Outpatient care is becoming more common in response to economic challenges. The development of outpatient foot surgery appears to have satisfied the vast majority of operated patients. However, adjustments should be made to improve their tolerance to the pain management protocol. Although the logistics of performing follow-up call can be complicated, the patients appreciate receiving this call the next day. The call also seems to reassure both the patients and care providers.
Background: Prosthetic hip infection (PHI) is a disastrous scenario after an arthroplasty. International guidelines contraindicate one-stage exchange arthroplasty for fistulizing chronic prosthetic hip infection (FCPHI), nevertheless few surgical teams, mostly from Europe, support one stage procedure for this indication. Questions/Purposes: Analysis of infection recurrence and implant failure of a series of FCPHIs treated with one stage arthroplasty. Patients and Methods: Sixty-six FCPHIs treated with one-stage exchange arthroplasty were prospectively followed up at least 2 years. Clinical, radiological and bacteriological signs suggestive of reinfection were sought, as well as implant failures and PHI related deaths. Results: Thirty-four females and thirty-two males with median age of 69.5 years [61-77] and BMI of 26 kg/m² [22-31] were included. Fistulae were productive in 50 patients (76%). Staphylococcus was responsible for 45% of PHI and 21% were polymicrobial. Twentynine patients (44%) received preoperative antibiotic therapy. After a median 60-month follow-up [35-82], 3 patients (4.5%) presented reinfection (two new infections, one relapse) and 3 patients experienced implant failure (1 femoral fracture, 1 stem breakage, 1 recurrent dislocation). One death was related to PHI. After a minimum of 2 years, the infection control rate was of 95.3% (±0.02). Conclusion: One-stage exchange arthroplasty for FCPHIs showed a good infection control rate similar to that of non-fistulizing PHI. Systematic preoperative microbiological documentation with joint aspiration and, in some specific cases, the use of preoperative antibiotic therapy are among the optimizations accounting for the success of the one-stage arthroplasty. In light of these results, and those of other studies, international recommendations could evolve. Level of Evidence: Descriptive therapeutic prospective cohort study. Level of evidence: IV.
PurposeThe literature suggests that "forgotten" knees are the most stable knees postoperatively. The main objective of our study was to determine whether a systematic alignment (mechanical, anatomical or kinematic) makes it possible to stabilise the operated joint in extension and in lexion. Methods This monocentric prospective cohort study was conducted between May 1st, 2021 and October 31st, 2021. A total of 132 consecutive patients undergoing primary navigated total knee arthroplasty were included, with a mean age of 72.4 years (7.9; 48.8-91.2 years), a mean body mass index (BMI) of 28.6 kg/m 2 (4.6; 17.6-41.6) and 71.2% (94/132) women. Mechanical, anatomical and kinematic knee alignments were simulated using Kick software for each patient. The primary outcome was the targeted rate of balanced knees for each type of alignment, based on a three-point score, aiming for a 3/3 score for each knee. Our secondary outcome was to characterise the speciic implantation inally achieved by the surgeon.
ResultsThe targeted balance was reached in 10.6% (14/132), 10.6% (14/132) and 12.9% (17/132) of knees with mechanical, anatomical and kinematic alignment simulations, respectively. None of these simulations provided a superior number of balanced knees (p = 0.87). When simulating a patient-speciic implantation, the highest score was reached in 89.1% (115/132) of cases. Conclusion Systematic alignment simulations achieved knee balance in only 11% of cases. Patient-speciic implantation, favouring knee balancing over alignment, allowed an 89% perfect score rate without having to perform any collateral release. Level of evidence Case series. Level 4.
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