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Equalized rectangular extension and flexion gaps are considered desirable to ensure proper kinematics in total knee arthroplasty (TKA). We compared soft tissue balancing in TKAs performed using navigation-assisted gap-balancing (60 knees) and conventional measured resection (56 knees). The outlier of soft tissue balancing was defined as a gap difference >3 mm between the medial and lateral sides in 90 degrees flexion and extension. Medial or lateral outliers in extension or flexion were observed in 12% (7 of 60) navigation TKAs and 25% (14 of 56) conventional TKAs (p = 0.028). There were more outliers in flexion-extension gap difference on the medial side in the conventional (23%) than in the navigation-assisted (5%) group (p = 0.025). However, the proportion of flexion gap difference, extension gap difference, and lateral gap difference outliers did not differ significantly between the two groups (n.s.). Additionally, clinicoradiologic outcomes were similar for the two groups except for the postoperative mechanical axis outlier (p = 0.012). Navigation-assisted soft tissue balancing in TKA reduced not only the postoperative alignment outlier, but also the medial gap difference and achieved a more rectangular flexion and extension gap compared with conventional TKA.

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BackgroundAlthough the proportion of Pseudomonas aeruginosa infections has reduced after the introduction of antibiotics with anti-pseudomonal effects, P. aeruginosa bacteremia still causes high mortality in immunocompromised patients. This study determined the clinical characteristics and outcomes of P. aeruginosa bacteremia and the antibiotic susceptibilities of strains isolated from febrile neutropenic patients.MethodsThirty-one febrile neutropenic children and adolescents with underlying hematologic/oncologic disorders diagnosed with P. aeruginosa bacteremia between 2011 and 2016 were enrolled in the study. Their medical records were retrospectively reviewed to evaluate the demographic and clinical characteristics. Antibiotic susceptibility rates of the isolated P. aeruginosa to eight antibiotic categories (anti-pseudomonal penicillin, anti-pseudomonal penicillin and β-lactamase inhibitor combination, anti-pseudomonal cephalosporin, monobactam, carbapenem, aminoglycoside, fluoroquinolone, and colistin) were also determined. Among the investigated factors, risk factors for mortality and infections by a multidrug-resistance (MDR) strain were determined.ResultsThirty-six episodes of P. aeruginosa bacteremia were identified. The mean age of the enrolled patients was 9.5 ± 5.4 years, and 26 (72.2%) episodes occurred in boys. Acute myeloid leukemia (41.7%) and acute lymphoblastic leukemia (33.3%) were the most common underlying disorders. The 30-day mortality was 38.9%, and 36.1% of the episodes were caused by MDR strains. The deceased patients were more likely to experience breakthrough infection (P = 0.036) and bacteremia (P = 0.005) due to MDR strains when compared with the patients who survived. The survived patients more likely received appropriate empirical antibiotic therapy (P = 0.024) and anti-pseudomonal β-lactam and aminoglycoside combination therapy (P = 0.039) compared with the deceased patients. The antibiotic susceptibility rates of the isolated P. aeruginosa strains were as follows: piperacillin/tazobactam, 67.6%; meropenem, 72.2%; and amikacin, 100%.ConclusionsMortality due to P. aeruginosa bacteremia remained at 38.9% in this study, and more than one-third of the isolated strains were MDR. In this context, empirical antibiotic combination therapy to expand the antibiotic spectrum may be a strategy to reduce mortality due to P. aeruginosa bacteremia in febrile neutropenic patients.

There are several reported disadvantages with conventional-length femoral stems in cementless total hip arthroplasty (THA). Therefore, various efforts have been made to develop a specific femoral short stem to improve physiologic bone remodeling at the femoral aspect of a cementless THA. However, there are potential disadvantages with specific femoral short stems, such as malalignment, inadvertent subsidence, and potential proximal femoral fracture. Therefore, the authors quantitatively compared radiographic and clinical outcomes as well as component-specific complications between 2 groups of patients following primary cementless THA. A matched comparison was made between specific femoral short stems (n=50) and conventional-length femoral stems (n=50) in cementless THA procedures performed between January 2008 and January 2012. Patients were matched for age, sex, body mass index, height, surgical approach, and surgeon. No significant differences were found between the 2 groups in mean postoperative radiographic outcomes, functional outcomes, or complications. Both groups showed satisfactory performance at 5-year follow-up. Specific femoral short stems resulted in a higher incidence of malalignment and subsidence and a lower incidence of thigh pain and proximal bone resorption compared with conventional-length femoral stems. Although longer follow-up is required, specific femoral short stems may have clinical and radiographic advantages with equivalent perioperative complications relative to conventional-length femoral stems. However, this technique requires proper patient selection in combination with careful preoperative planning and meticulous surgical technique.

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