Purpose: To study the frequency and the type of pathogen contaminating the surgical wound during total joint replacement in a standard operating theatre

Type of Study: A prospective study.

Material and Methods: 100 patients, mean age 67 years, 56 females and 44 males, were available for 5 years follow-up after total joint replacement, of the 100 patients 13 underwent total hip replacement and 87 total knee replacement for osteoarthritis, 1 gram of cefazolin was given with induction of anesthesia and a further three doses of 1 gram i.v. cefazolin were given every 8 hours after surgery. The following swab cultures were taking from: skin knife, deep soft tissue knife, joint prosthesis after implantation, orthopaedic lavage fluid, suction tip, lamp hundle, operator gown, deep facia suture, skin (after removal of steridrape), surgical gloves, ambient air. Altogether 1100 cultures were taken. At five years 20 patients were lost to follow up. Ptients of the contaminated groupe were all available for follow up.

Results: 8 patients ( 8%) had one or more positive culture. Non was from ambient air, suction tip, orthopaedic lavage fluid and gloves. Four skin knife had positive cultures ( all with Staph. Coag. Negative ), and 4 deep soft tissue knife cultures ( 2 Staph. Coag. Neg., 1 Staph. Coag. Positive and one Klepsiella). Two facial sutures cultures were positive ( both alfa hemolytic strep.) One lamp hundle positive culture ( Staph. Coag. Neg. ). One joint prosthesis positive culture ( Staph. Coag. Neg. ). One gown positive culture ( Alpha. Hemolytic Strept. ). One skin positive culture (Staph. Coag. Neg.). No clinical signs of infection were seen in any case in the first year. During the second and the third year two patients showed increasing pains due to septic loosening with Staph. Coag. Neg. ( the same contaminating microorganism).

Conclusions: Microbial contamination of the wound is common. Cefazolin seems to be an effective prophylactic, but despite the antibiotic treatment 20% of the contaminated patients developed late low grade infection, loosening of the prosthesis and needed revision surgery, therefore cultures should be taken during joint replacement surgery and antibiotic treatment should be continued in case of positive culture.

During the second Lebanon war, between 12/07/06 to 14/08/06, 241 war injuries were admitted to Rambam Medical Center emergency room: 202 soldiers and 39 citizens. (Post traumatic stress disorders victims were not included). Majority of the injured soldiers (98%) were mobilized by the Israeli Air Force helicopters. More then 40 helicopters had landed in the hospital heliport during the war. Distribution of injuries according to the injury type:

110 patients (44% of all injured) had Orthopedic injuries (including hand injuries)

Distributions of soldier’s injuries among soldiers were similar to the above :

81 soldiers (41%) Orthopedic injuries (including hand injuries)

About 75 % of the injured soldiers suffered from orthopedic injuries. Vast majority of the injuries were shrapnel injuries, which were divided to 3 levels:

Mild soft tissue damage due to few or superficial shrapnel injury – 107 (49%) soldiers.

Organs injury distribution:

24 Patients total of 54 fractures, 24 of those had been long bone fractures

Amputation – 5 soldiers were underwent completion of traumatic lower limb amputation. One soldiers had bilateral below knee amputation, 1 above knee amputation and 3 unilateral below knee amputation.

Two hundred and three orthopedic surgery interventions were done by Orthopedics’ B’ department in Rambam Medical Hospital, during the Second Lebanon War.

Purpose: Midterm follow up of complete knee dislocation and clinical outcome evaluation.

Materials and Methods: Between 1990–2004, we retrospectively reviewed the records of patients with complete knee dislocation. Eighteen patients, 19 knees were followed. Twelve males and 6 females. The average age at follow up was 40.7 years. Treatment consisted of primary knee stabilization with tutor cast in 10 knees and 9 by external fixation for 6 weeks. Following rehabilitation program, further surgical treatment was according to clinical relevancy. Functional and subjective evaluation was registered by the WOMAC questionnaire.

Results: Eleven were multiple trauma patients, involved in RTA, 2 had a crush injury, one patient involved in aviation accident had bilateral dislocation and 4 patients had low energy injury. Out of 7 patients, 8 knees had isolated dislocation. One died, 3 were not available for clinical follow up. Twelve patients returned the questionnaire. The average result of the WOMAC score was 46.5, range 7–91. Four knees presented advanced osteoarthritis with painful stiffness. Eight knees presented at the end of the follow up with instability as chief compliant. Five patients underwent later reconstructive procedures. One patient underwent knee arthrodesis.

Conclusion: In patients with knee dislocation, associated polytrauma should be regarded as a bed prognostic sign. The results suggest the need to revaluate the initial treatment strategy. The overall outcome shows that nearly all patients were able to perform daily activities, no patients in our study attempted any strenuous activity.

Introduction: Conventional total hip replacement has a high rate of failure in young or high demand patients due to polyethylene wear, therefore, we perform a metal on metal hip resurfacing in these patients. Materials and Methods: The cup is all chrome cobalt alloy, with HA coating and the beads of the porous ingrowth surface are integrated with the substrate metal. The metal head is þxed with low viscosity cement, after careful precise preparation of femoral head.33 hybrid hip resurfacing in 29 patients. Average age was 42.8 years. Results: Harris Hip Score: 34.2 points average preoperatively and 97.1 points at the last examination. The average follow-up was 14.7 month. Discussion: The advantages: Minimal bone resection which makes for easier future revision, normal proximal femoral loading that hence avoidance of the stress shielding present in standard hip replacements, less risk of dislocation with greater range of motion, the physiological biomechanics of the joint is maintained, proprioception is maintained and we have noted that the postoperative recovery is extremely smooth and quick.

The disadvantages: Leg length and neck version cannot be altered. Hip resurfacing is, technically, a demanding procedure.

Contraindications: osteoporosis, varus neck.

Conclusions: Our early results are encouraging. We believe that metal on metal hybrid resurfacing is a legitimate alternative for active patients who require hip arthroplasty.