Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Apr 2015
Is neuraxial anesthesia safe in patients undergoing surgery for treatment of periprosthetic joint infection?
There is concern that neuraxial anesthesia in patients undergoing surgery for treatment of a periprosthetic joint infection (PJI) may increase the risk of having a central nervous system infection develop. However, the available data on this topic are limited and contradictory. ⋯ Central nervous system infections after neuraxial anesthesia in patients with a PJI appear to be exceedingly rare. Based on the findings of this study, it may be time for the anesthesiology community to reevaluate the risk of sepsis as a relative contraindication to the use of neuraxial anesthesia.
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Clin. Orthop. Relat. Res. · Apr 2015
What are the functional results and complications from allograft reconstruction after partial hemipelvectomy of the pubis?
In patients undergoing hemipelvectomies including resection either of a portion of the pubis or the entire pubis from the symphysis to the lateral margin of the obturator foramen while sparing the hip (so-called Dunham Type III hemipelvectomies), reconstructions typically are not performed given the preserved continuity of the weightbearing axis and the potential complications associated with reconstruction. Allograft reconstruction of the pelvic ring may, however, offer benefits for soft tissue reconstruction of the pelvic floor and hip stability, but little is known about these reconstructions. ⋯ Allograft reconstruction after Type III pelvic resections can provide functional reconstruction of the pelvic ring, pelvic floor, and, in certain patients with partial anterior acetabular resections, the resected anterior acetabulum. This has implications in preventing the occurrence of hernia and hip instability in this patient population that is classically not reconstructed, although longer-term outcomes in a larger number of patients would help to better delineate this because infection, hernia, hip instability, and graft nonunion still remain concerns with this approach. The most important unanswered question remains whether, on balance, any benefits that may accrue to these patients as the result of reconstruction are offset by a relatively high likelihood of undergoing secondary or revision surgery.
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Clin. Orthop. Relat. Res. · Apr 2015
Correlations between a dedicated orthopaedic complications grading system and early adverse outcomes in joint arthroplasty.
Reliable classification of postoperative complications is important for quality improvement efforts. In 2014, The Knee Society proposed a grading system for complications after TKA, but to our knowledge, a relationship between complication grades and surgical outcomes has not yet been established. ⋯ We found that the proposed grading system is applicable to TKA and THA in terms of documentation of complication severity and as an indicator of increased LOS and increased unplanned readmissions or reoperation rates. That total complication grade was a better predictor of LOS than maximum grade suggests that multiple complications of a lesser grade can be just as important as a single higher grade complication in terms of effect on outcomes.