Culture-negative periprosthetic joint infections (CN-PJI) pose a significant challenge in terms of diagnosis and management. The reported incidence of CN-PJI is reported to be between 7% and 15%. Fungi and mycobacterium are thought to be responsible for over 85% of such cases with more fastidious bacteria accounting for the rest. With the advent of polymerase chain reaction, mass spectrometry and next generation sequencing, identifying the causative organism(s) may become easier but such techniques are not readily available and are very costly. There are a number of more straightforward and relatively low-cost methods to help surgeons maximize the chances of diagnosing a PJI and identify the organisms responsible. This review article summarizes the main diagnostic tests currently available as well as providing a simple diagnostic clinical algorithm for CN-PJI. Cite this article: EFORT Open Rev 2019;4:585-594. DOI: 10.1302/2058-5241.4.180067
Conclusion No stem was revised for aseptic loosening in this series. The contemporary Exeter V40 stem continues to perform well, and survival has remained comparable with that of the Exeter Universal stem. Cite this article: Bone Joint J 2018;100-B:1002-9.
This article describes the mechanisms of fracture healing (direct and indirect), general fracture management, the influence of the surgeon on the biology and biomechanical environment of bone healing, the management of articular fractures, and disorders of bone union.
Background: Major trauma patients are invariably received in the emergency department by a combination of emergency department and trauma team staff. The initial assessment is largely protocol led, using Advanced Trauma Life Support (ATLS) guidelines. The task of ordering and prescribing blood products often falls to the more junior members of this team. Aim: The aim of this postal questionnaire survey was to quantify the use of transfusion guidelines for major trauma in the UK and to assess whether generic national guidelines might be beneficial. Methods: A questionnaire was sent to all major emergency departments in the UK with an attendance .50 000 patients per year (total = 167). A reminder was sent to all non-responders. Each trust was asked whether guidelines are used; which blood products are specified; how useful they consider them to be; and how well they are adhered to. Results: 109 questionnaires (65%) were returned, of which only 17 (16%) currently use major trauma transfusion guidelines. While few trusts currently use guidelines, those being used were found to be very similar. Each trust was asked how useful their guidelines are, using a linear score of 0 to 5 (mean score 3.7). Those without guidelines were asked how useful they thought major trauma guidelines would be (mean score 3.3). Conclusion:The appropriate ordering and use of blood products has major clinical and cost implications. Few trusts currently have guidelines for major trauma despite being enthusiastic regarding their use. The authors propose there is now a role for national major trauma transfusion guidelines within the UK.Major trauma patients comprise a vulnerable group, often requiring rapid treatment plans despite invariably having complex medical demands. Their optimal transfusion requirements have been the topic of much recent research and debate, particularly relating to the use of individual blood products. To date, this work has not been combined to produce generic national guidelines.The aim of this postal questionnaire study was to quantify the proportion of major emergency departments in the UK using trauma transfusion guidelines and consider whether the introduction of generic national major trauma transfusion guidelines could be beneficial.
Before attempting to treat ankle fractures it is vital to appreciate the normal functional anatomy of this complex joint. The objectives of treatment, as with all fracture management, are to restore the anatomy and return normal function to the injured joint. This article describes the functional anatomy of the ankle and the epidemiology, assessment and definitive management required for a routine ankle fracture.
Aseptic loosening of the tibial component continues to be a significant mode of failure in total knee arthroplasty surgery. Surface cemented components preserve tibial bone stock, but are reliant on a strong bone-cement interface. This study compares standard surface cemented tibial component design to a tibial component with the addition of an undersurface cement containment skirt. The hypothesis was that the addition of a 2-mm underside skirt would allow cement containment and pressurization during implantation, which might improve the overall survival. Two identical tibial components were used, out of which one had the 2-mm underside skirt removed for the purposes of this study. Overall, 12 tibial Sawbones were prepared identically and transducers placed in the medial and lateral plateau. Each component was implanted six times, according to the manufacturer's operative technique. The series of implantation experiments showed no difference in cement pressurization (p = 0.86) regardless of the tibial component design used, with a wide variation in pressure measurements occurring in both groups. The tibial component skirt has not demonstrated any enhancement in cement pressurization. The cement containment skirt might still be advantageous by increasing the cement mantle thickness without causing excessive bone penetration; however, the biological effects cannot be predicted without further clinical evaluation.
Much emphasis has been placed on the role of patella resurfacing in total knee arthroplasty (TKA), yet the impact of soft tissue balancing has frequently been understated. The authors used a novel system to precisely assess patellofemoral joint (PFJ) tracking intraoperatively, to determine the impact of both retinacular reconstruction and tourniquet use on PFJ kinematics. PFJ kinematics assessed intraoperatively for 20 consecutive TKA patients. Measurements were recorded using both the "no thumb technique" and following reconstruction of the retinaculum with two positional sutures. The tourniquet was deflated and both measurements were repeated. Tourniquet inflation was not found to have a significant impact on the patella tracking (mean translation 0.9 mm, p = 0.15). Patella retinacular reconstruction generated a significant medialization of the patella by a mean of 5.5 mm (p < 0.0001) when compared with the traditional retinacular open "no thumb technique." The use of a tourniquet has been shown to have no effect on patella tracking. Reconstruction of the patella retinaculum markedly improves patella tracking, generating a mean medialization of 15%. The authors advocate the routine use of two positional sutures to restore the patella retinaculum, before trialing the patella component, as a reproducible means of assessing the PFJ kinematics.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.