MRSA in pork production shower facilities: an intervention to reduce occupational exposure.

Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been documented in swine and swine workers. MRSA has also been found in the shower facilities of conventional swine farms. We previously conducted a review of the literature to identify measures used to reduce MRSA prevalence in athletic facilities. In this study, we evaluated those measures for adaptability to the pork production environment. A best practices protocol was developed to reduce MRSA levels in pork production shower facilities and implemented in two conventional swine production systems.

151 endoprosthetic reconstructions for patients with primary tumors involving bone.

As part of the UCLA limb salvage program, 151 patients received 151 endoprostheses for primary tumors involving bone. Follow-up of all patients was to death (56), revision (21), or a minimum two years for the 74 additional survivors (range: 24-114 months; mean: 52 months). Endoprosthetic replacements were of the distal femur (81), proximal femur (19), proximal humerus (13), proximal tibia (11), scapula (11), total femur (8), total humerus (4), intercalary prostheses (2), and one each of the distal humerus and the pelvis. There were three soft tissue sarcomas, five benign bone lesions, and 143 primary malignant tumors of bone. MSTS function was good-excellent in 78%. There were 64 local complications in 55 patients (36%). Mechanical failure occurred in 24 patients (15.9%), local recurrence occurred in ten (6.6%), minor wound healing problems in nine (5.9%), and infection in eight (5.3%). Few systemic complications were reported. Function appeared to be location dependent. All of the 29 patients with benign or low grade malignant tumors (parosteal, IA, IB) have survived. Of the 116 patients with stage IIA and IIB disease, 59% survived three years, and a Kaplan-Meier analysis projects that 56% are expected to survive at five years. Only 17 (11%) of these 151 endoprostheses have been revised; an additional four (3%) eventually came to amputation. The Kaplan-Meier analysis revealed that 91% of the prostheses survived three years and 83% survived five years. The Cox Proportional Hazards model revealed that for patients with stage IIA and IIB disease, the risk of death is four times the risk of the need for revision at five years. Although endoprosthetic reconstructions have their own unique complications, they have proven durable in this series of patients. Local problems usually can be managed without amputation, and patient satisfaction is high.

Total knee arthroplasty in patients after patellectomy.

Twenty-six total knee arthroplasties (TKAs) were evaluated in 22 patients who had had a patellectomy. Fourteen knees (12 patients) had a primary TKA, and 12 patients had a revision TKA. Two patients in the revision group, whose prostheses failed, were from the primary TKA group. The mean follow-up time was 8.5 years in the primary TKA group and 7.6 years in the revision TKA group. A group of 14 control knees with patellae was randomly generated but matched for prosthesis, diagnosis, surgeon, age, and time of surgery. This group was similarly evaluated with an average follow-up time of 6.9 years. The primary TKA group had seven knees that were rated as good or excellent, two as fair, and three as poor. The control group had a significantly higher average rating than the primary TKA group. In this group, there were 12 good or excellent knees, three fair, and none poor. Postoperative pain, flexion contracture, extension lag, and range of motion all contributed significant information to the final score, whereas other variables (walking, function, strength, and instability) did not contribute any additional information. Although higher overall scores may have been expected if the patients had patellae, the results during the follow-up examination were satisfactory and justified TKA in these patients. In general, however, patients without patellae may be at a higher risk for failure of the prosthesis, as seen in five patients having primary TKA and another ten patients with failed TKA requiring revision.

Popliteal pterygium syndrome: an orthopaedic perspective.

Popliteal pterygium syndrome (PPS) is a rare autosomal dominant disorder consisting of popliteal webs and craniofacial, genitourinary, and extremity anomalies. The popliteal webs make this syndrome particularly important to the orthopaedic surgeon. The resultant fixed flexion deformity can be severe, at times approximating the ischium to the calcaneus. The neurovascular bundle is contained in the web's posterior subcutaneous (S.C.) margin, which makes surgery precarious and difficult. We reviewed four patients between 1964 and 1986, three of whom were severely affected with fixed flexion deformities at the knee. Distal femoral shortening and extension osteotomies provided good results, and this procedure should be considered earlier rather than later in treatment of this problem.