Perioperative Antibiotic Utilization by Orthopedic Surgeons in Arthroscopic Surgery A Survey of Practice Patterns.

BACKGROUND: Given the relatively low incidence of infection, the role of prophylactic antibiotics for infection prevention in arthroscopic surgery is unclear. Without established evidence-based guidelines, it becomes important to understand the trends and common practices in the field. HYPOTHESIS: We hypothesized that a majority of surgeons would use preoperative intravenous antibiotics and that postoperative antibiotics would be rarely used. METHODS: A web-based link containing a questionnaire on perioperative antibiotic use for arthroscopic surgery of the knee and shoulder was sent to sports medicine surgeons at several institutions in the New York tri-state region. The questionnaire addressed antibiotic use both preoperatively and postoperatively and the type of medication used. RESULTS: During the study period, 86 surgeons responded to the knee portion of the survey and 139 surgeons responded to the shoulder portion of the survey. A significant majority (94.24% for knee and 93.02% for shoulder) of the respondents routinely preferred to use preoperative intravenous antibiotics for both shoulder and knee surgery. The antibiotic of choice for a majority of the respondents was cefazolin (98.1% respondents). In patients with penicillin allergies, most preferred to use clindamycin. Most respondents (84.5%) did not routinely use postoperative oral antibiotics. CONCLUSION: There is significant consensus among orthopedic surgeons performing knee and shoulder arthroscopic surgery regarding use of preoperative antibiotics, with the majority routinely prescribing preoperative intravenous antibiotics for prophylaxis and cefazolin being the most commonly used antibiotic. The majority of surgeons prefer not to use postoperative oral antibiotics. CLINICAL RELEVANCE: This study describes the current trends in the use of perioperative antibiotics among orthopedic surgeons for routine arthroscopic procedures in the shoulder and knee.

Clinical and radiologic evaluation of the posterior cruciate ligament-injured knee.

PURPOSE OF REVIEW: Accurate isolated PCL diagnosis continues to present a challenge. This article reviews the current literature regarding clinical and radiographic evaluation of PCL injuries. RECENT FINDINGS: A thorough history to understand the mechanism of injury should begin any evaluation. Several clinical tests have been shown to effectively assess PCL laxity, with the posterior drawer test possessing the highest sensitivity and specificity. Any thorough exam should compare the contralateral, uninjured leg. If a PCL or multi-ligament injury is suspected, plain radiographs should be performed to avoid missing a fracture or avulsion. An MRI represents the current gold standard for diagnosing ligament injuries in the knee and should always be obtained in these cases. Due to the significant incidence of nerve injuries (25%) and vascular injuries (18%) with knee dislocations, any suspicion of neurovascular compromise necessitates further studies. A combination of a thorough clinical history and examination, followed by appropriate imaging optimizes PCL and multi-ligament injury evaluation.

Arthroscopic debridement of unicompartmental arthritis: fact or fiction?

Patients with recurrent or mechanical symptoms of unicompartmental knee arthritis that have failed conservative management are candidates for surgical intervention. Surgical options include debridement, lavage, chondroplasty, bone marrow-stimulating techniques, chondrocyte transfer, and chondrocyte implantation. These techniques have been well studied but it is still unclear which technique is superior. Various factors need to be accounted for when choosing the proper technique; among the factors discussed are the patient's age and the size of the articular cartilage defect.

Comparative diagnostic study of biomarkers using FibroMax™ and pathology for prediction of liver steatosis in patients with chronic hepatitis C virus infection: an Egyptian study.

BACKGROUND: Steatosis is common in patients with hepatitis C virus (HCV) infection and may be a major determinant of progression of liver injury. This study evaluated FibroMax™ for noninvasive diagnosis of steatosis in patients with chronic HCV. METHODS: This cross-sectional study included 44 patients naïve to treatment who were referred to our hepatology clinic for assessment of fitness for antiviral therapy. Chronic HCV infection was diagnosed by viral markers. Investigations included assessment of abdominal ultrasonography, liver biopsy, calculation of body mass index, and biomarker parameters in serum using FibroMax. RESULTS: Histopathology of liver biopsies showed steatosis in 30 of 44 (68%) patients. FibroMax results were positively correlated with viral load by quantitative polymerase chain reaction and histopathological findings. Body mass index was significantly higher in steatotic patients (P = 0.003) and was significantly associated with the results on FibroMax (P = 0.005). CONCLUSION: FibroMax was correlated with histopathology and body mass index in patients with HCV. Abdominal ultrasonography could not be used as a single tool to diagnose steatosis with HCV. Steatosis is correlated with viral load, which suggests a direct viral effect. We recommend FibroMax assessment in a larger number of patients to assess its applicability in patients with HCV and steatosis.