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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 9 - 9
24 Nov 2023
Stuetzle A Puelacher C Morgenstern M Sendi P Mueller C Clauss M
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Aim

Perioperative myocardial infarction/injury (PMI) is a common complication in noncardiac surgery, contributing to postoperative morbidity and mortality. We aimed to identify the risk for PMI in periprosthetic joint infection (PJI) in comparison to primary hip (THA) and knee arthroplasty (TKA) and to non-PJI revision surgery.

Methods

Patients undergoing primary/revision THA/TKA at a University Hospital who were eligible for the institutional PMI screening and response program were prospectively included. Revision arthroplasties were divided into 2 groups (PJI revision and non-PJI revision). PJI was defined according to the EBJIS criteria, and included DAIR, one-stage and two-stage revisions. Non-PJI revisions included partial and/or complete exchange of components. The primary endpoint was PMI, secondary endpoints were major adverse cardiovascular events (MACE) and all-cause mortality within 120 days.


The Bone & Joint Journal
Vol. 104-B, Issue 6 | Pages 696 - 702
1 Jun 2022
Kvarda P Puelacher C Clauss M Kuehl R Gerhard H Mueller C Morgenstern M

Aims

Periprosthetic joint infections (PJIs) and fracture-related infections (FRIs) are associated with a significant risk of adverse events. However, there is a paucity of data on cardiac complications following revision surgery for PJI and FRI and how they impact overall mortality. Therefore, this study aimed to investigate the risk of perioperative myocardial injury (PMI) and mortality in this patient cohort.

Methods

We prospectively included consecutive patients at high cardiovascular risk (defined as age ≥ 45 years with pre-existing coronary, peripheral, or cerebrovascular artery disease, or any patient aged ≥ 65 years, plus a postoperative hospital stay of > 24 hours) undergoing septic or aseptic major orthopaedic surgery between July 2014 and October 2016. All patients received a systematic screening to reliably detect PMI, using serial measurements of high-sensitivity cardiac troponin T. All-cause mortality was assessed at one year. Multivariable logistic regression models were applied to compare incidence of PMI and mortality between patients undergoing septic revision surgery for PJI or FRI, and patients receiving aseptic major bone and joint surgery.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 459 - 459
1 Jul 2010
Winter C Mueller C Hardes J Boos J Gosheger G Rosenbaum D
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Pediatric patients with lower extremity sarcoma often experience long lasting restrictions concerning physical activity and walking due to the required off-loading of the limb and other consequences of surgeries. Activity promotion during treatment in addition to physiotherapy could improve patients’ activity levels and walking capabilities.

In the present study we investigated the ambulatory activity of 31 pediatric patients (13.7 ± 3.1 years, 1.63 ± 0.15 m, 51.9 ± 15 kg, 19.3 ± 3.7 kg/m2) with Osteosarcoma or Ewing sarcoma at the lower limb using the StepWatch™ Activity monitor (SAM; Orthocare Innovations, USA). Sixteen patients regularly underwent supervised exercise interventions during inpatient stays, 15 did not receive any additional intervention. Step activities were measured for seven consecutive days during home stays at five different points in time, to determine a possible transfer of activity to everyday life.

Patients without intervention assembled considerably less steps than those in the intervention group. Before surgery they reached 25.4% of the intervention group (total n=16), six weeks after surgery 40% (total n= 8), after three months 46% (total n=10), after six months 72% (total n=13) and after one year 90%. However differences only reached significance at the first measurement.

Data presented must be considered as preliminary. Not all patients could be measured at all appointments due to impaired walking ability. Nevertheless activity promoting interventions during inpatient stays seem to have a positive influence on patients’ daily walking activity. Though the differences between the groups are not significant they are considerable. Especially during treatment – as reflected by the first three measurements- patients could benefit from additional interventions exceeding typical therapy regimes. Interventions should be individualized to the patients’ capabilities. Conclusions concerning tumor location or surgical procedures are not yet possible. Future research should furthermore concentrate on the effects of activity promotion on other fields of well-being.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 326 - 327
1 May 2010
Pramhas D Schneider W Mueller C Knahr K
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Background: A continuing controversy in total knee arthroplasty is the question whether the posterior cruciate ligament should be retained or substituted. This report reviews a series of total knee arthroplasties with a fixed bearing posterior cruciate ligament retaining implant (Nex Gen© CR, Zimmer Inc., Warsaw, IN).

Methods: Between May 1997 and April 2001 197 patients were provided with 218 primary implants. There were 142 females and 55 males with an average age of 71 years (range 53–88 years) and a BMI of 28,9 kg/m2 (range 19,1–41,2 kg/m2). The diagnosis was osteoarthritis in 212 patients, 3 cases of aseptic osteonecrosis, 1 fracture of the tibia plateau, 1 prior infection and 1 psoriatic arthritis. 84 knees had prior operations including high tibial osteotomies and menisectomies.

The operations were performed by 11 surgeons, with more than 80% done by 5 surgeons. 162 (74%) femur components and 181 (83%) tibia components were cemented. Patella resurfacing was performed in 135 (62%) cases.

We evaluated the results prospectively with a clinical inspection, radiographs (AP and lateral, longleg standing, patella sunrise view), and the use of the Knee Society Score, Quality-of-Life Short Form-36 and WOMAC rating score.

149 patients were examined at a mean follow up of 5,9 years (range 4,1–8,2 years). 29 were questioned on the telephone, 29 deceased, 7 revisions had to be performed and 4 (2%) were lost to follow up.

Results: The range of motion improved from 101° to 115° (range 80°–140°). All knees had sufficient antero-posterior and mediolateral stability. The Knee society score improved from 35 to 83 (good result) and the function score improved from 52 to 76 (good result).

Early complications included 12 haematoma, 10 wound healing problems, 5 early infections, 2 thrombosis and 1 non lethal pulmonary embolism. 7 revisions had to be performed: 3 late infections (2 one-stage revisions with synovectomy and exchange of polyethylene inlay, one two-stage revision with semi-constrained implant LCCK© Zimmer Inc.), 3 patella resurfacing due to anterior knee pain and 1 exchange of cemented tibia plateau due to aseptic loosening. Survivorship at 6 years including any reason of failure was 96,5%.

Conclusion: At a mid term follow up of 6 years this fixed bearing posterior cruciate retaining implant achieved a reasonable survivorship with good clinical results, kinematics and patient satisfaction.