The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3-5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment -other than an antibiotic protocol -would be required when facing a case of positive culture of a graft piece after its implantation.
A 28-year-old female patient came to our hospital 14 years after surgical correction of adolescent idiopathic scoliosis with a 316L stainless-steel instrumentation. She presented progressive paraparesis during the last 2 months. Plain radiography, computed tomography scan and computed tomography-scan-guided needle biopsy revealed that a metallotic mass penetrated into the spinal canal, causing compression of the spinal cord at the T5-T6 level. The patient's symptoms were related to corrosion of the implant and infection by Propionibacterium acnes. Through a posterior approach, the instrumentation was retrieved and the metallotic mass and tissues were excised. Six months after the surgery, the patient is completely asymptomatic. Corrosion of stainless-steel implants is a finding more common than supposed. Biocorrosion--or microbially influenced corrosion--is a concept to be taken into account. It is possible that bacteria may modify the rate of corrosion of metals. Early diagnosis of corrosion is essential in order to prevent cases like the one we report, and perhaps, as suggested for total hip arthroplasties, metal levels could be useful to monitor spinal implants.
La incidencia de las sinostosis congénitas del tarso se estima en torno al 1% de la población, siendo una de las causas más comunes de pie plano rígido doloroso en la población pediátrica. La barra calcáneoescafoidea (50%) y el puente astragalocalcáneo (40%) son las formas de presentación más frecuentes. La restricción de la movilidad, el dolor mecánico en el lugar de la fusión y la deformidad del calzado referida en la anamnesis deben hacernos sospechar esta entidad. En la exploración física destaca la rigidez del retropié con limitación dolorosa característica de la pronosupinación que ha motivado clásicamente la errónea denominación de pie plano peroneo espástico. El diagnóstico radiológico se hace normalmente con radiografías simples (proyecciones laterales y oblicuas entre 35 y 45º), en las que observamos el osteofito anterior de la cabeza del astrágalo o la imagen de condensación en "media luna" del astrágalo superpuesto con el calcáneo, siendo necesario en ocasiones recurrir al TAC. Entre las posibilidades terapéuticas, el tratamiento quirúrgico es el único resolutivo del problema de base. La resección-artroplastia de interposición debe intentarse en pacientes jóvenes en los que se quiera preservar la biomecánica normal del pie, evitándose los problemas a largo plazo de la artrodesis. La triple artrodesis o la artrodesis subastragalina, se reservan para pacientes mayores con signos degenerativos, en casos de fusiones tarsianas múltiples y tras fracaso de la resecciónartroplastia.
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