Effect of Soft Silicone Foam Dressings on Intraoperatively Acquired Pressure Injuries: A Randomized Study in Patients Undergoing Spinal Surgery.

The use of prophylactic dressings to help prevent intraoperatively acquired pressure injuries (IAPIs) merits further study. PURPOSE: To examine how the use of a soft silicone foam dressing affects the development of IAPIs in patients undergoing spinal surgery to obtain baseline data supporting evidence-based nursing care. METHODS: Using a self-controlled study design, 64 patients requiring thoracic or lumbar surgery on a Wilson frame at a hospital in Seoul, South Korea, were recruited between February 12 and September 1, 2018; 50 patients were eligible. Basic demographic, health, and surgical data were obtained. Before surgery, the left or right side chest and iliac crest areas were randomly assigned to be covered with a soft silicone foam dressing. The areas were assessed at 2 time points: immediately after and 30 minutes after surgery. If an IAPI was present at 30 minutes after surgery, all sites were reevaluated after 7 days. RESULTS: The majority of participants were male (26 participants, 52%). Average patient age was 62.54 (± 13.83) years, with a body mass index of 24.32 (± 4.23) kg/m2. Average length of surgery was 218.4 (± 137) minutes. Immediately after surgery, 26 IAPIs were observed and there was a significant difference between dressed and non-dressed chest areas for the number of IAPIs (4% vs. 28%; P = .002). After 30 minutes, the total number of IAPIs was 20 and the difference between IAPIs in the iliac crest area was significant between dressed and non-dressed areas (0% vs. 14%; P = .012). After 1 week, there were no chest or iliac crest IAPIs in the areas that had been covered by a dressing; however, 8 chest (61.5%) and 4 iliac crest (30.8%) area IAPIs remained when no dressing had been applied. The majority of IAPIs were stage 1 at all assessment times. After 1 week, 1 IAPI had evolved into a stage 3 injury. CONCLUSIONS: The results of this study show that many stage 1 IAPIs do resolve over time and that use of soft silicone foam dressings during spinal surgery can significantly reduce IAPI rates. Additional longitudinal studies are needed to help guide postoperative skin assessment intervals and increase the understanding about the evolution of stage 1 IAPIs.

Risk Factors for Radiographic Progression of Osteoarthritis After Meniscus Allograft Transplantation.

PURPOSE: To identify risk factors that predict radiographic progression of osteoarthritis after meniscus allograft transplantation (MAT) using multivariate logistic regression. METHODS: Inclusion criteria were consecutive patients who underwent medial or lateral MATs from January 2005 to September 2012 by one surgeon. Exclusion criteria were lack of postoperative magnetic resonance image, loss to follow-up for a minimum of 3 years, and simultaneous surgery on articular cartilage or the anterior cruciate ligament. According to the change of Kellgren-Lawrence (KL) grade at the mean final follow-up of 56.2 months, the enrolled MATs were sorted into the no progression of osteoarthritis (NOA) and progression of osteoarthritis (POA) groups. Multivariate logistic regression was used to analyze risk factors, including age, sex, body mass index, time from previous meniscectomy to MAT, extent of previous meniscectomy, previous anterior cruciate ligament reconstruction, knee alignment angle, KL grade, side of transplanted meniscus, Outerbridge grade, posterior repair technique, and relative percentage of extrusion. RESULTS: In comparison between the NOA (n = 38) and the POA (n = 31) groups, a significant risk factor for radiographic progression of osteoarthritis after MAT was medial MAT compared with lateral MAT. Medial MAT compared with lateral MAT was also a significant risk factor (adjusted odds ratio, 3.763; 95% confidence interval, 1.212-11.683). CONCLUSIONS: Patients need to be counseled about the increased risk of osteoarthritis progression after MAT over time, particularly for medial MAT. LEVEL OF EVIDENCE: Level III, retrospective case control study.

Multivariate Analysis of Risk Factors of Graft Extrusion After Lateral Meniscus Allograft Transplantation.

PURPOSE: To identify risk factors that predict major graft extrusion (>3 mm in relation to the margin of the tibial plateau) on magnetic resonance imaging (MRI) after lateral meniscus allograft transplantation (MAT) using multivariate logistic regression. METHODS: In this retrospective trial, inclusion criteria were consecutive lateral MATs from January 2004 to June 2013. Exclusion criteria were the lack of postoperative MRI, loss to follow-up for minimum 2 years, and simultaneous surgery of the articular cartilage or anterior cruciate ligament. According to the measured extent of graft extrusion in postoperative MRI, the lateral MATs were sorted into minor extrusion and major extrusion groups. Multivariate logistic regression was used to analyze risk factors including age, gender, body mass index, time from previous meniscectomy to MAT, extent of previous meniscectomy, previous anterior cruciate ligament reconstruction, knee alignment angle, Kellgren-Lawrence grade, lateral peripheral osteophyte, Outerbridge grade, posterior repair technique the position of bony bridge, and axial plane trough angle. RESULTS: Enrolled 72 lateral MATs were sorted into minor extrusion (n = 34) and major extrusion groups (n = 38). As time from previous meniscectomy to lateral MAT increased, the risk of the major graft extrusion after lateral MAT increased (adjusted odds ratio: 1.554, 95% confidence interval: 1.089 to 2.218). Increased axial plane trough angle was also a significant risk factor (adjusted odds ratio: 8.449, 95% confidence interval: 1.710 to 42.250). The other parameters were not significant risk factors. CONCLUSIONS: Most meniscal grafts after lateral MATs showed major graft extrusion. Significant risk factors for the major graft extrusion included delayed time from previous meniscectomy to MAT and increased axial plane trough angle. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Reduction Osteotomy vs Pie-Crust Technique as Possible Alternatives for Medial Release in Total Knee Arthroplasty and Compared in a Prospective Randomized Controlled Trial.

BACKGROUND: To compare the gap change between the pie-crust technique and reduction osteotomy to determine their effects on flexion and extension gaps and their success rates in achieving ligament balancing during total knee arthroplasty. METHODS: In a prospective randomized controlled trial, 106 total knee arthroplasties were allocated to each group with 53 cases. If there was a narrow medial gap with an imbalance of ≥3 mm after the initial limited medial release, either reduction osteotomy or pie-crust technique was performed. The changes of extension and flexion medial gaps along with the success rate of mediolateral balancing were compared. RESULTS: There was a significant difference in the change of medial gap in knee extension with mean changes of 3.5 ± 0.5 mm and 2.3 ± 0.8 mm in the reduction osteotomy and pie-crust groups, respectively (P < .001). For flexion gap, greater change was found in the pie-crust group compared with the reduction osteotomy group; the mean medial gap changes in knee flexion were 1.1 ± 0.5 mm and 2.3 ± 1.2 mm in the reduction osteotomy and pie-crust groups, respectively. The success rates were 90.6% and 67.9% in reduction osteotomy and pie-crust groups, respectively (P = .007). CONCLUSION: As an alternative medial release method, reduction osteotomy was more effective in extension gap balancing, and pie-crust technique was more effective in flexion gap balancing. The overall success rate of mediolateral ligament balancing was higher in the reduction osteotomy group than in the pie-crust group.

Varus-valgus stress radiograph as a predictor for extensive medial release in total knee arthroplasty.

PURPOSE: The purpose of this study was to identify the risk factors for predicting the reduction osteotomy as extensive medial release during total knee arthroplasty (TKA) using multivariate logistic regression. METHODS: A total of 404 TKAs were enrolled and sorted into two groups according to the extent of medial release and then analysed for the statistical significance of various risk factors including age, gender, body mass index (BMI), pre-operative knee mechanical axis angle (KMAA), mechanical varus stress angle (MVrSA), mechanical valgus stress angle (MVgSA), and sum of the mechanical varus and valgus stress angles (SMVVA) with use of multivariate logistic regression analysis. RESULTS: SMVVA to a more varus direction was found to be a significant risk factor for the reduction osteotomy (p < 0.0001, adjusted odds ratio (OR) = 2.705 with 95 % CI 2.126-3.443). KMAA and MVgSA to a more varus direction were also significant risk factors (p = 0.010, adjusted OR = 1.189 with 95 % CI 1.041-1.357, and p = 0.005, adjusted OR = 1.401 with 95 % CI 1.109-1.767). The other variables were not significant risk factors. CONCLUSIONS: The overall results suggest that careful attention should be given to the need for extensive medial release and failure of the conventional soft tissue release technique during TKA in patients with a greater varus angle in the pre-operative SMVVA, MVgSA, and KMAA, especially with a greater varus SMVVA, which was the strongest predictor of reduction osteotomy. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Risk factors of post-operative malalignment in fixed-bearing medial unicompartmental knee arthroplasty.

PURPOSE: The purpose of this study was to identify risk factors of post-operative malalignment in medial unicompartmental knee arthroplasty (UKA) using multivariate logistic regression. METHODS: We retrospectively enrolled 92 patients who had 127 medial UKAs. According to post-operative limb mechanical axis (hip-knee-ankle [HKA] angle), 127 enrolled knees were sorted into acceptable alignment with HKA angle within the conventional ± 3 degree range from a neutral alignment (n = 73) and outlier with HKA angle outside ± 3 degree range (n = 54) groups. Multivariate logistic regression was used to analyse risk factors including age, gender, body mass index, thickness of polyethylene tibial insert, pre-operative HKA angle, distal femoral varus angle (DFVA), femoral bowing angle (FBA), tibial bone varus angle (TBVA), mechanical distal femoral and proximal tibial angles, varus and valgus stress angles, size of femoral and tibial osteophytes, and femoral and tibial component alignment angles. RESULTS: Pre-operative DFVA, TBVA and valgus stress angle were identified as significant risk factors. As DFVA increased by one degree, malalignment was about 45 times probable (adjusted OR 44.871, 95 % CI 2.608-771.904). Shift of TBVA and valgus stress angle to a more varus direction were also significant risk factors (adjusted OR 13.001, 95 % CI 1.754-96.376 and adjusted OR 2.669, 95 % CI 1.054-6.760). CONCLUSIONS: Attention should be given to the possibility of post-operative malalignment during medial UKA in patients with a greater varus angle in pre-operative DFVA, TBVA and valgus stress angle, especially with a greater varus DFVA, which was the strongest predictor for malalignment.