role of pre-operative inflammatory markers in predicting postoperative infection in patients undergoing total knee arthroplasty

Background: C-reactive protein [CRP] and erythrocyte sedimentation rate [ESR] are frequently used to aid the diagnosis of postoperative peri-prosthetic infections [PPIs] following total knee arthroplasty [TKA]. The role of using these inflammatory markers preoperatively to predict the risk of postoperative PPIs in patients undergoing TKAs has not been well documented to date

Objective: To evaluate the role and cost-effectiveness of preoperative markers; ESR and CRP in predicting postoperative PPIs in patients undergoing elective primary TKA

Design: A Prospective Study

Setting: Department of Orthopedic Surgery, Salmaniya Medical Complex, Kingdom of Bahrain

Method: All patients who underwent primary or simultaneous bilateral TKA from 1 September 2014 to 31 December 2016 were included in the study. Patients who had uncontrolled diabetes, previous surgery or septic arthritis on the same knee, or lost for follow-up were excluded. Inflammatory markers were documented 1-2 days preoperatively. Patients were followed up over a period of 12 months postoperatively. All necessary data were collected prospectively and documented. The data were analyzed using SPSS 20

Result: One hundred thirty-nine patients were included in this study. One hundred and forty-two primary TKAs were performed during the study period, three patients underwent simultaneous bilateral TKA. Eighty-seven [62.59%] patients were females and 52 [37.41%] were males. The mean age was 64 years. Ninety-five [68.34%] patients had one or more preoperative comorbidities. High preoperative levels of CRP and/or ESR were found in thirty-seven [26.62%] patients. Two [1.44%] patients developed postoperative infection and were treated successfully. No other complications were recorded

Conclusion: In our study, we found no significant link between elevated preoperative inflammatory markers and the presence of PPI. Therefore, we do not support the routine use of preoperative inflammatory markers

Does the implant design influence the outcome after total Knee Arthroplasty?

Objective: To compare the outcome of the two different TKA implant designs used at SMC and to derive an estimate for the cost-effectiveness of using different implants

Design: A Retrospective Study

Setting: Department of Orthopedics, Salmaniya Medical Complex, Bahrain

Method: Two hundred ninety-eight patients who had TKA from January 2011 to June 2014 at SMC were reviewed. Patients with different implant designs were compared for pain severity, the range of motion [ROM], walking distance and satisfaction

Result: There were no significant statistical differences in pain severity, ROM, walking distance or patient's satisfaction between the two implant designs used at SMC

Conclusion: Selection of the implant design from the known manufacturers should be based on appropriate criteria

Acetabulum and pelvis fractures: a retrospective study

Fractured acetabulum and pelvis are serious injuries. In the last century, conservative treatment was the most common. Conservative approach carries high incidence of morbidity and mortality. Over the last two decades, operative treatment has become the treatment of choice. The aim of this study is to compare the outcome of conservative and operative treatment of fractured acetabulum and pelvis. A retrospective study. Salmaniya Medical Complex [SMC], Bahrain. The hospital records and radiographic images for all patients with fractured acetabulum and pelvis admitted to SMC from January 2000 to March 2005 were reviewed. Eighty-one patients were included in the study, 61 males and 20 females with a mean age of 41 years [ranges from 18 to 68]. Patients under the age of 18 years were excluded. Injuries were classified according to Tile's comprehensive classification. The main causes for injuries were as follows: 40 [49.4%] patients due to a fall from height and 37 [45.7%] due to road traffic accidents [RTA]. Sixty-five out of 66 were treated conservatively from January 2000 to July 2004. Ten out of 15 were treated operatively from August 2004 to March 2005. The operated group had early mobilization, less complications and shorter hospital stay. Operative treatment for acetabulum and pelvis fractures is technically demanding, but it has better outcome than conservative treatment