Examining the Efficacy of Drain Tip Cultures in Predicting Postoperative Surgical Site Infections in Hip Arthroplasty: A 15-Year Retrospective Study.

Background Postoperative surgical site infections (SSIs) are a significant complication of surgical procedures, leading to increased morbidity, prolonged hospital stays, and substantial healthcare costs; however, the use of drain tip cultures to diagnose SSIs in patients is controversial. The objective of this study was to evaluate the efficacy of drain tip cultures for the prediction of postoperative SSIs in patients recovering from hip arthroplasty. Methodology The data were collected from 1204 patients who underwent hip arthroplasty procedures over 15 years, and statistical analysis was performed to evaluate the diagnostic value of drain tip culture in determining surgical site infection. We also used these data to evaluate whether preexisting conditions such as hypertension or diabetes affected the probability of a patient getting an SSI. Results Drain tip cultures were positive in 12 of 1,112 cases of primary hip arthroplasty, but only one of these 12 patients was ultimately diagnosed with an SSI (sensitivity, 12.5%; specificity, 99.0%; p = 0.0834). Results from postoperative drain tip cultures performed in patients undergoing revision arthroplasty included two false positives and three false negatives; interestingly, no true positives were detected in any of the revision arthroplasty cases we evaluated (sensitivity, 0％; specificity, 97.8％; p = 0.9355). Conclusion Our results indicate that drain tip cultures have no statistically significant predictive value for the diagnosis of postoperative SSIs and thus should not be used as a primary diagnostic or predictive tool for SSIs. We recommend exploring other diagnostic tools for the postoperative diagnosis of SSIs. Standardized guidelines should therefore be established to improve the predictive value of the different methods.

Long-term assessment of morphological, functional, and quantitative parameters of skeletal muscle in older patients after unilateral total hip arthroplasty.

Total hip arthroplasty (THA) is performed for pain relief in patients with osteoarthritis of the hip joint. After THA, patients may recover muscle mass and physical function. Muscle quality is the main parameter used to indicate intramuscular fat content, and it is related with muscle function in older individuals. However, how THA affects muscle quality, as determined by echo intensity (EI), is not well understood. The purpose of this study was to determine the long-term characteristics of EI, muscle quantity, muscle function, and physical functions in the patients with THA surgery. In order to achieve the purpose, we performed two comparison. First, we compared muscle EI, quantity and function in operated leg with unoperated legs in the same patients and with the legs of healthy adults (i.e., both unoperated legs). Second, we compared physical functional tests between THA patient and age and body composition matched controls. Twenty-two older individuals (age: 67.1 ± 5.3 years, height: 160.9 ± 7.1 cm, body mass: 62.6 ± 16.1 kg) who underwent unilateral THA several (5.2 ± 3.1) years ago (THA group) and 22 healthy controls with matching age and body composition (age: 68.3 ± 4.4 years, height: 160.3 ± 7.9 cm, body mass: 61.7 ± 7.8 kg) (CON group) participated in this case-control study. EI, an index of muscle quality, and muscle thickness (MT), an index of muscle quantity, were measured from B-mode transverse images of the rectus femoris obtained through ultrasound. The maximal isometric knee extension torque was measured in both the operated and unoperated legs in the THA group and in the right leg in the CON group (control leg); physical function tests, such as sit-to-stand, walking speed, hip adduction, and abduction torque assessments, were performed in both groups. MT and maximal isometric knee extension torque in operated leg were not different with unoperated, and control legs; the EI in the operated leg was significantly higher than that in the control leg (106.9 ± 16.9 vs. 92.4 ± 21.0 a.u., P < 0.05). The THA group demonstrated slower walking speed and lower hip abduction torque than the CON group (walking speed: 1.3 ± 0.2 vs. 1.5 ± 0.2 m/s; hip abduction torque 1.2 ± 0.3 vs. 1.5 ± 0.5 Nm/kg, P < 0.05). Several years after THA, the operated legs completely recovered the same level of muscle quantity as that in healthy participants but with lower muscle quality and hip joint function. These defects may be associated with locomotive dysfunction in older THA patients.

Reference values for the locomotive syndrome risk test quantifying mobility of 8681 adults aged 20-89 years: A cross-sectional nationwide study in Japan.

BACKGROUND: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.

Development of a screening program to assess motor function in the adult population: a cross-sectional observational study.

BACKGROUND: Motor dysfunction is a major reason why the elderly lose their independence in their daily lives. The concept of locomotive syndrome has been proposed to describe the risk of mobility dependence caused by various locomotive organ disorders. The preservation of locomotive organs is now socially important in the middle-aged and geriatric population. Therefore, it is important to establish a screening program to evaluate motor function and related quality of life in a wide range of ages. METHODS: We propose a new set of pre-existing scales (the Two-Step test, Stand-Up test, and 25-question Geriatric Locomotive Function Scale) as screening tools to identify the population at high risk for locomotive syndrome. We performed a preliminary survey on 777 subjects who had no apparent disorders related to motor function. We also examined the reliability of the Two-Step test and Stand-Up test. RESULTS: We found that each scale did not show ceiling or floor effects in various age groups. Because the correlations between the three scales were significant but weak, we assume that each scale covers different aspects of mobility. The test-retest reliability was found to be satisfactory for the Two-Step test and the Stand-Up test. CONCLUSION: Our results suggest that our "Short Test Battery for Locomotive syndrome" is a feasible and reliable tool for screening the adult population as a preventative strategy for locomotive syndrome in a super-aged society.