The distal metatarsal angle (DMAA) is a measurement of the relationship between the longitudinal axis of the first metatarsal and the articular surface of the metatarsal head. We measured the DMAA on radiographs with and without markers on the articular edges and compared them with measurements of the anatomic specimens. Based on the studies, the significance of the radiographic measurements to the actual DMAA and the normal distribution of the measurement were determined.

Prophylactic antibiotics are frequently withheld until cultures are obtained in revision total knee arthroplasty (TKA). We undertook a prospective study to determine whether prophylactic preoperative intravenous antibiotics would affect the results of cultures obtained intraoperatively. We enrolled 25 patients with 26 infected TKAs, a known preoperative infecting organism, and no recent antibiotic therapy. Reaspiration of the infected TKA was performed after anesthesia and sterile preparation. Intravenous antibiotic prophylaxis was then administered and the tourniquet inflated. Intraoperative culture swabs and tissue were obtained at arthrotomy. The timing of events was recorded. Pre-and postantibiotic culture data were analyzed to determine the effect of intravenous preoperative prophylactic antibiotics on cultures obtained intraoperatively. Infections were acute postoperative (four), chronic (19), and acute hematogenous (three). The most common infecting organism was cloxacillin-sensitive Staphylococcus aureus (nine knees [35%]). Preoperative prophylactic antibiotics did not affect the results of intraoperative cultures and we therefore believe should not be withheld before surgery for an infected TKA when an organism has been identified on aspiration preoperatively, and there has been no recent (4 weeks) antimicrobial therapy.

Radiologically guided insertion of the Entristar skin-level gastrostomy tube is a safe procedure in patients with ALS that allows the creation of a permanent feeding gastrostomy without the need for sedation or endoscopy.

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We evaluated a consecutive series of patients followed for at least 1 year after revision total hip arthroplasty. We surveyed 488 patients treated at three referral centers from 1998 to 2002. An experienced medical interviewer contacted patients and rated their degree of satisfaction with the original and revision arthroplasties, the reason of original arthroplasty failure, and their expectations for revision arthroplasty longevity. Surveys were completed on 320 of the 488 patients (66%). A member of the research team reviewed patients' operative reports, clinical records, and radiographs to determine the diagnosis at revision, procedure performed, and the most likely cause of failure. Patient satisfaction with the primary procedure was directly related to the time to revision. Most patients (214 of 320; 67%) expected their revision to last longer than their primary arthroplasty regardless of revision diagnosis or how long the primary procedure lasted before revision. The surgeons' failure assessments agreed with the patients' failure assessments only 36% of the time. Although the majority of patients (262 of 320; 82%) were satisfied with the results of the revision procedure, most did not agree with their surgeon as to why the original arthroplasty failed, and most had unrealistic expectations regarding revision longevity.

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