Background The aim of the study is to identify those patients without improved pain sensation and functionality of the joint, thus with a potential necessity of re-intervention by using the evaluation of the PROMs (Oxford Hip Score, European Quality of Life Scale, EndoCert-Risk-Score). The task was to determine the value of the scores which represents the limit above/below, which a re-examination of the patient is necessary. Additionally, further secondary objectives such as influence of complications on scores, the percentage of questionnaire return and the quality of the provided data in the questionnaires were recorded to define minimal requirements on patientʼs response. Material and Methods Members of the EndoCert certification committee developed a questionnaire for pre- (decision on treatment) and post-operative (discharge and 3-months follow-up) use. A total of 112 primary hip replacements and 25 hip revision arthroplasties, which were recruited from a centre of excellence for joint replacement (EndoProthetikZentrum der Maximalversorgung), were included in the study. Results The return of questionnaires amounted to 80%. Quality of data in the questionnaires declined with BMI (≥ 25), ASA classification (≥ 3), age (≥ 65) and depended on the time point questioning. Based on the EndoCert risk score there was a significant improvement in the experience of pain postoperatively compared to pre-operation (p < 0.05). However, the functionality of the joint, as measured as the use of walking frames or crutches as well as the need for help from others, did not improve. The results revealed that there was no correlation between the incidence of complications and a detrimental score. It was furthermore shown that patient specific attributes, e.g. age or BMI, or perioperative performance (duration of operation) did not influence the likelihood of a complication. Conclusion It was shown that Oxford Hip Score and EQ-5D were not negatively influenced by complication during hospital stay. The evaluation of the EndoCert risk score showed not improvement between pre- and post-operative values regarding function but revealed a significant pain relief. A further study is intended to evaluate the intensity of pain after three months as part of an extended systemic follow-up. This could provide further insights whether the EndoCert risk score is a suitable tool to identify unsuccessfully treated patients.
Background The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet. Methods A survey on the principles of treatment of PJI in Germany was conducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%. Results For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI. Conclusion The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.
Introduction Various orthopedic surgical procedures cause mechanical stress for gloves. In some cases, sharp-edged objects impact on the glove surfaces. The systematic description of lesions is still missing. Methods 2289 gloves from 409 surgeries [primary hip and knee arthroplasties (PA), revisions arthroplasties (RA) and arthroscopic shoulder, hip and knee surgery (AY)] from 3 clinics were examined for lesions using water tightening test according to the European norm EN 455-1. Results Arthroscopies showed the lowest rate of operations with damaged gloves (6.9%). Depending on clinic, 32.7% and 59.2% of PA surgeries generated damaged gloves, while in RA, these numbers rose to 76.0% and 72.8%, respectively. In PA and RA, the most affected finger was the index finger, whereas in arthroscopies, more damage occurred on the middle finger and the thumb. The size of the lesions was rather small with the vast majority being 1 mm or 2 mm in size. Conclusion All investigated interventions led to glove lesions. With increasing mechanical stress, the number of glove defects increased. EN 455 does not account for the intraoperative tear risk. Stricter requirements for gloves should be introduced. Glove change intervals should be defined and implemented, and new materials should be developed.
Both the surgeon in training as well as the arthroplasty patient benefit from implementing the EndoCert system, because the postoperative outcome and the complication probability is independent of the qualifcation of the operating orthopaedic surgeon performing total hip arthroplasty when assisted by an experienced surgeon.
Background There are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI), however, national or international guidelines for a standardised treatment regime are still lacking. The present paper evaluates the use of the predominant treatment protocols for PJI in certified total joint replacement centres (EPZ) in Germany based on an EndoCert questionnaire. Materials and methods The questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the treatment protocols for septic revision arthroplasties in EPZ. Questions targeted the various treatment options including prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and diagnostic sampling prior to re-implantation. All certified EPZ participated (n = 504) and the results from the current survey in 2020 were compared to data from a previous analysis in 2015. Results The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option increased (hip: + 6.3%; knee: + 6.6%). The majority of the centres (73.2%) indicated a 4–8 week period as the preferred interval between prosthesis removal and re-implantation in two-stage revision in hip as well as knee revisions. Centres with a higher number of revision surgeries (> 200 revisions/year), opted even more often for the 4–8 week period (92.3%). In two-stage revision the use of metal-based spacers with/without reinforcement with antibiotic-containing cement as an interim placeholder was significantly reduced in 2020 compared to 2015. There was also a clear preference for cemented anchoring in two-stage revision arthroplasty in the knee in 2020, whereas the majority of hip replacements was cementless. Additionally, in 2020 the number of samples for microbiological testing during the removal of the infected endoprosthesis increased and 72% of the centres took five or more samples. Overall, the number of EPZ with a standardised protocol for the procedure expanded from 2015 to 2020. Conclusion While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.
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