Background. Well-fixed cementless stems are sometimes needed to be extracted in patients with complications including periprosthetic infection, stem-neck breakage or trunnionosis. The purpose of this study was to report the clinical outcome in patients undergoing re-implantation surgery following removal of a well-fixed porous-coated cementless stem by the femoral longitudinal split (FLS) procedure(Fig.1, Fig.2). Methods. We conducted a retrospective study and radiographic review of 16 patients who had undergone re-implantation following the FLS procedure to remove a well-fixed stem due to periprosthetic infection, stem-neck breakage or trunnionosis. The study group consisted of 2 men and 14women with an average age of 68.4 years. Mean follow-up was 33.1± 25.0 months. Operation time,
Purpose. Various approaches have been reported for the total hip replacement (THR). In recent years, a muscle sparing approach with low postoperative muscle weakness and low dislocation risk has been frequently selected. However, such surgery has a learning curve. Thus, at the time of switching from the conventional approach to such approaches, invasion or infection risk may increase with the operation time extension. The purpose of this study is to clarify the change of invasiveness or latent infection rate with the change in approach in order to select the cases safely at the beginning of introducing a new approach in THR. Methods. In facility A, THR was performed with Dall's approach (Dall), but 1 surgeon changed Dall to anterolateral modified Watson-Jones approach (OCM) and another surgeon changed Dall to direct anterior approach (DAA). In facility B, all 3 surgeons changed posterolateral (PL) approach to OCM. The subjects are 150 cases in total, including the each last 25 cases operated with the conventional approach and the each first 25 cases operated with a new approach (Dall to OCM: 25 + 25, Dall to DAA: 25 + 25, PL to OCM: 25 +25 cases). And, differences in operative time,
Introduction. Our department is responsible specifically for complex cases resulting from trauma. Our experience does not want to add what has been clearly demonstrated by multicenter studies on the efficacy of rivaroxaban but aims to demonstrate how the use of this molecule was effective also in mega-prosthesis and how it has proven to be flexible and safe in dealing with difficulties and surgical complications more common in such difficult cases. Materials and Methods. From January 2010 to date DVT prophylaxis in THR / TKR and revision was routinely performed with rivaroxaban. To date, in addition to first implant/revision in THR/TKR we treated over 30 cases of large segments replacements (large segments+mega-prosthesis) and we have not highlighted complications attributable to rivaroxaban. Discussion. We present in particular the medical and surgical management of three cases with a high risk of bleeding: a case of revision of total femur due to recurrent dislocation, one case of revision for early infection of a TKR and a case of traumatic acetabular revision for pelvicbreakthrough during rehabilitation. Conclusion. The major practical advantages found are: 1) the ability to choose when to start prophylaxis in relation to
Blood loss is a major concern in total knee arthroplasty (TKA) along with postoperative knee function. The present study explores the impact of tourniquet and closed-suction drains on blood loss as well as knee function in TKA. A prospective clinical trial was conducted on 111 patients admitted for TKA. Subjects were divided into three groups based on duration of tourniquet use (T+: whole-course tourniquet, T-: cementation only tourniquet) and usage of closed-suction drain (D+: drain use, D-: no drain). Thirty-six subjects were included in group T+D+, 42 in T-D+ and 33 in T-D-. Data from study population was analysed for pre and post-operative hemoglobin level (Hb), perioperative and total blood loss, blood transfusion rates, knee range of motion (ROM), and pain level assessment. Direct and indirect costs associated to nursing time and drains were calculated. Results are presented in mean ± SD. No statistically significant differences were observed among the three groups (T+D+, T-D+ and T-D-) concerning total blood lost (calculated using Gross' formula), Hb levels over the first six postoperative weeks, blood transfusion rates and intra-articular hematomas.
Introduction. The purpose of this study was to introduce our perioperative prophylaxis method for infection and clarify surgical site infection rate in our patients performed total hip arthroplasty (THA). Method. Two hundred and eighty four THA (including revision 18 cases) performed by single surgeon between Oct. 2007 and Jan. 2013 were evaluated. The mean age of patients was 65.7 years old. The male to female ratio was 46 to 238. BMI was 23.6. Ninety patients (32%) were compromised host suffering from diabetes mellitus, rheumatoid arthritis, autoimmune disease, history of malignant tumor, hemodialysis or skin disease at surgical site respectively. At preoperative period, we checked decayed tooth, alveolar pyorrhea, hemorrhoids, and leg skin condition. In addition, we examined culture of nasal cavity. At the day of surgery, patient took a shower just before entering surgical room. All of THA was performed in clean room NASA class 100. Surgeons and assistant nurse put on nonwoven fabric gown, space suit and double rubber gloves. We wiped surgical site leg by gauze impregnated by 0.5% chlorhexidine alchohol to eliminate skin bacteria twice just before surgeons scrubbing hands. Surgical site was covered by povidone iodine containing drape. Surgeons or nurse changed gloves when glove was broken at each time. We cleaned surgical field by pulse washer whenever necessary. We did not use drain except for 5 revision THAs. Regarding to prophylactic antibiotics usage, we administered cefcapene pivoxil orally the day before surgery. Drip infusion antibiotics (PIPC: until Oct. 2008, CEZ: after Oct. 2008) was administered at the period of 30 min. before surgery and 4 hours after surgery in case of prolonged surgical time (4 hours >). Skin closure was performed by staple and covered by gauze until May 2010. After that, we used surgical tape and transparent water proof sheet. After finishing surgery, antibiotic was administered 8 hours interval at surgery day and 12 hours interval for additional two days. In case multi-drug resistant bacteria (MRSA, MRSE) was positive in nasal culture, we applied mupirocin ointment to nasal cavity for 3 days before surgery and administered vancomycin (from Aug. 2011) or linezolid (from 2012) for prophylactic antibiotics in perioperative period. Results. Multi-drug resistant bacteria was detected from nasal cavity in 23 patients (8%). The mean operation time was 194 min (due to education for young surgeon).