Background

Acute soft tissue defects (wound dehiscence or necrosis) after a total knee arthroplasty (TKA) may be the cause of the devasting complication of deep infection. When a medium (4–6cm) defect is present, in patellar or infra-patellar localization, a medial hemi-gastrocnemius flap is widely used to cover it, because of its low morbidity and high functional results. Normally, this coverage is not associated to a debridement, antibiotics and implant retention surgery (DAIR).

When facing this situation, we should consider associating to the coverage treatment, like muscle flap, a DAIR procedure, in order to treat the possible acute infection, even when the diagnosis of infection is not clear. We could not find any studies comparing the benefice of this association in the same surgical act to isolated treatment of soft tissue defects.

Our hypothesis was that when a TKA surgical wound defect is present, the risk of an acute infection is elevated and the patient would benefit from a muscle flap with DAIR procedure and polyethylene exchange.

Introduction: Whereas adults with Low Back Pain (LBP) who seek medical attention show a decrease on HRQoL, there is little information if patients are adolescents with LBP. The aim of our study is to assess the impact on HRQoL of adolescents referred to a hospital of geographical reference due to non-specific LBP (NS-LBP).

Methods: All consecutive adolescents with NS-LBP (patients) referred to the hospital between January06 and October07 completed a self-administered questionnaire including a generic quality of life (KIDSCREEN-52) and two LBP-specific (Roland-Morris, Hannover) instruments. Comparisons were performed among patients and two groups of schoolchildren (one of them with self reporting LBP and another one without) selected from a representative sample of 1470 schoolchildren from Barcelona and Friburg, paired by sex, age and country. Comparisons were made using t-tests and effect size (ES) estimation.

Results: Seventy-six patients (mean age 14.1y, 59.2% girls) completed the questionnaire and were compared with 304 controls (152 reporting LBP and 152 without LBP). Patients reported significantly higher frequency (p=0.014), duration (p=0.009) and intensity (p< 0.001) of pain than symptomatic schoolchildren. Perceived functional capacity (Roland Morris 5.5 vs 4.3, p=0.023, and Hanover 4.5 vs 3.5, p=0.032) was also worse, even tough the overall disability was not high in 65% of them. However, HRQoL (KIDSCREEN) was better in almost all dimensions in patients than in symptomatic schoolchildren.

Discussion: Overall adolescent LBP is associated to low disability, and scarce impact on QoL. Adolescents with LBP referred to the hospital have worse clinical and functional picture but better HRQoL than symptomatic peers from the general population using the Kidscreen instrument.