Aims

The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD.

Utilization of C-arm fluoroscopy during direct anterior total hip arthroplasty (THA) is disruptive and potentially increases the risks of patient infection and cumulative surgeon radiation exposure. This pilot study evaluated changes in surgeon C-arm utilization during an initial 10 cases of direct anterior THA in which an imageless computer-assisted navigation device was introduced. This retrospective study includes data from 20 direct anterior THA cases performed by two orthopaedic surgeons (BC; SRE) in which an imageless computer-assisted navigation device was utilized (Intellijoint HIP®; Intellijoint Surgical, Waterloo, ON, Canada). Total C-arm image count was recorded in each case, and cases were grouped in sets of 5 for each surgeon. The mean C-arm image count was calculated for each surgeon, and combined C-arm image counts were calculated for the study cohort. Student's t-tests were used to assess differences. The use of intraoperative C-arm fluoroscopy decreased from a mean of 9.4 images (standard deviation [SD]: 8.6; Range: 3 – 23) to a mean of 2 images (SD: 2.9; Range: 0 – 7) for surgeon BC (P=0.10) and decreased from a mean of 10.75 images (SD: 1.2; range 9 – 12) to a mean of 6.7 images (SD: 8.3; range: 0 – 16) for surgeon SRE (P=0.36). Combined, an overall decrease in intraoperative C-arm image count from a mean of 11.3 images (SD: 6.9; range: 6 – 23) to a mean of 3.7 images (SD: 3.9; range: 0 – 8.5) was observed in the study cohort (P=0.06). The adoption of imageless computer-assisted navigation in direct anterior THA may reduce the magnitude of intraoperative C-arm fluoroscopy utilization; however further analysis is required.

Lumbar disc herniation represents by far the most prevalent pathology, causing pain and sciatica and constitutes an important cause of disability and one of the most cost-intensive health problems. The aetiology is very complex. In recent years, it has been suggested in twin and family studies that genetic risk factors contribute to the development of LDH. Our purpose is to analyse genetic susceptibility to symptomatic LDH in Spanish surgical patients treated with different surgical techniques.

Single-nucleotide polymorphisms (SNPs) in VDR, GDF5, Col1A1, THBS2 and CHST were genotyped in a case-control study with 50 symptomatic LDH in Spanish surgical patients and 50 Spanish health controls. All patients provided signed informed consent. Sampling was carried out with a puncture of the pad of a finger using a sterile, single-use lancet. SNPs were determined by real-time polymerase chain reaction (PCR) using specific, unique probes with the analysis of the melting temperature of hybrids. The X2 test compared genotypes between groups. Multivariate logistic regression analysed the significance of many covariates and the incidence of LDH.

We found significant differences in age, gender and smoking status between the two groups. There were significant differences in the CC (rs2228570) genotype in VDR in patients with LDH (p<0.05). There were significant differences in the GT (rs1800012) genotype in Col1A1 in patients with LDH (p=0.001). In Col1A1, T allele was more frequent in the case group than in the control group (p<0.001). Regarding surgical techniques, of the 50 patients included in the cases group, 25 were treated with open microdiscectomy and 25 received endoscopic discectomy. Outcomes were assessed at 12 months using VAS, and NASS instrument. Postoperative pain and pain medication were significantly reduced in the endoscopic group. Patient satisfaction is greater in the endoscopic group, with shorter hospital stays and earlier return to normal activity. GT genotype in Col1A1 was more frecuent in the endoscopic group compared to the microdiscectomy group (p=0.002).

CC genotype in VDR and GT genotype in Col1A1 are associated with symptomatic LDH susceptibility in Spanish surgical patients. GT genotype in Col1A1 is associated with symptomatic LDH treated with full-endoscopic discectomy.

Introduction: To introduce a unit of bone and joint infections and to show the first result after a-two-year clinic experience.

Material and Methods: The bone and joint infections represent the most fearsome difficulty for surgeons. In order to deal with this kind of patient a multidiciplinary team work is required. In our Health Centre, in the year 2001, it has been made up a unit, directed by an Orthopedic surgeon, Head doctor of the Centre, and which is formed by two more Orthopedic surgeons; belonging the first one to the unit of plastic surgery and the second to the infection commission; furthermore, there is a specialist in internal medicine, a specialist in family and community medicine, a specialist in rehabilitation, a specialist in laboratory and clinic analysis and a nurse. Five beds of restricted entry and a monographic consult are also available. The way of work consists of two-day-a-week combined visists to floors and a weekly clinic session. Outpatients are seen by Orhtopedic surgeons of the unit, the internist doctor, the rehabilitators in their everyday consults and the monographic consult of the enfermary. Patients who are admitted in the unit are affected with bone and joint infection: Only exceptionally, patients in need of hospital isolation and with tissue infections caused by germs, are admitted; namely, Acinetobacter baumannii, Staphylococcus methicillm-resistant.

Results: Results of the unit after two-year clinic experience are presented:

We have treated a total of 82 patients, 78 of them where men and 4 women, between 18 and 58 years old. Most of the patients were included in, first in the 40–50 (21 patients) and second in the 30-40 (26 patients) years-old range. Out of the 82 patients, 64 had ostheomyelitis, 10 arthritis and 8 soft tissue infection. The first localization for the ostheomyelitis has been in tibia (30 cases) and in femur (8 cases). The etiology is distributed in: 32 infections after osteosynthesis and 27 after an open fracture. The germs mostly isolated were Gram positives: Staphylococcus coagula negatives (21), staphylococcus methicillin-sensitive(14) y enterococcus (5); Gram negatives: Pseudomona aeruginosa (14), Serratia (3), Enterobacter (2).

Conclusions: In our opinion a unit of bone and joint infections as a multidiciplinary medical team work improves the clinic quality.