Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

OBJECTIVE: The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. DESIGN: A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. SETTING: UK University Teaching Hospital. PARTICIPANTS: All patients (n = 460) presenting across a single year study period with a confirmed hip fracture. OUTCOME MEASURES: The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. RESULTS: A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection (p-value: 0.0005). CONCLUSION: The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

Association and impact of patellofemoral dysplasia on patellofemoral arthropathy and arthroplasty.

BACKGROUND: The association of patellar and trochlear anomalies resulting in isolated patellofemoral osteoarthritis has often been postulated but rarely studied. The purpose of this study was to examine the association of patellofemoral dysplasia, specifically trochlear anomalies, which are a cause for degenerative disease and may result in a worse outcome after arthroplasty for isolated patellofemoral arthritis. METHODS: Eighteen consecutive patients who underwent robotic image-based patellofemoral arthroplasty were compared with an age and sex-matched group of patients who underwent medial unicompartmental arthroplasty using the same image-based navigation system and had no patellofemoral, lateral disease or malalignment. The compared parameters were the patellofemoral-trochlear angle and Dejour score in the preoperative radiographs and patellofemoral-trochlear angle and internal rotation of the trochlea compared to the intercondylar line in the proximal, middle and distal trochlea. RESULTS: Significantly higher rates of patella alta (T=5, P=0.0001) and trochlear dysplasia (6% vs. 55%) were found, as manifested by an increase in the trochlear angle and Dejour score. Furthermore, the trochlea was found to have a higher degree of internal rotation in patients with isolated patellofemoral arthritis compared to the control group. CONCLUSIONS: In conclusion, patellofemoral anomalies such as patella alta and trochlear dysplasia are present in association with isolated patellofemoral arthritis. Isolated patellofemoral arthritis is also associated with higher rates of trochlear internal rotation. Correction of this internal rotation is essential in the success of arthroplasty in patients with patellofemoral disease. LEVEL OF EVIDENCE: Level III study, It is a case control study.

Medium term results of the Miller-Galante knee arthroplasty with 10 year survivorship.

Seventy-four Miller-Galante unicompartmental knee arthroplasty procedures were performed in 69 patients between 1990 and 2003. All patients underwent regular prospective clinical and radiological followup. Their average age at the time of surgery was 63.9 years (range: 47-80 years). Seventeen patients died during the period of follow-up. At a mean of 10.7 years follow-up the average Knee Society Score was 79.9 (range: 51-95) and the average functional score was 75.5 (range : 45-90). On the basis of clinical knee scoring, 48 knees (85.7%) were graded as excellent or good. The average amount of flexion at final follow-up was 115.9 degrees (range : 90-140 degrees). Arthritic progression in the opposite compartment was seen in 13 knees (23.2%). Two such knees underwent revision to total knee replacement (TKR) and 3 other knees were revised to TKR for persistent pain or infection. Ten-year survivorship with "revision due to progression of arthritis in the opposite compartment" as the end point was 973% and with "revision due to any cause" as the end point was 94.6%.