Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2007
Does antibiotic elution from PMMA beads deteriorate after 1-year shelf storage?
Antibiotic-impregnated polymethylmethacrylate beads are widely used as an adjunct in the treatment of orthopaedic infections. Because there is no commercially available bead in the United States, surgeons must manufacture bead sets at the time of implantation. This can be time consuming and wasteful. ⋯ We were unable to detect any difference in the amount of antibiotic elution between beads tested immediately after manufacture and beads manufactured and stored for 6 or 12 months. Beads with hand-mixed antibiotics eluted higher levels of antibiotics than the beads prepared with factory-mixed antibiotics. We conclude antibiotic beads can be made, sterilized, and used after 1 year of storage with no deleterious effect on antibiotic elution characteristics.
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Clin. Orthop. Relat. Res. · Sep 2007
PMMA is superior to hydroxyapatite for colony reduction in induced osteomyelitis.
Staphylococcus aureus infection is a serious complication in patients receiving orthopaedic implants. Treatment with antibiotic-loaded cements can deliver high local concentrations and reduce toxic side effects associated with systemic antibiotic administration, but polymethylmethacrylate cement is nondegradable and may necessitate additional surgery for removal. Previous studies provide support for hydroxyapatite as a biodegradable carrier, but consensus has not been achieved. ⋯ We observed no difference between low- and high-dose vancomycin-loaded hydroxyapatite groups. The poor handling properties of hydroxyapatite paste may explain these findings. Based on these results, a hydroxyapatite carrier cannot be recommended for the treatment of osteomyelitis.
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We analyzed 124 papers published in the English language literature to define the indications and timing of surgery in spinal TB and to evaluate the outcome of various surgical procedures for kyphosis and neural outcome. Surgery in spinal tuberculosis is indicated for diagnostic dilemma, neural complications, and prevention of kyphosis progression. Up to 76% canal encroachment is compatible with a normal neurologic state as the spinal cord tolerates gradually developing compression. ⋯ Its outcome in a long-segment disease needs observation. The correction of healed kyphosis requires multistage surgery and is fraught with complications. Prospective studies are needed to define surgical approach, steps, stages, problems, and obstacles to correct severe kyphosis in spinal TB.
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Late-onset paraplegia is best avoided by correcting severe kyphosis in the active, healing, or healed stages of spinal tuberculosis. We report 16 patients with dorsal or dorsolumbar spinal TB--nine with paraplegia, seven without paraplegia--who underwent kyphus correction. Nine patients had active, five partially treated, and two healed disease. ⋯ All but one patient with neural deficit showed complete neural recovery. Mean kyphosis correction was 27.3 degrees (range, 9 degrees-42 degrees). Mean correction loss on 1-year followup was 1.4 degrees (range, 0 degrees-4 degrees).