Aims. Antibiotic
Prophylactic antibiotics can decrease the risk
of wound infection and have been routinely employed in orthopaedic surgery
for decades. Despite their widespread use, questions still surround
the selection of antibiotics for
Aims. The aim of this study was to assess the efficacy of non-selective
and selective non-steroidal anti-inflammatory drugs (NSAIDs) in
preventing heterotopic ossification (HO) after total hip arthroplasty
(THA). Methods. A thorough and systematic literature search was conducted and
29 studies were found that met inclusion criteria. Data were extracted
and statistical analysis was carried out generating forest plots. Results. Non-selective NSAIDs showed a significant decrease in the odds
for forming HO after THA (odds ratio (OR) -1.35, confidence interval
(CI) -1.83 to -0.86) when compared with placebo. Selective NSAIDs
also showed a significant decrease in the odds for forming HO after
THA when compared with placebo (OR -1.58, CI -2.41 to -0.75). When comparing
non-selective NSAIDs with selective NSAIDs, there was no significant
change in the odds for forming HO after THA (OR 0.22, CI -0.36 to
0.79). Conclusion. Our meta-analyses of all available data suggest that both non-selective
and selective NSAIDs are effective HO
Symptomatic and asymptomatic deep-vein thrombosis
(DVT) is a common complication of knee replacement, with an incidence
of up to 85% in the absence of
To investigate the bone penetration of intravenous antibiotic
prophylaxis with flucloxacillin and gentamicin during hip and knee
arthroplasty, and their efficacy against Bone samples from the femoral head, neck and acetabulum were
collected from 18 patients undergoing total hip arthroplasty (THA)
and from the femur and tibia in 21 patients during total knee arthroplasty
(TKA). The concentration of both antibiotics in the samples was
analysed using high performance liquid chromatography. Penetration
was expressed as a percentage of venous blood concentration. The
efficacy against common infecting organisms was measured against
both the minimum inhibitory concentration 50, and the more stringent epidemiological
cutoff value for resistance (ECOFF).Aims
Patients and Methods
Prophylactic antibiotics are important in reducing the risk of periprosthetic joint infection (PJI) following total knee arthroplasty. Their effectiveness depends on the choice of antibiotic and the optimum timing of their administration, to ensure adequate tissue concentrations. Cephalosporins are typically used, but an increasing number of resistant organisms are causing PJI, leading to the additional use of vancomycin. There are difficulties, however, with the systemic administration of vancomycin including its optimal timing, due to the need for prolonged administration, and potential adverse reactions. Intraosseous regional administration distal to a tourniquet is an alternative and attractive mode of delivery due to the ease of obtaining intraosseous access. Many authors have reported the effectiveness of intraosseous
The incidence of deep-vein thrombosis (DVT) and
pulmonary embolism (PE) is thought to be low following foot and ankle
surgery, but the routine use of chemoprophylaxis remains controversial.
This retrospective study assessed the incidence of symptomatic venous
thromboembolic (VTE) complications following a consecutive series
of 2654 patients undergoing elective foot and ankle surgery. A total
of 1078 patients received 75 mg aspirin as routine thromboprophylaxis
between 2003 and 2006 and 1576 patients received no form of chemical
thromboprophylaxis between 2007 and 2010. The overall incidence
of VTE was 0.42% (DVT, 0.27%; PE, 0.15%) with 27 patients lost to follow-up.
If these were included to create a worst case scenario, the overall
VTE rate was 1.43%. There was no apparent protective effect against
VTE by using aspirin. We conclude that the incidence of VTE following foot and ankle
surgery is very low and routine use of chemoprophylaxis does not
appear necessary for patients who are not in the high risk group
for VTE.
Abstract. Introduction. Neck of femur (NOF) fracture patients are at risk of developing venous thromboembolisms (VTE). VTE risks could be reduced by adhering to the National Institute for Health and Care Excellence (NICE) recommendation for 1 month of
Aim. In 10% of the presumed aseptic hip or knee revisions, a low-grade infection is unexpectedly diagnosed based on the tissue samples taken during revision. Extended antimicrobial
Aims. Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic
Despite the routine use of systemic antibiotic
Aims. To explore the effect of different durations of antibiotics after stage II reimplantation on the prognosis of two-stage revision for chronic periprosthetic joint infection (PJI). Methods. This study involved a retrospective collection of patients who underwent two-stage revision for chronic PJI and continued to use extended antibiotic
The recently published Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial found no benefit in extending antibiotic
There is an increasing incidence of revision for periprosthetic joint infection. The addition of vancomycin to beta-lactam antimicrobial
The incidence of PJI in knee replacements is 2.8% and slightly lower with hip replacement surgery. PJI make up 15% (or even more) of knee revisions. To combat PJI, antibiotic laden bone cement has been used for many decades, but antibiotic stewardship dictates more prudent management of antimicrobials. Projected increase in infection rate, due to increased surgery and latent infection to be almost 5-fold up to 2035. Biofilm is a complex structure of bacteria and polysaccharide matrix and, is recognised as a major component in PJI and other orthopaedic infections. Biofilm is responsible for high incidence of resistance to antimicrobials and ineffective host immune response. Method. Stabilized hypochlorous acid has been reported to have a rapid kill rate on all pathogens, including MDR pathogens associated with chronic and acute wound infections. It destroys biofilm on contact, is not cytotoxic, reduces inflammation and stimulates wound healing. 0,038% of Hypochlorous acid was used as
Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in patients undergoing elective hip arthroplasty surgery. The balance of post-operative VTE
Aims. Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic
Gram-negative organisms are increasingly seen as causative pathogens in orthopaedic fracture surgery, which might necessitate a change in antibiotic
Objectives. As well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic
Aim. The aim of the present work was (i) to survey the situation of healthcare regarding the use of antibiotics in orthopaedics and trauma surgery in Germany, (ii) to determine which empiric antibiotic regimens are preferred in the treatment of periprosthethic joint infections (PJI) and (iii) to evaluate the hypothetical antibiotic adequacy of the applied empirical antibiotic therapy regimens based on a patient collective of a German university hospital. Method. A survey on empirical and prophylactic antibiotic therapy was conducted at German university and occupational health clinics (BG clinics), each in the specialties of orthopedics and trauma surgery. A total of 71 clinics were contacted by email. The questionnaire sent included open-ended questions on systemic antibiotic
Thromboembolic disease (TED) remains as a major concern for orthopaedic surgeons and is a well-known complication of lower extremity joint replacement procedures. While there is voluminous literature on the topic, it is difficult for the average orthopaedic surgeon to keep up with all the advancements in this area as well as the newer pharmacological options for
Aims. We studied the safety and efficacy of multimodal thromboprophylaxis in patients with a history of venous thromboembolism (VTE) who undergo total hip arthroplasty (THA) within the first 120 postoperative days, and the mortality during the first year. Multimodal
Considerable debate exists regarding which agent(s) should be preferred for venous thromboembolism (VTE) chemical
The selection of a
We reviewed systematically the published evidence on the effectiveness of antibiotic
Venous Thromboembolism (VTE)
Aim. Alongside debridement and irrigation, soft tissue coverage and osseous stabilization, systemic antibiotic
Aim. Deep infection following endoprosthetic replacement (EPR) of long bones is a devastating complication occurring in 15% of musculoskeletal tumour patients. The recently published PARITY Trial demonstrated that extending antibiotic
The selection of venous thromboembolism (VTE)
Venous thromboembolic events (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), remain one of the most common complications following total joint arthroplasty. Reported rates of symptomatic VTE following THA and TKA range from 0.83% to 15% and 2% to 10%, respectively. Thus, VTE
Introduction. Guidelines from the North American Spine Society (2009 and 2013) are the best evidence-based instructions on venous thromboembolism (VTE) and antibiotic
Heterotopic ossification following joint replacement in the lower limb occurs in 3% to 90% of cases. Higher grades of heterotopic ossification can result in significant limitation of function and can negate the benefits of joint replacement. The understanding of the pathophysiology of this condition has improved in recent years. It would appear to be related to a combination of systemic and local factors, including over-expression of bone morphogenetic protein-4. There is currently little evidence to support the routine use of
Purpose. Antibiotic
Culture negative prosthetic joint infections (PJI) still remain an issue even the advantages in PJI diagnosis. This is the reason why some orthopedic surgeons fear to use preoperative antibiotic
Aim. Prosthetic joint infection (PJI) is a devastating and costly complication of total joint arthroplasty (TJA). Use of extended oral antibiotic
Aim. Tourniquet is widely used in extremity surgery. In order to prevent surgical site infection, correct timing of antimicrobial
Background. Total hip replacement (THR) has become the ideal treatment for any disorder causing joint destruction. Surgery-related infections are reported only in 1–2 % of THR, but antibiotic
Introduction: The delivery of regional antibiotic
Venous thromboembolism (VTE) remains an immediate
threat to patients following total hip and knee replacement. While
there is a strong consensus that steps should be taken to minimise
the risk to patients by utilising some forms of
There is high morbidity and mortality associated with infection following orthopaedic procedures. In accordance to local guidelines, most hospitals follow a set protocol for surgical
Aim: To assess the infection rate following Lower Limb Arthroplasty using single dose gentamicin antibiotic
Aim. Patients reporting penicillin allergy do often receive clindamycin as systemic antibiotic
Background:. Antibiotic
Objective To survey current antithrombotic
Introduction: Cephalosporins have traditionally been the preferred antimicrobial
Aim: To assess the infection rate following Primary Lower Limb Arthroplasty using single dose gentamicin antibiotic
Our American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP) have come to a consensus that the use of routine
Aims. The purpose of this article was to review the current literature
pertaining to the use of mobile compression devices (MCDs) for venous
thromboembolism (VTE) following total joint arthroplasty (TJA),
and to discuss the results of data from our institution. Patients and Methods. Previous studies have illustrated higher rates of post-operative
wound complications, re-operation and re-admission with the use
of more aggressive anticoagulation regimens, such as warfarin and
factor Xa inhibitors. This highlights the importance of the safety,
as well as efficacy, of the chemoprophylactic regimen. Results. Studies have shown a symptomatic VTE rate of 0.92% with use of
MCDs for
NICE guidelines state that patients undergoing hip or knee arthroplasty should start as an in-patient and then continue pharmacological VTE
Recent recommendations by the National Institute
for Health and Care Excellence (NICE) suggest that all patients undergoing
elective orthopaedic surgery should be assessed for the risk of
venous thromboembolism (VTE). Little is known about the incidence of symptomatic VTE after
elective external fixation. We studied a consecutive series of adult
patients who had undergone elective Ilizarov surgery without routine
pharmacological