Accuracy of Synovial Leukocyte and Polymorphonuclear Cell Count in Patients with Shoulder Prosthetic Joint Infection.

Joint aspiration in suspected infected implants is a validated diagnostic method in establishing the diagnosis of prosthetic joint infection (PJI). Cut-off values for synovial leukocyte counts and differentials are well described for patients with hip and knee PJI. In 19 failed shoulder implants, a leucocyte count of >12.2 G/L had a sensitivity and specificity of 92% and 100% respectively; A differential of >54% neutrophils had a sensitivity of 100 % and a specificity of 75%.

Total knee arthroplasty for valgus osteoarthritis: the results of a standardized soft-tissue release technique.

PURPOSE: The study reports the 2-year follow-up results of patients with valgus osteoarthritis undergoing total knee arthroplasty (TKA) with a standardized soft-tissue release. METHODS: Between 2008 and 2013, 222 TKAs were performed for valgus osteoarthritis by a single surgeon. A total of 181 TKAs in 164 patients were available for a minimum 2-year follow-up (range 24-87 months). Preoperative and postoperative range of motion (ROM), mechanical alignment, the postoperative medial proximal tibial angle (MPTA), Western Ontario and McMaster Universities Arthritis Index (WOMAC), VF-12 score, visual analogue pain scale (VAS), and the actual UCLA activity score, desired UCLA score, ligamentous stability (medial collateral ligament) and complications and revision rates were recorded. RESULTS: The ROM increased from a preoperative flexion contracture of 4.7° (range 0-40) and flexion of 110° (range 35-135) to a postoperative mean flexion contracture of 0.1° (range -5 to 10) and flexion of 128° (range 100-140). The mean hip-knee-ankle alignment was changed from 8.4° of mechanical valgus (range 5.3-25.4) to 0.02° of varus alignment (range -2.9 to 4.1). Tibia component angle (MPTA) was 90.4° (range 86.1-93.7). The WOMAC score, VF-12, UCLA and VAS significantly improved after surgery (p < 0.05). Two patients (1.1 %) underwent revision surgery for instability. CONCLUSION: The described standardized soft-tissue release (release of the iliotibial band and posterolateral corner) provided excellent clinical results at a minimum 2-year follow-up and can be used safely for a "cook-book" approach to the valgus knee with up to 25° mechanical valgus alignment. LEVEL OF EVIDENCE: IV.

Effects of thromboembolism prophylaxis with dabigatran on perioperative blood loss and wound secretion in primary hip arthroplasty.

BACKGROUND: Low-molecular-weight heparins (LMWH), e.g. enoxaparin, represent the standard thromboprophylactic agents in Europe after total hip replacement. The oral direct thrombin inhibitor dabigatran etexilate provides comparable effectiveness and safety. The present study aimed to evaluate the influence of dabigatran etexilate on perioperative blood loss and wound secretion in total hip arthroplasty compared to enoxaparin. METHODS: Patients receiving primary total hip replacement between January and June 2009 were included. The association between thromboembolism prophylaxis with dabigatran etexilate or enoxaparin and the perioperative blood loss was investigated. The effective blood loss (EBL) was calculated taking blood transfusions and the difference between preoperative haemoglobin and haemoglobin on the day of discharge into account. Additional comparison of wound secretion depending on thromboprophylactic agents was performed in a separate, prospectively collected patients' population. Statistical analysis was performed with χ ^{2}-Test, Student's t-test or Mann-Whitney U-test. Statistical significance was considered at p < 0.05. RESULTS: 198 patients (111 women, 87 men) with primary total hip arthroplasty were enrolled. Patients' mean age was 63.0 ± 11.9 years. Thromboembolism prophylaxis was performed in 111 patients (56.1%) with dabigatran etexilate, 87 patients (43.9%) received enoxaparin. No significant differences concerning EBL and wound secretion were found between both study groups. In the dabigatran etexilate group the EBL was 1.66 ± 0.56 l compared to 1.77 ± 0.65 l in patients with enoxaparin. CONCLUSIONS: Dabigatran etexilate can safely be used for thromboembolism prophylaxis after primary total hip replacement without an increased risk for perioperative blood loss and prolonged wound secretion.

Single-incision chronic distal biceps tendon repair with tibialis anterior allograft.

PURPOSE: Several techniques for chronic distal biceps tendon repair have been reported; however, the literature is sparse. METHODS: Seven male patients who underwent chronic distal biceps tendon reconstruction were retrospectively evaluated. All patients had significant retraction necessitating the use of an allograft for reconstruction. The procedure was done through a single incision using suture anchors and a tibialis anterior allograft. In each case, the graft was first fixed to the radial tuberosity with suture anchors, and then the allograft was sutured to the remnant of the native biceps tendon at 60° of elbow flexion. Patients were evaluated with the Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) scores and elbow range of motion (ROM). RESULTS: The average time from injury to surgery was 25 (12-56) weeks, and the average follow-up was 16 (minimum 12) months. Average postoperative elbow ROM was as follows: extension 4° (0-12°), flexion 134° (130-140°), pronation 82° (75-85°) and supination 80° (70-85°); average MEPS was 94 (80-100); average DASH score was 6.67 (0-19.8). One patient developed a lateral antebrachial cutaneous neuritis postoperatively that resolved by three months. CONCLUSION: Though many reported techniques for chronic distal biceps tendon repair achieve satisfactory outcomes with limited complications, we present a technique with theoretical advantages of a single incision, use of suture anchors, use of a tibialis anterior allograft and tensioning after attachment of the graft to the radial tuberosity. In a series of complicated patients, early results were good to excellent.

Complication rates after total ankle arthroplasty in one hundred consecutive prostheses.

INTRODUCTION: Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. However, the outcomes and postoperative complications are poorly described. PATIENTS AND METHODS: Between March 2005 and May 2010 114 S.T.A.R. prostheses were implanted by one surgeon at our institution. We retrospectively analysed the demographics, clinical outcomes and radiographic characteristics of 100 ankle prostheses (97 patients). RESULTS: The average follow up was 36 months. The average preoperative AOFAS score of 36.87 (22-58) significantly increased to 75.99 postoperative. A total of 87 % of the patients reported a better life quality. Twenty-seven ankles incurred complications after primary surgery, and 21 prostheses required revision surgery, including four patients who required arthrodesis. CONCLUSION: Our study shows a high satisfaction rate after total ankle replacement and clear pain relief. Patients with a body mass Index higher than 30 showed a higher rate of complications. Compared with ankle fusion, the rates of complications are comparable.

Characterization of the orientation and isometry of Humphrey's ligament.

OBJECTIVES/PURPOSE: The purpose of this study was to examine the effect of flexion angle on isometry and fiber obliquity of the anterior meniscofemoral ligament (Humphrey's ligament (HL)). METHODS: Following a medial parapatellar arthrotomy on 7 fresh frozen cadavers, the insertion points of the anterolateral (AL) and posteromedial (PM) bundles of the PCL, and HL were identified. Using a 9mm circular software tool, virtual fibers were created. Within each virtual graft, a central fiber was calculated and used to generate anisometry profiles for the AL and PM bundles and HL at flexion angles of 0°, 30°, 60°, 90°, and 120°. Previously validated computer navigation software was used to re-create three dimensional bundles to measure fiber obliquity in the sagittal, frontal, and axial planes. RESULTS: HL length increased with knee flexion from 0 to 120°, and underwent similar length changes as the PCL bundles. In full extension and at 90°, the average length of the PM and AL bundles were not statistically different (p=0.13 and p=0.85 respectively). From 0 to 120°, the PM bundle was the most isometric, but the anisometry profile was statistically similar to the AL bundle and HL. In general, HL and the PM bundle had similar graphic trends in terms of fiber obliquity in all planes. CONCLUSIONS: Using computer navigation, we have demonstrated that HL has similar isometry profiles as the PM and AL bundles of the PCL, and "mirrored" the obliquity of the PM bundle in all planes throughout flexion to 120°.

Eleven-year results of the anatomic coated CFP stem in primary total hip arthroplasty.

There is a paucity of intermediate term results relating to short stem prostheses. The current study represents the longest follow-up results of the CFP prosthesis to the authors' best knowledge. Between January 1999 and December 2000, all total hip arthroplasty patients (n = 149), treated with this anatomic neck preserving stem in the authors' institution were enrolled in this study. After a mean follow-up time period of 11.2 years 117 patients were available for the follow-up examination. The mean HHS increased from 53 to 93. Overall, revision surgery was required in 11 patients (9.4%), with implant-associated complications noted in only five cases (4.3%). Aseptic loosening leading to implant removal was noted in four patients (3.4%). The current study's data suggest that the CFP implant, used in young patients undergoing primary total hip arthroplasty, is safe and provides excellent results after 11 years.

Long-term survivorship of a unicondylar knee replacement--a case report.

Unicondylar knee arthroplasty (UKA) was introduced in the 1970s as a treatment option for isolated knee compartment gonarthrosis. Early results were discouraging secondary to poor patient selection, suboptimal surgical technique, and inferior prosthetic design. In recent years, there has been resurgence in the use of the UKA. Improvements in implant design, surgical technique, and patient selection have led to multiple studies demonstrating 94-98% survivorship of the implants at a 10 year follow-up. However, there still remains a paucity of evidence with regard to this treatment option for young, active patients. This case report presents the longest recorded follow-up (31 years) of a UKA in a young, active patient and it highlights that with appropriate patient selection and meticulous surgical technique, UKA may have a role as a long term treatment option in patients with isolated unicompartmental disease.