[Results of one-stage endoprosthesis revision in periprosthetic infection cause by methicillin-resistant Staphylococcus aureus]. / Ergebnisse einzeitiger Endoprothesenwechsel bei periprothetischer Infektion durch einen methicillin-resistenten Staphylococcus aureus (MRSA).

OBJECTIVE: Are the results of one-stage exchange arthroplasties to treat periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) comparable to bacteriologically unselected studies of one-stage exchange operations? METHOD: From 1996 to 1997 twenty patients with a periprosthetic infection caused by methicillin-resistant Staphylococcus aureus (MRSA) were treated at the ENDO-Klinik by an one-stage exchange arthroplasty. Mean follow-up of fifteen one-stage exchange total hip replacements and 5 one-stage exchange total knee replacements was 16 months. The patients were examined by means of clinical, laboratory-chemical and radiological tests. In addition, postoperative joint aspiration was performed on 14 patients. RESULTS: In 11 cases (61%) the periprosthetic infection was treated successfully with only one one-stage exchange operation. In cases with persisting infection the period between the first exchange arthroplasty and the repeated clinical manifestation of the infection (second exchange operation) was 2 months on average. 93% of the joint aspirations (n = 14), performed on average 4 weeks postoperatively, correlated with the result of the follow-up tests. CONCLUSION: Periprosthetic infection with MRSA is a problematic infection. Because of the reduced therapeutic possibilities it is associated with a higher rate of recurrence than the unselected group of patients as a whole [6, 11, 16, 17, 19, 20]. The authors recommend one-stage exchange arthroplasty using a combination of vancomycin and ofloxacin as admixture to polymethylmethacrylat (Refobacin Palacos R). This procedure does, however, need further development. Intraoperative use of an antiseptic and systemic administration of rifampicin, as recommended by Zimmerli [23] is a further possibility.

Effects of selective tachykinin-receptor antagonists on tachykinin-induced airway mucus secretion in the rat.

Tachykinins like substance P (SP), neurokinin A (NKA), neurokinin B (NKB) differentially stimulate airway mucus secretion with the following rank order of potency in rat trachea: SP>NKA>NKB. These differential actions are most likely due to different affinities to the tachykinin receptors, termed neurokinin (NK)(1), NK(2)and NK(3). In this study we characterized the receptor subtype responsible for the differential secretagogue effects in rat trachea by means of selective receptor antagonists and receptor agonists.SR 140333 [NK(1)-antagonist] completely inhibited SP action (283,29+/-21, 12%-->84,53+/-4, 09%; P<0,01) and significantly reduced the effects of NKA (179,08+/-17,34%-->118,86+/-6,7%; P<0,01) and NKB (171,89+/-5, 75%-->109,5+/-4,11%; P<0,01). SR 48968 [NK(2)-antagonist] did not affect SP action, but reduced the effects of NKA and NKB. SR 142801 [NK(3)-antagonist] did not change any effect of SP, NKA or NKB. [Sar(9)]SP (NK(1)-agonist) caused strong dose-dependent secretagogue effects similar to SP, [betaAla(8)]NKA (NK(2)-agonist) showed only slight and [Pro(7)]NKB (NK(3)-agonist) no effects. The present data suggest that the secretagogue effects elicited by tachykinins in rat trachea are mediated via NK(1)receptors.

[Intraoperative leg length measurement in total hip endoprosthesis]. / Intraoperative Beinlängenmessung bei totaler Hüftendoprothese.

Preservation or restoration of the equal length of both legs after total hip arthroplasty is best achieved by direct intraoperative measurement. The measuring instruments designed for this purpose are presented and their application described for the posterior approach to the hip. The instruments are easy and quick to use. They can also be used for other approaches to the hip and in addition they are a valuable aid when estimating the angles of anteversion and inclination of the acetabular component. The high degree of accuracy and the significant improvement in results when this instrument was used intraoperatively was confirmed by comparison of radiographic measurements of two operation series.

[Mid- to long-term results after treatment of 118 cases of periprosthetic infections after knee joint replacement using one-stage exchange surgery]. / Mittel- bis langfristige Ergebnisse nach Behandlung von 118 periprothetischen Infektionen nach Kniegelenkersatz durch einzeitige Austauschoperation.

From 1976 to 1985, 157 periprosthetic infections after knee arthroplasty were treated surgically at the ENDO-Klinik in Hamburg. Of these, 118 cases underwent one-stage revision arthroplasty using specific antibiotic-loaded cement; 104 were available for analysis after a postoperative follow-up period of 5-15 years. Seventy-six cases were cured as a result of this single operation. This number was increased to 84 by a repeated operation in cases that had failed to respond to therapy. In 20 cases one-stage revision arthroplasty failed in the treatment of periprosthetic infections after replacement of the knee joint.