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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 53 - 53
1 Sep 2012
Esteve C Esteve C Garcia-Forcada I Gina J
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Introduction

Surgical site infections (SSI) are related to a surgical procedure and affect the surgical wound or deeper tissues. With continuing emphasis on clinical governance and quality control, there is increasing demand from both patients and government for methods of assessing surgical results. Rates of morbidity and mortality may play important roles in these assessments. When crude comparisons between hospitals in the incidence of SSI are made, these should at least be stratified by the type of procedure. The aim of this study is to fix SSI incidence in relation to surgical procedure.

Methods

This report contains data of 19.948 procedures collected from 1996 to 2008 at a Specialist Orthopaedic Hospital and analyzed by a specific software designed for the study of infection in orthopaedic and trauma surgery.

The SSI surveillance is focused on categories of surgical procedure (Hip Arthroplasty, Knee Arthroplasty, Spine Surgery and Hip Fracture Surgery) with each category containing a defined set of similar procedures. A basic of demographic data and details about operation itself are collected for each procedure. Patients are followed up throughout their hospital stay and after hospital discharge.

We present the incidence of SSI by risk group and surgical procedure. SSI are categorized in type, moment of diagnosis and micro-organisms reported.

Analysis of the data was performed (SPSSv15.0 ®). Statistical methods used to determine significance were the independent samples t test, Pearson X2 test, Odds ratio and Spearman correlation coefficient, with a significance level of p<0,05.


Introduction: The success of total knee arthroplasty (TKA) is dependent on many factors. Postoperative extremity and component alignment are important determinants of outcome and longevity and malalignment results in higher failure rates. Computer-assisted (CAS) navigation devices were developed to improve implant positioning but their use increases the complexity of the surgery. The aim of this study is to assess the radiological outcome of conventional techniques versus CAS for TKA performed by an expert and other group performed by a beginner in CAS.

Methods: 90 patients patients with knee arthritis were prospective randomized into 3 groups: CAS performed by an expert, CAS performed during the learning curve and conventional technique (manual instrumentation) performed by an expert. Preoperative and postoperative clinical examinations were performed at four weeks, six months, and one year by an independent physician who was blinded to the surgical technique. Preoperative and postoperative radiographic measurements of the anterior-posterior mechanical axis and the sagittal tibial and femoral axes were evaluated by an observer who was blinded to the surgical technique. The Knee Society Scoring System was used to asses clinical and functional outcomes. All variables were analysed for differences between the groups either by Student’s t-test or the Mann-Whitney U test.

Results: There was no differences in implant positioning between the CAS groups. The mechanical axis of the leg was significantly better in the two CAS groups (96%, within +/−3° varus/valgus) compared with the conventional Group (78%, within +/− 3° varus/valgus). The frontal and sagittal alignment of the femoral component and the frontal tibial alignment were also more precise in the CAS groups. Improvement occurred in the Knee Society scores up to one year post-operatively and was similar for the three groups. No significant difference between the groups could be found at any time point in the study, with the mean difference being 3.5 points (95% CI;18.6 to 13.6).

Conclusions: We have not shown differences in the precise positioning of implants during the learning curve in computer-assisted total knee arthroplasty. Computer-assisted total knee arthroplasty gives a better correction of alignment of the leg and orientation of the components compared with the conventional technique. Potential benefits in the long-term outcome and functional improvement require further investigation.