Bacterial Contamination in Tips of Electrocautery Devices During Total Hip Arthroplasty.

Surgical equipment can become contaminated during surgery. It is unknown if electrocautery tips can become contaminated in clean orthopedic procedures despite the produced heat. Therefore, we conducted a prospective study to address this concern. The tips from 25 primary and 25 aseptic revision THAs were collected and an additional 5 sterile tips served as negative controls. Aerobic and anaerobic cultures were incubated for a minimum of 3 days. There were 3 positive cultures (6%); one in primary THA (4%) with Lactobacillus and Enterococcus faecalis; two among revisions (8%), one with E. faecalis and another one with alpha hemolytic streptococci and coagulase negative Staphylococcus. The mean exposure time of the contaminated tips was 132.3 minutes. Patients were followed for 90 days postoperatively and none of them developed surgical site infection. This is the first study to demonstrate that electrosurgical devices can become contaminated during THA in laminar flow equipped operating rooms.

Optimizing the fat and water content of impaction bone allograft.

Fresh morselized impacted bone graft usually fails due to shear forces. The presence of fat, water, and marrow particles act as interparticle lubricants, reducing the interlocking of particles and allowing the graft to move more freely. Furthermore, the presence of this incompressible fluid damps and resists compressive forces during impaction, preventing the graft particles from moving into a closer formation. We believe there exists an ideal concentration of fat and water that will maximize resistance to shear forces. We performed mechanical shear testing in vitro on morselized human femoral heads, varying the amount of fat and water to determine their optimum concentrations. Level of fat and water were determined that increased strength by 36% over unaltered bone graft. This is most closely approximated in an operating room by washing and subsequently squeezing the bone graft. Optimizing the fat and water content of bone graft produces a stronger graft that is more resistant to shear stresses, protecting the surgical construct until bone growth can occur.

Two-stage revision of infected hip arthroplasty using a shortened post-operative course of antibiotics.

INTRODUCTION: We present a series of 30 consecutive patients with 31 infected total hip arthroplasties treated by a single surgeon over a 4-year period in whom a shortened post-operative course of antimicrobial chemotherapy was used. METHODS: The treatment protocol consisted of a two-stage exchange with removal of infected components, insertion of an interim antibiotic eluting cement spacer and re-implantation of an extensively coated uncemented prosthesis on the femoral side. Systemic antibiotic treatment following each stage consisted of an abridged course of 5 days post-operative intra-venous administration followed by complete cessation of anti-microbial therapy. RESULTS: At a mean follow-up of 35 months (minimum 24 months), there were no cases of recurrent prosthetic infection and no patient had required revision for aseptic loosening or mechanical instability on the femoral side. The combination of effective-staged surgical joint debridement, a shortened post-operative course of systemic antibiotic treatment and an adequate latent period before re-implantation has led to encourage early results in this series of revised chronic hip joint prosthetic infections.

Less is more: lag screw only fixation of lateral malleolar fractures.

Displaced fractures of the lateral malleolus are typically treated with plate osteosynthesis with or without the use of lag screws, and immobilisation in a plaster cast for up to 6 weeks. Fixation through a smaller incision with less metal, such as lag screw only fixation, would theoretically lead to decreased infection rates and less irritation caused by hardware. The purpose of this study was to evaluate the benefits and success of lag screw only fixation of the lateral malleolus in non-comminuted oblique fractures of the lateral malleolus. A total of 25 patients who had non-comminuted unstable oblique fractures of their lateral malleolus that had been surgically fixed with lag screws only were retrospectively evaluated. All patients were younger than 60 years of age. Evaluation of the success of fixation, complications, resultant mobility and patient satisfaction was based on information gathered from chart reviews, X-ray findings and a standardised questionnaire based on the AOFAS Foot and Ankle Outcomes Questionnaire. These results were compared to an age-matched group of 25 consecutive patients treated with plate osteosynthesis. Of the 25 patients fixed with lag screws, nine had an unstable fracture of the lateral malleolus only, ten were bimalleolar fractures and six were trimalleolar. Eighteen patients were treated with two lag screws, and seven were treated with three lag screws. The bi- and trimalleolar fractures were treated with standard partially threaded cancellous screws. None of the lag screw-only group lost reduction. There were no documented wound infections in the lag screw group as compared to three deep infections in the plate group. Lag screw-only patients reported no palpable hardware as compared to 50% of the plate group. AOFAS scores at a mean of 12 months post-operative were similar in both groups. Lag screw only fixation of the lateral malleolus is a safe and effective method that has a number of advantages over plate osteosynthesis, in particular less soft tissue dissection, less prominent, symptomatic and palpable hardware and a reduced requirement for secondary surgical removal.