Risk factors for postoperative wound infections of sacral chordoma after surgical excision.

STUDY DESIGN: A retrospective study, analyzing the risk factors for postoperative wound infections of the sacral chordoma after surgical excision. OBJECTIVE: To determine the preoperative, intraoperative, and patient characteristics that contribute to an increased risk of postoperative wound infection in patients undergoing sacral chordoma resection. SUMMARY OF BACKGROUND DATA: Postoperative wound infection after spinal operations is a dreaded complication. The risk factors have been investigated earlier, but the patients with sacral chordoma may be distinct. METHODS: Between January 1992 and December 2007, 45 patients with sacral chordomas were treated with surgical resection. Data regarding preoperative and intraoperative risk factors for postoperative wound infection were evaluated using univariate analysis and multivariable conditional logistic regression. Odds ratios with 95% confidence intervals and P values were calculated. RESULTS: Of the 45 patients with sacral chordoma, 16 (35.6%) acquired postoperative wound infection. Significant risk factors associated with postoperative wound infection in the univariate analysis included the following: albumin <3.0, previous surgery, operating time, instrumentation, and surgical team. Albumin<3.0, operating time >6 hours, and previous surgery were statistically significant in the multivariable model. CONCLUSIONS: Patients undergoing sacral tumor surgery may be at greater risk for developing wound complications. In this study, it seems that albumin<3.0, operating time >6 hours, and previous surgery may predict those patients that were more prone to developing postoperative wound infection. Using a single surgical team and no instrumentation seems to provide protection against postoperative wound infection in this patient population.

The application of a zero-profile implant in anterior cervical discectomy and fusion.

We analyzed the clinical efficacy of the Zero-P implant (Synthes GmbH Switzerland, Oberdorf, Switzerland) in the treatment of single level cervical spondylotic myelopathy. The clinical data of 47 patients with single level cervical spondylotic myelopathy were retrospectively analyzed. Twenty-two patients were treated with a Zero-P implant (Group A) and 25 with a titanium plate with cage (Group B) between January 2009 and September 2010. Operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores and JOA recovery rate, dysphagia incidence and adjacent segment degeneration rate were measured. The mean operative time in Group A and Group B was 98.18 minutes and 105.4 minutes, respectively. The average intraoperative blood loss in Group A and Group B was 87.95 ml and 92.4 ml, respectively. There were no statistical differences in operation time and intraoperative blood loss between the two groups (p>0.05). The JOA score was significantly improved in the two groups (p<0.001), and the recovery rate was similar (60.86% for Group A versus 62.95% for Group B, p>0.05). Dysphagia was experienced by one (4.5%) patient in Group A and eight (32%) patients in Group B, which was significantly different (p=0.044). There was no statistical significance found in the adjacent level degeneration rates between Group A and Group B (p=0.330). The Zero-P implant and traditional titanium plate with cage are effective treatments for single level cervical spondylotic myelopathy, but the Zero-P implant has a lower dysphagia incidence.

Comparison of the mini-midvastus with the mini-medial parapatellar approach in primary TKA.

A prospective randomized study was performed to compare the clinical and radiological results of primary total knee arthroplasties (TKAs) using a mini-midvastus approach or a mini-medial parapatellar approach in 134 patients. The mini-midvastus approach was used on 68 patients (group A) and the mini-medial parapatellar approach on 66 patients (group B). All knees were implanted with the same posterior-stabilized prosthesis by the same surgeon (T.-S.T.) with the same set of downsized instruments. Mean follow-up in both groups was 30.5 months (range, 24-48 months). Patients in group A achieved an active straight-leg raise and 90° of flexion significantly earlier (P=.017 and P=.025, respectively). However, no significant difference was detected between the groups with respect to range of movement and Knee Society scores at all the postoperative visits and at final follow-up (all, P>.05). In contrast, the tourniquet time was significantly longer in group A (P=.015), with a higher incidence of medialized tibial component (P=.031). We believe that the early clinical results are similar between the mini-midvastus and mini-medial parapatellar approach. The mini-medial parapatellar approach is easier to initially apply and provides better visualization for TKA.