Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Our hospital trust introduced MSSA screening and decolonisation prior to hip and knee arthroplasty in 2010. Data was prospectively collected since 2013, including all MSSA carriers, decolonisation treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used. During the study period 15,958 primary hip and knee replacements were performed. 3,200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1,210 neomycin and 1,221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P<0.0001). There was no difference in S. aureus PJI rates (P=0.452). Of those negative at original screening 9.1% were positive on the day of surgery (1,164/12,758). MSSA decolonisation is an effective method to decrease PJI rates but there is little research into the best treatment. Both mupirocin and neomycin are more effective than octenidine at achieving MSSA decolonisation. There was poor correlation between the MSSA status after treatment and PJI rates. There is debate if treatment should be targeted by screening or if all patients she be treated without screening. Global decolonisation without screening is supported by the 26.7% of carriers that were negative at original screening in our study. Further research is needed comparing decolonisation treatments to reduce PJI rates and avoid the risk of drug resistance.
We assessed the difference in hospital based and early clinical
outcomes between the direct anterior approach and the posterior
approach in patients who undergo total hip arthroplasty (THA). The outcome was assessed in 448 (203 males, 245 females) consecutive
patients undergoing unilateral primary THA after the implementation
of an ‘Enhanced Recovery’ pathway. In all, 265 patients (mean age:
71 years (49 to 89); 117 males and 148 females) had surgery using
the direct anterior approach (DAA) and 183 patients (mean age: 70
years (26 to 100); 86 males and 97 females) using a posterior approach.
The groups were compared for age, gender, American Society of Anesthesiologists
grade, body mass index, the side of the operation, pre-operative
Oxford Hip Score (OHS) and attendance at ‘Joint school’. Mean follow-up
was 18.1 months (one to 50).Aims
Patients and Methods
The Direct Anterior Approach (DAA) offers potential advantages of quicker rehabilitation compared to posterior approach THR. The aim of this study was to compare hospital based and early clinical outcomes between these two groups with utilisation of Enhanced Recovery After Surgery (ERAS) protocol. Prospectively collected data for both cohorts were matched for age, gender, ASA grade, BMI, operation side, Pre-operative Oxford Hip score (OHS) and attendance at multi-disciplinary joint school. The pain scores at 0,1,2,3 post-op days, the day of mobilization, inpatient duration, complications, 28 days readmission rates and OHS at 6 and 24 months were compared.Introduction
Patients/Materials & Methods
