Clinical Outcome of Free Latissimus Dorsi Flaps for Coverage of Soft Tissue Defects in Multiply Revised Total Knee Arthroplasties.

BACKGROUND: Multiply revised total knee arthroplasties (TKAs) may present with large anterior soft tissue defects, which can be challenging to reconstruct. In the rare cases where local flaps are insufficient, we use free latissimus dorsi (LD) myocutaneous flaps to achieve soft tissue coverage. This study looked to determine implant survivorship, infection status, and patient-reported outcomes of patients undergoing simultaneous revision TKA and LD flaps in a tertiary unit. METHODS: This was a retrospective study of 18 consecutive patients who had revision TKA and free LD flap reconstruction. Twelve were male and the median age was 65 years (range, 35-83). Patients had undergone a median of 4 previous arthroplasty procedures (range, 3-6). Median follow-up was 49 months (range, 18 to 110). The primary outcome was revision-free implant survival. Secondary outcomes included soft tissue integrity, Oxford Knee Score, and EuroQol 5-domain score at latest follow-up. RESULTS: At latest follow-up, 14 of 18 patients had maintained their implant. Seven patients were infection-free, 7 were on suppressive antibiotics with the implant in situ, and 4 had undergone above-knee amputation. Five-year implant survival was 75% (95% confidence interval, 46-90). At median follow-up (49 months), mean Oxford Knee Score was 13.4 (range, 2-35) and mean EuroQol 5-domain index was 0.071 (range:-0.427 to 0.747). CONCLUSION: LD free flap is a viable option for limb salvage in patients with large anterior soft tissue defects following multiple revisions of TKA. However, functional outcomes can be poor and there is a significant risk of ongoing infection and amputation in this complex patient cohort.

Long-Term Comparison of Porous Versus Hydroxyapatite Coated Sleeve of a Modular Cementless Femoral Stem (SROM) in Primary Total Hip Arthroplasty.

UNLABELLED: Hydroxyapatite (HA) is commonly used on femoral stems to assist in osseous integration but there is limited evidence of the benefit it provides. We report a prospective comparison of 117 and 102 patients receiving either porous or HA coated sleeves respectively. Patients were evaluated at mean of 12.5 years in the porous and 13.7 years in the HA groups. The mean Harris Hip Score was 94.7 and 94.5 in the porous and HA groups respectively. One porous and 2 HA stems required revision. This study demonstrates that there is no long-term advantage to using an HA coating on the sleeve of this modular stem and confirms excellent long-term results for the SROM stem in a primary arthroplasty setting. LEVEL OF EVIDENCE: II (prospective cohort study).

Predicting job satisfaction: a new perspective on person-environment fit.

There may be 2 ways to look at person-environment (P-E) fit: the extent to which the environment matches the person (which, in the case of person-job [P-J] fit, we term ideal-job actualization) and the extent to which the person matches the environment (which we term actual-job regard; cf. Hardin & Larsen, 2014). Adults employed full time in the United States (n = 251; 49.8% women) completed an online survey that included measures assessing these 2 perspectives on P-J fit, along with measures of job and life satisfaction. Ideal-job actualization and actual-job regard were empirically and conceptually distinct, each accounting for unique variance in overall job satisfaction, even after controlling for overall life satisfaction and remuneration. Looking at fit from these 2 frames of reference may give a more complete perspective that accounts for critical outcomes, like satisfaction, as well as suggest novel approaches to career counseling.

The relationship between the presence of metallosis and massive infection in metal-on-metal hip replacements.

With the increased use of metal-on-metal as a bearing surface, complications and side effects are being recognised more frequently. We present a small series of a previously unreported complication, which appears specific to metal-on-metal bearing surface arthroplasties: three cases of infection in the presence of local metal debris and histological features of aseptic lymphocytic vasculitis associated lesions (ALVAL). Each case is associated with significant soft tissue loss and bone destruction to such an extent that pelvic discontinuity has occurred. We postulate that the combination of metal debris, ALVAL and tissue necrosis provides a unique environment for peri-prosthetic bacterial growth and rapid spread of infection.