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
Pre-specified pooling of data from the four phase III RECORD studies was conducted to determine whether rivaroxaban significantly reduced the less-frequent clinical endpoint of symptomatic venous thromboembolism (VTE) and all-cause mortality after total hip or knee arthroplasty (THA or TKA, respectively), compared with standard North American and European enoxaparin regimens. Patients (n=12,729) received rivaroxaban 10 mg once daily or enoxaparin 40 mg once daily (RECORD1-3) or 30 mg 12-hourly (RECORD4). Thromboprophylaxis was administered for 31-39 days (RECORD1; THA) or 10-14 days (RECORD3 and 4; TKA). RECORD2 (THA) compared 31-39 days' rivaroxaban with 10-14 days' enoxaparin followed by placebo. The pre-specified primary efficacy endpoint in the pooled analysis (composite of symptomatic VTE and all-cause mortality) and adjudicated bleeding events were analysed in the day 12±2 active treatment pool, when all patients had received active drug, and total treatment duration pool, where subgroup analyses were performed.Hypothesis
Methods and analysis
Varus positioning of cemented ‘composite beam’ stems is associated with increased risks of aseptic loosening and stem fracture. We investigated whether the incidence of varus malalignment of the Exeter polished, double taper design in a multicentre prospective study adversely affected outcome after total hip replacement (THR). A multicentre prospective study of 1189 THR was undertaken to investigate whether there is an association between surgical outcome and femoral stem malalignment. The primary outcome measure was the change in the Oxford hip score (OHS) at five years. Secondary outcomes included the rate of dislocation and revision, stem subsidence, quality of cementing. 938 (79.89%) were followed-up at five years.Introduction
Materials & Methods
A commonly held belief amongst surgeons and patients is that progression of disease (arthritis) to other compartments is a major cause of early failure of UKRs. We analysed the NJR database records of 17,643 primary UKRs performed between April 2003 and April 2009. Where these had been revised the reason for revision was noted.Background
Methods
An MRI scan of the patient's hip, knee and ankle is used to produce The Signature patient specific jig. The jig is used to aid the accuracy of implantation of a TKR. This study compared the accuracy of implantation of a TKR using The Signature patient specific jig or a standard jig. There is no difference in alignment between a patient specific and standard jig assisted TKR.Background
Hypothesis
There are different opinions amongst surgeons as to the selection criteria for UKR with regards to age and BMI. Many surgeons perceive higher rates of failure in young or overweight patients or often choose TKR for elderly patients. We analysed the registry records (UK National Joint Registry) of 10,104 patients who had undergone UKR with a minimum of two years follow-up from their primary surgery. BMI data was recorded in 1,831 (18%) and age in all. There were 295 deaths and these patients were excluded from our analysis. Patients' BMI were categorised according to Department of Health and WHO (2004) classification (Normal, Pre-Obese, Obese I, Obese II, Obese III)Background
Methods
