Arlen D Hanssen

Mayo Clinic - Rochester, Rochester, Minnesota, United States

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Publications (219)672.55 Total impact

  • Brandon J Yuan, David G Lewallen, Arlen D Hanssen
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    ABSTRACT: Total hip arthroplasty (THA) for the treatment of posttraumatic osteoarthritis (OA) after acetabular fracture has been associated with a high likelihood of aseptic loosening, instability, and infection. Porous metal components may help to address the issue of loosening, but there are few data on the use of porous metal acetabular components for posttraumatic OA after acetabular fracture.
    Clinical Orthopaedics and Related Research 08/2014; · 2.79 Impact Factor
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    ABSTRACT: Few registry-based studies in the United States have compared the survivorship of different knee implant designs in total knee arthroplasty. The purpose of this study was to compare differences in survivorship of commonly used tibial implant designs in primary total knee arthroplasty.METHODS: A total of 16,584 primary total knee arthroplasties in 11,992 patients were performed at a single institution from 1985 to 2005. Patients were prospectively followed at regular intervals to ascertain details of subsequent revisions. Overall revision rates and revisions for aseptic loosening, wear, and osteolysis were compared across twenty-two tibial implant designs using Cox proportional hazards regression models adjusting for age, sex, calendar year, and body mass index.RESULTS: In comparison with metal-backed modular implants, all-polyethylene tibial components had a significantly lower risk of revision (hazard ratio, 0.3; 95% confidence intervals: 0.2, 0.5 [p < 0.0001]). The risk reduction with all-polyethylene tibial components was not affected by age, sex, or body mass index. With metal-backed modular tibial designs, cruciate-retaining knees performed better than the posterior-stabilized knees (p = 0.002), but this finding was limited to one specific metal-backed modular tibial component, the Press Fit Condylar design. With all-polyethylene tibial components, there was no survivorship difference between cruciate-retaining and posterior-stabilized designs.CONCLUSIONS: All-polyethylene tibial components were associated with better outcomes than metal-backed modular components. Cruciate-retaining and posterior-stabilized designs performed equally well, except with the Press Fit Condylar design. Obese patients may have superior results with all-polyethylene and posterior-stabilized components.LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of bone and joint surgery. American volume. 07/2014; 96(14):e121.
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    ABSTRACT: Total femoral arthroplasty (TFA) is an option to amputation in the setting of excessive bones loss during revision total hip and knee arthroplasty. Twenty non-oncologic TFAs with a minimum of 2years follow-up were retrospectively reviewed. The average clinical follow-up was 73±49months. The incidence of new infection was 25% (5/20), while the overall infection rate was 35% (7/20). The incidence of primary hip instability was 10% (2/20), while the overall instability rate was 25% (5/20). Six patients (30%) required revision. The average pre-operative HHS was 30.2±13.1. The average post-operative HHS was 65.3±16.9. TFA is a viable alternative to amputation in non-oncologic patients with massive femoral bone deficiency. However, TFA performed poorly in the setting of infection and instability.
    The Journal of arthroplasty. 05/2014;
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    ABSTRACT: Fungal periprosthetic joint infections (PJIs) are rare. Fewer than 200 cases have been reported in the literature. The characteristics of systemic inflammatory markers and joint aspirate cell count analysis obtained in patients with fungal PJIs have not been fully assessed. The ability to diagnose involvement of fungal PJI preoperatively may optimize the surgical and medical management of these patients. We determined whether preoperative systemic inflammatory markers and total synovial fluid leukocyte count and neutrophil percentage were different between patients with fungal and bacterial PJI. We reviewed the medical records of 44 patients with culture-positive diagnosed fungal PJIs treated at our institution between January 1, 2002, and December 31, 2011, in this study. This represented 1.2% of the total 3822 PJIs treated at our institution during the study period. The mean values for C-reactive protein, erythrocyte sedimentation rate, leukocyte count, and neutrophil percentage of patients with purely fungal PJIs were compared to those of 59 patients with bacterial PJIs treated by one surgeon during the same time period. The mean erythrocyte sedimentation rate values for fungal and bacterial PJIs were 40 mm/hour (95% CI: 30, 50 mm/hour) and 41 mm/hour (95% CI: 33, 49 mm/hour), respectively (p = 0.61). The mean C-reactive protein values for fungal and bacterial PJIs were 42 mg/L (95% CI: 22, 62 mg/L) and 65 mg/L (95% CI: 43, 88 mg/L), respectively (p = 0.42). The mean total nucleated leukocyte counts for fungal and bacterial PJIs were 11,928 (95% CI: 3906, 19,950) with 81% (95% CI: 75%, 88%) neutrophils and 36,901 (95% CI: 21,822, 51,921) with 73% (95% CI: 65%, 81%) neutrophils, respectively (leukocyte count: p = 0.19; neutrophil percentage: p = 0.55). Early detection of fungal PJI is needed, but systemic inflammatory markers and synovial fluid cell count analyses from aspirations do not discriminate whether an infection may be of fungal origin. Level IV, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 04/2014; · 2.79 Impact Factor
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    ABSTRACT: Polymerase chain reaction coupled with electrospray ionization mass spectrometry applied to synovial fluid had an 81% sensitivity and a 95% specificity for the diagnosis of prosthetic joint infection.
    Journal of clinical microbiology 04/2014; · 4.16 Impact Factor
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    ABSTRACT: Although highly porous metals have demonstrated excellent bone ingrowth properties and so are an intriguing option for fixation in total knee arthroplasty (TKA), some surgeons are skeptical about the durability of uncemented tibial fixation and the potential for soft tissues to adhere to these porous metals and perhaps cause knee stiffness or pain. The purpose of this study was to compare, in the context of a randomized clinical trial, a highly porous metal tibia compared with a traditional modular cemented tibia in terms of survivorship, Knee Society scores, range of motion (ROM), and complications. From 2003 to 2006, 397 patients (age 67.8 ± 8.7 years; 54% female) were randomized to three groups: (1) traditional modular cemented tibia; (2) cemented highly porous metal tibia; and (3) uncemented highly porous metal tibia. The same posterior-stabilized femoral component and patella component were cemented in every case. Stratified randomization was done for surgeon, patient's age, sex, and body mass index. Survivorship at 5 years was compared between the groups, as were Knee Society scores, ROM, and complications. Radiographic assessment included alignment, radiolucency, and implant migration/loosening. Patients were followed until death, revision, or for a minimum of 2 years (mean, 5 years; range, 2-9 years). Four patients were lost to followup before 2 years. Highly porous metal tibias (both uncemented and cemented) were no different from traditional cemented modular tibial modular components in terms of survivorship at 5 years using a intention-to-treat analysis (96.8% [1]; 97.6% [2]; 96.7% [3]; p = 0.59). A per-protocol analysis revealed that no highly porous metal tibia was revised for aseptic loosening. Highly porous metal tibias performed comparably to traditional cemented modular tibias in terms of Knee Society scores, ROM, and the frequency of complications. At 5 years this randomized clinical trial demonstrated that highly porous metal tibias provided comparably durable fixation and reliable pain relief and restoration of function when compared with a traditional cemented modular tibia in TKA. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 04/2014; · 2.79 Impact Factor
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    ABSTRACT: Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important.
    The Journal of Bone and Joint Surgery 03/2014; 96(6):e47. · 3.23 Impact Factor
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    ABSTRACT: We previously described a rapid PCR panel targeting bacteria associated with prosthetic joint infection (PJI) for use on biofilms dislodged from explanted hip and knee arthroplasties. Herein, we tested the PCR panel on periprosthetic tissues from 95 subjects undergoing resection knee arthroplasty, all of whom had had tissue cultures performed. A subset also had synovial fluid culture (n = 89) and/or device vortexing and sonication with culture (n = 58), and a subset of these PCR (n = 36) of resulting sonicate fluid, performed. Of the 64 subjects with PJI, 10 and 44 had positive tissue PCR and cultures, respectively, one of whom had a positive tissue PCR with negative tissue cultures. The overall sensitivity of tissue PCR (16%) was much lower than that of tissue (69%), synovial fluid (72%) and sonicate fluid (83%) culture as well as sonicate fluid PCR (78%) (P <0.00001, P <0.00001, P <0.00001, and P = 0.0003, respectively). Periprosthetic tissue PCR, as performed herein, has poor sensitivity for PJI diagnosis.
    Diagnostic Microbiology and Infectious Disease. 01/2014;
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    ABSTRACT: We compared PCR-ESI/MS to culture using sonicate fluid from 431 subjects with explanted knee (n=270) or hip (n=161) prostheses. 152 and 279 subjects had PJI and aseptic failure, respectively. The sensitivity for detecting PJI was 77.6% for PCR-ESI/MS and 69.7% for culture (p=0.0105). The specificities were 93.5 and 99.3%, respectively (p=0.0002).
    Journal of clinical microbiology 11/2013; · 4.16 Impact Factor
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    ABSTRACT: Clinical pathways commonly modify multiple variables and deviate from long-established clinical practices. Therefore, it is difficult to perform prospective, randomized clinical trials comparing "standard care" to the "new clinical pathway." The goal of this investigation was to examine the impact of clinical pathways implementation on perioperative outcomes and institutional costs in patients undergoing total knee arthroplasty (TKA). This before-and-after study evaluated patient clinical outcomes and economic costs after the implementation of institutional clinical pathway. The primary outcome was hospital length of stay (LOS). Clinical and economic outcomes were analyzed as continuous variables using paired t test. Fifty-four patients were identified for study inclusion. Patients undergoing their TKA after implementation of the clinical pathway had a significantly shorter hospital LOS (3.4 vs 4.4 days; P < 0.001). Patients reported significantly less postoperative pain, less postoperative confusion, and an easier time participating in physical therapy sessions after their second (after the clinical pathway implementation) TKA. Patients undergoing their TKA after the clinical pathway implementation had reduced total direct hospital costs ($956; 95% confidence interval, $233-$1785; P = 0.02). Our findings demonstrated that the use of a standardized clinical pathway reduced hospital LOS, improved clinical outcomes and patient satisfaction while reducing costs for identical surgical procedures.
    Regional anesthesia and pain medicine 10/2013; · 4.16 Impact Factor
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    ABSTRACT: The existence of the diagnosis "lateral patellar facet impingement" (LPFI) is controversial and the outcomes for surgical revision for symptomatic LPFI uncertain. We found that of the 3361 index knee revisions performed at our institution from 1995 to 2008, eleven were done for symptomatic LPFI. Their clinical histories and radiographic imaging were reviewed before and after revision TKA and were also compared to a group of control patients. We found no statistically significant differences between the groups in preoperative KS pain and function scores or radiographic features. However, the combined findings of pain in the subpatellar/lateral aspect of the knee post TKA and radiographic lateral facet contact were significantly associated with revision due to LPFI. Surgical revision results were variable, but~2/3 of the patients were satisfied with the operation and had a significant improvement in KS function scores.
    The Journal of arthroplasty 10/2013; · 1.79 Impact Factor
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    ABSTRACT: Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth.
    The Journal of arthroplasty 08/2013; · 1.79 Impact Factor
  • Louis S Stryker, Matthew P Abdel, Arlen D Hanssen
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    ABSTRACT: The roles of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are well established in the diagnosis of total joint infection. However, it is not entirely clear what value preoperative CRP and ESR have in predicting outcomes following irrigation and debridement with insert exchange for acute hematogenous total knee arthroplasty infection. The total joint registry at the authors' institution was reviewed to identify all patients who underwent irrigation and debridement with insert exchange for a diagnosis of acute hematogenous infection of a primary total knee arthroplasty. Patient medical records were then reviewed for preoperative white blood cell count and CRP and ESR levels; interval from symptom onset to surgery; infecting organism; and any additional surgery for infection. Average patient age was 72 years (range, 51-91 years). Forty-four patients were men and 26 were women. Mean follow-up was 54 months (range, 12-176 months). Seventy-two procedures (69 patients) met the inclusion criteria. Of these, 20 (28%) additional procedures for infection were performed and were classified as treatment failures. Average CRP was 173.7 mg/L in the successful group and 159.0 mg/L in the failed group (P=.31). Mean ESR at the time of irrigation and debridement with insert exchange was 61.3 mm/hr in both groups (P=.49). Although CRP and ESR are well established in the diagnosis of infection, no role currently exists for them in predicting the outcomes of irrigation and debridement with insert exchange for the treatment of acute hematogenous total knee arthroplasty infection.
    Orthopedics 06/2013; 36(6):765-70. · 1.05 Impact Factor
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    ABSTRACT: We previously showed that culture of samples obtained by prosthesis vortexing and sonication was more sensitive than tissue culture for prosthetic joint infection (PJI) diagnosis. Despite improved sensitivity, culture-negative cases remained; furthermore, culture has a long turnaround-time.We designed a genus-/group-specific rapid PCR assay panel targeting PJI bacteria and applied it to samples obtained by vortexing and sonicating explanted hip and knee prostheses, comparing results to sonicate fluid and periprosthetic tissue culture obtained at revision or resection arthroplasty.We studied 434 subjects with knee (n=272) or hip (n=162) prostheses; using a standardized definition, 144 had PJI. Sensitivities of tissue culture, and sonicate fluid culture and PCR were 70.1, 72.9 and 77.1%, respectively. Specificities were 97.9, 98.3 and 97.9%, respectively. Sonicate fluid PCR was more sensitive than tissue culture (P=0.04).PCR of prosthesis sonication samples is more sensitive than tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, and provides same-day PJI diagnosis with definition of microbiology. High assay specificity suggests that typical PJI bacteria may not cause aseptic implant failure.
    Journal of clinical microbiology 05/2013; · 4.16 Impact Factor
  • Clinical Infectious Diseases 03/2013; · 9.37 Impact Factor
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    ABSTRACT: Background There are no prospective data regarding the risk of prosthetic joint infection following routine gastrointestinal endoscopic procedures. We wanted to determine the risk of prosthetic hip or knee infection following gastrointestinal endoscopic procedures in patients with joint arthroplasty. Methods We conducted a prospective, single-center, case-control study at a single, tertiary-care referral center. Cases were defined as adult patients hospitalized for prosthetic joint infection of the hip or knee between December 1, 2001 and May 31, 2006. Controls were adult patients with hip or knee arthroplasties but without a diagnosis of joint infection, hospitalized during the same time period at the same orthopedic hospital. The main outcome measure was the odds ratio (OR) of prosthetic joint infection after gastrointestinal endoscopic procedures performed within 2 years before admission. Results 339 cases and 339 controls were included in the study. Of these, 70 cases (21%) cases and 82 controls (24%) had undergone a gastrointestinal endoscopic procedure in the preceding 2 years. Among gastrointestinal procedures that were assessed, esophago-gastro-duodenoscopy (EGD) with biopsy was associated with an increased risk of prosthetic joint infection (OR = 3, 95% CI: 1.1-7). In a multivariable analysis adjusting for sex, age, joint age, immunosuppression, BMI, presence of wound drain, prior arthroplasty, malignancy, ASA score, and prothrombin time, the OR for infection after EGD with biopsy was 4 (95% CI: 1.5-10). Interpretation EGD with biopsy was associated with an increased risk of prosthetic joint infection in patients with hip or knee arthroplasties. This association will need to be confirmed in other epidemiological studies and adequately powered prospective clinical trials prior to recommending antibiotic prophylaxis in these patients.
    Acta Orthopaedica 01/2013; · 2.74 Impact Factor
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    ABSTRACT: These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.
    Clinical Infectious Diseases 01/2013; 56(1):1-10. · 9.37 Impact Factor
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    ABSTRACT: These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.
    Clinical Infectious Diseases 12/2012; · 9.37 Impact Factor
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    ABSTRACT: Periprosthetic tissue and/or synovial fluid PCR has been previously studied for prosthetic joint infection (PJI) diagnosis; however, few studies have assessed the utility of PCR on biofilms dislodged from the surface of explanted arthroplasties using vortexing and sonication (i.e., sonicate fluid PCR). We compared sonicate fluid 16S rRNA gene real-time PCR and sequencing to culture of synovial fluid, tissue, and sonicate fluid for the microbiologic diagnosis of PJI. PCR sequences generating mixed chromatograms were decatenated using RipSeq Mixed. We studied sonicate fluids from 135 and 231 subjects with PJI and aseptic failure, respectively. Synovial fluid, tissue, and sonicate fluid culture and sonicate fluid PCR had similar sensitivities (64.7, 70.4, 72.6, and 70.4%, respectively; P > 0.05) and specificities (96.9, 98.7, 98.3, and 97.8%, respectively; P > 0.05). Combining sonicate fluid culture and PCR, the sensitivity was higher (78.5%, P < 0.05) than those of individual tests, with similar specificity (97.0%). Thirteen subjects had positive sonicate fluid culture but negative PCR, and 11 had negative sonicate fluid culture but positive PCR (among which 7 had prior use of antimicrobials). Broad-range PCR and culture of sonicate fluid have equivalent performance for PJI diagnosis.
    Journal of clinical microbiology 08/2012; 50(11):3501-8. · 4.16 Impact Factor
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    ABSTRACT: We determined the frequency of isolation of non-aureus staphylococcal small colony variants (SCVs) from 31 patients with staphylococcal prosthetic joint infection (PJI) and described the antimicrobial susceptibility, auxotrophy, and biofilm-forming capacity of these SCVs. Eleven non-aureus SCVs were recovered, all of which were Staphylococcus epidermidis, and none of which was auxotrophic for hemin, menadione, or thymidine. Aminoglycoside resistance was detected in 5. Two were proficient, and 7 were poor, biofilm formers. With passage on antimicrobial free media, we observed a fluctuating phenotype in 3 isolates. We also noted a difference in antimicrobial susceptibility of different morphology isolates recovered from the same joints despite similar pulsed-field gel electrophoresis patterns. Our findings suggest S. epidermidis SCVs are common in PJI, and while they have a similar appearance to S. aureus SCVs, they do not necessarily share such characteristics as aminoglycoside resistance; auxotrophy for hemin, menadione, or thymidine; or enhanced biofilm formation. We also underscore the importance of antimicrobial susceptibility testing of all morphologies of isolates recovered from PJI.
    Diagnostic microbiology and infectious disease 08/2012; 74(3):224-9. · 2.45 Impact Factor

Publication Stats

5k Citations
672.55 Total Impact Points

Institutions

  • 1988–2014
    • Mayo Clinic - Rochester
      • • Division of Orthopaedic Surgery
      • • Department of Infectious Diseases
      • • Department of Orthopedics
      Rochester, Minnesota, United States
  • 1994–2012
    • Mayo Foundation for Medical Education and Research
      • • College of Medicine
      • • Department of Orthopaedic Surgery
      • • Division of Infectious Diseases
      • • Department of Orthopedics
      • • Mayo Medical School
      Scottsdale, AZ, United States
  • 2009
    • UConn Health Center
      Farmington, Connecticut, United States
  • 2008
    • Sinai Hospital
      Baltimore, Maryland, United States
  • 2006
    • OrthoCarolina
      Charlotte, North Carolina, United States
    • Rochester College
      Rochester, New York, United States
    • Medical University of South Carolina
      • Division of Infectious Disease
      Charleston, SC, United States
  • 2004
    • Rothman Institute
      Philadelphia, Pennsylvania, United States
  • 1996
    • University of Pennsylvania
      Philadelphia, Pennsylvania, United States
    • University of Rochester
      • Department of Neurosurgery
      Rochester, NY, United States