Pasteurella multocida infection of a total knee arthroplasty after a "dog lick".

The patient we report here underwent a total knee arthroplasty (TKA) which got infected with P. multocida after her dog had licked a small wound at the third toe of the same foot. Despite a correct treatment comprising synovectomy and cleansing, and an active antibiotic treatment for 3 months, the patient was readmitted for persistent infection of the same knee 2 weeks after the end of the antibiotic treatment. Sampling during surgery allowed for the growth of a P. multocida isolate proven by a molecular method to be identical to the previously isolated strain. This recurrent P. multocida infection was treated by a two-step change of the TKA comprising a 2-month period of antibiotic treatment between the two surgical interventions.

[Long-term results of surgical treatment of lumbar spinal stenosis]. / Résultats à long terme du traitement chirurgical des sténoses lombaires.

PURPOSE OF THE STUDY: Some discussion remains concerning the quality of the long-term functional outcome after surgical treatment of lumbar spinal stenosis. The purpose of this retrospective observational study was to evaluate outcome ten years after surgical treatment of lumbar spinal stenosis and to determine the rate of reoperation as well as to identify factors influencing outcome at last follow-up. MATERIAL AND METHODS: Between January 1990 and December 1992, 141 patients underwent surgery for lumbar stenosis all were included in present study. Mean follow-up was ten years. At last follow-up, functional signs were assessed with a designated self-administered questionnaire with items for lumbar and radicular pain, signs of radicular ischemia, and patient satisfaction and two visual analog scales for lumbar and radicular pain. Other data recorded included: epidemiological and morphological features of the study population, comorbidities, presence or not of objective neurological signs, anatomy of the stenosis, and results of two self-administered questionnaires on quality of life (SF36) and anxiety-depression (GHA28). Two data analysis methods were applied. The first was a descriptive analysis to quantify the importance of functional signs observed at last follow-up, patient satisfaction, and rate of recurrence as well as reasons for reoperation. The second was a multivariate analysis designed to identify factors influencing the score obtained on the designated stenosis self-administered questionnaire. RESULTS: Fifteen patients had undergone a revision procedure on the lumbar spine. At last follow-up overall satisfaction was 71%. The best results were obtained for radiculalgia and intermittent neurogenic claudication. Residual lumbalgia was the main complaint at last follow-up. The patient's psychological profile was found to be the predominant factor influencing functional outcome. Other factors having an effect in this population were: reoperation, persistence of objective neurological disorders, degree of comorbidity. CONCLUSION: For the majority of patients, surgical treatment of lumbar spinal stenosis provides good long-term results and patient satisfaction. At ten years, the risk of reoperation was 10% in this population. Compared with data in the literature, these results are better than with medical treatment. Surgery enables these patients to have a quality of life similar to an age-matched control population.

[Validation of a self-administered functional evaluation questionnaire after surgical treatment of lumbar spine stenosis]. / Validation d'un auto-questionnaire d'évaluation fonctionnelle du traitement chirurgical des sténoses lombaires.

PURPOSE OF THE STUDY: The main aim of this prospective, multicentric, observational study was to validate a self-administered quality-of-life questionnaire for patients with lumbar spine stenosis treated surgically. MATERIAL AND METHODS: The self-administered questionnaire was composed of eight questions exploring three dimensions: lumbalgia, radiculalgia, radicular ischemia. This questionnaire was associated with an index of neurological involvement (to take into account objective neurological data), and with an index of patient satisfaction (to assess the patient's perception of the impact of surgery on lumbalgia, radiculalgia, and gait disorders). The scoring scale was validated by studying the structure of the questionnaire (to ascertain the pertinence of the proposed three dimensions), by determining the questionnaire's reproducibility (intraobserver variability) and sensitivity to change, and by examining the contents of the questions (to assess the capacity of the scale to effectively measure the parameters it was designed to measure). Cronbach's alpha coefficient and principal component analysis were used to assess the questionnaire's structure. Reproducibility was tested on 49 patients who completed the self-administered questionnaire twice at a 15-day interval; intraclass correlation coefficients were determined. Sensibility was tested by correlating variation in the scores obtained pre- and postoperatively with the index of satisfaction; mean standard responses were determined. The validity of the questionnaire's content was assessed by correlating the scores obtained with the questionnaire to those obtained with three other self-administered questionnaires: SF36, EIFEL2 and GHA38. RESULTS: This work included 104 patients, 96 of whom were reviewed at consultations 6 and 12 months after surgery. The principal components analysis confirmed the presence of the three dimensions. The global Cronbach alpha coefficient was 0.86. The global intraclass coefficient of correlation was 0.95, varying from 0.86 to 0.97 depending on the dimension studied. There was a good correlation (0.82) between changes in the score studied and the index of satisfaction. All the mean standardized responses were higher than 1, indicating good sensitivity to change. There was also a good correlation between the questionnaire tested and the EIFEL2 self-administered questionnaire and the following dimensions of the SF36: physical activity, physical pain, vitality, and limitation due to physical pain. DISCUSSION AND CONCLUSION: Associating a simple 8-question self-administered questionnaire with an index of satisfaction (4 questions) and an objective index of neurological involvement provided a reliable, sensitive, and reproducible assessment of the changes in functional disorders resulting from lumber stenosis before and after surgical treatment.