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.

Purpose: To review the results of simple arthroscopic subacromial decompression in patiens with impingement syndrome and rotator cuff tears without repairing the tears.

Type of Study: prospective study.

Material and Methods: From 1998 to 2003, 160 patients (168 shoulders) had arthroscopic subacromial decompression for impingement syndrome with a torn rotator cuff without repairing the tear of the cuff (120 males and 40 females). The average patient age was 64 years and the average follow up was 24 months.

With increasing use of arthroscopy in the treatment of shoulder disorders, tears of the rotator cuff have been well described. Management of rotator cuff tears should include consideration of tear size, patient age and activity level, and tear etiology.

Operative treatment of impingement syndrome in elderly less active lower demand patients with small and moderate tears involves decompression with and without repairing the cuff.

We evaluated the clinical outcome of arthroscopic subacromial decompression and debridement in 160 patients ( 168 shoulders ) with impingement syndrome with small and moderate tears of the rotator cuff without repairing the cuff.

Rotator cuff tears are graded arthroscopically as small (< 1 cm), moderate (> 1 cm < 3 cm ), large (> 3 cm < 5 cm ), and massive rotator cuff tears (> 5 cm ).

Results: At follow up 96 patients (60%) were rated excellent or good , 56 patients (35%) were rated fair and 8 patients (5%) were rated poor. The average “Constant” score was 62 preoperative compared with 82 postoperative in the improved group (152 patients) . The 8 patients who showed no improvement had average postoperative “Constant” score of 64.

Conclusions: Arthroscopic subacromial decompression without suture of the cuff in elderly less active lower demand patients with impingement syndrome with small and moderate tears of the cuff is a legitimate method of treatment for their shoulder pain and limitation of function.

The main advantages were: immediate physiotherapy and return of function since there is no need for immobilization.

Purpose: To evaluate and compare the effect of arthroscopic depridement and lavage versus arthroscopic lavage only as a treatment in osteoarthritis of the knee.

Type of Study: A prospective study.

Material and Methods: 500 patients ( mean age 58 years ) were available for 6 years follow-up after arthroscopy of the knee as a treatment of osteoarthritis refractory to conservative treatment. 250 patients were treated with debridement and lavage and 250 patients were treated with lavage only.

Osteoarthritis of the knee is a common cause of knee pain. The pain from osteoarthritis is due to synovitis, capsular and ligamentous inflammation, and subchondral bone pain because cartilage has no nerves.

Degenerative arthritis is usually the end result of mechanical stress inflicted on the articular cartilage, either through a suddenly applied single load or through the cumulative effect of multiple or repetitive loads leads to breakdown of the articular cartilage.

The treatment of knee pain due to osteoarthritis of the knee includes conservative treatment such as rest, weight loss, physical therapy, nonsteroidal anti-inflammatory drugs, Cox-II inhibitors, nutritional supplements, steroid injections, Viscosupplementation, and surgical treatment such as arthroscopy, osteotomy or arthroplasty. With failure of conservative treatment, arthroscopic debridement and lavage is the treatment of choice for such patients.

Results: Arthroscopic debridement and lavage performed in earlier stages of osteoarthritis of the knee resulted in significant reduction of pain for long period of time. In advanced stages of osteoarthritis, patients experienced less pain relief for shorter period of time. Debridement and lavage was superior to lavage only at 6 years in reduction of pain.

In my group 93.8% (91.2% of the lavage group and 96.4% of the debridement group) were satisfied at 6 months and felt better than before their surgery, at 3 years 45.6% (35.6% of the lavage group and 55.6% of the debridement group) felt better, and at 6 years 30.2% (22.8% of the lavage group and 37.6% of the debridement group) felt better after the arthroscopic procedure.

Conclusions: Arthroscopic debridement and lavage of painful osteoarthritic knees has a better outcome than lavage only for the same treatment, however patients must be made aware that the procedure is not curative and that it is quite possible that they will need further surgery in the future. Arthroscopic surgery (debridement and lavage or even lavage only) is reasonably successful temporizing and palliative procedure. However, the patient must be informed about the prospects of success, the benefits, the alternative and the risks of that procedure.

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.