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101.
Sandra C.P. Jansen Jeroen Bransen Gust van Montfort Arnold T. Besselaar Alexander H. van der Veen 《The Journal of foot and ankle surgery》2018,57(6):1120-1124
The aim of this study was to evaluate the results of open reduction and internal fixation through the extended lateral approach (ELA) in displaced intra-articular calcaneal fractures and to determine whether this approach should remain part of standard therapy. This retrospective cohort study included 60 patients with 64 displaced intra-articular calcaneal fractures who underwent surgical treatment through the ELA. Outcome measures were the visual analog scale foot and ankle (VAS FA), the American Orthopedic Foot and Ankle Society (AOFAS) score, surgical site infections (SSIs), and reoperations. We determined the AOFAS score for 40 patients with 42 fractures, and 42 patients with 44 fractures completed the VAS FA questionnaire. The mean VAS FA score was 61.0 ± 23.4 and the median AOFAS score was 83 (range 33 to 100), with 55% good to excellent scores. We found 10.9% superficial SSIs successfully treated with antibiotics. In 4.7% of patients a deep SSI was diagnosed, wherefore premature implant removal was necessary. Patients with an SSI did not have significantly lower VAS FA or AOFAS scores than did patients without an SSI (p = .318 and p = .766, respectively). Implant removal in absence of SSIs was necessary in 17 patients because of pain, and 3 patients needed secondary arthrodesis because of persistent pain. We concluded that the ELA proved to be a safe procedure, and moreover the most common complications did not influence the long-term outcomes of patients. However, recent literature demonstrates that less invasive techniques seem to exceed the ELA with respect to wound complications. 相似文献
102.
Background
The first metatarsophalangeal joint may be fused in order to treat arthritis or instability. The use of shape-memory staples for fixation is well recognised, but little work has been done into the optimal configuration of staples.Methods
The structural behaviour of first metatarsophalangeal joint (MTPJ) arthrodeses using shape-memory staples or crossed screws was studied using cadaveric porcine joints. Five fixation configurations were tested: single vertical or horizontal staple, paired staples in dorsal‐medial configuration (0–90° to the sagittal plane), paired staples in oblique orthogonal configuration (45–135°); or two crossed screws. Specimens were loaded in cyclical dorsiflexion for 1000 cycles. Plantar gapping and shearing were measured. Specimens were then loaded to failure.Results
Cyclic testing caused more shear in the 45–135° staples than the crossed screws (1.0 mm ± 0.5 mm compared to 0.14 mm ± 0.4 mm, p < 0.01). No significant difference was found in plantar gap formation. Single vertical and horizontal single staples failed at 15N and 19.Conclusions
N, respectively. Paired 0–90° staples failed at 43 N ± 9 N, significantly lower than the 45–135° staples (141 N ± 25 N; p < 0.001) and crossed screws (180 N ± 67 N; p < 0.001). There was no significant difference between the 45–135° staples and crossed screws. Screws failed by sudden cortical fracture; staples displayed gradual pull‐out and shearing. First MTPJ arthrodeses fixed with single staples are not recommended. Arthrodeses fixed with staples at 0–90° to the sagittal plane were significantly less strong than two crossed screws. However, positioning oblique staples at 45–135° significantly improved stability, creating a construct as strong as, crossed screws. None of the constructs was strong enough for immediate weight bearing. 相似文献103.
Praveen Vijaysegaran Luke D. Knibbs Lidia Morawska Ross W. Crawford 《The Journal of arthroplasty》2018,33(5):1524-1529
Background
The role of space suits in the prevention of orthopedic prosthetic joint infection remains unclear. Recent evidence suggests that space suits may in fact contribute to increased infection rates, with bioaerosol emissions from space suits identified as a potential cause. This study aimed to compare the particle and microbiological emission rates (PER and MER) of space suits and standard surgical clothing.Methods
A comparison of emission rates between space suits and standard surgical clothing was performed in a simulated surgical environment during 5 separate experiments. Particle counts were analyzed with 2 separate particle counters capable of detecting particles between 0.1 and 20 μm. An Andersen impactor was used to sample bacteria, with culture counts performed at 24 and 48 hours.Results
Four experiments consistently showed statistically significant increases in both PER and MER when space suits are used compared with standard surgical clothing. One experiment showed inconsistent results, with a trend toward increases in both PER and MER when space suits are used compared with standard surgical clothing.Conclusion
Space suits cause increased PER and MER compared with standard surgical clothing. This finding provides mechanistic evidence to support the increased prosthetic joint infection rates observed in clinical studies. 相似文献104.
Ruben Scholten Keetie Kremers Sebastiaan A.W. van de Groes Diederik M. Somford Sander Koëter 《The Journal of arthroplasty》2018,33(5):1546-1551
Background
Postoperative urinary retention (POUR) appears to be a common complication in lower limb joint arthroplasty; however, reports on its incidence vary. There is no general consensus on its definition and there is no scientific evidence on treatment principles. We performed a prospective observational study to establish the incidence of POUR and its risk factors, including the preoperative postvoid residual urine volume and the perioperative fluid balance, in fast-track total joint arthroplasty (TJA). The preoperative residual urine volume and the perioperative fluid balance have not been studied in previous literature in the context of TJA and POUR.Methods
Three hundred eighty-one patients who underwent TJA of the lower limb were observed on developing POUR according to our local treatment protocol. Data on possible risk factors for POUR were collected including the perioperative fluid balance and the preoperative residual urine volume.Results
In total, 46.3% of patients were catheterized. A preoperative postvoid urine retention is a significant predictor of catheterization for postoperative residual urine (P = .03). Spinal anesthesia was correlated with urinary retention (P = .01). There was no cause-effect relationship between POUR and the perioperative fluid balance.Conclusion
This study underlines POUR as a common complication in fast-track lower limb arthroplasty, with spinal anesthesia as a risk factor. A higher preoperative residual urine volume leads to higher postoperative residual volume, but not to a higher change in urinary retention. Increased perioperative fluid administration is not correlated with the incidence of POUR. Furthermore, there seems to be little rationale for monitoring residual urine volume both preoperatively and postoperatively. 相似文献105.
Amanda L. Walsh Adam C. Fields James D. Dieterich Darwin D. Chen Michael J. Bronson Calin S. Moucha 《The Journal of arthroplasty》2018,33(5):1530-1533
Background
Several studies have shown that Staphylococcus aureus (S aureus) nasal colonization is associated with surgical site infection and that preoperative decolonization can reduce infection rates. Up to 30% of joint arthroplasty patients have positive S aureus nasal swabs. Patient risk factors for colonization remain largely unknown. The aim of this study was to determine whether there is a specific patient population at increased risk of S aureus nasal colonization.Methods
This study is a retrospective review of 716 patients undergoing hip or knee arthroplasty beginning in 2011. All patients were screened preoperatively for nasal colonization. Univariate and multivariate analyses were used to assess risk factors for nasal colonization.Results
A total of 716 patients undergoing joint arthroplasty had preoperative nasal screening. One hundred twenty-five (17.50%) nasal swabs were positive for methicillin-susceptible S aureus (MSSA), 13 (1.80%) were positive for methicillin-resistant S aureus (MRSA), and 84 (11.70%) were positive for other organisms. In bivariate analysis, diabetes (P = .04), renal insufficiency (P = .03), and immunosuppression (P = .02) were predictors of nasal colonization with MSSA/MRSA. In multivariate analysis, immunosuppression (P = .04; odds ratio, 2.0; 95% confidence interval, 1.03-3.71) and renal insufficiency (P = .04; odds ratio, 2.5; 95% confidence interval, 1.01-6.18) were independent predictors of nasal colonization with MSSA/MRSA.Conclusion
Overall, 17.5% of patients undergoing primary hip or knee arthroplasty screened positive for S aureus. Diabetes, renal insufficiency, and immunosuppression are risk factors for such colonization. Given that these comorbidities are already known independent risk factors for periprosthetic joint infection, these patients should be particularly screened and when necessary, decolonized. 相似文献106.
Adam I. Edelstein Kamil T. Okroj Thea Rogers Craig J. Della Valle Scott M. Sporer 《The Journal of arthroplasty》2018,33(7):2225-2229
Background
Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded cement spacer (ACS). The risk for acute kidney injury (AKI) related to use of antibiotic spacers has not been well defined. We aimed to identify the incidence of and risk factors for AKI after placement of an ACS.Methods
We performed a prospective cohort study of patients with an infected primary total hip or knee arthroplasty treated with ACSs with vancomycin, gentamicin, and tobramycin. Serum creatinine and glomerular filtration rate data were collected at baseline and weekly intervals for 8 weeks. Patients were classified into Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) stages to determine incidence of AKI. Risk factors for kidney injury were identified via regression analysis.Results
A total of 37 patients (20 total knee arthroplasty and 17 total hip arthroplasty) were included. During the 8 weeks after ACS placement, 10 patients (27%) fit RIFLE criteria for kidney injury and 2 patients (5%) fit RIFLE criteria for kidney failure. No baseline patient characteristics were associated with development of AKI.Conclusion
Patients should be monitored closely for development of AKI after placement of ACSs for the treatment of periprosthetic joint infection. Further research into minimizing risk for AKI is warranted. 相似文献107.
Xin Y. Mei Ibrahim S. Alshaygy Oleg A. Safir Allan E. Gross Paul R. Kuzyk 《The Journal of arthroplasty》2018,33(7):2050-2056
Background
Controversy remains over the surgical management of large osteochondral lesions of the femoral head in young, active patients. The purpose of this study is to assess midterm clinical and radiographic outcomes after fresh osteochondral allograft transplantation (OAT) for large femoral head lesions at minimum 2-year follow-up.Methods
A retrospective review of prospectively collected data was performed for 22 patients under the age of 50 years with defined femoral head osteochondral lesions who underwent fresh OAT between 2008 and 2015. Patients were assessed clinically using the modified Harris Hip Score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and Kellgren & Lawrence Grade for osteoarthritis severity. Complications and reoperation were assessed by chart review. Kaplan-Meier survivorship analyses with 95% confidence intervals were performed for the end point of conversion to total hip arthroplasty.Results
At a mean follow-up of 68.8 months (26-113), the mean mHHS improved significantly (P < .001) from 48.9 (19-84) to 77.4 (35-98). Sixteen of 22 patients (72.7%) had an mHHS ≥70 at the latest follow-up. Arthritic progression, as indicated by an increase in the Kellgren & Lawrence Grade, occurred in 4 of 22 hips (18.2%). Five patients (22.7%) underwent conversion to total hip arthroplasty. Graft survivorship was 86.4 ± 7.3% at 2 years, 78.5 ± 10.0% at 5 years, and 67.3 ± 13.5% at 9 years.Conclusion
Fresh OAT may be a viable treatment option for osteochondral defects of the femoral head in young, active patients with minimal preexisting joint deformity. 相似文献108.
Thomas R. Hickernell Akshay Lakra Ari Berg Herbert J. Cooper Jeffrey A. Geller Roshan P. Shah 《The Journal of arthroplasty》2018,33(12):3637-3641
Background
This study investigated the effects of dronabinol on pain, nausea, and length of stay following total joint arthroplasty (TJA).Methods
We retrospectively compared 81 consecutive primary TJA patients who received 5 mg of dronabinol twice daily in addition to a standard multimodal pain regimen with a matched cohort of 162 TJA patients who received only the standard regimen. A single surgeon performed all surgeries. Patient demographics, length of stay, opioid morphine equivalents (MEs) consumed, reports of nausea/vomiting, discharge destination, distance walked in physical therapy, and visual analog scale pain scores were collected for both groups. Student’s t-tests as well as chi-square or Mann-Whitney U-tests were used for statistical comparisons.Results
There were no significant differences between the 2 groups for age, gender, body mass index, American Society of Anesthesiologists score, anesthesia type, visual analog scale scores, distance walked with physical therapy, discharge disposition, or episodes of nausea/vomiting. The mean length of stay in the dronabinol group was significantly shorter at 2.3 ± 0.9 days versus 3.0 ± 1.2 days in the control group (P = .02). In the context of a shorter stay, the dronabinol group consumed significantly fewer total MEs (252.5 ± 131.5 vs 313.3 ± 185.4 mg, P = .0088). Although the dronabinol group consumed fewer MEs per day and per length of stay on average, neither of these achieved statistical significance. No side effects of dronabinol were reported.Conclusion
These findings suggest that further investigation into the role of cannabinoid medications for non-opioid pain control in the post-arthroplasty patient may hold merit. 相似文献109.
110.
Jonathan H. Garfinkel Brian P. Gladnick Niama Roland David W. Romness 《The Journal of arthroplasty》2018,33(2):533-536