The role of cefoxitin prophylaxis in chronic pilonidal sinus treated with excision and primary suture.

BACKGROUND: Treatment of chronic pilonidal sinus with excision and primary suture is followed by a relatively high proportion of wound infections. The role of preoperative antibiotic prophylaxis in improving results is not clear. STUDY DESIGN: One hundred fifty-three patients with chronic pilonidal sinus were operated on with radical excision and primary suture and randomized to receive a single dose antibiotic prophylaxis of 2 g cefoxitin intravenously (n = 78) or no prophylaxis (n = 75). RESULTS: The most common complications consisted of partial, slight separation of wound edges with slight discharge. In the group with cefoxitin, 34 patients (44 percent) had complications compared with 32 patients (43 percent) in the group without prophylaxis. Fifty-four patients (69 percent) healed within four weeks in the group with cefoxitin, whereas 48 (64 percent) healed within four weeks in the group without prophylaxis. After a follow-up period of six to 30 months, two patients in each group had not healed. Including these, two patients (3 percent) had recurrences in the group with cefoxitin and five patients (7 percent) in the group without prophylaxis (p = 0.41). CONCLUSIONS: The immediate and short-term results after excision and primary suture for chronic pilonidal sinus are not influenced significantly by a single dose prophylaxis of 2 g cefoxitin.

[Dorsal dislocation of the metacarpophalangeal joint of the index finger]. / Dorsal dislokasjon av pekefingerens metakarpofalangealledd.

Dorsal dislocation of the index metacarpophalangeal joint, although uncommon, is a serious injury. An open reduction is usually necessary. In the present case, an open reduction was performed by a dorsal approach. The pathological anatomy is described.

[The hip registry. Good economy for society]. / Hofteregisteret. God samfunnsøkonomi.

As many as 33,656 total hip arthroplasties (THA) have been recorded in the Norwegian Arthtroplasty Register from the start in September 1987 until January 1994. The annual costs for the about 5,500 THA performed in Norway (4.2 million inhabitants) are 72 million USD. We have documented before that some types of uncemented prostheses (Ti-Fit/ Bio-Fit (cup/stem) and Coxa/Femora) and types of cements (low-viscosity and Boneloc) show higher revision rates than others do. In this paper the costs of these "inferior" implants are estimated. The "inferior" implants were compared with a reference-THA (the Charnley prosthesis with antibiotic-containing high viscosity cement and with systemic antibiotic-prophylaxis (n = 4,970)). In addition, based on data in the literature, comparisons have been made for two earlier commonly used prostheses in Norway: The Christiansen prosthesis (n = 6,500) and the Wagner double-cup prosthesis (n = 2,200). For the period 1987-93, the annual over-all extra cost of using other implants than the reference-THA was 1.71 mill. USD for the first 3-5 years postoperatively. For the Christiansen and the Wagner prostheses the annual extra costs were estimated to 2.65 and 2.38 mill. USD respectively. By documenting poor results early the Register helps to stop the use of the inferior prostheses and cements, and thus reduce both the number of revisions, and, most important, the suffering of the patients.

[Quality control of prosthetic replacements of knee, ankle, toe, shoulder, elbow and finger joints in Norway 1994. A report after the first year of registration of joint prostheses in the national registry]. / Kvalitetskontroll av proteseoperasjoner i kne-, ankel-, tå-, skulder-, albue-og fingerledd i Norge 1994. En rapport etter det første året med registrering i Nasjonalt register for leddproteser.

Total hip replacements have been recorded in the Norwegian Arthroplasty Register since 1987, and recording of the other joint arthroplasties was started in January 1994. After 12 months 1,589 primary arthroplasties had been registered; these referred to 962 knees, 11 ankles, 76 toes, 113 shoulders, 69 elbows, 12 wrists, 335 fingers and 11 carpometacarpal 1 joints. Median age of the patients was 70 years. 80% were women. Rheumatoid arthritis was the predominant reason for joint replacement, except in the case of the knees where the dominant cause was osteoarthrosis (71%) and of shoulders, 28% of which were replaced because of fractures. Cement was used in 83% of the primary arthroplasties in knee, ankle, shoulder, and elbow joints. 74% of the cement types used contained antibiotics. 9% were uncemented and 8% hybrids. 97% were given systemic antibiotic prophylaxis, most commonly first generation cephalosporins. 114 reoperations were reported. The reason was aseptic loosening in 56%, and infection in 15%. The cooperation with Norwegian orthopaedic surgeons is good. The Register thus provides a reliable picture of implants of Norway, and a good basis for future follow-up studies.

The economic impact of failures in total hip replacement surgery: 28,997 cases from the Norwegian Arthroplasty Register, 1987-1993.

The Norwegian Arthroplasty Register was established in 1987. Until January 1994, approximately 200 different implant combinations had been used in total hip replacements (THR) in Norway. About 5,500 THR were performed each year in this period with a total cost of 70 million USD per year. We analyzed the economic consequences related to the use of some inferior primary hip arthroplasties in this period. As the reference arthroplasty, we chose the most commonly used prosthesis in Norway, i.e., the Charnley prosthesis fixed with high viscosity cement containing antibiotic and with systemic antibiotic prophylaxis (n 4,970). We compared this reference group to all other primary THR registered in the same time period (n 24,027), and to the following sub-groups of primary THR: 1) uncemented Ti-Fit/ Bio-Fit (acetabulum/femur) combination (n 173), 2) uncemented Coxa/Femora combination (n 153), 3) THR with low-viscosity cement (n 1,807) and 4) THR with Boneloc cement (n 1,250). We estimated the number of additional revisions compared to the reference arthroplasty after a follow-up of 3-5 years in the different groups, with adjustment for age, sex and diagnosis. The direct extra revision costs were calculated. Compared to the reference arthroplasty, the group of all other primary THR gave an extra revision cost estimated at about 1.7 million USD per year. About 1,000 uncemented Bio-Fit femoral prostheses have been applied in Norway, including those implanted before the registration started (1985-1987). The extra revision costs the first postoperative years for these 1,000 prostheses amount to about 0.7 million USD per year. Corresponding figures in the Coxa/ Femora group were 0.08 million USD, in the group with low-viscosity cement, 0.3 million USD and in the Boneloc group, 0.4 million USD per year.