The Journal of arthroplasty
-
Filtered exhaust helmets (space suits) have been reported as efficacious in decreasing wound infections following joint arthroplasty procedures; however, strict experimental control of the many variables related to the incidence of clinical infection has been lacking in these studies, making support of such conclusions difficult. Any potential benefit of filtered exhaust helmets in the control of infection rates can be logically assigned to the reduction of airborne bacterial counts within the operating room. A study was done using the Steri-Shield helmet (Bio-Medical Devices, Irvine, CA) to define its efficacy in limiting airborne bacterial contaminates during total joint arthroplasty. ⋯ Air samples were obtained with an Anderson two-stage viable particle sampler (Anderson Samplers, Atlanta, GA) placed immediately adjacent to the wound. Quantitative microbial cultures were obtained. The filtered exhaust helmet evaluated in this study provided no increased protection against bacterial contamination in the area of the surgical field than conventional paper hoods and masks.
-
Forty-eight total knee arthroplasties (42 patients) were treated arthroscopically for symptomatic peripatellar fibrosis. All patients complained of knee pain before surgery. In addition, 47 knees (98%) had clicking or clunking, 35 (73%) had difficulty climbing stairs, and 9 (19%) had motion problems. ⋯ In contrast to past reports, the arthroscopic treatment of peripatellar fibrosis was found to be unpredictable. Debridement of the offending soft tissue did not necessarily guarantee a good result. Arthroscopic management of peripatellar fibrosis is recommended; however, limited and specific surgical goals should be established prior to intervention.
-
A large Q angle induced by technical error such as an internally rotated femoral component causes patellar failure after total knee arthroplasty. The effect of medial displacement of the tibial tubercle to decrease the Q angle for patellar tracking was studied by evaluating the patellar position relative to the patellar groove on the femoral component in cadaver specimens. A 5 degrees internally rotated femoral component caused the patella to shift medially about 5 mm, and also caused the tibia to rotate internally about 3 degrees at full extension. ⋯ Medialization of the tibial tubercle caused the patella to shift about 2 mm medially from the patellar groove. The transfer also caused an external rotation of the tibia (2 degrees-5 degrees). Medial transfer of the tibial tubercle changes patellar kinematics and corrects the tendency toward lateral patellar dislocation caused by internally rotating the femoral component; however, it also creates minor patellar and tibial kinematic changes that may have a clinical effect.
-
Multicenter Study Comparative Study
Oxford meniscal bearing knee versus the Marmor knee in unicompartmental arthroplasty for arthrosis. A Swedish multicenter survival study.
In the Swedish Knee Arthroplasty Study, all 699 Oxford meniscal bearing cemented unicompartmental prostheses (Biomet, Bridgend, UK) were identified and analyzed regarding failure pattern and compared with all Marmor prostheses (Smith & Nephew Richards, Orthez, France) and with a time-, age-, and sex-matched subset of Marmor prostheses using survival statistics expressed as cumulative revision rates. After 1 year there was already a higher rate, and after 6 years the rate of the Oxford group was more than twice that of the Marmor group. ⋯ It is still unclear if the design with the sliding menisci will, in the long turn, reduce wear and loosening, thereby compensating for the initially inferior results. It is recommended that until this question is clarified, the Oxford knee should be used on a limited scale for long-term comparative studies only.
-
Comparative Study
Perioperative bladder management after primary total hip arthroplasty.
A retrospective review of 95 consecutive primary total hip arthroplasty patients was performed to assess the clinical outcome of two postoperative bladder management protocols. The first 49 patients (group 1) were treated with a pro re nata straight catheterization protocol. The next 46 patients (group 2) were treated with an indwelling catheterization protocol. ⋯ There were no infections in group 1. In group 2, one patient (2%) had bacteriuria and one patient (2%) had a urinary tract infection (P > .1). This trend of increased contamination in the catheterization group may be related to a mean catheterization duration of 72 hours.