Citations

Introduction No study to date has examined the association between organism profile and ideal interstage duration in patients undergoing two-stage exchange arthroplasty. The purpose of this study was to evaluate the impact of the type of infecting organism on the optimal timing of reimplantation in this patient population. Methods This retrospective study identified 576 patients with chronic periprosthetic joint infection (PJI) of the knee that underwent two-stage exchange arthroplasty with a minimum 1-year follow-up. PJI was defined using the 2013 Musculoskeletal Infection Society (MSIS) criteria. Patients with a time to reimplantation >180 days from resection arthroplasty (n=76) and those that underwent spacer exchange were excluded (n=49). Treatment failure was defined as any reoperation for infection or PJI-related mortality. Receiver operator characteristic (ROC) curve analyses were used to identify whether the optimal interstage duration differed by infecting organism. Multivariate regression analyses were performed to identify risk factors for failure. Results 451 patients with a mean follow-up time of 5.8 ± 3.6 years were included. Of these, 71 (15.7%) patients experienced failure and 380 (84.3%) experienced success. ROC curve analyses demonstrated that the optimal interstage duration was longest for patients infected with “high-virulence” pathogens (129 days), followed by those with MSSA (117 days), culture negative PJI (98 days), and coagulase-negative Staphylococci (86 days). After controlling for co-variates, regression analyses showed that an interstage duration above the identified cutoff for each pathogen group was a predictor of treatment failure (all p<0.05). Conclusion We found that the ideal interstage duration varied considerably by the type of infecting organism in patients undergoing two-stage exchange. Greater awareness of this data may help guide the optimal timing of reimplantation in this patient population.

Introduction The alpha-defensin test has witnessed a surge in popularity following reports of its superior diagnostic capabilities, when compared to more conventional synovial markers. Despite this, no study to date has evaluated the utility of alpha-defensin for the diagnosis of acute periprosthetic joint infection (PJI). The purpose of this multicenter study was to determine whether the alpha-defensin test provided additional clinical benefit, when compared to synovial white blood cell (WBC) count and polymorphonuclear leukocyte percentage (PMN%), in the diagnosis of acute postoperative PJI. Methods This retrospective study identified all patients who underwent arthrocentesis within 90 days of their primary total joint arthroplasty (TJA) at three institutions. PJI was defined as revision TJA for infection within 2-weeks of joint aspiration with >=1 positive intraoperative culture. Patients were considered aseptic if they had no reoperation for >=1-year after arthrocentesis. Receiver operator characteristic (ROC) curves were used to assess the utility of alpha-defensin, WBC count, and PMN% in the diagnosis of acute PJI. Pairwise comparison was performed to compare whether the area under the curve (AUC) was significantly different between the three markers. Results A total of 143 patients were included. Of these, 85 (59.4%) were infected and 58 (40.6%) were aseptic. After plotting ROC curves, WBC count was found to have the highest diagnostic utility (AUC 0.912, sensitivity 80.0%, specificity 91.2%), followed by PMN% (AUC 0.869, sensitivity 70.5%, specificity 93.0%), and alpha-defensin (AUC 0.812, sensitivity 62.4%, specificity 100%). Using pairwise comparison, the AUC for WBC count was found to be significantly higher than that of alpha-defensin (p=0.005). However, there was no difference in the AUC between alpha defensin and PMN% (p=0.154). Conclusion Based on our findings, it appears that alpha-defensin provides little to no additional clinical benefit in the diagnosis of acute PJI, when compared to synovial WBC count and PMN%.

ABSTRACT Background Chronic post‐thrombotic syndrome (PTS) involving the peroneal venae comitantes is an uncommon but potentially flap‐threatening finding during fibular free flap reconstruction that may not be detected on routine preoperative computed tomography angiography. We describe the successful management of extensive chronic PTS encountered unexpectedly during fibular free flap reconstruction for advanced oral cavity squamous cell carcinoma. Methods Following unsuccessful mechanical thrombectomy, arterial inflow was established before venous reconstruction to identify the dominant functional venous outflow pathway, followed by selective venous anastomosis. Results Early postoperative venous congestion was successfully managed with revision and a second venous anastomosis. The flap remained viable with excellent functional and oncologic outcomes at 1 year. Conclusion This case demonstrates that chronic PTS should not necessarily preclude fibular free flap reconstruction and presents a practical intraoperative and postoperative strategy for managing this challenging and previously underreported scenario.

Abstract INTRODUCTION Combining Alzheimer's disease blood biomarkers may improve prediction of amyloid positivity (A+) compared with single biomarkers. METHODS Logistic regression models using plasma phosphorylated tau 217 (p‐tau217), amyloid beta (Aβ) 42, and Aβ40 were developed in cognitively impaired (CI) participants from Mayo Clinic Rochester (MCR) and validated in Alzheimer's Disease Neuroimaging Initiative (ADNI) and Mayo Clinic Florida (MCF) cohorts. Performance was measured by area under the curve (AUC) and Probability of Amyloid Positivity Score (PAPS). RESULTS Plasma p‐tau217 alone showed high AUC (95% confidence intervals) across cohorts MCR, 0.928 (0.900–0.953); ADNI, 0.938 (0.915–0.959); MCF, 0.935 (0.893–0.970). Adding Aβ42 to regression models yielded marginal model improvement MCR, 0.940 (0.915–0.963); ADNI, 0.945 (0.922–0.965); MCF, 0.960 (0.925–0.986). Utilization of two cutpoints (≥ 90% sensitivity and specificity), yielded ≤ 10% intermediate results for p‐tau217, and ≤ 8% for p‐tau217+Aβ42. Addition of Aβ40 did not improve models’ performance. DISCUSSION An immunoassay‐based p‐tau217 PAPS model accurately predicted amyloid positivity across independent CI cohorts and achieved confirmatory‐test performance with two cutpoints. The added value of Aβ42 was modest and cohort dependent, supporting the potential of use of p‐tau217–based PAPS in clinical workflows.

Purpose To describe whether subspecialty training, specifically arthroscopic fellowship training, influences intraoperative range‐of‐motion (ROM) gains, postoperative ROM retention, and lysis of adhesions (LOA) complication rates. Methods Between August 1989 and May 2025, all patients who underwent arthroscopic LOA for stiffness after primary total knee arthroplasty (TKA) at a single multisite academic institution with a minimum follow‐up of 3 months were reviewed. Cases were stratified by the surgeon's training: 1 group with arthroscopic fellowship training and another with nonarthroscopic or no fellowship training. Primary outcomes were intraoperative ROM change and postoperative ROM retention compared with intraoperative and pre‐TKA baseline values. Revision and periprosthetic joint infection rates were also collected. Results A total of 94 LOA cases were identified, where 48 (51.1%) were performed by nonarthroscopically trained surgeons. Intraoperative ROM improvements were similar between groups in both knee flexion (35.2° arthroscopic vs 31.1° nonarthroscopic, P = .130) and extension (2.43° vs 3.91°, P = .079). Compared with the intraoperative ROM, procedures performed by arthroscopically trained surgeons showed significantly better long‐term retention of both flexion (loss of 4.85° vs 15.98°, P = .006) and extension (gain of 0.50° vs loss of 1.58°, P = .036) at postoperative follow‐up. When compared with preprimary TKA baseline ROM, flexion at follow‐up was slightly improved in the arthroscopic group but declined significantly in the nonarthroscopic group (gain of 1.66° vs loss of 21.76°, P < .001). Eight revision TKAs (8.51%) occurred after LOA, 6 of which involved nonarthroscopic surgeons, and 1 periprosthetic joint infection case was reported. Conclusions LOA performed by arthroscopic fellowship‐trained surgeons results in significantly better retention of postoperative ROM than nonfellowship‐trained surgeons when used for arthrofibrosis after TKA. Level of Evidence Level III, retrospective comparative study.

Objective Hospitalization, particularly for surgery, represents a period of heightened stress. We evaluated how frailty attenuates the association of rheumatoid arthritis (RA) with negative health outcomes after elective noncardiac surgery. Methods We conducted a cross‐sectional study using the National Inpatient Sample (2018 to 2020), including adults (aged ≥18 years) with elective hospitalizations with noncardiac surgery. Frailty was measured using the Hospital Frailty Risk Score (HFRS). Surgeries were categorized by risk level. Outcomes included discharge health resources need (DHRN), composite adverse clinical events (CACE), and death. Results Among 8,800,359 hospitalizations (2.14% among patients with RA), 73.36% underwent intermediate‐risk surgery and 62.25% had HFRS above 0. DHRN occurred in 28.9%, CACE occurred in 0.93%, and all‐cause mortality occurred in 0.17%. A 10‐point increase in HFRS was associated with a 3.8‐fold increased DHRN, 8.5‐fold increased CACE, and 22.8‐fold increased mortality. RA was not independently associated with CACE (adjusted odds ratio [aOR] 0.91; 95% confidence interval [CI] 0.82–1.01; P = 0.08) or death (aOR 0.90; 95% CI 0.71–1.15; P = 0.41) but was significantly associated with DHRN (aOR 1.28, 95% CI 1.25–1.31; P < 0.001) after adjusting for confounders and frailty. In sensitivity analysis, RA had 10% higher relative odds of DHRN following orthopedic (aOR 1.10; 95% CI 1.07–1.13; P < 0.001) but not nonorthopedic intermediate‐risk surgery (aOR 1.10; 95% CI 0.98–1.23; P = 0.11). Conclusion RA was associated with higher odds of DHRN after orthopedic intermediate‐risk surgery but not CACE or inpatient mortality. Moreover, HFRS was associated with DHRN, CACE, and death. These findings underscore the need for disease‐specific clinical considerations and highlight the potential utility of HFRS in discharge planning.

Abstract INTRODUCTION Plasma phosphorylated tau 217 (p‑tau217) immunoassays are increasingly being used to assess Alzheimer's disease (AD) pathology despite limited data affirming test reliability over time. METHODS Clinical performance of the Fujirebio Lumipulse G p‑tau217 assay was assessed in 744 Mayo Clinic patients presenting for evaluation of cognitive impairment between July 2024 and December 2025. Cerebrospinal fluid p‑tau181/amyloid beta 42 or amyloid positron emission tomography, within 1 year of p‐tau217 testing, were used as reference. Analytical robustness was evaluated by tracking result frequencies over time, conducting quality control checks, performing 10 lot‑to‑lot comparisons, and comparing two versions of reagents. RESULTS Diagnostic accuracy for detection of AD pathology was 93% (95% confidence interval 91–95) with 23% intermediate results. Reduced estimated glomerular filtration rate was associated with increased intermediate results among amyloid‐negative individuals. Result frequencies remained stable, average imprecision was 8%, and analytical bias between lots and version changes were ≤ 11%. DISCUSSION The findings support plasma p‐tau217 reliability in clinical practice for evaluation of cognitively impaired individuals.