The Effectiveness of C-Reactive Protein Surveillance as a Method to Monitor the Post-Operative Antibiotics Administration after Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness of using C-reactive protein (CRP) surveillance as a method to monitor the effect of postoperative antibiotics for the prevention of early infection after total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: A prospective study was performed in 115 primary TKRAs. We examined the values of CRP of all cases on the 3rd, 5th, 7th, 10th and 14th days post-operatively. Some patients were administrated additional antibiotics under certain specific situations based on the pattern of CRP. The patients were divided into two groups: group I with planned period of administration and group II with administration longer than the planned period. RESULTS: No acute infection after TKRA due to CRP surveillance was observed. The mean duration of antibiotics administration was 5.9 days in all cases, 5 days in group I and 13.3 days in group II. Twelve cases (10.4%) were included in group II. The CRP was increased on the 5th and 10th days after operation in group II. CONCLUSION: The surveillance of CRP was thought to be helpful in monitoring the effects of post-operative antibiotics and prevention of early infection after TKRA.

Minimally Invasive Plate Osteosynthesis for Proximal Tibial Shaft Fracture

PURPOSE: To report the results of patients treated by minimally invasive plate osteosynthesis (MIPO) for proximal tibial shaft fractures. MATERIALS AND METHODS: From September 2003 to June 2008, thirty-two patients with proximal tibial shaft fractures weretreated by MIPO. There were 22 men and 10 women and mean age was 43.8 years (range; 21~72 years). Follow-up was available for all patients and the mean follow-up period was 19.5 months (range; 12~40 months). Duration of union, range of knee motion and postoperative complications were evaluated. RESULTS: Twenty-nine patients (90.6%) healed after the MIPO technique. The mean duration of radiographic union was 18.3 weeks (range; 10~28 weeks). The mean range of knee motion was 134 degrees at the last follow-up. There were 1 non-union, 2 delayed unions, 1 superficial infection, 1 deep infection, 2 malunions with more than 5 degrees of malalignment and 14 cases of skin irritation by plate. CONCLUSION: MIPO is an effective treatment for closed, proximal tibialshaft fractures. More aggressive treatment such as dual plating should be considered in fractures with severe comminution or bone loss.

Risk Factors for Dislocation after Primary Total Hip Arthroplasty with the Transtrochanteric Approach

PURPOSE: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. MATERIALS AND METHODS: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. RESULTS: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). CONCLUSION: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.