Risk infection factors in the total hip replacement

Infection is a complication that occurs in a considerable percentage of hip prostheses replacements, being in many cases necessary to retire them, which generates important health and economical problems. Objectives: To know the distribution of infection and its risk factors in total hip replacement. Material and methods: A four year prospective study was developed in the rehabilitation and orthopedic center of La Paz Hospital. A total of 873 patients were included. Patients were controlled by means of active epidemiological surveillance until the day of discharge, listing up their characteristics at admission and risk factors during their stay. A multivariant study was carried out to determine risk factors. Results: Patients, average age was 63 years, 3.4% of them suffered from diabetes and there were no inmunocompromised patients. The percentage of wound infection during the four years was 6%, being reduced to 1.2% in the last year. The risk factors found in the multivariant study were: incorrect prophylaxis (OR: 3.85), wrong scaring (OR: 14.06), suffering more than one intervention (OR: 7.31) and a hospitalization period longer than 30 days (OR: 2.84). Conclusion: We think that special attention in the care of the surgical wound, as well as the correct use of prophylaxis, can significantly collaborate to the reduction of infection.     

Lumbosacral fracture dislocation in a lumberjack

Summary Lumberjack fractures normally occur in the thoracic and upper lumbar spine as a result of hyperextension and shear. This case, however, involves a lumberjack who suffered a lumbosacral fracture dislocation without neurological deficits, which occurred as the result of shear and hyperflexion. Due to the high degree of instability of this lesion, the treatment consisted of dorsoventral fusion with instrumentation.     

Ultrasound of femoral head cartilage: a new method of assessing bone age

This paper analyses the relationship between the thickness of the anterior femoral head cartilage (FHC), as measured by ultrasound, and some anthropometric parameters, such as height, weight, skeletal and chronological age. In addition, it provides standard norms for FHC thickness in a paediatric population. Both hips were examined in 213 consecutive subjects (99 boys and 114 girls), aged 1.9–14 years. Seventy-four subjects underwent hand and wrist X-rays for skeletal maturation: 32 of these were dropped from the study because a discrepancy as high as two standard deviations was found between their skeletal and their chronological age. The thickness of FHC correlated strongly with skeletal and chronological age, standing height and body weight. A side difference of 0.2 mm in FHC was considered to be abnormal. The study population was divided into 13 groups according to chronological age and values of FHC for boys and girls are provided for each group. It is suggested that the magnitude of hyaline FHC is a valuable feature in the evaluation of skeletal maturation in children.     

Introduction

The number of femoral fractures after hip arthroplasty has increased proportionally to the number of hip arthroplasties. Eleven university-orthopaedic centers in eastern France co-operated to review 250 femoral fractures in relation to hip prothesis. This is the largest published review. The aims of this retrospective study were:

全髋关节置换术后早期脱位发生原因探讨

目的：探讨全髋关节置换术后早期脱位发生原因,以指导预防和治疗。方法：统计１０１例患者的１１３侧全髋置换术临床资料,对其中发生早期脱位的７例患者进行治疗及随访观察。结果：脱位主要由术后搬动及康复锻炼不适当引起,保守治疗效果良好。结论：髋关节周围的组织完整是全髋关节术后稳定的主要因素之一     

Osteochondroma and secondary synovial osteochondromatosis

Secondary synovial osteochondromatosis (SOC) is a rare disorder caused by a variety of joint disorders. Two unusual cases of secondary SOC are presented. The first patient is a 43-year-old man with extensive SOC developing within a bursa surrounding an osteochondroma of the pubic bone. The second patient is a 23-year-old man who developed florid and progressive SOC of his hip joint following excision of a femoral neck osteochondroma. SOC recurred despite three excisions over a 15-month period. Imaging was useful in pre-operative diagnosis of bursal SOC in the first patient and in detecting multiple recurrences in the second patient. Both cases illustrate prominent SOC developing secondary to osteochondroma. The different hypotheses regarding bursal and secondary SOC are reviewed. Received: 8 October 1998 Revision requested: 28 October 1998 Revision received: 13 November 1998 Accepted: 16 November 1998     

外伤性晶状体脱位继发性青光眼的治疗分析

目的 探讨外伤性晶状本脱位继发性青光眼的治疗方法。方法 药物保守治疗１８例,单纯小梁切除７例,单纯晶状体摘出１４例,晶状体摘出联合小梁切除７例。结果 ４６例中２例在局部滴用噻吗心安后,眼压控制在２１ｍｍＨｇ以下。治疗后矫正视力和前相比差异有显著性。结论 外伤性晶状体脱位继发性青光眼的治疗关键是尽早地用药物或手术方法缓解瞳孔阻滞,房角损伤≥２个象限者加用滤过性手术。     

Transient osteoporosis of the Hip: a densitometric study

Summary Three new cases of transient osteoporosis of the hip are reported. Diagnosis was achieved by plain radiographs, bone scintiscan, magnetic resonance imaging and X-ray absorptiometry of proximal femurs. The densitometry showed at the Ward's triangle a mean reduction of bone mineral density in the affected side of 36%. All subjects were treated with i.v. clodronate for ten consecutive days with a complete recovery of femoral density within 4 months. X-ray absorptiometry allows a quantification of the demineralization process and can be useful in the long term evaluation of this entity.     

Four and a half years experience with a vertical flow sterile enclosure

Summary During the use of a vertical flow enclosure of our own design for almost five years, bacteriological studies and the infection rates in different groups of patients have taught us the following:1. In a clean room operating theatre, the use of a respired air exhaust system improves the sterility compared with the use of ordinary masks. In a vertical flow enclosure, the chest, the arms, and the hands of the team are contaminated from respired airborne bacteria if helmets, etc., are not worn.2. In our vertical flow enclosure with almost continuous absolute sterility of the air, the infection rate in primary total hip replacement is very low and less than 1%, including early and late infections. Antibiotics have not been used.In secondary surgery, i.e., total hip replacement in hip joints previously operated upon, the infection rate is markedly higher, probably because of a flare-up of latent infection.Clean room surgery therefore, can only prevent air borne contamination, and no more; but this is very valuable.3. Vertical flow enclosures of the Charnley-Howorth (1975) and Weber et al. (1971) type provide considerable improvement in sterility of the air compared with adaptations of more conventional theatres. We recommend that these facilities be made available for implant surgery. It is also necessary to have a stringent operational policy with cooperation and discipline on the part of all members of the theatre team.

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Résumé Durant l'utilisation, depuis plus de 5 ans, de la serre stérile à flux laminaire vertical que nous avons construite, nous avons pratiqué des études bactériologiques et pu comparer les taux d'infection suivant les groupes de patients.1. Dans une salle d'opération propre, la stérilité est considérablement améliorée par le port de casques possédant un système d'aspiration de l'air expiré, ceci par rapport au port de masques ordinaires. De plus, si l'on ne porte pas le casque dans une serre à flux laminaire vertical, le tronc, les mains et les membres supérieurs de l'équipe chirurgicale sont contaminés par les microbes en suspension dans l'air expiré.2. Dans notre serre où l'air est pratiquement stérile, le taux d'infections précoces et tardives est inférieur à 1% dans les arthroplasties de la hanche, et cela sans utilisation d'antibiotiques.Lors d'interventions dites secondaires, c'est-à-dire dans les cas déjà opérés au préalable, par exemple par ostéotomie, ostéosynthèse, etc., le taux d'infection est plus élevé. On doit probablement en rechercher la cause dans une contamination de la plaie lors de la première intervention, l'infection alors à l'état latent pouvant se réveiller à la faveur d'une nouvelle opération.En opérant dans une serre stérile, on peut donc prévenir la contamination par l'air ambiant, mais pas plus. Cela est cependant déjà très appréciable.3. Comparées aux salles d'opération conventionnelles modernes, les serres stériles à flux laminaire vertical, comme celle de Charnley-Howorth (1975) et Weber-Meierhans (1971), améliorent considérablement la stérilité de l'air. Surtout pour la chirurgie prothétique de la hanche, dont les risques d'infection sont élevés, nous recommandons l'emploi de ce genre d'installation. Mais il est nécessaire que tous les membres de l'équipe chirurgicale adoptent des règles très strictes de discipline.