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Article ; Online: Digital Radiography During Total Hip Arthroplasty: Early Results With a Combined Anteversion Technique.

Wojcik, Jay J / Lyons, Steven T

2022 Volume 45, Issue 4, Page(s) 221–226

Abstract: Ideal component positioning is critical to outcomes in total hip arthroplasty. We describe our early results using digital radiographs with a combined ante-version technique. We report the incidence of component adjustments made based on digital ... ...

Abstract	Ideal component positioning is critical to outcomes in total hip arthroplasty. We describe our early results using digital radiographs with a combined ante-version technique. We report the incidence of component adjustments made based on digital radiographs and show how this technology can be used during patient positioning to achieve appropriate starting pelvic alignment. We reviewed 176 cases of primary total hip arthroplasty performed by a single arthroplasty surgeon using a posterior approach. Mean follow-up was 1 year (range, 3 months to 2.7 years). Digital radiographs (Surgeon's Checklist Hip; Radlink) and a combined anteversion technique were used for component positioning. For a subset of 100 patients, we recorded the incidence of pelvic mal-positioning found on digital radiographs obtained during initial positioning of the patient. For this same subset we also detail the component changes made as a result of intraoperative radiographs during trialing. Among 176 cases we have had 2 (1.1%) postoperative dislocations. Both underwent closed reduction with no further dislocation. We have had no revisions and 1 intraoperative calcar fracture. For our 100-case subset, digital radiographs during patient positioning identified pelvic malpositioning greater than 5° (coronal or axial plane) among 17% of cases. During trialing, we made component adjustments 71% of the time because of findings on intraoperative imaging. Digital radiography can be a valuable tool for component positioning during total hip arthroplasty. We experienced favorable early outcomes and show the utility of digital radiographs for proper pelvic positioning and making intraoperative adjustments to achieve optimal component placement. [
MeSH term(s)	Acetabulum/surgery ; Arthroplasty, Replacement, Hip/methods ; Hip Prosthesis ; Humans ; Postoperative Period ; Radiographic Image Enhancement ; Radiography
Language	English
Publishing date	2022-03-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	424447-3
ISSN	1938-2367 ; 0147-7447
ISSN (online)	1938-2367
ISSN	0147-7447
DOI	10.3928/01477447-20220225-05
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Article ; Online: Clinical Outcomes of Total Knee Arthroplasty With Concomitant Total Ankle Arthroplasty Versus Ankle Arthrodesis.

Lara, Taylor R / Waples, William W / Simon, Peter / Lyons, Steven T

The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons

2023 Volume 62, Issue 3, Page(s) 553–555

Abstract: Prior studies have demonstrated a high incidence of ankle osteoarthritis (OA) in patients undergoing total knee arthroplasty (TKA) as well as inferior outcomes in the setting of ankle OA or hindfoot malalignment. Little is known about the effect of the 2 ...

Abstract	Prior studies have demonstrated a high incidence of ankle osteoarthritis (OA) in patients undergoing total knee arthroplasty (TKA) as well as inferior outcomes in the setting of ankle OA or hindfoot malalignment. Little is known about the effect of the 2 most common surgical treatments for ankle OA, ankle arthrodesis and total ankle arthroplasty (TAA) on TKA. This hypothesis is that the preservation of ankle motion afforded by total ankle arthroplasty may reduce pathologic stresses across the knee joint. This study compares outcomes of patients who underwent both TKA and TAA versus those that underwent TKA and ankle arthrodesis. We retrospectively reviewed a cohort of patients who had undergone TKA and either TAA or ankle arthrodesis at this institution, examining knee injury and OA outcome scores, foot and ankle ability measure scores, revision surgery, knee range of motion, and pain. There were 69 eligible subjects, 13 who had undergone total knee arthroplasty and total ankle arthroplasty and 56 who had undergone TKA and ankle arthrodesis. No significant differences were observed in KOOS Jr scores, FAAM scores, incidence of revision, knee range of motion, or pain at final follow up (p > .05). Mean follow-up time was 46 months after both surgeries were completed. Equivalent outcomes were observed between the 2 groups. The presence of a TKA should not alter the indications for treatment of ankle OA with TAA versus arthrodesis. Further studies are needed as these relatively rare concomitant procedures are likely to become more common in the future.
MeSH term(s)	Humans ; Ankle/surgery ; Arthroplasty, Replacement, Knee ; Retrospective Studies ; Arthroplasty, Replacement, Ankle/adverse effects ; Arthroplasty, Replacement, Ankle/methods ; Ankle Joint/surgery ; Osteoarthritis/surgery ; Osteoarthritis/etiology ; Arthrodesis/methods ; Pain/etiology ; Treatment Outcome
Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	1146972-9
ISSN	1542-2224 ; 1067-2516
ISSN (online)	1542-2224
ISSN	1067-2516
DOI	10.1053/j.jfas.2022.12.013
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Zs.A 1468: Show issues

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Article ; Online: Frailty is Associated With Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Knee Arthroplasty.

Lakra, Akshay / Tram, Michael K / Bernasek, Thomas L / Lyons, Steven T / O'Connor, Casey M

The Journal of arthroplasty

2023 Volume 38, Issue 7 Suppl 2, Page(s) S182–S186.e2

Abstract: Background: Frailty has been associated with poor postoperative outcomes in various medical conditions and surgical procedures. However, the relationship between frailty and outcomes after primary total knee arthroplasty (TKA) has not been well- ... ...

Abstract	Background: Frailty has been associated with poor postoperative outcomes in various medical conditions and surgical procedures. However, the relationship between frailty and outcomes after primary total knee arthroplasty (TKA) has not been well-described. This study investigated the association of the Hospital Frailty Risk Score (HFRS) with postoperative events and hospitalization costs after primary TKA. Methods: Using a nationwide readmissions database, we identified 884,479 patients discharged after primary TKA for osteoarthritis between January 2017 and November 2019. HFRS was calculated for each patient to determine frailty status. We used multivariate logistic regressions to evaluate the association of frailty with 30-readmission rate and negative binomial regressions to evaluate lengths of hospital stay and hospitalization costs. The 30-day reoperation and complication rates were compared using chi-square tests. Results: Frailty was associated with increased odds of 30-day readmissions (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.82-1.96), longer lengths of stay (OR: 1.43, 95% CI: 1.43-1.44), and higher hospitalization costs (OR: 1.16, 95% CI: 1.16-1.17). Frail patients also had significantly higher rates of 30-day reoperations (0.6 versus 0.4%), surgical complications (0.6 versus 0.4%), medical complications (3.4 versus 1.3%), and other complications (0.9 versus 0.5%) (P < .01). Conclusions: Frailty, as measured using HFRS, was associated with increased adverse events and health care burdens in patients undergoing TKA. The HFRS could be used to swiftly identify high-risk patients undergoing TKA and to potentially help optimize patients prior to elective TKA. Type of study: Level III retrospective cohort study.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Patient Readmission ; Retrospective Studies ; Frailty/complications ; Frailty/epidemiology ; Risk Factors ; Hospitalization ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Language	English
Publishing date	2023-02-28
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.2023.02.036
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Zs.A 2134: Show issues

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Article ; Online: Soft Tissue Releases in Total Knee Arthroplasty for Valgus Deformities.

Xie, Ke / Lyons, Steven T

The Journal of arthroplasty

2017 Volume 32, Issue 6, Page(s) 1814–1818

Abstract: Background: Primary total knee arthroplasty (TKA) for valgus knee deformities can be challenging. Soft tissue releases are often necessary to achieve a well-balanced knee. We reviewed the frequency of soft tissue releases including lateral retinacular ... ...

Abstract	Background: Primary total knee arthroplasty (TKA) for valgus knee deformities can be challenging. Soft tissue releases are often necessary to achieve a well-balanced knee. We reviewed the frequency of soft tissue releases including lateral retinacular release (LRR) as it pertains to preoperative limb alignment. Postoperatively, we evaluated limb alignment, knee range of motion, and complications. Methods: From 2010 to 2016, 214 primary TKAs with valgus deformity were performed by a single surgeon. One hundred eighty-one patients had an average follow-up of 24 months. For these patients, clinical data including preoperative and postoperative range of motion, complications, and revision rates were collected. Soft tissue releases, preoperative and postoperative limb axis deviation, and level of prosthetic constraint were recorded in all patients regardless of length of follow-up. Results: There were 33 knees (15%) that required 1 release, 69 knees (32%) required 2 releases, 81 knees (38%) required 3 releases, and 31 knees (14%) that required 4 or more releases. The average preoperative mechanical axis was 9.4°, and the average postoperative mechanical axis was 0.13°. There were 85 knees (40%) that required an LRR. Increased severity of preoperative deformity correlated with the need for more soft tissue release, but did not correlate with the need for LRR. No knees were revised for instability. No patella complications resulted from LRR. Conclusion: Selective soft tissue release for primary valgus TKA was effective without increasing prosthetic constraint. Severe deformities required more soft tissue releases. LRR can be frequently used with minimal complications.
Language	English
Publishing date	2017-06
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.2017.01.024
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Article ; Online: Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Knee Arthroplasty.

Kyaw, Nyi-Rein / Tram, Michael K / Lakra, Akshay / Bernasek, Thomas L / Lyons, Steven T / O'Connor, Casey M

The Journal of arthroplasty

2023 Volume 39, Issue 5, Page(s) 1165–1170.e3

Abstract: Background: Frailty can predict adverse outcomes after various orthopaedic procedures, but is not well-studied in revision total knee arthroplasty (rTKA). We investigated the correlation between the Hospital Frailty Risk Score (HFRS) and post-rTKA ... ...

Abstract	Background: Frailty can predict adverse outcomes after various orthopaedic procedures, but is not well-studied in revision total knee arthroplasty (rTKA). We investigated the correlation between the Hospital Frailty Risk Score (HFRS) and post-rTKA outcomes. Methods: Using the Nationwide Readmissions Database, we identified rTKA patients discharged from January 2017 to November 2019 for the most common diagnoses (mechanical loosening, infection, and instability). Using HFRS, we compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients with multivariate and binomial regressions. The 30-day complication and reoperation rates were compared using univariate analyses. We identified 25,177 mechanical loosening patients, 12,712 infection patients, and 9,458 instability patients. Results: Frail patients had higher rates of 30-day readmission (7.8 versus 3.7% for loosening, 13.5 versus 8.1% for infection, 8.7 versus 3.9% for instability; P < .01), longer length of stay (4.1 versus 2.4 days for loosening, 8.1 versus 4.4 days for infection, 4.9 versus 2.4 days for instability; P < .01), and greater cost ($32,082 versus $27,582 for loosening, $32,898 versus $28,115 for infection, $29,790 versus $24,164 for instability; P < .01). Frail loosening patients had higher 30-day complication (6.8 versus 2.9%, P < .01) and reoperation rates (1.8 versus 1.2%, P = .01). Frail infection patients had higher 30-day complication rates (14.0 versus 8.3%, P < .01). Frail instability patients had higher 30-day complication (8.0 versus 3.5%, P < .01) and reoperation rates (3.2 versus 1.6%, P < .01). Conclusions: The HFRS may identify patients at risk for adverse events and increased costs after rTKA. Further research is needed to determine causation and mitigate complications and costs.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Knee/adverse effects ; Frailty/complications ; Frailty/epidemiology ; Hospitalization ; Patient Readmission ; Patient Discharge ; Retrospective Studies ; Reoperation/adverse effects
Language	English
Publishing date	2023-12-20
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.2023.12.025
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Article ; Online: Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Total Hip Arthroplasty.

Tram, Michael K / Tabbaa, Ameer / Lakra, Akshay / Anoushiravani, Afshin A / Bernasek, Thomas L / Lyons, Steven T / O'Connor, Casey M

The Journal of arthroplasty

2023 Volume 39, Issue 5, Page(s) 1151–1156.e4

Abstract: Background: Frailty has been associated with poor outcomes and higher costs after primary total hip arthroplasty. However, frailty has not been studied in relation to outcomes after revision total hip arthroplasty (rTHA). This study examined the ... ...

Abstract	Background: Frailty has been associated with poor outcomes and higher costs after primary total hip arthroplasty. However, frailty has not been studied in relation to outcomes after revision total hip arthroplasty (rTHA). This study examined the relationship between the Hospital Frailty Risk Score (HFRS), postoperative outcomes, and cost profiles following rTHA. Methods: In this retrospective cohort study, we identified patients who underwent rTHA from January 2017 to November 2019 in the Nationwide Readmission Database. The 3 most frequently reported diagnosis codes for rTHA were then selected: dislocation; mechanical loosening; and infection. We calculated the HFRS for each patient to determine frailty status. We compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients, using multivariate logistic and negative binomial regressions to adjust for covariates. We identified 36,243 total patients who underwent rTHA. Overall, 15,448 patients had a revision for dislocation, 11,062 for mechanical loosening, and 9,733 for infection. Results: Compared to nonfrail patients, frail patients had higher rates of 30-day readmission, longer length of stay, and higher hospitalization cost. Frail patients had significantly higher rates of 30-day complication and 30-day reoperation. Conclusions: Frailty, measured using HFRS, is associated with increased postoperative complications and costs after rTHA. The HFRS has the ability to efficiently identify frail patients at-risk for perioperative complications enabling care teams to better focus optimization interventions on this patient cohort.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip/adverse effects ; Retrospective Studies ; Frailty/complications ; Frailty/epidemiology ; Reoperation/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Risk Factors
Language	English
Publishing date	2023-12-21
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.2023.12.027
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Article ; Online: Conversion total hip arthroplasty following extracapsular hip fracture fixation with a cephalomedullary device: a comprehensive review.

O'Connor, Casey M / Young, Joseph R / Villacres Mori, Benjamin / Murtaza, Hamza / Lyons, Steven T / Czajka, Cory / Bernasek, Thomas

Archives of orthopaedic and trauma surgery

2022 Volume 143, Issue 6, Page(s) 3525–3533

Abstract: With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly ... ...

Abstract	With the annual incidence of hip fractures and hip fracture fixation rising, the need for conversion total hip arthroplasty has also risen. About half of the 280,000 hip fractures that occur annually in the United States are extracapsular. Commonly extracapsular hip fractures are treated with either cephalomedullary nails (CMNs) or sliding hip screws (SHS). More recently, there has been a shift toward increased CMN use due to increased training with this fixation method as well as perioperative and biomechanical benefits. Given this shift, orthopedic surgeons need to understand the factors that lead to CMN failure. Failed CMN treatment leaves both patients and surgeons with few management options including revision fixation with or without osteotomy, conversion total hip arthroplasty, and conversion hemiarthroplasty. Surgeons must consider the patient and injury characteristics before deciding the best treatment plan. Conversion total hip arthroplasty is indicated in younger patients without femoral head and/or acetabular articular injury, degenerative joint disease, or avascular necrosis. Conversion total arthroplasty is a technically demanding and resource-intensive surgery associated with lower success rates and outcomes than primary total hip arthroplasty. Orthopedic surgeons should have thorough understanding of preoperative workup needed prior to surgery, implant selection associated with best outcomes, most common surgical approaches used, intraoperative considerations, and complications associated with conversion total hip arthroplasty. A comprehensive understanding of these concepts gives patients the best chance of having a successful outcome.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip ; Fracture Fixation, Internal ; Hip Fractures/surgery ; Fracture Fixation, Intramedullary ; Acetabulum/surgery
Language	English
Publishing date	2022-08-20
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-022-04570-7
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Article ; Online: The Microbiome of Osteoarthritic Hip and Knee Joints: A Prospective Multicenter Investigation.

Goswami, Karan / Clarkson, Samuel / Tipton, Craig / Phillips, Caleb D / Dennis, Douglas A / Klatt, Brian A / O'Malley, Michael / Smith, Eric L / Gililland, Jeremy / Pelt, Christopher E / Peters, Christopher L / Malkani, Arthur L / Palumbo, Brian T / Lyons, Steven T / Bernasek, Thomas L / Minter, Jon / Goyal, Nitin / Purtill, William / McDonald, James F /

Cross, Michael B / Prieto, Hernan A / Lee, Gwo-Chin / Hansen, Erik N / Bini, Stefano A / Ward, Derek T / Zhao, Neil / Shohat, Noam / Higuera, Carlos A / Nam, Dennis / Della Valle, Craig J / Parvizi, Javad

The Journal of bone and joint surgery. American volume

2023

Abstract: Background: Recent advances in high-throughput DNA sequencing technologies have made it possible to characterize the microbial profile in anatomical sites previously assumed to be sterile. We used this approach to explore the microbial composition ... ...

Abstract	Background: Recent advances in high-throughput DNA sequencing technologies have made it possible to characterize the microbial profile in anatomical sites previously assumed to be sterile. We used this approach to explore the microbial composition within joints of osteoarthritic patients. Methods: This prospective multicenter study recruited 113 patients undergoing hip or knee arthroplasty between 2017 and 2019. Demographics and prior intra-articular injections were noted. Matched synovial fluid, tissue, and swab specimens were obtained and shipped to a centralized laboratory for testing. Following DNA extraction, microbial 16S-rRNA sequencing was performed. Results: Comparisons of paired specimens indicated that each was a comparable measure for microbiological sampling of the joint. Swab specimens were modestly different in bacterial composition from synovial fluid and tissue. The 5 most abundant genera were Escherichia, Cutibacterium, Staphylococcus, Acinetobacter, and Pseudomonas. Although sample size varied, the hospital of origin explained a significant portion (18.5%) of the variance in the microbial composition of the joint, and corticosteroid injection within 6 months before arthroplasty was associated with elevated abundance of several lineages. Conclusions: The findings revealed that prior intra-articular injection and the operative hospital environment may influence the microbial composition of the joint. Furthermore, the most common species observed in this study were not among the most common in previous skin microbiome studies, suggesting that the microbial profiles detected are not likely explained solely by skin contamination. Further research is needed to determine the relationship between the hospital and a "closed" microbiome environment. These findings contribute to establishing the baseline microbial signal and identifying contributing variables in the osteoarthritic joint, which will be valuable as a comparator in the contexts of infection and long-term arthroplasty success. Level of evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Language	English
Publishing date	2023-05-16
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.22.00594
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Article ; Online: Complete Eradication of Biofilm From Orthopedic Materials.

Leary, Jeffrey T / Werger, Matthew M / Broach, William H / Shaw, Lindsey N / Santoni, Brandon G / Bernasek, Thomas L / Lyons, Steven T

The Journal of arthroplasty

2017 Volume 32, Issue 8, Page(s) 2513–2518

Abstract: Background: Interest exists in finding alternatives to current management strategies in periprosthetic joint infections, which typically include a 2-stage revision with placement of an antibiotic spacer and delayed placement of a new implant. We studied ...

Abstract	Background: Interest exists in finding alternatives to current management strategies in periprosthetic joint infections, which typically include a 2-stage revision with placement of an antibiotic spacer and delayed placement of a new implant. We studied the efficacy of autoclaving, ultrasonication, and mechanical scrubbing for sterilization and biofilm eradication on infected cobalt-chrome discs. Methods: Strains of Staphylococcus aureus MRSA252 or Staphylococcus epidermidis RP62A were grown on the discs. For each strain, discs were divided into 5 groups (5 discs each) and exposed to several sterilization and biofilm eradication treatments: (1) autoclave, (2) autoclave + sonication, (3) autoclave + saline scrub, (4) autoclave + 4% chlorhexidine (CHC) scrub, and (5) autoclave + sonication + CHC scrub. Sterilization and biofilm eradication were quantified with crystal violet assays and scanning electron microscopy. Results: Relative to nontreated controls, autoclaving alone reduced biofilm load by 33.9% and 54.7% for MRSA252 and RP62A strains, respectively. Biofilm removal was maximized with the combined treatment of autoclaving and CHC scrub for MRSA252 (100%) and RP62A (99.5%). The addition of sonication between autoclaving and CHC scrubbing resulted in no statistically significant improvement in biofilm removal. High-resolution scanning electron microscopy revealed no cells or biofilm for this combined treatment. Conclusion: Using 2 commonly encountered bacterial strains in periprosthetic joint infection, infected cobalt-chrome discs were sterilized and eradicated of residual biofilm with a combination of autoclaving and CHC scrubbing.
Language	English
Publishing date	2017-08
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.2017.03.050
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Article ; Online: Confirming Sterility of an Autoclaved Infected Femoral Component for Use in an Articulated Antibiotic Knee Spacer: A Pilot Study.

Lyons, Steven T / Wright, Coy A / Krute, Christina N / Rivera, Frances E / Carroll, Ronan K / Shaw, Lindsey N

The Journal of arthroplasty

2016 Volume 31, Issue 1, Page(s) 245–249

Abstract: Antibiotic spacer designs have proven effective at eradicating infection during a two-stage revision arthroplasty. Temporary reuse of the steam-sterilized femoral component and a new all poly tibia component has been described as an effective ... ...

Abstract	Antibiotic spacer designs have proven effective at eradicating infection during a two-stage revision arthroplasty. Temporary reuse of the steam-sterilized femoral component and a new all poly tibia component has been described as an effective articulating antibiotic spacer, but sterility concerns persist. Six explanted cobalt chrome femurs from patients with grossly infected TKA's and six stock femurs inoculated with different bacterial species were confirmed to be bacteria-free after autoclaving under a standard gravity-displacement cycle. The effect of steam sterilization on cobalt chrome fragments contaminated with MRSA biofilm was analyzed microscopically to quantify remaining biofilm. The autoclave significantly reduced the biofilm burden on the cobalt chrome fragments. This study confirmed sterility of the femur after a standard gravity-displacement cycle (132°C, 27 PSIG, 10 minutes).
MeSH term(s)	Acinetobacter baumannii ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Arthroplasty, Replacement, Knee/instrumentation ; Biofilms ; Cobalt/chemistry ; Enterococcus faecium ; Female ; Femur/surgery ; Humans ; Klebsiella pneumoniae ; Knee Joint/surgery ; Knee Prosthesis/microbiology ; Male ; Microscopy, Electron, Scanning ; Middle Aged ; Pilot Projects ; Prosthesis Design ; Prosthesis-Related Infections/prevention & control ; Prosthesis-Related Infections/surgery ; Pseudomonas aeruginosa ; Reoperation/instrumentation ; Staphylococcus aureus ; Staphylococcus epidermidis ; Sterilization ; Tibia/surgery
Chemical Substances	Anti-Bacterial Agents ; Cobalt (3G0H8C9362)
Language	English
Publishing date	2016-01
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.2015.06.068
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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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