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Article ; Online: CORR Insights®: Are Corticosteroid Injections Associated With Secondary Adrenal Insufficiency in Adults With Musculoskeletal Pain? A Systematic Review and Meta-analysis of Prospective Studies.

Chisari, Emanuele

Clinical orthopaedics and related research

2022 Volume 480, Issue 6, Page(s) 1075–1076

MeSH term(s)	Adrenal Cortex Hormones/adverse effects ; Adrenal Insufficiency/chemically induced ; Adrenal Insufficiency/diagnosis ; Adult ; Humans ; Injections ; Injections, Intra-Articular ; Musculoskeletal Pain/diagnosis ; Musculoskeletal Pain/drug therapy ; Prospective Studies
Chemical Substances	Adrenal Cortex Hormones
Language	English
Publishing date	2022-04-27
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review ; Comment
ZDB-ID	80301-7
ISSN	1528-1132 ; 0009-921X
ISSN (online)	1528-1132
ISSN	0009-921X
DOI	10.1097/CORR.0000000000002227
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Article ; Online: Adaptive and Pragmatic Approach to Clinical Research: The Silver Lining of a Global Pandemic.

Chisari, Emanuele / Parvizi, Javad

Narrative inquiry in bioethics

2021 Volume 11, Issue 1, Page(s) E9–E10

MeSH term(s)	COVID-19 ; Humans ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2021-07-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2632728-4
ISSN	2157-1740 ; 2157-1732
ISSN (online)	2157-1740
ISSN	2157-1732
DOI	10.1353/nib.2021.0017
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Article ; Online: Comprehensive Guidance for the Prevention of Periprosthetic Joint Infection After Total Joint Arthroplasty and Pitfalls in the Prevention.

Parvizi, Javad / Cha, Yonghan / Chisari, Emanuele / Kim, Kangbaek / Koo, Kyung-Hoi

Journal of Korean medical science

2024 Volume 39, Issue 15, Page(s) e147

Abstract: Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged ... ...

Abstract	Total joint arthroplasty (TJA) is a surgical procedure, in which parts of damaged joints are removed and replaced with a prosthesis. The main indication of TJA is osteoarthritis, and the volume of TJA is rising annually along with the increase of aged population. Hip and knee are the most common joints, in which TJAs are performed. The TJA prosthesis is composed of metal, plastic, or ceramic device. Even though TJA is the most successful treatment for end-stage osteoarthritis, it is associated with various complications, and periprosthetic joint infection (PJI) is the most serious complication after TJA. With the increasing volume of TJAs, there is a simultaneous rise in the incidence of PJI. Contamination of the surgical wound and the adherence of bacteria to the surface of prosthetic component represent the initial step in the pathogenesis of PJI. The main sources of the contamination are 1) patient's own flora, 2) droplets in the operation room air, and 3) surgical gloves and instruments. Even though modern techniques have markedly reduced the degree of contamination, TJAs cannot be done in completely germ-free conditions and some degree of contamination is inevitable in all surgical procedures. However, not all contamination leads to PJI. It develops when the burden of contamination exceeds the immune threshold or the colony forming units (CFUs) and various factors contribute to a decrease in the CFU level. Surgeons should be aware of the germ burden/CFU concept and should monitor sources of contamination to maintain the germ burden below the CFU to prevent PJI.
MeSH term(s)	Humans ; Prosthesis-Related Infections/prevention & control ; Arthroplasty, Replacement, Knee/adverse effects ; Arthroplasty, Replacement, Hip/adverse effects ; Anti-Bacterial Agents/therapeutic use
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-04-22
Publishing country	Korea (South)
Document type	Journal Article ; Review
ZDB-ID	639262-3
ISSN	1598-6357 ; 1011-8934
ISSN (online)	1598-6357
ISSN	1011-8934
DOI	10.3346/jkms.2024.39.e147
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Article: Osteoarthritis Can Also Start in the Gut: The Gut-Joint Axis.

Gleason, Brendan / Chisari, Emanuele / Parvizi, Javad

Indian journal of orthopaedics

2022 Volume 56, Issue 7, Page(s) 1150–1155

Abstract: Background: Osteoarthritis is a common cause of pain and disability with an increasing prevalence among the global population (Hunter and Bierma-Zeinstra in Lancet 393(10182):1745-1759, 2019; Zhang and Jordan in Clinics in Geriatric Medicine 26(3):355- ... ...

Abstract	Background: Osteoarthritis is a common cause of pain and disability with an increasing prevalence among the global population (Hunter and Bierma-Zeinstra in Lancet 393(10182):1745-1759, 2019; Zhang and Jordan in Clinics in Geriatric Medicine 26(3):355-369, 2010). Altered immune responses and low-grade systemic inflammation driven by gut dysbiosis are being increasingly recognized as contributing factors to the pathophysiology of OA (Tan et al. in International Journal of Rheumatic Diseases. https://doi.org/10.1111/1756-185X.14123, 2021; Binvignat et al. in Joint, Bone, Spine 88(5):105203, 2021; Ramasamy et al. in Nutrients 13(4):1272, 2021), which increased the interest in the so-called "gut-joint axis". The various microbiota in the gastrointestinal tract is commonly referred to as the gut microbiome. The gut microbiome is affected by age, sex, and immune system activity as well as medications, environment, and diet (Arumugam in Nature. https://doi.org/10.1038/nature09944, 2011). The microbiome is pivotal to maintain host health and contributes to nutrition, host defense, and immune development (Nishida et al. in Clinical Journal of Gastroenterology 11:1-10, 2018). Alterations in this microbiome can induce dysbiosis, which is associated with many human disease states including allergies, autoimmune disease, diabetes, and cancer (Lin and Zhang in BMC Immunology 18(1):2, 2017). A gut-joint axis is proposed as a link involving the gastrointestinal microbiome, the immune response that it induces, and joint health. Results: Emerging evidence has shown that there are specific changes in the microbiome that are associated with osteoarthritis, including increased Firmicutes/Bacteroides ratio, Conclusions: The gut is an intriguing and novel target for OA therapy. Dietary modification or supplementation with fiber, probiotics, or prebiotics could provide a positive impact on the gut joint axis.
Language	English
Publishing date	2022-03-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	603194-8
ISSN	0019-5413
ISSN	0019-5413
DOI	10.1007/s43465-021-00473-8
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Article ; Online: Accuracy of blood-tests and synovial fluid-tests in the diagnosis of periprosthetic joint infections.

Chisari, Emanuele / Parvizi, Javad

Expert review of anti-infective therapy

2020 Volume 18, Issue 11, Page(s) 1135–1142

Abstract: Introduction: Periprosthetic joint infection (PJI) is one of the most complex complications following total joint arthroplasty. Despite significant progress in recent years, the use of blood and synovial biomarkers to diagnose PJI remains a challenge.!## ...

Abstract	Introduction: Periprosthetic joint infection (PJI) is one of the most complex complications following total joint arthroplasty. Despite significant progress in recent years, the use of blood and synovial biomarkers to diagnose PJI remains a challenge. Areas covered: A combination of serological, synovial, microbiological, histological, and radiological investigations is suggested by consensus and international guidelines. Novel biomarkers and molecular methods have shown promise in recent years. The purpose of this review is to provide an update about the biomarkers used to diagnose PJI and highlight their sensitivity and specificity. In addition, guidance on the diagnostic steps and clinical workflow will be included. Expert opinion: The diagnostic algorithm developed and validated by the international consensus meeting group is still the most valuable resource to approach PJI diagnosis. The current combination of blood and synovial biomarkers yield acceptable results and good performance. However, there is a need for new biomarkers and further research to understand the limitations of current tests better, as well as explore new options such as alpha-defensin, D-dimer, interleukin-6, and leukocyte esterase.
MeSH term(s)	Algorithms ; Arthroplasty, Replacement/adverse effects ; Biomarkers/analysis ; Humans ; Joint Diseases/diagnosis ; Joint Diseases/microbiology ; Prosthesis-Related Infections/diagnosis ; Sensitivity and Specificity ; Synovial Fluid/microbiology
Chemical Substances	Biomarkers
Language	English
Publishing date	2020-07-26
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2181279-2
ISSN	1744-8336 ; 1478-7210
ISSN (online)	1744-8336
ISSN	1478-7210
DOI	10.1080/14787210.2020.1792771
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Article ; Online: Gut permeability and osteoarthritis, towards a mechanistic understanding of the pathogenesis: a systematic review.

Guido, Giorgio / Ausenda, Guido / Iascone, Veronica / Chisari, Emanuele

Annals of medicine

2021 Volume 53, Issue 1, Page(s) 2380–2390

Abstract: Osteoarthritis (OA) is the most common condition affecting human joints. Along with mechanical and genetic factors, low-grade inflammation is increasingly supported as a causal factor in the development of OA. Gut microbiota and intestinal permeability, ...

Abstract	Osteoarthritis (OA) is the most common condition affecting human joints. Along with mechanical and genetic factors, low-grade inflammation is increasingly supported as a causal factor in the development of OA. Gut microbiota and intestinal permeability,
MeSH term(s)	Dysbiosis ; Gastrointestinal Microbiome ; Humans ; Inflammation/pathology ; Osteoarthritis/microbiology ; Osteoarthritis/therapy ; Permeability
Language	English
Publishing date	2021-12-18
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	1004226-x
ISSN	1365-2060 ; 1651-2219 ; 0785-3890 ; 1743-1387
ISSN (online)	1365-2060 ; 1651-2219
ISSN	0785-3890 ; 1743-1387
DOI	10.1080/07853890.2021.2014557
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Article ; Online: Fungal periprosthetic joint infection

Emanuele Chisari / Feitai Lin / Jun Fei / Javad Parvizi

Chinese Journal of Traumatology, Vol 25, Iss 2, Pp 63-

Rare but challenging problem

2022 Volume 66

Abstract: Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcus aureus and Coagulase-negative ... ...

Abstract	Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcus aureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%–2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.
Keywords	Fungi ; Periprosthetic joint infection ; Diagnosis and treatment ; Medicine (General) ; R5-920
Subject code	630
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: Intraoperative Greater Trochanteric Fractures During Revision Total Hip Arthroplasty May Not Always Need Surgical Fixation.

D'Amore, Taylor / Chisari, Emanuele / Scaramella, Amira / Frenz, Brian / Courtney, P Maxwell

Orthopedics

2023 Volume 46, Issue 5, Page(s) 297–302

Abstract: Many fixation techniques have been described to manage intraoperative greater trochanteric (GT) fractures during revision total hip arthroplasty (rTHA), but complications such as broken hardware and bursitis are common. The purpose of this study was to ... ...

Abstract	Many fixation techniques have been described to manage intraoperative greater trochanteric (GT) fractures during revision total hip arthroplasty (rTHA), but complications such as broken hardware and bursitis are common. The purpose of this study was to determine whether surgical fixation of an intraoperative GT fracture resulted in improved outcomes in rTHA. We reviewed a consecutive series of 1442 rTHA patients at our institution from 2008 to 2019. We identified all patients with an intraoperative GT fracture and noted whether the fracture was fixed surgically or left without fixation. Demographics, comorbidities, complications, radiographic union, and dislocations were compared between the groups. Of the 44 (3%) intra-operative GT fractures identified, 23 (52%) underwent fixation, most commonly with claw plates (8 patients) and cables (10 patients). There were no differences in the rates of radiographic union (86% vs 100%,
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Bursitis/surgery ; Hip Fractures/diagnostic imaging ; Hip Fractures/surgery ; Hip Fractures/etiology ; Intraoperative Complications/etiology ; Intraoperative Complications/surgery ; Joint Dislocations/surgery ; Reoperation/adverse effects ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2023-03-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	424447-3
ISSN	1938-2367 ; 0147-7447
ISSN (online)	1938-2367
ISSN	0147-7447
DOI	10.3928/01477447-20230310-02
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Article ; Online: Gloves Contamination During Revision Surgery for Periprosthetic Joint Infection.

Ludwick, Leanne / Chisari, Emanuele / Ong, Christian / Krueger, Chad / Courtney, Paul Maxwell / Parvizi, Javad

The Journal of arthroplasty

2023 Volume 39, Issue 2, Page(s) 480–482

Abstract: Background: The use of double gloving has become a standard practice for joint replacement surgeons. However, since there are limited data on how gloves are contaminated during both primary and revision arthroplasty, no precise protocol exists to direct ...

Abstract	Background: The use of double gloving has become a standard practice for joint replacement surgeons. However, since there are limited data on how gloves are contaminated during both primary and revision arthroplasty, no precise protocol exists to direct surgeons on when, or if, to change their gloves. The goals of this preliminary study were to evaluate the contamination of gloves during total joint arthroplasties (TJAs). Methods: We included 25 infected cases and 10 primaries, which were performed at the same institution using the same surgical protocol from 3 fellowship trained surgeons. Samples were taken every 20 minutes from the start of the surgery until the joint was irrigated. Procedural steps were noted. To evaluate cross-contamination during infected cases, we sampled gloves using blood agar plates. In primary cases, culture swabs of anterior chamfer cuts and sterile instruments on the back table were used as negative controls. Next-generation sequencing (NGS) was used as an adjunct to identify low virulence bacteria. Results: In the primary cases, all samples were found culture negative but 3 (8.1%) of the 37 samples were found to have a low, unidentifiable bacterial mass via NGS testing. In the infected cases, 41 (59.4%) of the 69 samples yielded positive microbial results. The positivity rate was higher in the samples collected after the arthrotomy was performed (70%) compared to samples collected before the arthrotomy was performed (40%), and the surgeon was only dissecting superficial layers (P = .502). Conclusion: Gloves seem to be a common source of cross-contamination in the intraoperative field during revision TJA. Due to the higher percent of positive samples following the opening of the joint, we hypothesize that the arthrotomy allows for the spread of bacteria across the operative site. While further investigation is necessary to formulate a precise protocol for the changing of gloves during TJA, it may be beneficial to perform a thorough irrigation of the joint and change of the gloves immediately following arthrotomy.
MeSH term(s)	Humans ; Prosthesis-Related Infections/surgery ; Reoperation ; Arthroplasty, Replacement ; Bacteria ; Arthritis, Infectious ; Gloves, Surgical/microbiology
Language	English
Publishing date	2023-07-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2023.07.007
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Article ; Online: Plasma D-Dimer Is Noninferior to Serum C-Reactive Protein in the Diagnosis of Periprosthetic Joint Infection.

Tarabichi, Saad / Goh, Graham S / Baker, Colin M / Chisari, Emanuele / Shahi, Alisina / Parvizi, Javad

The Journal of bone and joint surgery. American volume

2023 Volume 105, Issue 7, Page(s) 501–508

Abstract: Background: No single test has demonstrated absolute accuracy in the diagnosis of periprosthetic joint infection (PJI). Serological markers are often used as screening tools in the workup of patients with suspected PJI. This study aimed to determine the ...

Abstract	Background: No single test has demonstrated absolute accuracy in the diagnosis of periprosthetic joint infection (PJI). Serological markers are often used as screening tools in the workup of patients with suspected PJI. This study aimed to determine the diagnostic utility of plasma D-dimer for PJI in a variety of clinical scenarios. Methods: This prospective study enrolled 502 patients undergoing revision hip or knee arthroplasty. PJI was defined per a modified version of the 2018 International Consensus Meeting (ICM) criteria. Plasma D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fibrinogen were measured preoperatively. Receiver operating characteristic curves were used to assess the utility of each biomarker in the diagnosis of PJI. Pairwise comparison with Bonferroni correction was performed to determine whether the differences in areas under the curve (AUCs) between the markers were significant. Results: Of the 412 patients included, 317 (76.9%) did not have an infection (aseptic group) and 95 (23.1%) had an infection (PJI group). All 4 serological markers, D-dimer (AUC, 0.860; sensitivity, 81.3%; specificity, 81.7%), CRP (AUC, 0.862; sensitivity, 90.4%; specificity, 70.0%), ESR (AUC, 0.833; sensitivity, 73.9%; specificity, 85.2%), and fibrinogen (AUC, 0.798; sensitivity, 74.7%; specificity, 75.4%), demonstrated comparable accuracy for the diagnosis of PJI (all p > 0.05). When examining the performance of the different inflammatory markers in diagnosing infection caused by indolent organisms, D-dimer demonstrated the highest sensitivity at 93.8%. Conclusions: We found that plasma D-dimer was noninferior to serum CRP and ESR in the diagnosis of PJI and may be a useful adjunct when screening patients undergoing revision total joint arthroplasty. Level of evidence: Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
MeSH term(s)	Arthroplasty, Replacement, Knee ; Humans ; Arthroplasty, Replacement, Hip ; Prosthesis-Related Infections/blood ; Prosthesis-Related Infections/diagnosis ; Fibrin Fibrinogen Degradation Products/metabolism ; C-Reactive Protein/metabolism ; Male ; Female ; Aged ; Biomarkers/blood
Chemical Substances	fibrin fragment D ; Fibrin Fibrinogen Degradation Products ; C-Reactive Protein (9007-41-4) ; Biomarkers
Language	English
Publishing date	2023-02-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	220625-0
ISSN	1535-1386 ; 0021-9355
ISSN (online)	1535-1386
ISSN	0021-9355
DOI	10.2106/JBJS.22.00784
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