The Burch–Schneider cage for reconstruction after metastatic destruction of the acetabulum: outcome and complications

Introduction  

The Burch–Schneider cage is an established implant in revision surgery after hip arthroplasty that is used for reconstructing osseous defects in the acetabulum. However, there are only a few reports about the use of cages in patients with metastatic destruction of the acetabulum. The aim of this retrospective study was to assess the outcome and complications of this procedure.     

Vacuum‐assisted closure therapy for vascular graft infection (Szilagyi grade III) in the groin—a 10‐year multi‐center experience

The aim of the study was to evaluate the benefit of vacuum‐assisted closure (VAC) therapy in the management of deep, alloplastic graft infections (Szilagyi grade III) in the groin. From 2000 to 2009, we identified and included in our study 72 deep inguinal infections in 68 patients, involving native as well as synthetic graft or patch material. There were 29 early graft infections (<30 days after implantation) and 43 late infections (≥30 days after implantation). Among these, 17 cases involved native grafts/patches (12 grafts and 5 patches), while 55 cases involved non‐native grafts/patches [26 polytetrafluorethylene (PTFE) grafts and 24 Dacron grafts (Haemashield, Meadox Medical, Boston Scientific Corporation, Natick, NY; Gelsoft graft, Vascutek, Inchinnan, Renfrewshire, Scotland, UK; Intervascular, Mahwah, NJ); INVISTA, and 5 Vascu‐Guard^? bovine pericardial patches; Synovis Surgical Innovation]. All patients were treated with multiple wound debridements, graft salvage, sartorius myoplasty, intravenous antibiotics and VAC therapy until thorough surface healing was achieved. Exclusion criteria were an alloplastic graft infection with proximal expansion above the inguinal ligament, blood culture positive for septicaemia or septic anastomotic herald or overt bleeding. Nine months after initiation of therapy, overall, graft/patch salvage was achieved in 61 of 72 (84·7%) cases. Of the native graft/patch group, infected graft material was replaced with an autogenous great saphenous vein graft or patch in four patients (23·5%). In the non‐native group, vein or synthetic graft preservation without revision was achieved in 48 of 55 (87·3%) patients. The mean duration of VAC therapy was 16 ± 7·7 days, and postoperative mean hospital stay was 25·3 ± 8·5 days. In 23 of 72 (31·9%) cases, a secondary closure of the wound was achieved; in the other 49 cases, wound healing was achieved by meshed split‐thickness skin grafting. Mean wound healing time for all wounds was 24·3 ± 12·5 days. Specific complications during VAC therapy were wound fluid retention in 2 cases and an increased need for analgesics in 12 cases (16·66%). Negative pressure wound therapy (NPWT) has been reported to be useful in the treatment of severe wound infections. Even in the presence of synthetic vascular graft material, NPWT can greatly simplify challenging wound‐healing problems leading to wound dehiscence and its sequelae. Our long‐term experience demonstrates the safety and effectiveness of VAC therapy in the management of deep graft infections.     

A comparison of conventional and patient-specific instruments in total knee arthroplasty

Purpose

Several authors have observed that standard instrumentation (SI) may be insufficient for addressing component malalignment. Patient-matched cutting blocks (PMCB) technology was introduced to improve surgeons’ ability to achieve a neutral postoperative mechanical axis following total knee arthroplasty (TKA). The current retrospective study was designed to compare the ability of SI and PMCB to achieve a hip-knee-ankle angle (HKA) within ±3° of the ideal alignment of 180°.

Methods

Between October 2009 and December 2012, 170 TKAs in 166 patients (four bilateral) using VISIONAIRE (Smith & Nephew) PMCB technology were performed. Additionally, 160 TKAs in 160 consecutive patients that had received a total knee arthroplasty using SI during the same time period were used as a control group, All surgeries were performed by the same surgeon. Standardized pre- and postoperative long-leg standing x-rays were retrospectively evaluated to compare the two patient cohorts.

Results

X-rays were available for analysis for 156 knees in the SI group and 150 in the PMCB group. The average post-surgical HKA was 178.7 ± 2.5 in the SI group and 178.4 ± 1.5 in the PMCB group. However, the rate of ± 3° outliers was 21.2 % in the SI group and 9.3 % in the PMCB group. There were no intraoperative complications with the use of PMCB technology or SI.

Conclusions

PMCB technology proved superior to conventional instrumentation in achieving a neutral mechanical axis following TKA. Further follow-up will be needed to ascertain the long-term impact of these findings.     

Trauma fatalities: time and location of hospital deaths

BACKGROUND: Analysis of the epidemiology, temporal distribution, and place of traumatic hospital deaths can be a useful tool in identifying areas for research, education, and allocation of resources. STUDY DESIGN: Trauma registry-based study of all traumatic hospital deaths at a Level I urban trauma center during the period 1993 to 2002. The time and hospital location where deaths occurred were analyzed according to mechanism of injury, age, Glasgow Coma Score, and body areas with severe injury (Abbreviated Injury Scale [AIS] >/= 4). Logistic regression analysis was used to identify risk factors associated with death at various times after admission. RESULTS: During the study period there were 2,648 hospital trauma deaths. The most common body area with critical injuries (AIS >/= 4) was the head (43%), followed by the chest (28%) and the abdomen (19%). Overall, 37% of victims had no vital signs present on admission. Chest AIS >/= 4, penetrating trauma, and age greater than 60 years were significant risk factors associated with no vital signs on admission. Patients with severe chest trauma (AIS >/= 4) reaching the hospital alive were significantly more likely to die within the first 60 minutes than were patients with severe abdominal or head injuries (17% versus 11% versus 7%). In patients reaching the hospital alive, the time and place of death varied according to mechanism of injury and injured body area. Deaths caused by severe head trauma peaked at 6 to 24 hours, and deaths caused by severe chest or abdominal trauma peaked at 1 to 6 hours after admission. CONCLUSIONS: The temporal distribution and location of trauma deaths are influenced by the mechanism of injury, age, and the injured body area. These findings may help in focusing research, education, and resource allocation in a more targeted manner to reduce trauma deaths.     

Oxidative stress responses in older men during endurance training and detraining

PURPOSE: Aging is associated with increased oxidative stress, whereas systematic exercise training has been shown to improve quality of life and functional performance of the aged. This study aimed to evaluate responses of selected markers of oxidative stress and antioxidant status in inactive older men during endurance training and detraining. METHODS: Nineteen older men (65-78 yr) were randomly assigned into either a control (C, N = 8) or an endurance-training (ET, N = 11, three training sessions per week, 16 wk, walking/jogging at 50-80% of HR(max)) group. Before, immediately posttraining, and after 4 months of detraining, subjects performed a progressive diagnostic treadmill test to exhaustion (GXT). Plasma samples, collected before and immediately post-GXT, were analyzed for malondialdehyde (MDA) and 3-nitrotyrosine (3-NT) levels, total antioxidant capacity (TAC), and glutathione peroxidase activity (GPX). RESULTS: ET caused a 40% increase in running time and a 20% increase in maximal oxygen consumption (VO(2max)) (P < 0.05). ET lowered MDA (9% at rest, P < 0.01; and 16% postexercise, P < 0.05) and 3-NT levels (20% postexercise, P < 0.05), whereas it increased TAC (6% at rest, P < 0.01; and 14% postexercise, P < 0.05) and GPX (12% postexercise, P < 0.05). However, detraining abolished these adaptations. CONCLUSIONS: ET may attenuate basal and exercise-induced lipid peroxidation and increase protection against oxidative stress by increasing TAC and GPX activity. However, training cessation may reverse these training-induced adaptations.