Infection is disastrous in arthroplasty surgery and requires multidisciplinary treatment and debilitating revision surgery. Between 80-90% of bacterial wound contaminants originate from colony forming units (CFUs) present in operating room air, originating from bacteria shed by personnel present in the operating environment. Steps to reduce bacterial shedding should reduce wound contamination. These steps include the use of unidirectional laminar airflow systems and the introduction of theatre attire modelled on this principle (e.g. total body exhaust suits). Our unit introduced the use of the Stryker Sterishield Personal Protection System helmet used with laminar flow theatre systems. This study compares an enclosed helmet system used with standard gowns, with standard hood and mask attire. 12 simulated hip arthroplasties were performed, six using disposable sterile impermeable gown, hood and mask and a further 6 using a Sterishield helmet and hood. Each 20 minute operation consisted of arm and head movements simulating movements during surgery. Air was sampled at wound level on a sterile draped operating table using a Casella slit sampler, sampling at 700l/minute. Samples were incubated on Blood agar for 48 hours at 37°c and the CFUs grown were counted.Introduction
Method
Developments in adjuvant therapies and surgical techniques have allowed more confident excision of the neoplastic scapula without radical margins. Total scapular excision has been proven to be an effective limb salvage procedure for tumours involving the whole scapula, with or without gleno-humeral extension. The two most common types of excision are the Tikhoff-Linberg procedure or total scapulectomy. We identified 13 patients who had undergone total scapular excision between 1995 and 2008. Eight patients underwent total scapulectomy and five underwent a Tikhoff-Linberg procedure. All reconstructions were in the form of humeral suspension. There were four females and nine males with a mean age at operation of 47.7 years (range 16-81). Most tumours excised were either Ewing's sarcoma or chondrosarcoma and mean follow-up was 44 months (7-167). Functional outcomes were assessed using the Musculoskeletal Tumor Society Score (MSTS) and the Disabilities of the Arm, Shoulder and Hand Score (DASH). Active flexion and abduction ranges were also assessed. Of the original 13 patients, five died at a mean of 21 months post-operatively. One patient developed a recurrence after five months, which was successfully excised. The mean forward flexion and abduction following all procedures was 22.5 degrees (0-30) and 22.9 degrees (0-40) respectively. There was no statistical difference between ranges of motion of total scapulectomy and Tikhoff-Linberg procedures. The mean MSTS score for the entire group was 65.8% and there was no statistical difference between total scapulectomy and Tikhoff-Linberg (p = 0.69). The mean DASH score for all patients was 39.7 with no statistically significant difference between the two procedures (p = 0.46). Both procedures allow successful excision of scapular tumours with an acceptable level of post-operative function. Total scapulectomy and Tikhoff-Linberg procedures followed by humeral suspension compare favourably with forequarter amputation, endoprosthetic reconstruction and allografting.
