- Volume:3 Issue:2, 2016
- تاریخ انتشار: 1395/04/10
- تعداد عناوین: 7
Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Six)Page 1Context: There is a need to find the recommended perioperative antibiotic prophylaxis for current MRSA carriers and to determine if patients with prior history of MRSA should be re-screened and what should the choice of perioperative prophylactic antibiotics be in these patients. There is also a need to determine the recommended prophylaxis in patients undergoing major orthopaedic reconstructions for either tumor or non-neoplastic conditions using megaprosthesis or allograft.
Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 30 of 221 articles were relevant to the 4 following questions regarding perioperative antibiotic prophylaxis to prevent PJI.ResultsFor current MRSA carriers, vancomycin or teicoplanin is the recommended perioperative antibiotic prophylaxis. Patients with prior history of MRSA should be re-screened preoperatively. If patients are found to be negative for MRSA, we recommend routine perioperative antibiotic prophylaxis. Until the emergence of further evidence, we recommend the use of routine antibiotic prophylaxis for patients undergoing major reconstructions such as allograft or megaprostheses.ConclusionsBased on evidences in the literature and consensus of expert delegates from consensus meeting recommendations for type of antibiotic prophylaxis in patients who are current MRSA carriers, the protocol for screening and type of prophylactic antibiotics for patients with prior history of MRSA and antibiotic prophylaxis for patients undergoing major reconstructions such as megaprosthesis and allograft were provided.Keywords: Infection, Joint, Periprosthetic
Page 2BackgroundValgus deformity (more than 10° valgus on anatomical measurement) is seen in about 10% of patients undergoing total knee arthroplasty (TKA). Valgus deformity is a challenge for the surgeons both for gap balancing and constraint choice.ObjectivesThe aim of this study was to describe a surgical technique to perform TKA in valgus knee.
Patients andMethodsWe retrospectively reviewed 32 primary TKA in 27 patients (25 females and 2 males), with valgus knee deformity performed since 2006 to 2014. All procedures have been done by the senior author. In the balancing stage of each procedure, the iliotibial band has been released completely in the first step, and then step by step pie crusting of other lateral structures has been done as needed. Preoperative and postoperative data were obtained retrospectively through chart review and review of radiographs. All patients were clinically examined by the senior author. Preoperative and postoperative knee society scores (KSSs) and functional knee society score (functional KSS) were obtained accordingly.ResultsThe patients had an average age of 68 years (range, 52 - 83 years) with an average postoperative follow-up period of 47.5 months (range, 12 - 100 months). The average KSS improved significantly postoperatively from 42 (range, 20 - 69) to 90 (range, 67 - 99) (PConclusionsThe results of our study show that complete release of the iliotibial band and step by step pie-crusting of other lateral structures correct valgus deformities in a safe and simple manner with high success rate and less constrained prosthesis.Keywords: Total Knee Arthroplasty, Valgus Deformity, Surgical Technique
Page 3BackgroundAdamantinoma of long tubular bones is a rare primary malignant bone tumor. According to the literature, different prognosis and recurrence rates have been reported.ObjectivesThe purpose of this case series study was to evaluate the clinical behavior and prognostic features of adamantinoma of long bones.
Patients andMethodsIn this study, 13 histologically proven cases of adamantinoma of long bones which were treated in our hospital during March 1977 to June 2015 were evaluated. The mean follow-up period was 72 ± 44.4 months. The male:female ratio was 10:3, aged between 13 and 63 years at the time of diagnosis (mean = 24.8 ± 13.1 years). There was a period between the onset of disease and definite diagnosis (mean: 17.5 ± 14.7 months). In two cases according to the imaging and clinical symptoms the lesion seemed to be osteofibrous dysplasia, but during the follow-up, the diagnosis was changed to adamantinoma when open biopsy and pathologic assessment were performed. In 10 cases the tumor was located in the tibial diaphysis, in two cases the location was the distal shaft of the femur, and in one case the location was proximal of the humerus. All the cases underwent wide resection and intercalary or osteoarticular allograft reconstruction as the main surgery after primary incisional biopsy.ResultsIn eight cases, at least one local recurrence happened in an average 33.4-month period after the wide resection. In four of these patients rather than one local recurrence was occurred, but in one patient despite pulmonary metastasis the patient underwent pulmonary lobectomy and was alive at the end of the study. Allograft-related complications happened in five cases (two infections, one osteoarthritis of ankle, and two allograft fractures). For five patients ultimately recurrence and complication lead to amputation. Six patients died because of this disease, in all of which pulmonary metastasis occurred. The five-year survival rate in this study was 69%.ConclusionsAdamantinoma of long bone is a low-grade malignant tumor; however, wide resection tends to local recurrence and metastasis to the lung. Recurrence and metastasis can occur many years after surgery and there is a long disease-free period between the first wide resection and first recurrence and metastasis. This study underlined that despite the low-grade pathologic feature of this tumor, its behavior is like a high grade sarcoma and it may be better to perform sufficient wide resection at the first surgery with wide clear margin to reduce the rate of recurrence, but this approach needs to be assessed by prospective studies. According to clear wide margins for all of our cases, we guess this high interest for recurrence may be due to skip lesions of this tumor along the affected bone or even in the neighbor bones.Keywords: Adamantinoma, Recurrence, Metastasis, Prognosis
Pain, Disability and Sleep Quality in Patients With Rotator Cuff Tendinopathy and Concurrent Myofascial PainPage 4BackgroundRotator cuff tendinopathy and concurrent myofascial pain may result in sleep disturbances, poor quality of life, and social dysfunction along with chronic annoying pain and progressive physical disability.ObjectivesThe present study aimed to assess severity of pain, physical disability, and sleep quality in patients with rotator cuff tendinopathy and concurrent myofascial pain.
Patients andMethodsThis case-control study was conducted on 30 consecutive patients with rotator cuff tendinopathy without tear (impingement syndrome) and concurrent myofascial pain referred to the shoulder clinic in Shafa-Yahyaian Hospital during year 2014 (January to April). Eighteen gender and age-matched healthy individuals without any history of rotator cuff tendinopathy were included as controls. Along with baseline assessment, for determining the level of arm, shoulder and hand disability, the quick disabilities of the arm, shoulder and hand questionnaire was also used. Sleep quality was assessed by the pittsburgh sleep quality index (PSQI).ResultsCompared to healthy individuals, the mean shoulder disability score was significantly higher in the patient group (P = 0.001). Also, regarding sleep quality, the mean score was significantly higher in the patient group when compared with healthy subjects (P = 0.002).ConclusionsPatients with rotator cuff tendinopathy concurrent with myofascial pain experienced low level of sleep quality along with severe pain and physical disability. In order to improve clinical outcome of these patients, improving physical function and sleep quality in these patients is necessary.Keywords: Impingement Syndrome, Shoulder, Myofascial Pain, Sleep
Page 5IntroductionTotal knee arthroplasty (TKA) associated with heterotopic ossifications (HOs) are rare occurrences despite the relatively frequent surgery procedure of the hip arthroplasty. Up to present, different types of treatment were described in the literature.Case PresentationWe report an unusual case of TKA in a 70-year-old woman, which was early complicated by development of HO. It was successfully treated with a second surgery and a selective cyclooxygenase (COX)-2 inhibitor (celecoxib) with good clinical results.ConclusionsThis case illustrates that early operative and medical treatment can be used to optimally resolve stiffness caused by HO after total knee replacement.Keywords: Heterotopic Ossification, Cox, 2, Early Surgical Removal
Page 6IntroductionOs odontoideum (OO) is a form of odontoid anomaly presented by a separate ossicle with a smooth, sclerotic border not fused with C2 body. The current paper reports a boy with irreducible displaced os odontoideum with severe neurologic deficit after a minor trauma.Case PresentationA 16-year-old boy admitted in the center due to neck pain and torticollis with neurologic deficit. He had a history of multiple minor traumas. Advanced imaging assessment demonstrated displaced os odontoideum with minimal space available for cord (SAC) and myelomalacia. After unsuccessful closed reduction a 2-stage operation was planned: first, the anterior transoral release and odontoid resection with subsequent halo-traction and second, the posterior atlanto-axial instrumented fusion with bilateral C1 hook and C2 pedicular screws.ConclusionsCongenital anomalies of the odontoid are associated with C1-C2 instability that can be subluxated or dislocated with minor trauma and cause permanent neurologic deficit or even death. When acute cervical spine trauma is imaged, os odontoideum should be distinguished from an acute dens fracture with a multimodality imaging approach including computed tomography (CT), magnetic resonance imaging (MRI) and radiography. Here is the report of a rare case with irreducible displaced os odontiodeum treated him with anterior release, odontoid resection and posterior C1-C2 instrumented fusion.Keywords: Os Odontoideum, Myelopathy, Odontoidectomy
Page 7IntroductionOchronosis is a rare autosomal recessive disorder of tyrosine metabolism, leading to deposition of elevated levels of homogentisic acid in different parts of the body, especially in fibrous and cartilaginous tissues. The current study presents a case with delayed diagnosis and osteoporotic fracture in addition to severe osteoarthritis and calcification.Case PresentationA 56-year-old female with low back pain and painful knees and hips referred to the center. Right hip arthroplasty was performed to manage her severe osteoarthritis. Although characteristic features of ochronosis such as urine darkening, subcutaneous pigmentation and degenerative ochronotic arthropathy resembling osteoarthritis were observed in this patient, surprisingly it remained unrecognized until the 5th decade. Bone mineral density showed that osteoporosis and zoledronic acid had started.ConclusionsUsually, osteoarthritis is inversely correlated with the osteoporosis. Considering ochronosis as an osteoarthritis predisposing factor, the osteoporosis manifestation is not expected in such patients. However, in the current case, simultaneous osteoarthritis and osteoporosis fracture was observed, indicating unreliability of bone mineral density (BMD) in such patients. Authors believe that ochronosis could reduce bone quality, while its quantity might increase.Keywords: Ochronosis, Osteoporosis, Osteoarthritis