Infected tumor prostheses.

Infection of tumor prostheses has been a major concern because of the extensive soft tissue dissection, long operating times, and patients' immunosuppression by cancer and adjuvant treatments. Infections most often present within 2 years postoperatively, with approximately 70% of postoperative deep infections presenting within 12 months after surgery. They are typically low organism burden infections, the pathogenesis of which is related to bacteria growing in biofilms. Staphylococci are the most common pathogens involved in prosthetic joint infections, accounting for approximately 50% of infections overall, followed by streptococci, enterococci, Enterobacteriaceae species, Pseudomonas aeruginosa, and anaerobe species. Multiple pathogens may be isolated in approximately 25% of cases, with the most common combination being coagulase-negative Staphylococcus and group-D Streptococcus. Early diagnosis and appropriate treatment are necessary. However, diagnosis may be challenging because clinical symptoms are highly variable and numerous preoperative and intraoperative diagnostic laboratory tests are nonspecific. In most cases, a 1- or 2-stage revision surgery is necessary for eradicating the megaprosthetic infection. Prevention of infection is important. The future will see technical advances for infections of tumor prostheses in areas such as microbiological diagnostics and biofilm-resistant prostheses.

Hibernomas: clinicopathological features, diagnosis, and treatment of 17 cases.

Hibernomas are rare benign adipose tumors composed of brown fat cells with granular, multivacuolated cytoplasm admixed with white adipose tissue. They account for 1.6% of benign lipomatous tumors and approximately 1.1% of all adipocytic tumors. They are more common in the third and fourth decades of life. The most common location is the thigh, followed by the shoulder, back, and head and neck. Four histological types have been reported; abundant vascularity is characteristic, and atypias are rare. The treatment of choice for hibernomas is complete surgical excision. Metastases or malignant transformation have not been reported.This article presents a series of 17 patients with hibernomas diagnosed and treated at our institution from January 1986 to December 2009. Six men and 11 women (M:F, 1:2) had a mean age of 38 years (range, 10 months to 64 years). All patients underwent surgical treatment; 14 patients had marginal and 3 had wide excision. Adjuvants such as radiation therapy, chemotherapy, or embolization were not administered for any patient. The most common symptom was a painless palpable mass, followed by a tender or painful mass; in 2 patients, the tumor was an incidental finding. The duration of symptoms ranged from 1 month to 10 years (mean, 27 months). The most common location was the thigh, followed by the buttock, scapula, and neck. The most common histological variant was the typical variant followed by the lipoma-like variant. At a mean follow-up of 5 years (range, 1-9 years), local recurrences were not observed.

Acute renal failure in orthopaedic surgery.

Orthopaedic diseases affect a broad spectrum of patients, and many of these have concomitant medical problems that may differ from those of the general surgical population. Acute postoperative renal failure is thought to arise secondary to acute tubular necrosis from volume depletion, reduction in glomerular filtration rate, hypotension, and nephrotoxic drugs. If acute renal failure occurs and necessitates hemodialysis, morbidity and mortality are significantly increased. To enhance the literature, we performed this study to review the rates and risk factors for acute renal failure in orthopaedic surgery. This information may be useful for orthopaedic surgeons and treating physicians during the rehabilitation stage, to provide a rationale to stratify a patient's risk of acute renal failure or death on the basis of perioperative medical factors and type of surgery, or for improved perioperative monitoring, better surveillance, and preventive measures to reduce this risk.

Reproducibility measuring the angle of proximal junctional kyphosis using the first or the second vertebra above the upper instrumented vertebrae in patients surgically treated for scoliosis.

STUDY DESIGN: A historical cohort study. OBJECTIVE: To evaluate the reproducibility of this measure in proximal junctional kyphosis (PJK) and to determine whether differences exist between first and second vertebrae angles. SUMMARY OF BACKGROUND DATA: There are no previous studies on the precision and accuracy of selecting the first or the second vertebra above the upper instrumented vertebrae to determine the degree of spinal angulation after surgery.In several studies, the first or the second vertebrae above the upper instrumented vertebrae (UIV) have been selected to measure the angle of PJK in a surgical setting. However, to our knowledge, no studies have addressed the reliability of this measure.We aimed to evaluate the reproducibility of this measure in PJK and to determine whether differences exist between first and second vertebrae angles. METHODS: A total of 38 randomly ordered radiologic digital images were obtained at 2 different times from 19 consecutive patients (aged 18.4 +/- 6.0 years at intervention) surgically treated for scoliosis. Using these images in a blinded manner, 2 surgeons independently measured angles at both the first and second vertebrae above the UIV. The measures were repeated in different periods to test intra- and intersurgeon concordances. RESULTS: For 152 measures, intrasurgeon concordance correlation coefficients ranged from 0.78 to 0.92 (high to very high reproducibility) and comparative intersurgeon concordance correlation coefficients ranged from 0.55 to 0.80 (moderate to high reproducibility). No differences were found between the first and the second vertebrae angles. CONCLUSION: Good reproducibility and agreement using the first and second vertebrae above the UIV to measure the angle of PJK was found in this study.