Background: The number of ankle and revision ankle replacements performed is increasing. There is limited research into functional outcomes, especially in revision ankle replacements. The primary aim of this cohort study was to determine the functional improvements following primary and revision ankle replacements and compare which gave the greatest improvement in functional scores. Methods: A single-center prospective cohort study was undertaken between 2015 and 2018. All patients were followed up for a minimum of 2 years. Patients undertook a preoperative and 2-year Manchester Oxford Foot Questionnaire (MoxFQ) score. The Mann Whitney test was undertaken. Results: A total of 33 primary and 23 revision ankle replacements were performed between 2015 and 2018. The mean age was 69.3 years for primary replacements and 64.7 years for revision replacements. All primary replacements were the Infinity ankle replacement. Revision replacements were either the Inbone II or Invision. The indication for revision was 9 aseptic loosening, 6 infections, 5 cysts, and 3 malposition. Seventeen were performed as a single stage and 6 as a 2-stage revision. The overall MoxFQ improved by a mean of 48.8 for primaries and 20.2 for revisions ( P = .024). The walking/standing domain improved by 57.5 for primaries and 22.5 for revisions ( P = .016), the pain score improved by 43.0 and 32.3 ( P = .009), and the social interaction improved by 40.0 and 11.7 ( P = .128). Conclusion: Both primary and revision ankle replacements result in improved functional scores. In this relatively small cohort with the implants used, primary ankle replacements though have a significantly greater improvement in functional scores compared to revision ankle replacements. Level of Evidence: Level II, prospective cohort study.
Background This review aims to establish current knowledge of the shoulder skin microbiome and how to manage the bacteria that reside within it. Methods A review was undertaken of the current literature through OvidSP. All abstracts were reviewed by three independent researchers. Results Thirty-five studies met the inclusion criteria. With forward referencing an additional 14 were included. None commented on organisms specific to the shoulder microbiome other than Cutibacterium acnes. Therefore, this review is focussed on the current knowledge of C. acnes. Discussion C. acnes is a skin commensal within the pilo-sebaceous glands reported to be the primary pathogen in up to 86% of shoulder joint infections. Pre-operative culture of unprepared skin can be indicative of underlying joint infection in shoulder arthroplasty revision. Intra-articular biopsies may have a high false positive due to skin contamination. Correlating the number of positive samples and certain associated signs can give a greater than 90% probability of a true infection. Standard surgical skin preparation, peri-surgical intravenous antibiotics and oral pre-operative antibiotics do not reduce bacterial load within the skin. However, topical benzoyl peroxide and clindamycin have both demonstrated significantly reduced bacteria load. Phylogenetically there are six main types. Patients may have more than one phenotype present during infection.
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