Level III, prospective case-control study.

Increasing the number of outer glove renewals, notably during certain surgical stages at risk for contamination (prosthesis reduction) or perforation (surgical incision/femoral cementing) can reduce the risk of contamination and perforation. The bacteria isolated suggest a cutaneous origin. Regularly changing gloves has resulted in a sterile state in 80% of cases. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level III prospective diagnostic study.

Level IV retrospective study.

No abstract

Wiltse has described in 1968 an intermuscular lumbar approach with two vertical incisions made at 30 mm each on both sides of the midline. Since 1988, Wiltse recommends to practice a single median incision because of aesthetic arguments and because it avoids potential difficulties in case of iterative surgery. In this paper, the goal of authors was to determine the advantages of two lateral incisions, particularly in term of cutaneous vascularization. This cadaveric study concerned ten specimens. Colored latex was injected into the lumbar segmentary arteries before taking a cutaneous flap. We calculated the mean of the number of vessels injected and cut on the midline, then all the 10 mm on both sides. The goal was to establish a cutaneous cartography, and to determine a zone of less vascular sacrifice. The lumbar skin was vascularized by an arteriolar network which spreads out from the midline. At 30 mm from the midline, the number of cut vessels is statistically less than in the others areas (P < 0.05). At this distance, the small arteries are superficial, fine, and the subcutaneous tissue appears poorly vascularized. The two lateral incisions have the advantage compared to a single median incision of being short, and of allowing a direct access to the muscular plan of cleavage without subcutaneous detachment, with a less pressure retraction. We think that an incision at 30 mm from spinous processes is less noxious for the skin because it is located at the border of two vascular territories, which depend of a median network for one, and a lateral network for the other. These incisions generate technical difficulties, however, when the approach is prolonged with the top of L2/L3, when a lateral and/or central canalar decompression is considered, and finally, in the event of iterative surgery.

Several flaps have been described to treat severe soft tissue defects of the finger dorsal side. Many authors studied vascular organization of the hand on its dorsal side; most of them insisted on deep vascularization into the intermetacarpal spaces, which is formed by the dorsal metacarpal arteries. Those dorsal metacarpal arteries are the anatomical support of many flaps, which do not preserve the dorsal interosseous muscles fascias. Only few authors described dorsal vascular organization at the level of the proximal phalanx; however, using a rotation point of a flap distally to the metacarpal head with a donor site on the dorsal aspect of the hand could cover all distal soft tissue defect of long finger. In order to determine the technical limitations of dorsal digito-metacarpal flap procedures, we studied number and location of arterial anastomoses between the reticular subcutaneous dorsal network and the rest of the vascularization at this level, which was formed by the deeper dorsal metacarpal arteries, common palmar digital arteries and proper palmar digital arteries, and between the dorsal digital arteries. Twenty-four long fingers from embalmed cadavers were studied after a reverse flow injection of colored latex and dissected layer-by-layer preserving the digital-metacarpal arterial network. At the level of the hand, the dorsal metacarpal arteries of the third and fourth intermetacarpal spaces were inconstant. When present, two or three arteries anastomosed in star shape with the reticular network. No such arterial anastomosis was observed proximally to the level of the intertendinous connections (junctura tendinorum) that bridge the extensor digitorum communis tendons. When no dorsal metacarpal artery was present, some communicant arteries arose from the common palmar digital arteries. Moreover, all the nutrient branches were more numerous distally to the intertendinous connections (junctura tendinorum). At the level of the metacarpophalangeal joints, the hand cutaneous network was always anastomosed with the dorsal cutaneous network. At the level of fingers, the dorsal cutaneous network was always supplied by four branches arising from the proper digital artery. Our study supported the reliability of dorsal digitometacarpal flaps, supplied by numerous palmodorsal digital anastomoses and by a rich plexiforme network joining the hand skin supply and that of the dorsal finger skin. During the procedure, we recommend limiting the surgical dissection of the flap at the level of the middle phalanx.

This prospective study compares the outcome of 157 hydroxyapatite (HA)-coated tibial components with 164 cemented components in the ROCC Rotating Platform total knee replacement in 291 patients. The mean follow-up was 7.6 years (5.2 to 11). There were two revisions for loosening: one for an HA-coated and one for a cemented tibial component. Radiological evaluation demonstrated no radiolucent lines with the HA-coated femoral components. A total of three HA-coated tibial components exhibited radiolucent lines at three months post-operatively and these disappeared after three further months of protected weight-bearing. With HA-coated components the operating time was shorter (p < 0.006) and the radiological assessment of the tibial interface was more stable (p < 0.01). Using revision for aseptic loosening of the tibial component as the end point, the survival rates at nine years was identical for both groups at 99.1%. Our results suggest that HA-coated components perform at least as well as the same design with cemented components and compare favourably with those of series describing cemented or porous-coated knee replacements, suggesting that fixation of both components with hydroxyapatite is a reliable option in primary total knee replacement.

No abstract