Variation of Practice in Prophylactic Protocol to Reduce Prosthetic Joint Infection in Primary Hip and Knee Arthroplasty: A National Survey in the United Kingdom.

Purpose: Prosthetic joint infection (PJI) has an enormous physiological and psychological burden on patients. Surgeons rightly wish to minimise this risk. It has been shown that a standardised, evidence-based approach to perioperative care leads to better patient outcomes. A review of current practice was conducted using a cross-sectional survey among surgeons at multiple centers nationwide. Materials and Methods: An 11-question electronic survey was circulated to hip and knee arthroplasty consultants nationally via the BOA (British Orthopaedic Association) e-newsletter. Results: The respondents included 56 consultants working across 19 different trusts. Thirty-four (60.7%) screen patients for asymptomatic bacteriuria (ASB) preoperatively, with 19 (55.9%) would treating with antibiotics. Fifty-six (100%) screen for methicillin-resistant Staphylococcus aureus and treat if positive. Only 15 (26.8%) screen for methicillin-sensitive S. aureus (MSSA) or empirically eradicate. Zero (0%) routinely catheterise patients perioperatively. Forty-one (73.2%) would give intramuscular or intravenous gentamicin for a perioperative catheterisation. All surgeons use laminar flow theatres. Twenty-six (46.4%) use only an impervious gown, 6 (10.7%) exhaust pipes, and 24 (42.3%) surgical helmet system. Five different antimicrobial prophylaxis regimens are used 9 (16.1%) cefuroxime, 2 (3.6%) flucloxacillin, 19 (33.9%) flucloxacillin and gentamicin, 10 (17.9%) teicoplanin, 16 (28.6%) teicoplanin and gentamicin. Twenty-two (39.3%) routinely give further doses. Conclusion: ASB screening, treatment and intramuscular gentamicin for perioperative catheterisation is routinely practiced despite no supporting evidence base. MSSA screening and treatment is underutilised. Multiple antibiotic regimens exist despite little variation in organisms in PJI. Practice varies between surgeons and centers, we should all be practicing evidence-based medicine.

How does hip and knee arthroplasty affect golfer performance and what should be expected regarding return to play?

AIMS: Hip and knee arthroplasty is commonly performed for end-stage arthritis. There is limited information to guide golfers on the impact this procedure will have postoperatively. This study aimed to determine the impact of lower limb arthroplasty on amateur golfer performance and return to play. METHODS: A retrospective observational study was designed to collect information from golfers following arthroplasty. Data were collected from 18 April 2019 to 30 April 2019 and combined a patient survey with in-app handicap data. RESULTS: A total of 2,198 responses were analyzed (1,097 hip and 1,101 knee). Of the respondents, 1,763 (80%) were male and the mean age was 70 years (26 to 92). Hip arthroplasty was associated with a mean increase in handicap of 1.03 (95% confidence interval (CI) 0.81 to 1.25). No difference was seen between isolated leading or trailing leg (p = 0.428). Bilateral hip arthroplasty increased handicap (p < 0.001). Overall, 1,025 (94%) maintained or increased the amount of golf played, 258 (23.5%) returned to iron shots at six weeks, 883 (80%) returned to club competitions at six months, 18 (1.6%) had persistent pain, and 19 (1.7%) were unable to return to play. Knee arthroplasty was associated with a mean increase in handicap of 1.18 (95% CI 0.99 to 1.38). Trailing leg arthroplasty alone was associated with higher postoperative handicap (p = 0.002) as was bilateral surgery (p = 0.009). Overall, 1,009 (92%) maintained or increased the amount of golf played, 270 (25%) returned to iron shots at six weeks, 842 (76%) returned to club competition at six months, 66 (6%) had persistent pain, and 18 (1.6%) were unable to return to play. CONCLUSION: Hip and knee arthroplasty enables patients to maintain or increase the amount of golf played. The majority return to competitions within one year. Return to iron shots occurs from six weeks. A small increase in handicap following surgery is expected and is larger in patients undergoing bilateral surgery or those with knee arthroplasty to their trailing leg. Patients may still experience pain when playing golf. Cite this article: Bone Jt Open 2022;3(6):510-514.

Biochemical and biomechanical influence on peri anchor cyst formation in rotator cuff repair.

This review aims to provide a detailed analysis of the pathological processes underlying peri anchor cyst formation. As a consequence providing methods that can be implemented to reduce cyst occurrence and also to highlight areas of current weakness in the literature that could be strengthened so as to improve our ability to manage peri anchor cyst formation. We performed a literature review of the National Library of Medicine focused around rotator cuff repair and peri anchor cysts. We summarise the literature whilst incorporating a detailed analysis of the pathological processes underpinning peri anchor cyst formation. There are two theories behind peri anchor cyst occurrence, biochemical and biomechanical. It is our belief that cyst formation occurs as a result of both. The biochemical make up of an anchor plays a crucial role in cyst occurrence and it's timing post-operatively. Consequently anchor material plays a vital role in peri anchor cyst formation. Tear size, degree of retraction, number of anchors and varying bone density within the humeral head are all important biomechanical factors. Further investigation is required into certain aspects of rotator cuff surgery to improve our understanding of peri anchor cyst occurrence. From a biomechanical perspective these include: Anchor configuration to both the tear and each other and also tear type itself. From a biochemical perspective we need to further investigate the anchor suture material. It would also be of benefit if a validated grading criteria of peri anchor cysts was produced.

Congenital Talipes Equinovarus: Results of Treatment and Are We Bracing Effectively?

The aim of this retrospective study was to assess our management of Congenial Talipes Equinovarus (CTEV) in relation to national standards published by the British Society for Children's Orthopaedic Surgery (BSCOS). A secondary aim was to evaluate if a more tailored bracing regime than advocated in the traditional Ponseti technique, would be appropriate for some cases of CTEV. One hundred and thirty-three feet in 96 patients were treated between June 2006 and January 2016. All patients were clinically assessed prospectively by the senior author at initial presentation using the Harrold & Walker classification system. A combination of the senior author's database, Elogbook and trust IT systems were used for data collection. The results of Ponseti surgical procedures such as tendoachilles release and tibialis transfer fell within the BSCOS guidelines. The rate of radical subtalar surgical release was higher than advocated (12.3%) which was partly due to the number of primary syndromal patients in the series. There was a significantly lower mean time spent in bracing of 14.3 months (95% confidence interval 14.8-19.3) compared to recommended national guidelines. There was a clinically significant difference in the lower relapse rate of female patients compared to male patients and also a higher propensity of surgical intervention in male patients. In addition, there was a statistically significant difference in both time spent in bracing, between H&W classifications and between patients who had bracing removed pre walking age or post walking age. This potentially demonstrates a more tailored bracing regime may be possible when applied to less severely affected feet and the condition may be more benign in female cases.

Aneurysmal Bone Cyst Involving the Pisiform: A Case Report.

BACKGROUND: Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare. METHODS: A rigorous review of the literature showed that this type of tumor has not previously been described in the pisiform. In this article, we report the occurrence of an aneurysmal bone tumor in the pisiform of the left hand of a 19-year-old male. RESULTS: This tumor was successfully treated through surgical excision with an uneventful recovery. We describe the process behind the diagnosis of the lesion and the subsequent treatment in an attempt to highlight the rare but possible occurrence of aneurysmal bone cysts in the pisiform. CONCLUSION: Appropriate treatment of aneurysmal bone cysts in this location is required, due to the anatomical nature of the pisiform itself with the risks of pathologic fracture and ulnar nerve compression.

Haemostatic property of cyanoacrylate in pedicled flaps.

We present a technique that can, in principle, be applied to any pedicled flap that is routinely used for reconstructions of the forehead. In our experience, cyanoacrylate glue applied to the pedicle before the flap is inserted decreases postoperative bleeding and wound exudate.