina Hip and Knee Center, Atrium Musculoskeletal Institute, Charlotte, NC, USA
| | - Paul Stoodley
- Departments of Microbial Infection and Immunity and OrthopedicsInfectious Diseases Institute, The Ohio State University, 716 Biomedical Research Tower, 460 West 12th Avenue, Columbus OH, Canada
- National Centre for Microbial Tribology at Southampton (nCATS), National Biofilm Innovation Centre (NBIC), Mechanical Engineering, University of Southampton, Southampton, UK.
| | - Thomas P. Sculco
- Department of Orthopaedic Surgery, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Barry D. Brause
- Department of Infectious Diseases, Weill Cornell Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Javad Parvizi
- Department of Orthopaedics, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Alex C. McLaren
- Department of Orthopaedic Surgery, University of Arizona, College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, Department of Orthopaedics, University of Rochester, Rochester, NY, USA
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19
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Malahias MA, Bauer TW, Gu A, Nocon AA, De Martino I, Sculco PK. Questioning the Clinical Relevance of Positive Post-implantation Allergy Testing for Metal Hypersensitivity in Total Knee Arthroplasty: A Didactic Case Report. HSS J 2020; 16:485-489. [PMID: 33380984 PMCID: PMC7749884 DOI: 10.1007/s11420-019-09710-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021 USA
| | - Alex Gu
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Allina A. Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Ivan De Martino
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 USA
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Sherafati M, Bauer TW, Potter HG, Koff MF, Koch KM. Multivariate use of MRI biomarkers to classify histologically confirmed necrosis in symptomatic total hip arthroplasty. J Orthop Res 2020; 38:1506-1514. [PMID: 32162716 PMCID: PMC8100875 DOI: 10.1002/jor.24654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/24/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
The failure of total hip arthroplasty (THA) is commonly associated with the necrosis of the periprosthetic tissue. To date, there is no established method to noninvasively quantify the progression of such necrosis. Magnetic resonance imaging (MRI) of soft tissues near implants has undergone a recent renaissance due to the development of multispectral metal-artifact reduction techniques. Advanced analysis of multispectral MRI has been shown capable of detecting small magnetism effects of metallic debris in periprosthetic tissue. The purpose of this study is to demonstrate the diagnostic utility of these MRI-based tissue-magnetism signatures. Together with morphological MRI metrics, such as synovial volume and thickness, these measurements are utilized as biomarkers to noninvasively detect soft-tissue necrosis in symptomatic THA patients ( N = 78 ). All subjects underwent an advanced MRI scan before revision surgery and tissue biopsies utilized for necrosis grading. Statistical analyses demonstrated a weak, but significant positive correlation (P = .04) between MRI magnetism signatures and necrosis scores, while indicating no meaningful association between the latter and serum cobalt and chromium ion levels. Receiver-operating characteristic (ROC) analyses were then performed based on uni- and multivariate logistic regression models utilizing the measured MRI biomarkers as predictors of severe necrosis. The area under the curve of the ROC plots for MRI biomarkers as combined predictors were found to be 0.70 and 0.84 for cross-validation and precision-recall tests, respectively.
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Affiliation(s)
| | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Matthew F. Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
| | - Kevin M. Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
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21
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Borowsky AD, Glassy EF, Wallace WD, Kallichanda NS, Behling CA, Miller DV, Oswal HN, Feddersen RM, Bakhtar OR, Mendoza AE, Molden DP, Saffer HL, Wixom CR, Albro JE, Cessna MH, Hall BJ, Lloyd IE, Bishop JW, Darrow MA, Gui D, Jen KY, Walby JAS, Bauer SM, Cortez DA, Gandhi P, Rodgers MM, Rodriguez RA, Martin DR, McConnell TG, Reynolds SJ, Spigel JH, Stepenaskie SA, Viktorova E, Magari R, Wharton KA, Qiu J, Bauer TW. Digital Whole Slide Imaging Compared With Light Microscopy for Primary Diagnosis in Surgical Pathology. Arch Pathol Lab Med 2020; 144:1245-1253. [DOI: 10.5858/arpa.2019-0569-oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/28/2022]
Abstract
Context.—The adoption of digital capture of pathology slides as whole slide images (WSI) for educational and research applications has proven utility.Objective.—To compare pathologists' primary diagnoses derived from WSI versus the standard microscope. Because WSIs differ in format and method of observation compared with the current standard glass slide microscopy, this study is critical to potential clinical adoption of digital pathology.Design.—The study enrolled a total of 2045 cases enriched for more difficult diagnostic categories and represented as 5849 slides were curated and provided for diagnosis by a team of 19 reading pathologists separately as WSI or as glass slides viewed by light microscope. Cases were reviewed by each pathologist in both modalities in randomized order with a minimum 31-day washout between modality reads for each case. Each diagnosis was compared with the original clinical reference diagnosis by an independent central adjudication review.Results.—The overall major discrepancy rates were 3.64% for WSI review and 3.20% for manual slide review diagnosis methods, a difference of 0.44% (95% CI, −0.15 to 1.03). The time to review a case averaged 5.20 minutes for WSI and 4.95 minutes for glass slides. There was no specific subset of diagnostic category that showed higher rates of modality-specific discrepancy, though some categories showed greater discrepancy than others in both modalities.Conclusions.—WSIs are noninferior to traditional glass slides for primary diagnosis in anatomic pathology.
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Affiliation(s)
- Alexander D. Borowsky
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Eric F. Glassy
- The Affiliated Pathologists Medical Group, Rancho Dominguez, California (Glassy, Kallichanda)
| | | | - Nathash S. Kallichanda
- The Affiliated Pathologists Medical Group, Rancho Dominguez, California (Glassy, Kallichanda)
| | - Cynthia A. Behling
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Dylan V. Miller
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Hemlata N. Oswal
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Richard M. Feddersen
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Omid R. Bakhtar
- Scripps Clinic Torrey Pines, La Jolla, California (Bakhtar, Ghandi)
| | - Arturo E. Mendoza
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Daniel P. Molden
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Helene L. Saffer
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - Christopher R. Wixom
- The Pacific Rim Pathology Lab and Sharp Healthcare, San Diego, California (Behling, Mendoza, Molden, Saffer, Wixom)
| | - James E. Albro
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Melissa H. Cessna
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Brian J. Hall
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - Isaac E. Lloyd
- Intermountain Central Laboratory, Salt Lake City, Utah (Miller, Albro, Cessna, Hall, Lloyd)
| | - John W. Bishop
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Morgan A. Darrow
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Dorina Gui
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Kuang-Yu Jen
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Julie Ann S. Walby
- From the Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento (Borowsky, Bishop, Darrow, Gui, Jen, Walby)
| | - Stephen M. Bauer
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Daniel A. Cortez
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Pranav Gandhi
- Scripps Clinic Torrey Pines, La Jolla, California (Bakhtar, Ghandi)
| | - Melissa M. Rodgers
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - Rafael A. Rodriguez
- The Pathology Department, Lucent Pathology Partners Mercy San Juan Hospital, Carmichael, California (Oswal, SM Bauer, Cortez, Rodgers, Rodriguez)
| | - David R. Martin
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Thomas G. McConnell
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Samuel J. Reynolds
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - James H. Spigel
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | - Shelly A. Stepenaskie
- The Histology Lab, TriCore Reference Laboratories, Albuquerque, New Mexico (Feddersen, Martin, McConnell, Reynolds, Spigel, Stepenaskie)
| | | | - Robert Magari
- Beckman Coulter, Inc., Miami, Florida (Viktorova, Magari)
| | - Keith A. Wharton
- Leica Biosystems Imaging, Inc., Danvers, Massachusetts (Wharton)
| | | | - Thomas W. Bauer
- The Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York (TW Bauer)
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Bauer TW, Behling C, Miller DV, Chang BS, Viktorova E, Magari R, Jensen PE, Wharton KA, Qiu J. Precise Identification of Cell and Tissue Features Important for Histopathologic Diagnosis by a Whole Slide Imaging System. J Pathol Inform 2020; 11:3. [PMID: 32154040 PMCID: PMC7032023 DOI: 10.4103/jpi.jpi_47_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Previous studies have demonstrated the noninferiority of pathologists’ interpretation of whole slide images (WSIs) compared to microscopic slides in diagnostic surgical pathology; however, to our knowledge, no published studies have tested analytical precision of an entire WSI system. Methods: In this study, five pathologists at three locations tested intra-system, inter-system/site, and intra- and inter-pathologist precision of the Aperio AT2 DX System (Leica Biosystems, Vista, CA, USA). Sixty-nine microscopic slides containing 23 different morphologic features suggested by the Digital Pathology Association as important to diagnostic pathology were identified and scanned. Each of 202 unique fields of view (FOVs) had 1–3 defined morphologic features, and each feature was represented in three different tissues. For intra-system precision, each site scanned 23 slides at three different times and one pathologist interpreted all FOVs. For inter-system/site precision, all 69 slides were scanned once at each of three sites, and FOVs from each site were read by one pathologist. To test intra- and inter-pathologist precision, all 69 slides were scanned at one site, FOVs were saved in three different orientations, and the FOVs were transferred to a different site. Three different pathologists then interpreted FOVs from all 69 slides. Wildcard (unscored) slides and washout intervals were included in each study. Agreement estimates with 95% confidence intervals were calculated. Results: Combined precision from all three studies, representing 606 FOVs in each of the three studies, showed overall intra-system agreement of 97.9%; inter-system/site agreement was 96%, intra-pathologist agreement was 95%, and inter-pathologist agreement was 94.2%. Conclusions: Pathologists using the Aperio AT2 DX System identified histopathological features with high precision, providing increased confidence in using WSI for primary diagnosis in surgical pathology.
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Affiliation(s)
- Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
| | | | - Dylan V Miller
- Intermountain Central Laboratory, Salt Lake City, UT, USA
| | | | | | | | | | | | - Jinsong Qiu
- Leica Biosystems Imaging, Inc., Vista, CA, USA
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24
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Eliasberg CD, Lin KM, Bauer TW, Rodeo SA. Development of a Meniscal Ossicle After a Meniscal Root Repair Augmented with Bone Marrow Aspirate Concentrate: A Case Report. JBJS Case Connect 2020; 10:e0419. [PMID: 32224660 DOI: 10.2106/jbjs.cc.19.00419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE A 17-year-old boy had persistent knee pain 1 year after medial meniscal root repair augmented with bone marrow aspirate concentrate injection. Radiographs and magnetic resonance imaging (MRI) demonstrated an intrameniscal ossicle which was not present on MRI performed before 6 months. He underwent arthroscopic excision of the meniscal ossicle. At the 7-month follow-up, he had complete relief of his pain. CONCLUSIONS It is possible that the meniscal ossicle developed because of osteoinductive cells and cytokines from the injected bone marrow or the drill hole for root repair and should be considered as a possible complication of this procedure.
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Affiliation(s)
- Claire D Eliasberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Kenneth M Lin
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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McGrath JS, Honrado C, Moore JH, Adair SJ, Varhue WB, Salahi A, Farmehini V, Goudreau BJ, Nagdas S, Blais EM, Bauer TW, Swami NS. Electrophysiology-based stratification of pancreatic tumorigenicity by label-free single-cell impedance cytometry. Anal Chim Acta 2019; 1101:90-98. [PMID: 32029124 DOI: 10.1016/j.aca.2019.12.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/13/2019] [Accepted: 12/14/2019] [Indexed: 12/14/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer lacking specific biomarkers that can be correlated to disease onset, promotion and progression. To assess whether tumor cell electrophysiology may serve as a marker for PDAC tumorigenicity, we use multi-frequency impedance cytometry at high throughput (∼350 cells/s) to measure the electrical phenotype of single PDAC tumor cells from xenografts, which are derived from primary pancreatic tumors versus those from liver metastases of different patients. A novel phase contrast metric based on variations in the high and low frequency impedance phase responses that is related to electrophysiology of the cell interior is found to be systematically altered as a function of tumorigenicity. PDAC cells of higher tumorigenicity exhibited lowered interior conductivity and enhanced permittivity, which is validated by the dielectrophoresis on the respective cell types. Using genetic analysis, we suggest the role of dysregulated Na+ transport and removal of Ca2+ ions from the cytoplasm on key oncogenic KRAS-driven processes that may be responsible for lowering of the interior cell conductivity. We envision that impedance cytometry can serve as a tool to quantify phenotypic heterogeneity for rapidly stratifying tumorigenicity. It can also aid in protocols for dielectrophoretic isolation of cells with a particular phenotype for prognostic studies on patient survival and to tailor therapy selection to specific patients.
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Affiliation(s)
- J S McGrath
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA
| | - C Honrado
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA
| | - J H Moore
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA
| | - S J Adair
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - W B Varhue
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA
| | - A Salahi
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA
| | - V Farmehini
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA
| | - B J Goudreau
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - S Nagdas
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - E M Blais
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - T W Bauer
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - N S Swami
- School of Engineering and Applied Sciences, University of Virginia, Charlottesville, VA, USA.
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Affiliation(s)
- Chun Hoi Yan
- Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Carla Renata Arciola
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Spain
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Bauer TW, Bechtold JE, Swiontkowski MF. JBJS Will Require Adherence to ARRIVE Guidelines for Animal Research to Reduce Bias and Improve Quality of Reporting. J Bone Joint Surg Am 2019; 101:1891-1893. [PMID: 31693522 DOI: 10.2106/jbjs.19.01001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Bauer TW, Resnick L. Coagulopathic Complications in Orthopaedics. JBJS Case Connect 2019; 9:e0266. [PMID: 31211749 DOI: 10.2106/jbjs.cc.19.00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Piuzzi NS, Ng M, Chughtai M, Khlopas A, Ramkumar PN, Harwin SF, Mont MA, Bauer TW, Muschler GF. Accelerated Growth of Cellular Therapy Trials in Musculoskeletal Disorders: An Analysis of the NIH Clinical Trials Data Bank. Orthopedics 2019; 42:e144-e150. [PMID: 30668881 DOI: 10.3928/01477447-20190118-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/23/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to (1) determine the growth rate and the trends of musculoskeletal cellular therapy trials in the National Institutes of Health Clinical Trials Data Bank; (2) analyze the study design and characteristics; and (3) assess which cellular therapies and disease conditions are studied. A systematic review of musculoskeletal clinical trials from 2005 to 2016 using cell-based therapies as the primary intervention was performed through ClinicalTrials.gov. The number of musculoskeletal cell-based clinical trials is increasing, with most being early stage, phase I/II, and using autologous cells harvested mostly from bone marrow to target cartilage-related diseases. Among the 282 clinical trials identified, only 99 (35.1%) were completed; 62 of the 99 (62.6%) did not list any related publications. [Orthopedics. 2019; 42(2):e144-e150.].
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Aalirezaie A, Bauer TW, Fayaz H, Griffin W, Higuera CA, Krenn V, Krenn V, Molano M, Moojen DJ, Restrepo C, Shahi A, Shubnyakov I, Sporer S, Tanavalee A, Teloken M, Velázquez Moreno JD. Hip and Knee Section, Diagnosis, Reimplantation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S369-S379. [PMID: 30343965 DOI: 10.1016/j.arth.2018.09.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Bauer TW, Bedair H, Creech JD, Deirmengian C, Eriksson H, Fillingham Y, Grigoryan G, Hickok N, Krenn V, Krenn V, Lazarinis S, Lidgren L, Lonner J, Odum S, Shah J, Shahi A, Shohat N, Tarabichi M, W-Dahl A, Wongworawat MD. Hip and Knee Section, Diagnosis, Laboratory Tests: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S351-S359. [PMID: 30343973 DOI: 10.1016/j.arth.2018.09.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Piuzzi NS, Dominici M, Long M, Pascual-Garrido C, Rodeo S, Huard J, Guicheux J, McFarland R, Goodrich LR, Maddens S, Robey PG, Bauer TW, Barrett J, Barry F, Karli D, Chu CR, Weiss DJ, Martin I, Jorgensen C, Muschler GF. Proceedings of the signature series symposium "cellular therapies for orthopaedics and musculoskeletal disease proven and unproven therapies-promise, facts and fantasy," international society for cellular therapies, montreal, canada, may 2, 2018. Cytotherapy 2018; 20:1381-1400. [PMID: 30316562 PMCID: PMC8487641 DOI: 10.1016/j.jcyt.2018.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Abstract
The Signature Series Symposium "Cellular Therapies for Orthopaedics and Musculoskeletal Disease Proven and Unproven Therapies-Promise, Facts and Fantasy" was held as a pre-meeting of the 26th International Society for Cellular Therapy (ISCT) annual congress in Montreal, Canada, May 2, 2018. This was the first ISCT program that was entirely dedicated to the advancement of cell-based therapies for musculoskeletal diseases. Cellular therapies in musculoskeletal medicine are a source of great promise and opportunity. They are also the source of public controversy, confusion and misinformation. Patients, clinicians, scientists, industry and government share a commitment to clear communication and responsible development of the field. Therefore, this symposium convened thought leaders from around the world in a forum designed to catalyze communication and collaboration to bring the greatest possible innovation and value to patients with musculoskeletal conditions.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopedic Surgery and Biomedical Engineering Cleveland Clinic, Cleveland, Ohio, USA; Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Massimo Dominici
- Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Marc Long
- MTF Biologics, Edison, New Jersey, USA
| | - Cecilia Pascual-Garrido
- Adult Reconstruction-Adolescent and Young Adult Hip Service, Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA
| | - Scott Rodeo
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Johnny Huard
- Department of Orthopaedic Surgery, UTHealth Medical School, Houston, Texas, USA; Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jérome Guicheux
- INSERM, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Nantes University School of Dental Medicine, ONIRIS, Nantes, France; CHU Nantes, PHU4 OTONN, Nantes, France
| | - Richard McFarland
- Advanced Regenerative Manufacturing Institute, Manchester, New Hampshire, USA, and Standards Coordinating Body, Gaithersburg, Maryland, USA
| | - Laurie R Goodrich
- Orthopaedic Research Center and Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | | | - Pamela G Robey
- Skeletal Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York, USA
| | - John Barrett
- Stem Cell Allogeneic Transplant Section, National Institutes of Health, Bethesda, Maryland, USA
| | - Frank Barry
- Regenerative Medicine Institute, National University of Ireland, Galway, Ireland
| | - David Karli
- Steadman Philippon Research Institute, Vail, Colorado, USA; Greyledge Technologies, LLC, Vail, Colorado, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Daniel J Weiss
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Ivan Martin
- Department of Biomedicine, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Christian Jorgensen
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Hôpital Lapeyronie, Montpellier, France
| | - George F Muschler
- Department of Orthopedic Surgery and Biomedical Engineering Cleveland Clinic, Cleveland, Ohio, USA.
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Bauer TW, Resnick L. Causes and Conditions Associated with Septic Arthritis. JBJS Case Connect 2018; 8:e103. [PMID: 30601273 DOI: 10.2106/jbjs.cc.18.00456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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George J, Zhang Y, Jawad M, Faour M, Klika AK, Bauer TW, Higuera CA. Diagnostic Utility of Histological Analysis for Detecting Ongoing Infection During Two-Stage Revision Arthroplasty in Patients With Inflammatory Arthritis. J Arthroplasty 2018; 33:S219-S223. [PMID: 29352690 DOI: 10.1016/j.arth.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgeons often rely on intra-operative histology (frozen sections [FS]) to determine the next step in surgical management during the second stage (re-implantation surgery) of 2-stage revision arthroplasty. The purpose of the study is to assess the accuracy of permanent sections (PS) and FS in the diagnosis of persistent infection during re-implantation in patients with an inflammatory arthritis. METHODS From 2001 to 2016, 47 planned second-stage revision total hip arthroplasty and total knee arthroplasty in patients with inflammatory arthritis were identified. Revisions were classified as having persistent infection if they were Musculoskeletal Infection Society positive at the time of second stage. PS or FS was considered to be positive for infection when at least one of the specimens demonstrated an acute inflammation. Receiver operating characteristic analysis was performed to obtain the diagnostic parameters. RESULTS There were 9 (19%) persistent infections. Both PS and FS had very high specificity (PS = FS = 94.7%). Sensitivity of PS was higher than FS, although not statistically significant (PS = 88.9%, FS = 55.6%, P = .083). Overall, PS had a better diagnostic utility than FS (area under the curve: PS vs FS = 0.92 vs 0.75, P = .045). Four specimens had discrepancies between PS and FS histology. In all 4 instances, the specimens were read as positive (infected) by PS, but negative by FS. CONCLUSION Histological analysis is recommended at the time of re-implantation surgery even in patients with inflammatory arthritis. PS had a better diagnostic utility than FS suggesting that areas of acute inflammation may be scattered and may not always be captured in the specimens taken for FS.
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Affiliation(s)
- Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Yaxia Zhang
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Michael Jawad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Mhamad Faour
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
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Bauer TW, Harper A. Complicated Total Hip and Knee Replacement in Patients with Underlying Skeletal and Vascular Disorders. JBJS Case Connect 2018; 8:e40. [PMID: 29952774 DOI: 10.2106/jbjs.cc.18.00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Evans AJ, Bauer TW, Bui MM, Cornish TC, Duncan H, Glassy EF, Hipp J, McGee RS, Murphy D, Myers C, O'Neill DG, Parwani AV, Rampy BA, Salama ME, Pantanowitz L. US Food and Drug Administration Approval of Whole Slide Imaging for Primary Diagnosis: A Key Milestone Is Reached and New Questions Are Raised. Arch Pathol Lab Med 2018; 142:1383-1387. [PMID: 29708429 DOI: 10.5858/arpa.2017-0496-cp] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
April 12, 2017 marked a significant day in the evolution of digital pathology in the United States, when the US Food and Drug Administration announced its approval of the Philips IntelliSite Pathology Solution for primary diagnosis in surgical pathology. Although this event is expected to facilitate more widespread adoption of whole slide imaging for clinical applications in the United States, it also raises a number of questions as to the means by which pathologists might choose to incorporate this technology into their clinical practice. This article from the College of American Pathologists Digital Pathology Committee reviews frequently asked questions on this topic and provides answers based on currently available information.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Liron Pantanowitz
- From the Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto, Ontario, Canada (Dr Evans); the Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York (Dr Bauer); the Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Dr Bui); the Department of Pathology, University of Colorado Denver, Aurora (Dr Cornish); Economic and Regulatory Affairs, College of American Pathologists, Washington, DC (Ms Duncan); Affiliated Pathologists Medical Group, Rancho Dominguez, California (Dr Glassy); the Medical Brain Team, Google, San Francisco, California (Dr Hipp); Covance, Indianapolis, Indiana (Dr McGee); the Surveys Department, College of American Pathologists, Northfield, Illinois (Mr Murphy); the Department of Pathology, Emory University Hospital, Atlanta, Georgia (Dr Myers); the Department of Pathology, Manchester Memorial Hospital, Manchester, Connecticut (Dr O'Neill); the Department of Pathology, Ohio State University Wexner Medical Center, Columbus (Dr Parwani); the Department of Pathology, Dell Medical School, University of Texas at Austin (Dr Rampy); ARUP Laboratories Incorporated, Salt Lake City, Utah (Dr Salama); and the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Pantanowitz)
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Nahal A, Batac CMO, Slaw RJ, Bauer TW. Setting Up an ePathology Service at Cleveland Clinic Abu Dhabi: Joint Collaboration With Cleveland Clinic, United States. Arch Pathol Lab Med 2018; 142:1216-1222. [PMID: 29688032 DOI: 10.5858/arpa.2017-0216-ra] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The production of whole slide images is the most advanced form of digital pathology, in which a high-resolution digital scanner is used to rapidly scan glass microscope slides and produce a computer-generated whole slide image that can be saved, stored in a network-attached storage device, and accessed through slide management software within the hospital domain and remotely by authorized users. Digital transformation of glass slides has revolutionized the practice of anatomic pathology by facilitating and expediting consultative services, improving clinical workflow, and becoming an indispensable tool in education and research. OBJECTIVE.— To highlight the institutional need of Cleveland Clinic Abu Dhabi (Abu Dhabi, United Arab Emirates) and the cultural background for obtaining the United Arab Emirates' first comprehensive digital pathology program; to describe a multiphase road map for achieving full implementation of this platform; and to describe the system's clinical applications and its future potential growth. DATA SOURCES.— At Cleveland Clinic Abu Dhabi, we prioritized our efforts to initiate digital consultations (eConsultations) and digital immunohistochemistry services (eIHC) with Cleveland Clinic Laboratories (Cleveland, Ohio). After this, we established an internal archiving system together with a subspecialty-based, organ-specific digital library of pathologic diseases. CONCLUSIONS.— We describe the strategic adoption and implementation of digital pathology into the clinical workflow of the pathology and laboratory medicine institute of Cleveland Clinic Abu Dhabi, and we highlight its impact on clinical operations, educational activities, and patient care.
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Affiliation(s)
| | | | | | - Thomas W Bauer
- From the Pathology and Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates (Dr Nahal and Ms Batac); the Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio (Ms Slaw and Dr Bauer); and the Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York (Dr Bauer)
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Zhang XF, Chakedis J, Bagante F, Chen Q, Beal EW, Lv Y, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Soubrane O, Martel G, Groot Koerkamp B, Guglielmi A, Itaru E, Pawlik TM. Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg 2018; 105:857-866. [PMID: 29656380 DOI: 10.1002/bjs.10827] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of routine lymph node dissection (LND) in the surgical treatment of intrahepatic cholangiocarcinoma (ICC) remains controversial. The objective of this study was to investigate the trends of LND use in the surgical treatment of ICC. METHODS Patients undergoing curative intent resection for ICC in 2000-2015 were identified from an international multi-institutional database. Use of lymphadenectomy was evaluated over time and by geographical region (West versus East); LND use and final nodal status were analysed relative to AJCC T categories. RESULTS Among the 1084 patients identified, half (535, 49·4 per cent) underwent concomitant hepatic resection and LND. Between 2000 and 2015, the proportion of patients undergoing LND for ICC nearly doubled: 44·4 per cent in 2000 versus 81·5 per cent in 2015 (P < 0·001). Use of LND increased over time among both Eastern and Western centres. The odds of LND was associated with the time period of surgery and the extent of the tumour/T status (referent T1a: OR 2·43 for T2, P = 0·001; OR 2·13 for T3, P = 0·016). Among the 535 patients who had LND, lymph node metastasis (LNM) was noted in 209 (39·1 per cent). Specifically, the incidence of LNM was 24 per cent in T1a disease, 22 per cent in T1b, 42·9 per cent in T2, 48 per cent in T3 and 66 per cent in T4 (P < 0·001). AJCC T3 and T4 categories, harvesting of six or more lymph nodes, and presence of satellite lesions were independently associated with LNM. CONCLUSION The rate of LNM was high across all T categories, with one in five patients with T1 disease having nodal metastasis. The trend in increased use of LND suggests a growing adoption of AJCC recommendations in the treatment of ICC.
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Affiliation(s)
- X-F Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J Chakedis
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - F Bagante
- Department of Surgery, University of Verona, Verona, Italy
| | - Q Chen
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - E W Beal
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Y Lv
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - M Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - I Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - H P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - L Aldrighetti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - S K Maithel
- Department of Surgery, Emory University, Atlanta, Georgia, USA
| | - C Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - T W Bauer
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - G A Poultsides
- Department of Surgery, Stanford University, Stanford, California, USA
| | - O Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Assistance Publique - Hôpitaux de Paris, Beaujon Hospital, Clichy, France
| | - G Martel
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - B Groot Koerkamp
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A Guglielmi
- Department of Surgery, University of Verona, Verona, Italy
| | - E Itaru
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - T M Pawlik
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Bauer TW. Commentary: Whole-slide Images - Good Enough for Primary Diagnosis? J Pathol Inform 2018. [PMID: 29531848 PMCID: PMC5841012 DOI: 10.4103/jpi.jpi_72_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, NY, USA
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Grosso MJ, Frangiamore SJ, Yakubek G, Bauer TW, Iannotti JP, Ricchetti ET. Performance of implant sonication culture for the diagnosis of periprosthetic shoulder infection. J Shoulder Elbow Surg 2018; 27:211-216. [PMID: 29037535 DOI: 10.1016/j.jse.2017.08.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diagnosing infection after shoulder arthroplasty can be a challenge because of the high prevalence of low-virulence organisms, such as Propionibacterium acnes. The purpose of this study was to evaluate the utility of implant sonication fluid cultures in the diagnosis of periprosthetic joint infection compared with standard culture techniques in patients undergoing revision shoulder arthroplasty. METHODS Routine perioperative testing was performed in 53 patients who underwent revision shoulder arthroplasty. In addition to routine tissue and fluid culture, the retrieved shoulder implants underwent sonication with culture of the sonicate fluid. Diagnostic performance of implant sonication culture was determined on the basis of previously defined infection criteria and compared with standard intraoperative cultures. RESULTS Of the 53 revision cases that underwent implant sonication fluid culture, 25 (47%) were classified as infected. Intraoperative culture (tissue and fluid) sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were 96%, 75%, 77%, 95%, and 85%, respectively. Using a cutoff of >20 colony-forming units per milliliter to exclude contaminants, the sensitivity, specificity, PPV, NPV, and accuracy of implant sonicate culture were 56% (P < .001, compared with standard intraoperative cultures), 93% (P = .07), 88% (P = .4), 70% (P = .02), and 75% (P = .22), respectively. Without use of a sonication fluid culture cutoff value, the sensitivity, specificity, PPV, NPV, and accuracy of implant sonicate culture were 96% (P = 1.0, compared with standard intraoperative cultures), 64% (P = .38), 71% (P = .53), 95% (P = .9), and 79% (P = .45). CONCLUSIONS Implant sonication fluid culture in revision shoulder arthroplasty showed no significant benefits over standard intraoperative cultures in diagnostic utility for periprosthetic joint infection.
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Affiliation(s)
- Matthew J Grosso
- Department of Orthopaedic Surgery, NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Salvatore J Frangiamore
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - George Yakubek
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas W Bauer
- Department of Anatomic Pathology, Department of Orthopedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Bauer TW. CORR Insights ®: Current Pathologic Scoring Systems for Metal-on-metal THA Revisions are not Reproducible. Clin Orthop Relat Res 2017; 475:3012-3014. [PMID: 28956270 PMCID: PMC5670081 DOI: 10.1007/s11999-017-5512-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/22/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Thomas W. Bauer
- 0000 0001 2285 8823grid.239915.5Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
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43
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Zhang XF, Beal EW, Bagante F, Chakedis J, Weiss M, Popescu I, Marques HP, Aldrighetti L, Maithel SK, Pulitano C, Bauer TW, Shen F, Poultsides GA, Soubrane O, Martel G, Koerkamp BG, Itaru E, Pawlik TM. Early versus late recurrence of intrahepatic cholangiocarcinoma after resection with curative intent. Br J Surg 2017; 105:848-856. [PMID: 29193010 DOI: 10.1002/bjs.10676] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND The objective of this study was to investigate the characteristics, treatment and prognosis of early versus late recurrence of intrahepatic cholangiocarcinoma (ICC) after hepatic resection. METHODS Patients who underwent resection with curative intent for ICC were identified from a multi-institutional database. Data on clinicopathological characteristics, initial operative details, timing and sites of recurrence, recurrence management and long-term outcomes were analysed. RESULTS A total of 933 patients were included. With a median follow-up of 22 months, 685 patients (73·4 per cent) experienced recurrence of ICC; 406 of these (59·3 per cent) developed only intrahepatic disease recurrence. The optimal cutoff value to differentiate early (540 patients, 78·8 per cent) versus late (145, 21·2 per cent) recurrence was defined as 24 months. Patients with early recurrence had extrahepatic disease more often (44·1 per cent versus 28·3 per cent in those with late recurrence; P < 0·001), whereas late recurrence was more often only intrahepatic (71·7 per cent versus 55·9 per cent for early recurrence; P < 0·001). From time of recurrence, overall survival was worse among patients who had early versus late recurrence (median 10 versus 18 months respectively; P = 0·029). In multivariable analysis, tumour characteristics including tumour size, number of lesions and satellite lesions were associated with an increased risk of early intrahepatic recurrence. In contrast, only the presence of liver cirrhosis was independently associated with an increased likelihood of late intrahepatic recurrence (hazard ratio 1·99, 95 per cent c.i. 1·11 to 3·56; P = 0·019). CONCLUSION Early and late recurrence after curative resection for ICC are associated with different risk factors and prognosis. Data on the timing of recurrence may inform decisions about the degree of postoperative surveillance, as well as help counsel patients with regard to their risk of recurrence.
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Affiliation(s)
- X-F Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - E W Beal
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - F Bagante
- Deparment of Surgery, University of Verona, Verona, Italy
| | - J Chakedis
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | - M Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - I Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - H P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - L Aldrighetti
- Department of Surgery, Ospedale San Raffaele, Milan, Italy
| | - S K Maithel
- Department of Surgery, Emory University, Atlanta, USA
| | - C Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - T W Bauer
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - G A Poultsides
- Department of Surgery, Stanford University, Stanford, California, USA
| | - O Soubrane
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Assistance Publique - Hôpitaux de Paris, Beaujon Hospital, Clichy, France
| | - G Martel
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - B G Koerkamp
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E Itaru
- Gastroenterological Surgery Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - T M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
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44
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Bauer TW, Harper A. Uncommon Metastases to and from the Musculoskeletal System. JBJS Case Connect 2017; 7:e88. [PMID: 29286957 DOI: 10.2106/jbjs.cc.17.00249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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45
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Ramkumar PN, Navarro SM, Haeberle HS, Chughtai M, Demetriades C, Piuzzi NS, Mont MA, Bauer TW, Muschler GF. Cellular therapy injections in today's orthopedic market: A social media analysis. Cytotherapy 2017; 19:1392-1399. [PMID: 28916228 DOI: 10.1016/j.jcyt.2017.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND The current state of cellular therapy for musculoskeletal conditions is at a crossroads. Marketing efforts are often outpacing clinical evidence and regulatory control. QUESTIONS/PURPOSES This study was an effort to describe the marketing of cellular therapy in musculoskeletal medicine by evaluating the content in popular social media channels. Specifically, media posts were evaluated for the following: (1) perspective, (2) tone, (3) content and (4) visibility. PATIENT AND METHODS Social media content related to cell therapy for musculoskeletal conditions was assessed in a search using 28 hashtags on the public domains of Instagram and Twitter over a 2-year period (2014-2016) that resulted in analysis of 698 posts. Supplemental analyses of LinkedIn and Facebook domains were also conducted. A categorical scoring system was used to analyze perspective (patient, family or friend, business or organization), tone (positive, negative), content (education, advertisement, research, media coverage or patient experience) and visibility (number of hashtags per post). Sub-analyses of the advertisement content from various perspectives (patients, physicians and businesses) were performed. RESULTS The media perspective was most frequently from a business or organization (83%; n = 575). A total of 94% of the posts had a positive tone and only 6% had a negative tone, and the only negative posts came from patients (60% positive and 40% negative). The most common content of social media posts were advertisements, representing 68% (n = 477) of all posts; this was confirmed in the Facebook analysis. The mean number of hashtags was five per post. Sub-analyses revealed approximately half of the advertising posts originated from a single business that recruited physicians to market their cell-based therapies on social media, which was confirmed in the LinkedIn analysis. CONCLUSION The market messages related to cell-based therapies for musculoskeletal conditions available on social media are dominated by businesses that seem to use a network of physicians, apply several hashtags to enhance visibility and advertise these largely unproven modalities. The posts portray an almost exclusively positive tone, without providing a "fair balance" on the risks, benefits and limitations.
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Affiliation(s)
- Prem N Ramkumar
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA.
| | - Sergio M Navarro
- Baylor College of Medicine, Department of Orthopaedic Surgery, Houston, Texas, USA
| | - Heather S Haeberle
- Baylor College of Medicine, Department of Orthopaedic Surgery, Houston, Texas, USA
| | - Morad Chughtai
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | | | - Nicolas S Piuzzi
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Michael A Mont
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - Thomas W Bauer
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
| | - George F Muschler
- Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA
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46
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Stephens L, McDonald L, Mackie S, Slaw RJ, Bauer TW. A small reduction in control tissue size yields a significant reduction in digital image storage cost. J Histotechnol 2017. [DOI: 10.1080/01478885.2017.1336316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Scott Mackie
- ePathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Thomas W. Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, NY, USA
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47
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Zhang Y, Ilaslan H, Bauer TW. Giant cell tumor of bone: imaging and histology changes after denosumab treatment : Comment on: von Borstel D, Taguibao RA, Strle NA, Burns JE. Giant cell tumor of the bone: Aggressive case initially treated with denosumab and intralesional surgery. Skeletal Radiol 2017;46:571-578. Skeletal Radiol 2017; 46:961-962. [PMID: 28389819 DOI: 10.1007/s00256-017-2643-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Yaxia Zhang
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, 9500 Euclid Avenue/L25, Cleveland, OH, 44195, USA.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Hakan Ilaslan
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas W Bauer
- Department of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, 9500 Euclid Avenue/L25, Cleveland, OH, 44195, USA. .,Department of Neurosurgery and Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA. .,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Koch KM, Koff MF, Bauer TW, Shah PH, Nencka AS, Sivaram Kaushik S, Potter HG. Off-resonance based assessment of metallic wear debris near total hip arthroplasty. Magn Reson Med 2017. [PMID: 28643347 DOI: 10.1002/mrm.26807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The presence of metallic debris near total hip arthroplasty can have a significant impact on longitudinal patient management. Methods for magnetic resonance imaging-based quantification of metallic debris near painful total hip replacements are described and applied to cohorts of symptomatic and control subject cases. METHODS A combination of metal artifact reduction, off-resonance mapping, off-resonance background removal, and spatial clustering methods are utilized to quantify off-resonance signatures in cases of suspected metallosis. These methods are applied to a cohort of symptomatic hip arthroplasties composed of cobalt-chromium alloys. Magnetostatic simulations and theoretical principles are used to illuminate the potential sources of the measured off-resonance effects. Reported metrics from histological tissue assays extracted during surgical revision procedures are also correlated with the proposed magnetic resonance imaging-based quantification results. RESULTS The presented methods identified quantifiable metallosis signatures in more than 70% of the symptomatic and none of the control cases. Preliminary correlations of the MR data with direct histological evaluation of retrieved tissue samples indicate that the observed off-resonance effect may be related to tissue necrosis. CONCLUSIONS Magnetostatic simulations, theoretical principles, and preliminary histological trends suggest that disassociated cobalt is the source of the observed off-resonance signature. Magn Reson Med 79:1628-1637, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Kevin M Koch
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew F Koff
- Division of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Thomas W Bauer
- Anatomic Pathology and Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Parina H Shah
- Division of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Andrew S Nencka
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - S Sivaram Kaushik
- MR Applications and Workflow, GE Healthcare, Milwaukee, Wisconsin, USA
| | - Hollis G Potter
- Division of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
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49
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Bauer TW. CORR Insights ®: How Reliable Is the Alpha-Defensin Immunoassay Test for Diagnosing Periprosthetic Joint Infection? A Prospective Study. Clin Orthop Relat Res 2017; 475:416-418. [PMID: 27444031 PMCID: PMC5213929 DOI: 10.1007/s11999-016-4969-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/01/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Thomas W. Bauer
- Departments of Anatomic Pathology and Orthopaedic Surgery L25, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195-5138 USA
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50
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Frangiamore SJ, Saleh A, Grosso MJ, Farias Kovac M, Zhang X, Daly TM, Bauer TW, Derwin KA, Iannotti JP, Ricchetti ET. Neer Award 2015: Analysis of cytokine profiles in the diagnosis of periprosthetic joint infections of the shoulder. J Shoulder Elbow Surg 2017; 26:186-196. [PMID: 27720413 DOI: 10.1016/j.jse.2016.07.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) after shoulder arthroplasty can present a diagnostic and therapeutic challenge. This study evaluated the diagnostic utility of broader synovial fluid cytokine analysis for identifying PJI in patients undergoing revision shoulder arthroplasty. METHODS Synovial fluid levels of 9 cytokines (interleukin [IL] 6, granulocyte-macrophage colony-stimulating factor, IL-1β, IL-12, IL-2, IL-8, interferon-γ, IL-10, and tumor necrosis factor-α) were measured in 75 cases of revision shoulder arthroplasty with a multiplex immunoassay. Cases were classified into infection categories and groups based on objective perioperative findings. Differences in cytokine levels among infection groups were evaluated. Receiver operating characteristic curves were used to assess the diagnostic utility of the individual synovial fluid cytokines and combinations of cytokines in determining infection status. RESULTS Synovial IL-6, granulocyte-macrophage colony-stimulating factor, interferon-γ, IL-1β, IL-2, IL-8, and IL-10 were significantly elevated in cases of revision shoulder arthroplasty classified as infected. Individually, IL-6, IL-1β, IL-8, and IL-10 showed the best combination of sensitivity and specificity for predicting infection, and a combined cytokine model consisting of IL-6, tumor necrosis factor-α, and IL-2 showed better diagnostic test characteristics than any cytokine alone, with sensitivity of 0.80, specificity of 0.93,, positive and negative predictive values of 0.87 and 0.89, and positive and negative likelihood ratios of 12.0 and 0.21. CONCLUSIONS Individual and combined synovial fluid cytokine analysis were both more effective than routine perioperative testing, such as serum erythrocyte sedimentation rate and C-reactive protein, in the diagnosis of PJI of the shoulder. Once validated, combined synovial fluid cytokine analysis could be used as a predictive tool to determine the probability of PJI in patients undergoing revision shoulder arthroplasty and better guide treatment.
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Affiliation(s)
- Salvatore J Frangiamore
- Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic & Rheumatologic Institute, Cleveland, OH, USA
| | - Anas Saleh
- Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic & Rheumatologic Institute, Cleveland, OH, USA
| | - Matthew J Grosso
- Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mario Farias Kovac
- Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic & Rheumatologic Institute, Cleveland, OH, USA
| | - Xiaochun Zhang
- Department of Laboratory Medicine, Cleveland Clinic, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland, OH, USA
| | - Thomas M Daly
- Department of Laboratory Medicine, Cleveland Clinic, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland, OH, USA
| | - Thomas W Bauer
- Department of Pathology, Cleveland Clinic, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland, OH, USA
| | - Kathleen A Derwin
- Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic & Rheumatologic Institute, Cleveland, OH, USA
| | - Joseph P Iannotti
- Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic & Rheumatologic Institute, Cleveland, OH, USA
| | - Eric T Ricchetti
- Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic & Rheumatologic Institute, Cleveland, OH, USA.
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