Background. There are limited data on the complication rates and risk of periprosthetic joint infection (PJI) in patients who have an acute
Aims:. Identifying and scoring risk factors that predict early
Aim. In the context of total knee arthroplasty (TKA), trauma with perigenicular fracture fixation or oncological surgical treatment, soft tissue defects can expose critical structures such as the extensor apparatus, the knee joint, bone or implants. This work compares soft tissue reconstruction (STR) between a classical pedicled gastrocnemius (GC) muscle flap and a pedicled chimeric sural artery perforator (SAP) musculocutaneous GC flap in complex orthoplastic scenarios. Method. A retrospective study was conducted on prospectively maintained databases in three University Hospitals from January 2016 to February 2021 after orthopaedic, traumatological or oncological treatment. All patients with a perigenicular soft tissue defect and implant-associated infection were included undergoing STR either with a pedicled GC flap or with a pedicled chimeric SAP-GC flap. The outcome analysis included successful STR and flap related complications. The surgical timing, preoperative planning and surgical technique are discussed together with the postoperative rehabilitation protocol. Results. 43 patients were included (22 GC muscle flaps, 21 SAP-GC musculocutaneous flaps). The GC and SAP-GC patient group were comparable in terms of age, comorbidities, defect size and follow-up. The incidence of flap related complications was comparable among the two groups. Specifically, in the SAP-GC group 1
Background. Surgical wound closure is not the surgeon”s favorite part of the total knee arthroplasty (TKA) surgery however it has vital rule in the success of surgery. Knee arthoplasty wounds are known to be more prone to infection, breakdown or delayed healing compared to hip arthroplasty wounds, and this might be explained by the increased tensile force applied on the wound with knee movement. This effect is magnified by the enhanced recovery protocols which aim to obtain high early range of movement. Most of the literature concluded that there is no difference between different closure methods. Objectives. We conducted an independent study comparing the complication rate associated with using barbed suture (Quill-Ethicon), Vicryl Rapide (polyglactins910-Ethicon) and skin staples for wound closure following TKA. Study Design & Methods. Retrospective study where the study group included all the patients admitted to our unit for elective primary knee arthroplasty in 2015, we excluded patients admitted for partial knee arthroplasty, revision knee arthroplasty or arthroplasty for treatment of acute trauma due to the relatively higher complication rates. All the patients notes were reviewed to identify wound related problems such as
Introduction. We describe a novel single incision approach and its safety in the largest reported series of Lisfranc injuries to date. Via separate subcutaneous windows it is possible to access the medial three rays of the foot for bridge plating, without the concern of narrow skin bridges between multiple incisions. Methods. A retrospective review identified all 150 patients who underwent a Lisfranc ORIF via the modified dorsal approach at the Royal Melbourne Hospital between January 2011 and June 2016. All patients were operated by a single surgeon. Removal of metalwork (ROM) was routinely undertaken at six months post-operatively via the same incision. Medical recored were reviewed to record patient demographics, mechanism of injury and surgical details. Outpatient notes were reviewed to identify wound-related complications including; delayed wound healing, superficial infection,
Introduction. Cerament, a bioresorbable hydroxyapatite and calcium sulfate cement, is known to be used as a bone-graft substitute in traumatic bone defect cases. However, its use in open fractures has not previously been studied. Materials and Methods. Retrospective, single-centre review of cases between November 2016 and February 2021. Open fractures were categorised according to the Orthopaedic Trauma Society classification (OTS). Cases were assessed for union, time to union, and associated post-operative complications. Results. Twenty-four patients were identified. Fifteen cases were classified as OTS simple open fractures, and nine cases were complex open fractures requiring soft tissue reconstruction. Four cases were lost to follow-up. Four cases had limited follow-up beyond 6 months but showed evidence of progressive radiographic union. Of the remaining 16 cases, eight cases (50%) went on to union with a mean time to union of 6.7 months (5 to 12 months). Persistent non-union remained in six cases (38%). Two cases required return to theatre due to an infected skin graft and
Introduction. Amputation or disarticulation is a reliable option for management of severe foot deformities and limb-length discrepancies, the surgical restoration of which are unpredictable or unfavourable. Of the various surgeries involving foot ablation, Syme's amputation is preferred for congenital deformities as it provides a growing, weight bearing stump with proprioception and cushioning. Materials and Methods. We reviewed data of all children who underwent Syme's amputation over the past 13 years at our institution. Surgical technique followed the same principles for Syme's but varied with surgeons. Results. Ten boys and ten girls, with an average age of 18 months and average follow up of 70 months were included in the study. The most common indication was fibular hemimelia. Wound complications were reported in three children, phantom pain in one, heel pad migration in two. None had
This large UK multicentre study evaluates clinical outcomes and identifies factors associated with local complication following PFR for non-oncological conditions. 132 patients across four UK centres underwent PFR from 01/08/2004-28/03/2023 with median follow-up of 1.9 (Q10.5-Q34.2) years. 75 (56.8%) patients were female and the mean age was 74.0 (SD 11.7) years. 103 (78%) patients had Charleston Comorbidity Index ≥3. ASA class was III or IV in 66.6%. Indications were infected revision (39, 29.5%), periprosthetic fracture (36, 27.3%), acute trauma (30, 22.7%), aseptic revision (17, 12.9%), failed trauma (nine, 6.8%) and complex primary arthroplasty (one, 0.8%). The primary outcome was the local complication rate. Secondary outcomes were systemic complications, reoperation and mortality rates. Comparisons were made with t-tests and Chi2 tests to investigate patient and surgical factors associated with local complication. Statistical significance was p<0.05. There were 37(28.0%) local complications. These were 18 (13.6%) dislocations, eight (6.1%) prosthetic joint infections, four (3.0%) haematomas, three (2.3%) superficial infections, one (0.8%)
Aim. The optimal surgical approach for patients hospitalized for moderate to severe septic bursitis is not known, and there have been no randomized trials of a one-stage compared with a two-stage (i.e., bursectomy, followed by closure in a second procedure) approach. Thus, we performed a prospective, non-blinded, randomized study of adult patients hospitalized for an open bursectomy. Method. Patients were randomized 1:1 to a one-stage vs. a two-stage surgical approach. All patients received postsurgical oral antibiotic therapy for 7 days. These are the final results of the prospective study registered at ClinicalTrials (NCT01406652). Results. Among 164 enrolled patients, 130 had bursitis of the elbow and 34 of the patella. The surgical approach used was one-stage in 79 and two-stage in 85. The two groups were balanced with regards to sex, age, causative pathogens, levels of serum inflammatory markers, co-morbidities, and cause of bursitis. Overall, there were 22 treatment failures: 8/79 (10%) in the one-stage arm and 14/85 (16%) in the two-stage arm (Pearson-χ2-test; p=0.23). Recurrent infection was caused by the same pathogen a total of 7 patients (4%), and by a different pathogen in 5 episodes (3%). The incidence of infection recurrence was not significantly different between those in the one- vs. two-stage arms (6/79 vs. 8/85; χ2-test: p=0.68). In contrast, outcomes were better in the one- vs. two-stage arm for
Introduction and Aims: The use of the triradiate approach has been associated with high rates of
Introduction. Intraarticular calcaneal fractures often need open reduction and internal fixation (ORIF) with plate osteosynthesis. The wound complication is one of the common problems encountered following this and affects the outcome adversely. Our study was done to assess how far postoperative slab/cast can avert wound complications. Methods. Out of 42 patients with unilateral intraarticular calcaneal fractures, 20 were offered postoperative slab/cast and this was continued for six weeks. The remaining 22 patients were not offered any plaster. All patients were followed-up for two years. Results. The incidence of
Since its approval by the FDA two decades ago, Negative Pressure Wound Therapy (NPWT) has become a valuable asset in the management of open fractures with significant soft tissue damage as those seen in high velocity gunshot injuries. These lesions are often associated with grossly contaminated wounds and require a prompt and effective approach.
Open reduction and internal fixation (ORIF) of ankle fractures is associated with well known complications including
For soft tissue sarcoma patients receiving preoperative radiation therapy, wound complications are common and potentially devastating; they may result in multiple subsequent surgeries and significant patient morbidity. The purpose of this study was to assess the feasibility of intraoperative indocyanine green fluorescent angiography (ICGA) as a predictor of wound complications in resections of irradiated soft tissue sarcoma of the extremities. A consecutive series of patients of patients with soft tissue sarcoma of the extremities or pelvis who received neoadjuvant radiation and a subsequent radical resection received intraoperative ICGA with the SPY PHI device (Stryker Inc, Kalamazoo MI) at the time of closure. Three fellowship trained Orthopaedic Oncologic Surgeons were asked to prospectively predict likelihood of wound complications based on fluorescence. Retrospective analysis of fluorescence signal along multiple points of the wound length was performed and quantified. The primary endpoint was wound complication, defined as delayed wound healing or
The posterior midline approach used in spinal surgery has been associated with a significant rate of
Blood management protocols attempt to reduce blood loss by strategies including autologous blood donation, red cell salvage, normovolaemic haemodilution and haemostatic agents such as tranexamic acid (TXA). TXA usage in particular has become increasingly commonplace with numerous studies demonstrating a significant reduction in peri-operative blood loss and proportion of patients requiring transfusion, without increasing the risk of venous thromboembolism. Tourniquet usage has now become ubiquitous in TKA operations with reported benefits of improved visualization, shorter operative time and decreased intra-operative bleeding. However, its use is not without considerable complications including
Introduction. The purpose of the study was to assess the clinical outcomes of an algorithm for soft tissue femoral release in anterior approach (AA) total hip arthroplasty (THA). Specifically, the following were assessed in this series of patients utilizing a standardized soft tissue release sequence: 1) clinical outcomes with the Harris Hip Score (HHS); 2) re-operation rates; 3) component survivorship; and 4) complications. Methods. We retrospectively analyzed a prospectively maintained database of patients who underwent AA THA from 2014 to 2017. A total of 1000 patients were included, with minimum follow up of 2 years (range 2–5 years). The mean age was 65 years (range, 22–89), 48% were males, and the mean Body Mass Index was 34 (range, 20–52). Descriptive statistics were performed for most endpoints except for component survivorship, which was assessed with Kaplan-Meier analysis. Result. There was 95% follow-up (54 patients lost to follow-up). The HHS improved from mean 56 preoperatively (range, 34–78) to mean 88 post-operatively (range, 65–100) (p<0.01). There were three complications: one superficial
Introduction: The purpose of this study was to review the results of revision total hip replacement, using cement, done by a single surgeon in a tertiary referral centre. 164 patients underwent revision hip surgery for aseptic loosening, infection or recurrent dislocation. Methods: 95 patients had a one stage revision, 25 patients had two stage revisions and the remainder had either the stem or socket revised. 10 patients had application of a PLAD for recurrent dislocation. Structural and morselized bone grafting was carried out in patients with extensive bone loss. 46 patients had morselized impaction bone grafting to the acetabulum. The first hundred patients with revision of both components and minimum follow up of twelve months were reviewed. Patients were routinely followed up in the clinic and assessed using the Oxford Hip Score and Merle D’Abigne scores for pain, function and range of movements. Radiographs were assessed for any demarcation or loosening. Results: The mean age at surgery was 69.99 years (36ys to 95yrs). The mean follow up was 25 months (12 to 60 months). There were 5 dislocations, 2
Aims: Acquired defects of the back primarily are the result of radiation injury, trauma, tumour ablation, or
Purpose: Multi-modal therapy remains the cornerstone of post-operative pain management following knee replacement surgery. Femoral nerve catheters and blocks have been used with success in the management of post-operative pain yet most practicing arthroplasty surgeons and anaesthesiologists are unaware of the potential complications and risks of the procedure. The purpose of this study is to report on the complications associated with these techniques following knee replacement surgery. Method: One thousand one hundred and ninety patients underwent knee replacement surgery between January 2004 and July 1, 2007 and received an indwelling continuous infusion femoral catheter for post-operative marcaine pump infusion. For the initial 469 patients (Group 1), the continuous infusion ran for 2 to 3 days. In 721 patients, the continuous infusion was discontinued 12 hours following surgery (Group 2). Results: There were 15 major complications observed in 1190 patients: 7 femoral nerve palsies (2 in Group 1, 5 in Group 2) and 8 falls (4 in each group). For the patients who had fallen in hospital, the injuries sustained were: traumatic hemarthrosis, hemarthrosis requiring arthrotomy, major