Operating room traffic has been implicated in several studies to contribute to the risk of surgical site infections and periprosthetic joint infections. The purpose of this study was to evaluate the effect of a door alarm on operating room traffic during total joint arthroplasty. This prospective cohort study evaluated 100 consecutive primary total hip and knee arthroplasty surgeries performed by a single surgeon. An inconspicuous electronic door counter was placed on the substerile operating room door. Door openings and time left ajar were recorded. After 50 cases, an audible alarm was placed on the substerile operating room door that sounded continuously when the door was ajar. Door-opening data were then recorded for an additional 50 cases. There was a significant difference in the overall mean door openings per minute (P<.001) between the period with no alarm (0.53±0.1) and with an alarm (0.42±0.1). This effect slowly decreased over the time of the intervention, with door openings per minute increasing by a factor of 1.01. The percentage of time the door was left ajar per case also decreased significantly (P<.001) with the alarm (6.63%±1.6%) compared with no alarm (8.65%±1.5%). This study indicates that the use of a door alarm can decrease door openings and potentially the risk for surgical site infection. However, the effect is subject to tolerance and may not result in the elimination of unnecessary operating room traffic long term. [Orthopedics. 2017; 40(6):e1081-e1085.].
To avoid inadvertent vertical positioning of the acetabular component during total hip arthroplasty (THA), the authors routinely "cheat" component abduction an additional 10° horizontal (goal=30°). This likely increases the incidence of components placed into abduction of less than 30°, the clinical consequences of which are not well studied. The purpose of this study was to determine the clinical and radiographic outcomes in patients undergoing THA with acetabular components positioned in less than 30° of abduction as compared with those with components positioned between 30° and 50°. A retrospective review was performed of consecutive patients undergoing primary THA with horizontally cheated acetabular component position performed by a single surgeon. Patients were grouped into cohorts with either component abduction less than 30° or between 30° and 50°. Demographic data, operative data, and complications were recorded. Harris Hip Scores (HHS) and radiographic analysis were obtained from preoperative and most recent clinic visits. Between September 2004 and September 2010, 320 consecutive THA procedures were performed. A total of 149 hips had component abduction less than 30° (mean, 25.8°; range, 15.7°-29.4°). No components had greater than 50° of abduction. At an average 37-month follow-up, no significant difference in HHS was found between the 2 cohorts (P=.137). The horizontal cohort had no dislocations, component loosening, or osteolysis. By cheating the acetabular component more horizontal, an excessively vertical position was avoided. Component abduction less than 30° yielded equivalent clinical outcomes to component abduction between 30° and 50°. [Orthopedics. 2016; 39(6):e1092-e1096.].
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