Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review.

BACKGROUND: The best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies. The aim of this systematic review is to compare the infection recurrence rate after a single-stage versus a two-stage exchange arthroplasty, and the rate of cemented versus cementless single-stage exchange arthroplasty for chronic periprosthetic hip infections. METHODS: We searched for eligible studies published up to December 2015. Full text or abstract in English were reviewed. We included studies reporting the infection recurrence rate as the outcome of interest following single- or two-stage exchange arthroplasty, or both, with a minimum follow-up of 12 months. Two reviewers independently abstracted data and appraised quality assessment. RESULTS: After study selection, 90 observational studies were included. The majority of studies were focused on a two-stage hip exchange arthroplasty (65 %), 18 % on a single-stage exchange, and only a 17 % were comparative studies. There was no statistically significant difference between a single-stage versus a two-stage exchange in terms of recurrence of infection in controlled studies (pooled odds ratio of 1.37 [95 % CI = 0.68-2.74, I2 = 45.5 %]). Similarly, the recurrence infection rate in cementless versus cemented single-stage hip exchanges failed to demonstrate a significant difference, due to the substantial heterogeneity among the studies. CONCLUSION: Despite the methodological limitations and the heterogeneity between single cohorts studies, if we considered only the available controlled studies no superiority was demonstrated between a single- and two-stage exchange at a minimum of 12 months follow-up. The overalapping of confidence intervals related to single-stage cementless and cemented hip exchanges, showed no superiority of either technique.

Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review.

BACKGROUND: The best surgical modality for treating chronic periprosthetic shoulder infections has not been established, with a lack of randomised comparative studies. This systematic review compares the infection eradication rate and functional outcomes after single- or two-stage shoulder exchange arthroplasty, to permanent spacer implant or resection arthroplasty. METHODS: Full-text papers and those with an abstract in English published from January 2000 to June 2014, identified through international databases, such as EMBASE and PubMed, were reviewed. Those reporting the success rate of infection eradication after a single-stage exchange, two-stage exchange, resection arthroplasty or permanent spacer implant, with a minimum follow-up of 6 months and sample size of 5 patients were included. RESULTS: Eight original articles reporting the results after resection arthroplasty (n = 83), 6 on single-stage exchange (n = 75), 13 on two-stage exchange (n = 142) and 8 papers on permanent spacer (n = 68) were included. The average infection eradication rate was 86.7 % at a mean follow-up of 39.8 months (SD 20.8) after resection arthroplasty, 94.7 % at 46.8 months (SD 17.6) after a single-stage exchange, 90.8 % at 37.9 months (SD 12.8) after two-stage exchange, and 95.6 % at 31.0 months (SD 9.8) following a permanent spacer implant. The difference was not statistically significant (p = 0.650). Regarding functional outcome, patients treated with single-stage exchange had statistically significant better postoperative Constant scores (mean 51, SD 13) than patients undergoing a two-stage exchange (mean 44, SD 9), resection arthroplasty (mean 32, SD 7) or a permanent spacer implant (mean 31, SD 9) (p = 0.029). However, when considering studies comparing pre- and post-operative Constant scores, the difference was not statistically significant. CONCLUSION: This systematic review failed to demonstrate a clear difference in infection eradication and functional improvement between all four treatment modalities for established periprosthetic shoulder infection. The relatively low number of patients and the methodological limitations of the studies available point out the need for well designed multi-center trials to further assess the best treatment option of peri-prosthetic shoulder infection.

Single perioperative dose of tranexamic acid in primary hip and knee arthroplasty.

INTRODUCTION: Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the activation of plasminogen to plasmin. It has been shown to reduce blood loss in trauma and other haemorrhagic conditions and has recently been utilised in elective orthopaedic surgery. There are various methods of administering TXA described in the literature. METHODS: This retrospective cohort study reviews the effects of a single perioperative 1 g intravenous bolus on patients undergoing primary hip and knee arthroplasty and its effect on operative blood loss. After excluding patients who did not fulfil our inclusion criteria, a total of 110 patients were included in this study. Fifty underwent primary hip arthroplasty (30 treated with TXA; 60.0 %), and 60 underwent primary knee arthroplasty (29 treated with TXA; 48.3 %). The main outcome measure was red cell volume and total blood loss, and secondary measures were needed for blood transfusions, presence of thromboembolic events, and length of hospital stay. RESULTS: Both cohorts who received TXA showed a reduction in immediate postoperative red cell volume loss and total blood loss (p < 0.01). There was no association with the administration of TXA and the rate of postoperative blood transfusions (hip p = 0.36, knee p = 0.13), incidence of symptomatic deep vein thrombosis (hip p = 0.36, knee p = 0.31), or postoperative hospital length of stay (hip p = 0.70, knee p = 0.68). CONCLUSION: This study demonstrates that a single perioperative bolus of intravenous TXA may significantly reduce operative blood loss in both primary total hip and knee arthroplasty in a cost-effective manner, in combination with meticulous perioperative haemostasis.

The genetic composition of populations of cynomolgus macaques (Macaca fascicularis) used in biomedical research.

BACKGROUND: The genetic composition of cynomolgus macaques used in biomedical research is not as well-characterized as that of rhesus macaques. METHODS: Populations of cynomolgus macaques from Sumatra, Corregidor, Mauritius, Singapore, Cambodia, and Zamboanga were analyzed using 24 STRs. RESULTS: The Sumatran and Cambodian populations exhibited the highest allelic diversity, while the Mauritian population exhibited the lowest. Sumatran cynomolgus macaques were the most genetically similar to all others, consistent with an Indonesian origin of the species. The high diversity among Cambodian animals may result from interbreeding with rhesus macaques. The Philippine and Mauritian samples were the most divergent from other populations, the former due to separation from the Sunda Shelf by deepwater and the latter due to anthropogenic translocation and extreme founder effects. CONCLUSIONS: Investigators should verify their research subjects' origin, ancestry, and pedigree to minimize risks to biomedical experimentation from genetic variance stemming from close kinship and mixed ancestry as these can obscure treatment effects.

Assessment of the young adult hip joint using plain radiographs.

Radiographic examination remains the mainstay of the initial assessment of the young adult hip; however, common parameters are required to assist in the formation of accurate diagnoses and appropriate management plans. This paper aims to summarise the most important aspects of the assessment of plain radiographs performed on the young adult hip joint.

Sex pheromone of the codling moth: structure and synthesis.

The structure of a sex pheromone of the codling moth. Laspeyresia pomonella (L.), has been determined by spectrometric and chemical degradative techniques and by synthesis to be (2Z, 6E)-7-methyl-3-propyl-2,6-decadien-1-ol. In field cage tests the synthesized sex pheromone was as attractive as the natural, but neither was as attractive as ten virgin females per trap.

Patellar reconstruction following previous patellectomy: a review of the literature and a case series using distal femoral autograft during total knee arthroplasty.

During total knee arthroplasty, the reconstruction of the patella following a previous patellectomy is challenging, and is undertaken to improve functional outcomes and patient satisfaction. In this case series, we have reconstructed the patella using a femoral condyle resected during total knee arthroplasty. The resected femoral condyle with best available bone stock is selected and secured to the extensor mechanism. We reviewed the preoperative indications and postoperative outcomes of two patients who underwent the above procedure at our Institute, and compared this to the literature. The cases include a 68-year old male (6 months follow-up) who sustained a multi-fragmentary fracture of his right patella and underwent a patellectomy 30 years previously, and a 45-year old female (4 years follow-up) who underwent a left-sided patellectomy 15 years previously following polytrauma. As a result of progressive osteoarthritis they required total knee arthroplasty, and simultaneous patella reconstruction with a femoral condyle autograft. Compared to their preoperative range of motion, both patients demonstrated an improvement post-operatively with successful pain-free knee function, with no radiological signs of graft resorption. In this limited, small series we have reported two patients who are clinically and functionally satisfied by the outcome of surgery, with comparable outcomes to alternative methods. We believe the use of a femoral condyle autograft for patellar reconstruction is a safe and simple technique that optimises knee kinematics, without associated donor morbidity.

Calcium-Based, Antibiotic-Loaded Bone Substitute as an Implant Coating: A Pilot Clinical Study.

Background: Implant-related infections remain a major complication after orthopaedic surgery. Antibacterial coating of implants may prevent bacterial adhesion and biofilm formation. However, in spite of extensive preclinical research in the field, antibacterial coatings to protect orthopaedic implants in the clinical setting remain particularly few. The aim of the present study is to evaluate the safety of a calcium-based, antibiotic-loaded bone substitute as an antibacterial coating of cementless joint prosthesis. Methods: From March 2013 to August 2015, 20 consecutive patients scheduled for cementless or hybrid two-stage revision surgery for peri-prosthetic joint infection were included in this prospective, observational, pilot study. Cerament G or Cerament V, a gentamicin or vancomycin-loaded calcium-based resorbable bone substitute (60% calcium sulphate, 40% hydroxyapatite), was applied at surgery on the stem surface of hip (n=7) or knee (n=13) revision prosthesis. After surgery, all patients underwent clinical (HHS or KSS and SF-12 score), laboratory and radiographic evaluation at 3, 6 and 12 months and yearly thereafter. Results: At a minimum of 12 months follow-up, 19/20 (95%) patients showed no recurrence of infection and no signs of radiographic loosening of the stem. No adverse events were associated with the use of Cerament G or V. Conclusions: This is the first pilot clinical study on the short-term safety of using a calcium-based, gentamicin or vancomycin-loaded bone substitute as a surface coating on cementless prosthetic implants. If confirmed by larger studies and at longer follow-ups, these findings may open a new prospective to protect intra-operatively orthopedic implants from bacterial adhesion, through the use of resorbable, osteoconductive, antibiotic carriers.

The management of periprosthetic infections in the future: a review of new forms of treatment.

The number of arthroplasties being undertaken is expected to grow year on year, and periprosthetic joint infections will be an increasing socioeconomic burden. The challenge to prevent and eradicate these infections has resulted in the emergence of several new strategies, which are discussed in this review. Cite this article: Bone Joint J 2015;97-B:1162-9.

The role of near-patient coeliac serology testing in the follow-up of patients with coeliac disease.

OBJECTIVE: This pilot study was undertaken to assess the validity and effectiveness of near-patient coeliac immunological testing, compared to standard laboratory immunological techniques, used in the context of dietician-led coeliac disease follow-up clinics. DESIGN: The study was designed in two phases, each assessing the near-patient test and standard laboratory immunological techniques. Phase 1 analysed stored serum samples; Phase 2 analysed whole blood from patients attending the dietician-led coeliac disease clinics. SETTING: Patients were recruited from New Cross Hospital, Wolverhampton (n=50), and Imperial College London (n=30), between March 2010 and February 2011. PATIENTS: Those with a diagnosis of coeliac disease for greater than 12 months attending dietician-led coeliac disease clinics. INTERVENTIONS: In addition to whole blood taken for routine analysis, patients required a capillary finger-prick blood sample. MAIN OUTCOME MEASURE: To determine if the whole blood and serum near-patient test results were in correlation with outcomes of standard laboratory evaluation. RESULTS: Phase 1 demonstrated that the near-patient serum test had a sensitivity of 93.5% (95% CI 0.79% to 0.98%), specificity of 94.9% (0.83% to 0.99%), when compared to standard laboratory ELISA. Phase 2, involving patients whole blood, had a sensitivity of 77.8% (0.45% to 0.93%), and specificity of 100% (0.94% to 1%). CONCLUSIONS: This pilot study has demonstrated that there appears to be a role for near-patient testing in coeliac disease, but further studies are recommended.

Patient satisfaction following Bio-Alcamid injection for facial contour defects.

Bio-Alcamid, a polyalkylimide gel, can be injected into subcutaneous tissue as an endoprosthesis for correcting contour deformities and soft tissue defects. We have reviewed its facial uses and longer-term outcomes over a 7-year period, including a patient satisfaction survey. 69 patients were included in the study, 89.9% undergoing treatment secondary to HIV-associated facial lipoatrophy. 55.0% of patients responded to questionnaires: 52.5% experienced severe pain associated with injections, and 50.0% experienced at least one complication (migration, hardening, irregularity). 94.4% stated an improvement in their cheek volume, 77.8% would undergo the procedure again, and 86.1% would recommend the treatment to a friend. Despite the relatively high patient satisfaction, we no longer recommend this treatment to our patients for cosmetic indications, due to significant long-term complication rates.

Environmental exposure characterization of fish processing workers.

BACKGROUND: Aerosolization of seafood and subsequent inhalation, during processing is a potential high-risk activity for allergic respiratory disease. OBJECTIVES: To quantify total thoracic particulate, protein concentration and specific fish (pilchard, anchovy) antigen concentrations in fish processing plants; to determine the correlation between these exposure metrics; and to identify the major determinants of variability and the optimal grouping strategies for establishing dose-response relationships for fish antigen exposures. METHODS: Exposure assessments were conducted on randomly selected individuals within each of the identified 'exposure groups' (EGs) in two fish processing factories. Personal time-integrated sampling was conducted with a thoracic fraction sampler and analysed for particulate mass, total protein and specific fish antigens. Exposure metrics were developed on the basis of individually measured exposures and average levels of these personal samples within EGs. The main components of the exposure variability were determined using ANOVA techniques. RESULTS: A total of 198 full-shift personal aerosol samples were collected and analysed. Twenty-two percent of the samples were below the limit of detection (LOD) for pilchard and 23% for anchovy assays. Personal sampling revealed wide variations across EGs in arithmetic mean concentrations of thoracic particulate 0.61 mg m(-3) (range: LOD-11.3), total protein 0.89 microg m(-3) (LOD-11.5), pilchard antigen 150 ng m(-3) (LOD-15 973) and anchovy antigen 552 ng m(-3) (LOD-75 748) levels. The fishmeal loading and bagging sections of both plants showed consistently high thoracic particulate mass (0.811-2.714 mg m(-3)), total protein (0.185-1.855 microg m(-3)), pilchard antigen (538-3288 ng m(-3)) and anchovy antigen (1708-15 431 ng m(-3)). The a priori strategy that grouped workers according to EGs produced reasonably satisfactory summary exposure metric statistics. An alternative grouping strategy based on department revealed comparable elasticity (exposure contrast). While the correlation between the log-transformed thoracic particulate mass and fish antigen concentrations were generally modest (Pearson's r = 0.32-0.35, P < 0.001), a high correlation was found between pilchard and anchovy antigen concentrations (Pearson's r = 0.71, P < 0.001). Models using factory and department grouping strategies accounted for a significant portion of the variability (adjusted r(2) = 0.18, P = 0.043) in pilchard antigen levels. Grouping strategies using a combination of factory and department yielded the highest degree of elasticity for thoracic particulate (0.38) and pilchard antigen (0.42) levels. CONCLUSIONS: Workers involved in bony fish processing are at risk of inhaling aerosols containing pilchard and anchovy fish antigens. Antigen exposures are highest during fishmeal production and bagging. Grouping strategies based on department and factory may provide a more efficient approach than a priori classification of EGs for evaluating fish antigen exposures.

Determination of residues of fensulfothion and its metabolites in Chinese cabbage, Japanese radish , and turnips.

A method was developed using a selective nitrogen-phosphorus detector to determine the combined total residues, as the oxygen analogs, of fensulfothion (O,O-diethyl O-[p-(methylsulfinyl)-phenyl] phosphorothioate) and its 3 metabolites. The procedure was used to determine harvest residues in Chinese cabbage, Japanese radish, and turnips treated with 2 application rates of fensulfothion. Residues found after application of 2 oz active ingredient (AI)/100 lineal ft of row ranged from 0.026 ppm for Japanese radish to 1.543 ppm for turnip greens. When the application rate was doubled, the amount of residue found was approximately doubled.

Permethrin and its two metabolite residues in seven agricultural crops.

Metabolite residues of permethrin are not reported in the literature for most agricultural crops. This paper reports residues of permethrin and its 2 metabolites (dichlorovinyl acid and metaphenoxybenzyl alcohol) in 7 different agricultural crops (Chinese cabbage, spinach, asparagus, raspberries, green peas, turnip roots, and turnip greens). Permethrin residues declined approximately 85% within 7 days after treatment in all crops. In most cases, the acid metabolite residues peaked at 3 days, and declined after that. Translocation of residues into turnip roots was very slight; the average was less than 0.05 ppm for permethrin and alcohol metabolite residues and none was detected for the acid metabolite residue. Permethrin residues in the turnip greens averaged approximately 2 ppm for the 0.112 kg ai/ha treatment, and 6 ppm for the 0.224 kg ai/ha treatment.

Microdetermination of bioethanomethrin.

A microanalytical method was developed for the determination of the experimental synthetic pyrethroid insecticide Bioethanomethrin ((5-benzyl-3-furyl) methyl trans-(+)-3-(cyclopentylidenemethyl) -2,2-dimethylcyclopropanecarboxylate). After saponification, trichloroacetyl chloride is used to form an ester from the acid moiety. Infrared and mass spectral data support the expected structures of the derivatives formed. Nanogram sensitivity is realized by utilizing a gas chromatograph with an electron capture detector.