Minimal resection interposition arthroplasty of the first metatarsophalangeal joint.

BACKGROUND: Interposition arthroplasty of the first metatarsophalangeal (MTP) joint is a viable alternative to fusion in patients with advanced hallux rigidus. The purpose of this study is to evaluate the midterm results of a modification of the technique. METHODS: Case series of 18 interposition arthroplasties were performed on 13 female patients with Grade III-IV hallux rigidus. The technique included cheilectomy, bunionectomy when needed, minimal resection of the base of the proximal phalanx and interposition of a fascia lata allograft in the first metatarsophalangeal joint. Mean follow up was nine years (range 75-136 months). Patients were evaluated according to the AOFAS score, the ability to tip toe and their subjective satisfaction. RESULTS: There was a significant difference between preoperative (mean 43.2, range 15-83) and postoperative (mean 77.3, range 40-100) AOFAS scores (p<0.001). The patients were able to tip toe on 12 of the 18 operated feet and 9 of the 13 patients were satisfied from the operation. All dissatisfied patients had a coexistent hallux valgus deformity. CONCLUSIONS: The technique had satisfactory midterm outcomes in older patients with advanced hallux rigidus without hallux valgus. Advantages of the method are the preservation of tip toe function in most patients and a technically easy conversion to fusion when needed.

Lumbar Discectomy: Generic Outcome Measures for Specific Outcome Prediction: A Short-term, Observational, Pilot Study.

STUDY DESIGN: We followed a longitudinal observational design with 2 assessment points, presurgery and postsurgery, in 83 consecutive patients undergoing single-level lumbar discectomy. OBJECTIVE: Prognostic data can be gathered from commonly used generic outcome measures to identify patients at risk of persistent leg pain-associated chronicity, following lumbar discectomy SUMMARY OF BACKGROUND DATA:: Suboptimal results observed, following open lumbar discectomy, have been connected to the interplay among presurgery pain characteristics, functional and psychosocial adaptations like persistent pain, disability, and depression. Outcome predictive qualities have been recently attributed to well-known outcome measures. However, most studies on prognostic indicators use multiple tools designs, inhibiting clinical application. Here we elaborate on predictive indications identified in 2 generic patient-rated questionnaires, Short Form-36 (SF-36) and McGill Pain, as many of their domains can evaluate factors related to unfavorable outcomes. METHODS: For the prognostic value calculations, multivariate logistic [Short-Form McGill Pain Questionnaire (SF-MPQ)] and linear regression models (SF-36) were fitted to investigate the association between presurgery and postsurgery scores. In all models, the presurgical score at question was assigned as the dependent variable while age, sex and presurgery score at question were the independent variables. RESULTS: Overall, a statistically significant amelioration in both SF-MPQ and SF-36 scores was observed postsurgically. For the SF-MPQ leg cramping, gnawing, burning, and aching pain symptoms, when present presurgically, were the least responsive to treatment. For the SF-36, mental scores overall were less responsive than physical equivalents postoperatively, while general health perception improved only marginally. Differences in pain level scores did not correlate with an equivalent reduction in postsurgery anxiety and depression indices. CONCLUSIONS: SF-MPQ and SF-36 can assist in treatment decision, as they can readily identify patients at risk of unfavorable outcomes even in primary/clinical settings. The above findings additionally suggest a wider scope of clinical use for the above questionnaires allowing parallel processing and interpretation of the same patient data. LEVELS OF EVIDENCE: Level I.

Perioperative variations of the intracompartmental pressures of the paraspinal muscles.

STUDY DESIGN: Study of the influence of thoracolumbar spinal surgery through a posterior approach to the intercompartmental pressure of the paraspinal muscles. OBJECTIVE: To create waveforms according to the pressure variations up to 24 hours postoperatively and relate these measurements to independent parameters. SUMMARY OF BACKGROUND DATA: The existence of a paraspinal anatomic compartment and a relevant compartment syndrome has been supported theoretically, proven experimentally, and confirmed in clinical cases. The perioperative variations of the intercompartmental pressures remain largely unknown. METHODS: Five measurements were taken from both paraspinal compartments in each operated patient: preoperatively, intraoperatively, immediately after wound closure, and at 6 and 24 hours postoperatively. The recorded pressures were grouped as normal, elevated, or suggestive of a paraspinal compartment syndrome. Abnormal pressures were correlated with patient-related and operation-related parameters. Forty-two patients participated in the study, 21 male and 21 female patients aged 13 to 83 years (mean age 51 y). Seventy compartments were included in the final analysis. RESULTS: Forty-two compartments developed abnormally elevated pressures postoperatively and in 22 of these, pressures suggestive of a compartment syndrome were recorded. In no case was there a clinical presentation of a true compartment syndrome. Different waveforms were created for the normal and elevated pressures group. In compartments with high measurements, pressures were likely to continue to rise at 6 and 24 hours postoperatively. The body mass index was greater in both the elevated pressures and compartment pressures groups. Procedures lasting >2 hours, extended approaches, and instrumented posterior interbody fusion operations were related with lower postoperative pressures. CONCLUSIONS: A large percentage of patients develop increased paraspinal muscle pressures up to 24 hours after posterior thoracolumbar spine surgery. These increases are related to patient-related and operation-related factors and may not present clinically as a compartment syndrome.

Cuff width increases the serum biochemical markers of tourniquet-induced skeletal muscle ischemia in rabbits.

Tourniquet application is a widely accepted adjuvant technique in extremity surgery. The purpose of this prospective, randomized trial was to evaluate the effect of cuff width on skeletal muscle ischemia-reperfusion injury. A 2- or 4-cm wide curved tourniquet cuff was applied around the midthigh of 36 New Zealand White rabbits and inflated to a pressure of 200 or 400 mm Hg for 2 hours: group A=2 cm to 200 mm Hg; group B=2 cm to 400 mm Hg; group C=4 cm to 200 mm Hg; group D=4 cm to 400 mm Hg. Blood levels of potassium, lactic acid, urea, lactic dehydrogenase, and creatinine phosphokinase MM isoenzyme (CPK-MM) were measured as basic indicators for limb ischemia before tourniquet inflation and 1, 5, and 30 minutes after cuff release.Potassium values did not differ among the 4 groups. Lactic acid and urea concentrations were always higher in the 400 mm Hg groups (B and D) (P<.001). However, cuff width did not affect their levels (P>.16). Lactic dehydrogenase and CPK-MM values were also greater in the 400 mm Hg groups at all times (P<.001). Further subgroup analysis of 200 mm Hg pressure groups showed higher lactic dehydrogenase (P<.02) but not CPK-MM (P>.9) concentrations in group C than in group A during the 30-minute period. At 400 mm Hg, lactic dehydrogenase and CPK-MM values were higher in group D compared with group B only 30 minutes after cuff deflation (P<.001). Broad tourniquets are associated with significantly greater and prolonged elevation of serum biochemical markers of inducible skeletal muscle ischemia-reperfusion injury compared with narrow ones. This difference is more prominent when a wide cuff is inflated to a high pressure.

Long-term results of posterior-cruciate-retaining Genesis I total knee arthroplasty.

BACKGROUND: Long-term results of Genesis I modular total knee system are not well known. METHODS: We analyzed data from 345 patients with 393 primary total knee arthroplasties (TKA) using the Genesis I prosthesis. In all cases, the posterior cruciate ligament (PCL) was retained, and the patella was not resurfaced. The minimum follow-up was 10 (range 10-16) years. RESULTS: Preoperative range of motion improved from 89° preoperatively to 105° at the time of the most recent follow-up (p < 0.001). Mean preoperative Knee Society pain and function scores increased from 29 and 25 points to 91 and 85 points, respectively (p < 0.001). Tibiofemoral angle shifted from 2.40° of varus before to 4.8° of valgus after the operation (p < 0.001). Early postoperative complications occurred in 34 knees (8.6%). Manipulation under general anesthesia was done in six knees (1.5%). Nonprogressive radiolucent lines were seen around the femoral component in 16 knees (4%) and at the tibial bone-cement interface in 101 knees (25%). However, in only five cases (1.3%) was there significant progression leading to implant loosening and revision surgery. Eight more revisions were performed due to infection (three knees), stiffness (three knees), excessive wear and fracture of polyethylene liner (one knee), and instability (one knee). The overall survivorship of knee replacement reached 96.7%. CONCLUSIONS: In the long term (up to 16 years), PCL-retaining Genesis I total knee prosthesis is associated with good functional outcomes and low failure rates.

Rotaglide total knee arthroplasty: a long-term follow-up study.

BACKGROUND: Mobile-bearing knee designs represent an alternative to conventional fixed-bearing implants in total knee arthroplasty. The purpose of this study was to determine the clinical results of a mobile-bearing knee implant. METHODS: From 1990 to 1998, 326 primary consecutive mobile-bearing total knee prostheses were implanted in 260 patients who had a mean age and standard deviation of 66.7 ± 6.9 years. Femoral and tibial components were cemented in all knees, and the patella was resurfaced in 199 knees (61%). Patients were evaluated with the use of the Knee Society clinical rating system and radiographic examinations. Complications were noted, and survivorship of the prostheses was determined. RESULTS: The mean follow-up period was 156 ± 27.3 months, with maximum follow-up at eighteen years. The mean Knee Society knee score improved from 32.4 ± 21.2 preoperatively to 92.6 ± 10.0 at the time of the last follow-up (p = 0.00), and the mean Knee Society functional score improved from 39.3 ± 18.7 preoperatively to 66.7 ± 18.6 at the time of the last follow-up (p = 0.00). Mean knee flexion improved from 92.3° ± 14.5° preoperatively to 112.1° ± 13.4° at the time of the last follow-up (p = 0.00). There were twenty-four (7.4%) knees that required revision. In eighteen (5.5%) knees, worn out or broken polyethylene was found and a polyethylene-only exchange was done. Six knees (1.8%) were fully revised. The survival rate was 0.96 (95% confidence interval, 0.93 to 0.98) at ten years and 0.87 (95% confidence interval, 0.79 to 0.93) at eighteen years. CONCLUSIONS: A fully congruent, mobile-bearing total knee prosthesis had excellent survivorship during the ten to eighteen-year follow-up interval.

Hemiarthroplasty for pigmented villonodular synovitis of the shoulder: a report of two cases.

Pigmented villonodular synovitis is a reactive condition characterised by exuberant proliferation of synovial villi and nodules. It may be localised or diffuse and can cause severe articular damage. This report is of 2 patients with pigmented villonodular synovitis of the shoulder causing extensive arthritic changes. Both patients underwent shoulder hemiarthroplasty and total synovectomy and achieved satisfactory painless range of motion, with no signs of local recurrence or loosening of the prosthesis after 4 to 5 years of follow-up.

External fixation for stable and unstable intertrochanteric fractures in patients older than 75 years of age: a prospective comparative study.

OBJECTIVE: External fixation has been advocated as an alternative treatment method of intertrochanteric fractures in elderly and high-risk patients. However, the efficacy of the technique in all fracture types has not been clearly defined. The null hypothesis of this study was that external fixation showed equal results in either stable or unstable intertrochanteric fractures in patients older than 75 years of age. DESIGN: Prospective comparative study. SETTING: Level I trauma center. PATIENTS: Between July 2006 and June 2007, 100 patients older than 75 years of age (mean, 82.3 ± 5.2 years) and American Society of Anesthesiologists 3 or 4 who sustained an isolated intertrochanteric fracture met the inclusion criteria for the study. The patients were followed up at regular intervals until 1 year postoperatively. INTERVENTION: All fractures were stabilized with external fixation under epidural anaesthesia. The patients were divided in two groups according to the Orthopaedic Trauma Association classification system for intertrochanteric fractures. Types A1.1, A1.2, A1.3, and A2.1 fractures were considered stable (Group A) and Types A2.2, A2.3, A3.1, A.3.2, and A.3.3 unstable (Group B). Fifty patients were collected in each group. MAIN OUTCOME MEASUREMENTS: Operation and hospitalization time, union time, complication rate, Harris hip score, and patients' walking status were evaluated. RESULTS: The median operative time was 17 minutes (range, 15-50 minutes) in Group A and 21.5 minutes (range, 15-60 minutes) in Group B (P < 0.001). The median hospitalization time was 5 days (range, 2-11 days) in Group A and 7 days (range, 4-17 days) in Group B (P < 0.001). The average union time was 11.24 ± 1.66 weeks (range, 9-16 weeks) for Group A and 14.1 ± 1.63 weeks (range, 10-17 weeks) for Group B (P < 0.001). The overall complication rate was 8% for the stable fractures and 26% for the unstable fractures (P = 0.03). The rate of varus collapse in unstable fractures was 11%. The median Harris hip score was 75 points (range, 28-100) in Group A and 68 points (range, 25-99) in Group B (P = 0.006). No difference was found between groups in terms of mortality (P = 0.913) or walking status (P = 0.736). CONCLUSION: External fixation for the treatment of Orthopaedic Trauma Association Types A2.2, A2.3, A3.1, A.3.2, and A.3.3 intertrochanteric fractures in the elderly was associated with prolonged union time, increased incidence of varus position of the fracture site, and inferior functional outcome. Therefore, it should be used with caution in the geriatric population with an unstable intertrochanteric fracture.

The effect of haematoma aspiration on intra-articular pressure and pain relief following Mason I radial head fractures.

BACKGROUND: The aspiration of the accompanying haematoma by Mason type I radial head fractures is advocated by several authors to achieve an analgesic effect. The purpose of this study was to investigate the effect of haematoma aspiration on intra-articular pressure and on pain relief after Mason I radial head fractures. MATERIALS AND METHODS: A total of 16 patients (10 men and six women, age 23-47 years) with an isolated Mason I radial head fracture were subjected to haematoma paracentesis. Initially, intra-articular pressure was measured by using the Stryker Intra-Compartmental Pressure Monitor System. After haematoma aspiration, a new pressure measurement without moving the needle was performed. Pain before and after haematoma aspiration was evaluated by using an analogue 10-point pain scale. RESULTS: Intra-articular elbow pressure prior to haematoma aspiration varied from 49 to 120 mmHg (median, 76.5 mmHg), while following aspiration, it ranged from 9 to 25 mmHg (median, 17 mmHg). The median quantity of the aspired blood was 2.75 ml (range, 0.5-8.5 ml). Patients reported a decrease in the visual analogue score (VAS) for pain from 5.5 (4-8) before to 2.5 (1-4) after aspiration. Decrease for both pressure and pain was statistically significant (p=0.005). CONCLUSION: The formation of an intra-articular haematoma in the elbow joint following an undisplaced Mason I radial head fracture leads to a pronounced increase of the intra-articular pressure accompanied by intense pain for the patient. The aspiration of the haematoma results in an acute pressure decrease and an immediate patient relief.

Delayed foreign-body reaction to absorbable implants in metacarpal fracture treatment.

BACKGROUND: First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions. QUESTIONS/PURPOSES: This retrospective study addressed the following questions: Can absorbable implants consisting of trimethylene carbonate, L-lactide, and D,L-lactide provide adequate fixation for healing of a metacarpal fracture? Will these implants obviate a second removal operation? What complications can occur in the reaction to implant breakdown? PATIENTS AND METHODS: Twelve unstable, displaced, metacarpal fractures were studied in 10 consecutive patients (seven men, three women; mean age, 36.4 years; range, 18-75 years). The fractures were treated with absorbable plates and screws consisting of the aforementioned copolymers and designed to resorb in 2 to 4 years. Nine patients (10 fractures) were available for clinical and radiographic followups (mean, 45.7 months; range, 34-61 months). RESULTS: Fracture healing was uneventful in all cases. Four patients experienced a foreign-body reaction during the second postoperative year and required surgical débridement to remove implant remnants. Histologic examination confirmed the diagnosis of a foreign-body reaction. Two other patients reported a transient local swelling that subsided without treatment. CONCLUSIONS: Our results indicate these absorbable implants for metacarpal fractures achieved adequate bone healing but simply postponed the problem of foreign-body reactions. Patients treated with bioabsorbable implants should be advised of potential late complications and should be followed for at least 2 years, possibly longer.

Primary cementless total hip arthroplasty with an alumina ceramic-on-ceramic bearing: results after a minimum of twenty years of follow-up.

BACKGROUND: The biological problems related to wear debris after total hip arthroplasty have stimulated renewed interest in alternatives to metal-on-polyethylene bearing surfaces. METHODS: We retrospectively evaluated the clinical and radiographic results of 100 patients who had undergone a total of 109 primary total hip arthroplasties with a cementless alumina ceramic-on-ceramic prosthesis between January 1985 and December 1989. The mean age of the patients at the time of the index arthroplasty was forty-six years. Clinical evaluation was performed with use of the Charnley modification of the Merle d'Aubigné-Postel scale. Seventy-eight patients who had had a total of eighty-five arthroplasties were available for follow-up evaluation at an average of 20.8 years. The patients' average age at the time of the latest follow-up was 66.8 years. RESULTS: Six hips (six acetabular cups and one femoral stem) in six patients underwent revision. Aseptic loosening of the cup combined with focal osteolysis was the cause of all six revisions. In one patient, the stem was also revised because of aseptic loosening. At the time of final follow-up, the result was excellent (according to the Merle d'Aubigné-Postel scale) in 68% of the hips, good in 19%, fair in 9%, and poor in 4%. The mean Merle d'Aubigné-Postel score improved from 7.9 points preoperatively to 16.9 points postoperatively (p < 0.001). The cumulative rate of survival of the prostheses was 84.4% at 20.8 years. CONCLUSIONS: The results of these cementless ceramic-on-ceramic total hip arthroplasties continued to be satisfactory at a minimum of twenty years postoperatively. The improved design of contemporary prostheses and the new generation of ceramic-on-ceramic bearing surfaces may lead to even better long-term results.

Is obesity a contraindication for minimal invasive total knee replacement? A prospective randomized control trial.

BACKGROUND: Although total knee replacement (TKR) has been proven a very successful treatment modality for the end-stage knee osteoarthritis (OA) in obese patients, the rehabilitation period often is long and painful. Minimal invasive surgery (MIS) has gained much attention in TKR promising fast and less painful recovery. However, little is known about the effectiveness of the technique in the obese adult population. METHODS: One hundred consecutive patients with body mass index (BMI) > 30 kg/m(2) and tricompartmental knee OA were randomly assigned to undergo either standard TKR (50 patients) or MIS-TKR (50 patients). The patients were assessed clinically and radiologically before the procedure and at subsequent postoperative follow-up visits, until 2 years after the operation. RESULTS: Knee society function and pain scores were significantly higher in MIS group for 3 months following surgery. Patients after MIS had also lower levels of pain during hospitalization. Tourniquet time was on average 7 min longer during MIS-TKR (p = 0.03) but operative time was almost equal in both groups (p = 0.11). No statistical significant difference was found between groups regarding the amount of blood loss (p = 0.49) or incidence of allogeneic blood transfusion (p = 0.27). Active straight leg raising was achieved 2.2 days earlier, on average, after MIS-TKR (p < 0.001). No severe complications or residual coronal and sagittal imbalance were identified. Component alignment was in normal limits and similar in both groups. In MIS group, higher BMI did not have a negative predictive effect on knee pain and function. CONCLUSIONS: MIS is a reliable and safe option in obese patients undergoing TKR regardless the level of BMI. It is associated with improved early clinical outcome without sacrificing radiographic positioning of the implants.

Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions.

Reliability and validity of the adapted Greek version of scoliosis research society - 22 (SRS-22) questionnaire.

BACKGROUND: The SRS-22 is a valid instrument for the assessment of the health related quality of life of patients with Idiopathic scoliosis. The SRS-22 questionnaire was developed in USA and has been widely used in the English speaking countries. Recently it has been translated and validated in many other languages. The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the refined Scoliosis Research Society-22 Questionnaire. METHODS: Following the steps of cross - cultural adaptation the adapted Greek version of the SRS-22 questionnaire and a validated Greek version of the SF-36 questionnaire were mailed to 68 patients treated surgically for Idiopathic Scoliosis. 51 out of the 68 patients returned the 1st set of questionnaires, while a second set was emailed to 30 randomly selected patients of the first time responders. 20 out of the 30 patients returned the 2nd set. The mean age at the time of operation was 16,2 years and the mean age at the time of evaluation was 21,2 years. Descriptive statistics for content analysis were calculated. Reliability assessment was determined by estimating Cronbach's alpha and intraclass correlation coefficient (ICC) respectively. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains in the SF-36 questionnaire using Pearson's Correlation Coefficient (r). RESULTS: The calculated Cronbach's alpha of internal consistency for three of the corresponding domains (pain 0.85; mental health 0.87; self image 0.83) were very satisfactory and for two domains (function/activity 0.72 and satisfaction 0.67) were good. The ICC of all domains of SRS-22 questionnaire was high (ICC>0.70), demonstrating very satisfactory or excellent test/retest reproducibility. Considering concurrent validity all correlations were found to be statistically significant at the 0.01 level among related domains and generally demonstrated high correlation coefficient. CONCLUSION: The adapted Greek version of the SRS-22 questionnaire is valid and reliable and can be used for the assessment of the outcome of the treatment of the Greek speaking patients with idiopathic scoliosis.

Management of posttraumatic arthritis of the wrist with radiolunate fusion enhanced with a sliding autograft: a case report and description of a novel technique.

Although in rheumatoid cases radiolunate fusion presents with satisfying results, in cases with posttraumatic carpal distortion, the variability of injury pattern can influence the type of fixation and the rate of bony union. In this case report, we present an alternative technique of radiolunate fusion for the management of posttraumatic arthritis, which combines the traditional procedure with a corticocancellous autograft, created from the dorsal side of the radius that slides over the bones to be fused. That procedure provides the best environment for the bones to heal and an additional stabilizing effect on the radiolunate construct, thus better preserving the normal intercarpal relationships and wrist height. Patient's clinical and radiological outcome was very satisfactory until the last follow-up.

Mid-term results of hydroxyapatite-coated threaded cup implanted without supplementary supporting screws.

We retrospectively reviewed the clinical, radiographic, and survivorship outcomes in a series of 180 patients that underwent 204 primary Total Hip Arthroplasties with the use of a second generation threaded hydroxyapatite-coated acetabular cup that was implanted without any supplementary supporting screws. At an average follow-up period of 10.2 (range: 8-14) years, one hundred and seventy-four patients (198 cups) were available for assessment. All patients underwent detailed physical and radiographic examination; their functional status was evaluated according to the Harris Hip Score (HHS). Following their digitization, all radiographs were further reviewed in order to determine the existence of any migration of the acetabular cup. Osteolytic lesions, radiolucent lines or zones of increased bone density were also recorded and classified according to the system of DeLee & Charnley. The modified Engh's criteria were used in order to evaluate the stability of the prosthesis. The patients' mean HHS at their latest follow-up visit (97.24 points) was statistically significantly better than the preoperative mean score of 40.31 points (p<0.001). Radiographic analysis showed "stable with bone ingrowth" fixation (modified Engh's criteria) of all implants with no significant migration of the cup (mean cranial migration: 0.597 mm, mean horizontal migration: 0.607 mm, mean observed difference of the cup's inclination angle: 0.26 degrees). No areas of significant osteolysis were found. The cumulative survival rate of the implants was 97.05%. Our results suggest that second generation hydroxyapatite-coated threaded acetabular cups can be successfully implanted (and achieve excellent results) without the use of any supplementary supporting screws.

Prognostic value of suction drain tip culture in determining joint infection in primary and non-infected revision total hip arthroplasty: a prospective comparative study and review of the literature.

INTRODUCTION: Closed suction drainage in joint replacement surgery has been considered to carry an obvious risk of bacteria invasion. Previous studies have shown controversial results regarding the role of suction drain culture in predicting artificial joint infection. Furthermore, the efficacy of the method has not been established in revision total hip or knee arthroplasty. MATERIALS AND METHODS: Suction drain tips from 110 patients who underwent 73 primary and 37 revision non-infected total hip arthroplasties were prospectively cultured. The drains removed at 48 h postoperatively. The patients had an average age of 64.3 years (range 25-81 years) and followed up for 2-4 years (average 2.8 years). RESULTS: Positive cultures were identified in two primary (2.74%) and six revision (16.22%) total hip replacements (p = 0.017). The most frequently isolated microorganisms were Staphylococcus aureus (3 cases) and S. epidermidis (2 cases). Resistance to perioperative antibiotics was found in three out of eight isolated pathogens. However, no infection was recorded in any of the eight patients whose cultures found positive. CONCLUSION: Although suction drains are more often contaminated in revision total hip arthroplasty, the prognostic value of the method in determining joint infection is very limited and its routine use is not supported from the clinical data.

Cementless total hip arthroplasty for osteonecrosis of the femoral head after allogenic bone marrow transplantation.

From 1998 until 2004, we performed 26 consecutive cementless total hip arthoplasties in 15 patients who had developed advanced avascular necrosis of the femoral head after allogenic bone marrow transplantation. The average age at transplantation was 31.1 years, and the mean age at implantation was 33.6 years. Follow-up period ranged from 2 to 8 years with an average of 56.4 months. The mean D'Aubigne-Postel score improved from 7.5 points preoperatively to 17 points postoperatively. The overall result was excellent in 92.3%, good in 3.8%, and fair in 3.8% of cases. There were no radiological signs of components loosening and no severe complications. Cementless total hip arthroplasty appears as a favorable alternative for the treatment of avascular necrosis of the femoral heads after allogenic bone marrow transplantation.

The Effectiveness of the Burch-Schneider antiprotrusio cage for acetabular bone deficiency: five to twenty-one years' follow-up.

From 1985 to 2001, the Burch-Schneider antiprotrusio cage (B-S APC) was implanted in 57 cases (55 patients) with massive acetabular deficiency. The B-S APC survived until the last review 5 to 21 years after operation in 89.5% of the cases, produced substantial pain relief, and increased range of hip motion and walking capacity. The 10.5% failure rate was due to aseptic loosening in 2 cases and mechanical failure in 4 cases. It appears that application of the B-S APC in extensive acetabular deficiency presents a durable solution provided that proper indications and technique are used.