Adjuvant treatments including Betadine, Dakin's solution (sodium hypochlorite), or hydrogen peroxide (H O ) have been attempted to eradicate prosthetic joint infection caused by biofilm or intracellular bacteria. The purpose of this study was to evaluate the in vitro abilities of chemical adjuvants to decrease Staphylococcus aureus (S. aureus) biofilm presence on orthopaedic implant grade materials, including titanium, stainless steel, and cobalt chrome. S. aureus biofilms were grown for 48 h and evaluated for baseline colony forming units/centimeter squared (CFU/cm ) and compared to treatments with Betadine, Dakin's solution, H O , or 1% chlorine dioxide (ClO ). Control discs (n = 18) across all metals had an average of 4.2 × 10 CFU/cm . All treatments had statistically significant reductions in CFU/cm when compared to respective control discs (p < 0.05). For all metals combined, the most efficacious treatments were Betadine and H O , with an average 98% and 97% CFU/cm reduction, respectively. There were no significant differences between reductions seen with Betadine and H O , but both groups had statistically greater reductions than Dakin's solution and ClO . There was no change in antibiotic resistance patterns after treatment. Analysis of S. aureus biofilms demonstrated a statistically significant reduction in biofilm after a five-minute treatment with the modalities, with an average two log reduction in CFU/cm . Statement of clinical significance: While statistically significant reductions in CFU/cm were accomplished with chemical adjuvant treatments, the overall concentration of bacteria never fell below 10 CFU/cm , leading to questionable clinical significance. Further techniques to eradicate biofilm should be investigated. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1599-1604, 2018.

Purpose of Review To discuss the automated risk calculators that have been developed and evaluated in orthopedic surgery. Recent Findings Identifying predictors of adverse outcomes following orthopedic surgery is vital in the decision-making process for surgeons and patients. Recently, automated risk calculators have been developed to quantify patient-specific preoperative risk associated with certain orthopedic procedures. Automated risk calculators may provide the orthopedic surgeon with a valuable tool for clinical decision-making, informed consent, and the shared decision-making process with the patient. Understanding how an automated risk calculator was developed is arguably as important as the performance of the calculator. Additionally, conveying and interpreting the results of these risk calculators with the patient and its influence on surgical decision-making are paramount. Summary The most abundant research on automated risk calculators has been conducted in the spine, total hip and knee arthroplasty, and trauma literature. Currently, many risk calculators show promise, but much research is still needed to improve them. We recommend they be used only as adjuncts to clinical decision-making. Understanding how a calculator was developed, and accurate communication of results to the patient, is paramount.

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