Perioperative transfusion threshold and ambulation after hip revision surgery--a randomized trial.

BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision surgery. METHODS: The trial was registered at Clinicaltrials.gov ( NCT00906295). Sixty-six patients aged 18 years or older undergoing hip revision surgery were randomized to receive RBC at a Hb threshold of either 7.3 g/dL (restrictive group) or 8.9 g/dL (liberal group). Postoperative ambulation was assessed using Timed Up and Go-test (TUG) and ability to walk was also assessed daily by a physiotherapist blinded to the allocation. RESULTS: Fifty-three patients were able to perform the TUG and included in the analysis. The TUG could be completed in a median of 36 sec vs. 30 sec in the restrictive group and the liberal group, respectively (P = 0.02). The mean difference in TUG was 14.5 sec (95% CI 2.8-26.2 sec). No difference was found in the day patients could perform TUG or walk 10 meters. The Hb at the day of testing was 10.2 g/dL in the restrictive group and 9.9 g/dL in the liberal group. Only 26 patients received RBC. CONCLUSIONS: A Hb transfusion threshold of 8.9 g/dL was associated with a statistically significantly faster TUG after hip revision surgery compared to a threshold of 7.3 g/dL but the clinical importance is questionable and the groups did not differ in Hb at the time of testing.

Implants induce a new niche for microbiomes.

Although much work is being done to develop new treatments, research and knowledge regarding factors underlying implant-related microbial colonization leading to infection are less comprehensive. Presence of microorganisms in and around implants clinically characterized as uninfected remains unknown. The objective of this study was to detect and identify bacteria and fungi on implants from various groups of patients with no prior indications of implant related infections. Patient samples (implants and tissue) were collected from five different hospitals in the Capital region of Denmark. By in-depth microbiological detection methods, we examined the prevalence of bacteria and fungi on 106 clinically uninfected implants from four patient groups (aseptic loosening, healed fractures, craniofacial complications and recently deceased). Of 106 clinically uninfected implants and 39 negative controls investigated, 66% were colonized by bacteria and 40% were colonized by fungi (p < 0.0001 compared to negative controls). A large number of microbes were found to colonize the implants, however, the most prevalent microbes present were not common aetiological agents of implant infections. The findings indicate that implants provide a distinct niche for microbial colonization. These data have broad implications for medical implant recipients, as well as for supporting the idea that the presence of foreign objects in the body alters the human microbiome by providing new colonization niches.

[Septic arthritis].

Septic arthritis (SA) is a rare, but crucial differential diagnosis in any patient with acute arthritis and is associated with high morbidity and mortality. Many chronic diseases predispose for the development of SA and poor prognosis. Reports speak of increasing rates of SA due to multiresistant bacteria, but the development in Denmark is uncertain. Diagnosis is difficult, and absence of positive microbiological findings does not disprove the diagnosis. In addition, evidence supporting one regiment of treatment over another is scarce. Thus, SA requires prompt treatment by orthopaedic specialists.

[Pneumomediastinum and airway obstruction after traumatic rib fractures]. / Pneumomediastinum og luftvejsobstruktion efter costafrakturer.

We present a case of upper airway obstruction not previously reported in combination with traumatic rib fractures, pneumothorax, pneumomediastinum and subcutaneous emphysema. A 95-year-old female presented with swelling of the face, neck and upper body. Stridor indicated upper airway obstruction and intubation was performed. A computed tomography revealed subcutaneous emphysema, pneumo-thorax, pneumomediastinum and rib fractures. Bilateral chest tubes were placed and the patient was admitted to intensive care. Upper airway obstruction should be considered in patients with chest trauma.

[Bilateral traumatic dislocation of both total hip arthroplasties].

A 77-year-old man was brought to the emergency department after a fall on stairs. X-rays showed bilateral dislocation of both total hip arthroplasties (THA). Dislocation of THA occurs in 2-4% of the patients, most often within three months post-operatively, and for three fourths of the cases within the first year, often due to lack of observing movement restrictions, fails or malpositions of the components. Bilateral THA dislocation is a rare occurrence. It may be assumed that the dislocations did not occur simultaneously but rather as two successive dislocations.

[Necrotizing fasciitis after arthroscopic synovectomy of an infected prepatellar bursa]. / Fasciitis necroticans efter artroskopi af praepatellar bursitis.

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection in superficial and deep fascias. NF is most often caused by mixed aerobic and anaerobic bacteria. The treatment is early and aggressive surgical debridement, antibiotics and hyperbaric oxygen. In this case description, a nearly 60-year-old man developed NF after arthroscopic synovectomy of an infected prepatellar bursa. We stress the point that the endoscopic technique itself might be responsible for the spreading of bacteria to the fascias. This is a subject for further investigation.