ABSTRACT
BACKGROUND: Semi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. Debate exists whether full preparation and draping is safer than semi-sterile technique in regards to infection risk and the utility of pre-operative antibiotics. This study is a comparison of infection rates, pre-operative antibiotic administration, cost and surgical time between techniques. METHODS: A retrospective chart review of 336 pediatric patients with supracondylar fractures repaired with CRPP at our institution was completed between January 2014 and April 2018, 168 per technique. Infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping versus full preparation and draping techniques were compared. RESULTS: Of the 336 patients, 1/168 (0.1%) in the full preparation and draping group developed an infection compared to 0/168 (0%) patients in the semi-sterile group. Pre-operative antibiotics (Cefazolin) were administered to 76/168 (23%) patients in the full preparation and draping group and 0/168 (0%) in the semi-sterile group. The infection found received pre-operative antibiotics. Mean preparation-to-incision time for the semi-sterile group was 2.4±2.0 minutes and the full preparation and draping group was 9.9 ±4.2 minutes (p <0.001). Surgical supply cost was $80.72 [CDN] and 108.24$ [CDN], respectively, for the semi-sterile and full preparation and draping groups. CONCLUSION: Risk of infection using a semi-sterile draping technique was safe and comparable to a full preparation and draping technique when used in CRPP of supracondylar fractures. The administration of pre-operative antibiotics does not appear to make a difference in infection rates. Semi-sterile operative technique is cost effective and has decreased preparation-to-incision time.
ABSTRACT
BACKGROUND: Varus-valgus constrained (VVC) inserts are used in primary total knee arthroplasty (TKA) when stability cannot be achieved with a traditional insert. Concern has been raised regarding premature loosening and failure of these primary TKAs due to the increased load transfer through the prosthesis. This study seeks to assess the survival, clinical outcomes and radiographic assessment of VVC total knee inserts used in a single primary TKA system without diaphyseal stem extensions. METHODS: A consecutive cohort of 74 primary TKAs with VVC inserts was identified from an institutional database. A two-to-one matched group of 136 posterior-stabilized (PS) primary TKAs was generated from the same database. Survival analysis was assessed for all-cause revision surgery. Patient outcome measures were the Oxford Knee Score (OKS) and patient reported satisfaction. Radiographs were assessed in accordance with the Knee Society radiographic scoring system for radiolucency. RESULTS: Survival rates at three and five years were 98.1% and 95.1% for the VVC liner group and 98.1% and 98.1% for the PS liner group, respectively. OKS improved from pre-op to post-op for both groups (p < .001). OKS was reduced in the VVC liner group compared to the PS liner group at latest available follow-up (p = .012). However, clinical satisfaction rates did not differ between the two groups. Small, non-progressive radiolucent lines existed on several radiographs; however, no components in either group were deemed radiographically loose. CONCLUSION: The survivorship, clinical, and radiographic outcomes of VVC knees were similar to the PS comparison group at short- to mid-term follow-up.
Subject(s)
Arthroplasty, Replacement, Knee/instrumentation , Knee Prosthesis , Polyethylene , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Male , Middle Aged , Patient Reported Outcome Measures , Prosthesis Design , Young AdultABSTRACT
BACKGROUND: Despite the extensive study of primary arthroplasty, revision surgery is rarely discussed due to the reduced frequency and variability between patients. A new revision knee system was introduced to build off the geometry of a successful knee replacement system. This study seeks to assess the survival, clinical outcomes and radiographic assessment of this revision system at the early to mid-term. METHODS: A consecutive cohort of 234 rTKAs was identified from an institutional database. Survival analysis was assessed for aseptic loosening and any-cause failure. Patient outcome measures were the Oxford Knee Score (OKS) and patient reported satisfaction. Radiographs were assessed in accordance with the Knee Society radiographic scoring system. Mechanical alignment was assessed on three-foot standing radiographs. RESULTS: Aseptic survivorship at one year, two years, and five years was 100%, 100%, and 99.1%, respectively. Any-cause survival at one, two, and five years was 99.6%, 98.7%, and 92.3%, respectively. OKS improved from pre-op (average 18.8) to one year (average 31.7), two years (average 30.7), and mid-term (average 30.6) follow-up (pâ¯<â¯0.001 for all). At all intervals, patient satisfaction exceeded 70%. One component (0.4%) failed radiographically and was later revised. Neutral mechanical alignment was achieved in 83% of cases. In the remaining cases, alignment was in varus (10%) or valgus (seven percent). No consistent relationship between radiographs or mechanical alignment and clinical outcomes was noted. CONCLUSION: The survivorship, clinical, and radiographic outcomes of the single rTKA system studied are equivalent or superior to other hybrid fixation rTKA systems reviewed in the literature at similar follow-up intervals.
