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  • ISSN: 2373-9290
    Volume 8, Issue 1
    Research Article
    Nicole Kennard*, Daniel Mohammadi, Aniruth Srinivasaraghavan, Arianna Mixon and Gerhard E Maale
    Background: Multidirectional Instability (MDI) and fibrosis associated with nickel allergies have been described in 1.5% of all primary total knees. The symptoms of MDI include pain getting up from the sitting position, audible clunking on varus and valgus stressing, feelings of instability in gait, increasing pain, and joint effusion. Hypoallergenic implants have been designed to alleviate this issue. One, the Genesis II primary knee replacement from Smith and Nephew contains very little nickel (<0.0035% for the zirconium femoral component and <0.1% for the titanium baseplate). We believe that, even with the small amount of nickel in the titanium baseplate, that it demonstrates all the findings that were seen with other implants in presentations of MDI and nickel allergies. 
    Methods: All patients referred with clinical MDI following a primary total knee joint with the Genesis II prosthesis underwent the Metal-Lymphocyte Transformation Test (metal-LTT) for metal allergies. Patients had symptomatology of MDI. They underwent routine labs including CBC, CRP, and ESR as well as staging studies including X-rays, tri-phase bone scan, WBC scan, and CT scan. Surgical revision using a fully constrained hinge coated with zirconium or niobium nitride was the treatment option.
    Results: 20 patients with clinical symptoms of MDI associated with the Genesis II prosthesis were investigated. Fifteen patients were female, 5 were male with an average time to failure of 36 months (range of 5 to 96 months). Imaging revealed hypervascular synovitis, as demonstrated by the bone scan, with a large effusion with minimal prosthetic uptake.
    Conclusion: Although the Genesis II prosthesis was believed to be hypoallergenic, we found that 20 of our patients with the Genesis II prosthesis and nickel allergies still had clinical symptoms of MDI. All patients required hinge revision with hypoallergenic implants.
    Review Article
    Jason Scalise, MD*
    Although rare, periprosthetic infection of the shoulder is a serious event resulting in inferior clinical outcomes. Infections about the shoulder present unique diagnostic challenges owing to the relative high frequency of lower virulent organisms which often have subtle and modest clinical presentations and diagnostic findings. Success of treatment depends on micro-organism identification, appropriate surgical procedures and appropriate antibiotic therapy. Early periprosthetic shoulder infection can be treated with debridement and exchange of modular components, while chronic PSI requires a one-stage or two-stage revision procedure. Indications for a one-stage revision procedure are evolving but have demonstrated promising results in initial studies. Two-stage revision procedures are more common and demonstrate favorable survival rates. Resection arthroplasty remains an option for lower-demand patients or recalcitrant infection. The surgeons should understand the diagnostic and treatment strategies that are most likely to have the most favorable outcome for patients with a periprosthetic shoulder infection.
    Case Report
    Robert W. Ike*
    Drainage of joint purulence is a critical component in the management of septic arthritis. Methods from arthrocentesis to open arthrotomy and arthroscopy are mainstays, with different efficacies and morbidities. Percutaneous tube instillation techniques have been employed since World War I. Methods to effect joint distension and irrigation to mimic what is accomplished at arthroscopy employed over the past 50 years have been honed to a simple bedside technique since the 80s and applied successfully in management of septic arthritis. Wider employment of this technique has the potential to improve efficacy of septic arthritis treatment, particularly when access to O.R. based procedures is limited.
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