Peri-operative renal morbidity secondary to gentamicin and flucloxacillin chemoprophylaxis for hip and knee arthroplasty.

INTRODUCTION: This retrospective cohort study uses serum creatinine levels to assess the effect of gentamicin and flucloxacillin on renal function in hip and knee arthroplasty patients. METHODS: Serum creatinine levels were recorded pre-operatively and at two points post-operatively (sample 1 and sample 2) for all patients undergoing hip and knee arthroplasty. Either cefuroxime, or gentamicin and flucloxacillin were used for chemoprophylaxis. The Risk, Injury, Failure, Loss, End Stage classification was used to assess renal injury. RESULTS: The differences in mean percentage change between the two groups were 5.86% (p = 0.077) and 11.34% (p = 0.030) at sample 1 and sample 2, respectively. Two patients (1.62%) receiving cefuroxime were exposed to renal risk or worse at some point. A total of nine patients (6.04%) receiving flucloxacillin and gentamicin were exposed to renal risk. Of these, three (2.01%) sustained renal injury and two (1.34%) sustained renal failure. The risk of being exposed to renal risk was 3.75 times greater for the gentamicin and flucloxacillin group. The risks of sustaining a significant deterioration of renal function were 1.9 and 17 times greater for the gentamicin and flucloxacillin group at the first and second post-operative samples, respectively. DISCUSSION: Flucloxacillin and gentamicin significantly worsens renal function post-operatively compared with cefuroxime.

Effect of surgical approach for total hip replacement on hip function using Harris Hip scores and Trendelenburg's test. A retrospective analysis.

OBJECTIVE: A retrospective analysis of osteoarthritis patients undergoing primary hip arthroplasty, to assess which surgical approach produces the best functional results at one-year post-operatively, using common clinical scoring systems and tests. The aim of this study was to compare the anterolateral and the posterior approaches to total hip arthroplasty using Harris Hip scores and Trendelenburg's test by looking at pre-operative results and comparing them to post-operative results. METHODS: Data from 3416 consecutive cases were extracted from a multicentre database, maintained by the Tayside Arthroplasty Audit Group (TAAG) situated in Tayside, using only patients who had undergone a primary hip arthroplasty and had a clinical diagnosis of osteoarthritis. RESULTS: Analysis showed that there was statistically significant difference between the two approaches for Harris Hip score (p = 0.0344), Harris Hip function score (p = 0.0035) and Trendelenburg Test (p =< 0.00001). The posterior approach showed larger improvements in Harris Hip scores. There was an increased incidence of dislocation in the posterior approach group (6.9%) but an increased incidence of Trendelenburg gait in anterolateral approach group (5.7%). It was found that patients who suffered a dislocation had similar functional outcomes for both groups with no statistical difference. CONCLUSIONS: These results suggest that there may be benefit in using a posterior approach to primary total hip arthroplasty but due to limitations of the data within this study further more detailed research is required.

Offset acetabular cups: A solution to wear?

Change of tribological properties has been the main goal in the effort to augment the longevity of total hip arthroplasty, while the reduction of forces acting across the artificial joint space has received little attention. Spurred by recent reports of wear behaviour and good clinical results of the offset low friction arthroplasty cups, the authors, using the simplified free body technique, estimated the resultant hip joint reaction force and the angle of its application on 100 individual anteroposterior pelvic radiographs, by templating on the same hip a conventional concentric cup and an offset eccentric one. The results showed a highly significant reduction (p<0.0001) of the resultant hip joint reaction force in the offset group by 28.8% or 1.02 body weight and of the angle of the hip joint reaction force by 2.8 degrees. The authors believe that the reduction of the resultant hip joint reaction force in the offset cup group is the result of lowering and medialising the centre of rotation of the hip, a previously reported fact on non-clinically applicable conditions. They are also tempted to propose the generalized use of the offset type acetabular cup, since adverse events are not anticipated. (Hip International 2005; 15: 149-54).

Degenerative spondyloarthropathy of the cervical and lumbar spine in jockeys.

This prospective study analyzed the long-term effects of horse riding on the cervical and lumbar spine of jockeys. Thirty-two jockeys were observed for 13 years. All jockeys had clinical and radiographic evaluation of the spine; three consecutive age groups were studied. Results were compared to age-matched, normal population control groups. The incidence of degenerative changes of the spine was higher in the jockeys compared with the control groups and was more prominent in the older age group for both the lumbar and cervical spine. These findings suggest that equestrian sports, particularly professional horse riding, apart from the increased risk of direct spinal injury caused by a fall from the horse, can lead to progressive spine degeneration as a result of repetitive trauma and increased physical stress on the spine.

Calcitonin effects on cartilage and fracture healing.

The literature about the effects of systemically administered calcitonin on fracture healing and in the prevention of disuse osteoporosis after fracture are reviewed in this study. Fracture healing is a biological process of great importance for the survival of the injured animal. Endochondral ossification is augmented in the fracture site followed by fast remodeling of the produced woven bone. There is strong evidence of the direct effects of calcitonin on cartilage proliferation as well as the vascularization of the callus. Calcitonin is found to promote the cartilaginous phase of fracture healing. On the other hand, the innervation of callus reveals an extensive distribution of sensory fibers containing a calcitonin gene-related peptide, a neuropeptide with potent vasodilatory actions. From several experimental studies, salmon calcitonin administration has been found to have a beneficial effect on fracture healing. Studies in humans also concur that calcitonin may speed up the time of fracture repair and facilitate early mobilization of the injured limb. Finally, calcitonin prevents post-fracture bone loss due to increased post-injury remodeling and lowers hydroxyproline and calcium excretion of patients who underwent internal fixation of fracture on the hip.