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ABSTRACT
2
INFECTED
TOTAL KNEE ARTHROPLASTY:
POTENTIAL ACUPUNCTURE COMPLICATION?
By
Major Steven E. Braverman, M.D.,
Chief, Department of Physical Medicine
and Rehabilitation
Director, Residency Training,
Walter Reed Army Hospital, Washington, DC
INTRODUCTION
No acupuncture
trials specifically addressing acupuncture
risk and complications are underway presently
in the United States. This case report and
follow-up survey concerns a previously unreported
acupuncture complication: infection of - total
joint prosthesis (TJP).
CASE
The patient
was a 59-year-old male, referred for treatment
of worsening low back pain, three weeks status
post bilateral total knee arthroplasties.
Physical exam and MRI confirmed lumbar spinal
stenosis as the likely cause of pain. Three,
weekly acupuncture treatments included bilateral
KI 10 and BL 40 points behind the knees. One
week later, this individual developed a left
knee prosthesis Staph Aureus infection, requiring
surgical debridement and antibiotics.
DISCUSSION
Following up
on this occurrence involved a retrospective
survey being sent to 300 practice members
of the American Academy of Medical Acupuncture
(AAMA); determining acupuncture practice patterns
and risk of infection in patients with TIP
was the goal. The overall response rate was
44% (131 out of 300). Physicians (107, or
82%) reported performing acupuncture on patients
with TIP; 91 physicians (85%) placed needles
in the vicinity of the joint. These 91 physicians
averaged 50 treatments per year, with no reported
infections.
CONCLUSION
The overall
surgical risk of TIP infection is 8%. It is
likely, but uncertain, that the aforementioned
case represents a coincidental infection.
This case also demonstrates the need for large
prospective controlled studies regarding the
safety of acupuncture.
AUTHOR
INFORMATION
Dr. Steven Braverman is Chief, Department
of Physical Medicine and Rehabilitation, and
Director, Residency Training, in the Department
of Physical Medicine and Rehabilitation, Walter
Reed Army Medical Center, Washington, DC.
Major
Steven E. Braverman, M.D.
Chief, Department of PM&R
Director, Residency Training
Department of Physical Medicine and Rehabilitation
Walter Reed Army Medical Center
Washington, DC 20307-5001
Phone: 202-782-6368 Fax:
202-782-0970
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