Thalidomide prolongs survival after experimental musculoskeletal injury, through an effect on mononuclear apoptosis.

BACKGROUND: This study was conducted to investigate the effects of intravenous thalidomide administration in an experimental model of musculoskeletal trauma. We hypothesized that because thalidomide inhibits secretion of tumor necrosis factor alpha (TNF-α), survival of animals that received thalidomide would be significantly prolonged. MATERIAL AND METHODS: After an open fracture of the right femur, 24 rabbits were randomly assigned to control and thalidomide groups. Intravenous therapy with thalidomide was started 30 min after fracture. Hemodynamic monitoring of all animals was performed for 4 h. Survival was recorded and bacterial growth in blood and organs was measured after animal death or sacrifice. Blood was sampled for TNF-α measurement and for isolation of peripheral blood mononuclear cells (PBMCs). Apoptosis of PBMCs was measured by flow cytometry. RESULTS: Survival was significantly prolonged in the thalidomide group. Apoptosis of PBMCs was increased in the control group compared with the thalidomide group at 24 h. There were no differences in vital signs, blood and tissue cultures, and serum TNF-α concentration between the two groups. CONCLUSIONS: Intravenous thalidomide prolonged survival in an experimental model of severe musculoskeletal injury in rabbits. Its mechanism of action did not involve TNF-α suppression but prevention of mononuclear apoptosis. In view of these promising results, further research is needed to clarify the immunomodulatory mechanism of action of thalidomide and its potential use for the management of severe trauma.

A novel technique for femoral canal occlusion during cement pressurization in proximal femoral arthroplasty.

We describe a novel technique for occluding the femoral canal distal to the isthmus during proximal femoral arthroplasty. Synthetic bone models were reamed and sectioned to simulate loss of the proximal femur. Two experimental conditions were used. The first used no restrictor to act as a control. The second used calcium sulphate pellets impacted in distal femoral canal. A 100 × 12 mm Limb Preservation System stem (DePuy, Leeds, UK) was used in all experiments. We recorded cement pressure, leakage of cement, and penetration of cement into the femoral condyles. The calcium sulphate pellets prevented cement leakage, enabled higher cementing pressures, and prevented penetration of the cement into the femoral condyles. We would recommend this technique in cases where loss of proximal femoral bone loss requires the use of a cemented proximal femoral replacement.

Polymethylmethacrylate arteriography--A complication of total hip arthroplasty.

We report a complication of contemporary cementing technique in total hip arthroplasty, that is, extensive retrograde filling with polymethylmethacrylate cement of the nutrient artery of the femur.

Poor predictive value of broad-range PCR for the detection of arthroplasty infection in 92 cases.

BACKGROUND: The diagnosis of prosthetic infection remains a challenge, as no test is 100% sensitive and 100% specific. Recent advances in molecular biology have enabled the detection of infection in culture negative cases. PATIENTS AND METHODS: We evaluated the effectiveness of polymerase chain reaction (PCR) in detecting infection in failed joint replacements prospectively in 91 consecutive patients (92 prosthetic joints) undergoing revision total hip or knee arthroplasty. Synovial fluid was collected intraoperatively and examined by broad-range PCR assay for detection of bacterial DNA. The clinical diagnosis of infection was based on the results of blood tests, preoperative joint aspiration, culture and histology of multiple intraoperative tissue samples, as well as the surgeon's assessment. 12 joints (13%) were infected, but the PCR was positive in 32 cases. The sensitivity of the technique was 92%, the specificity 74%, the accuracy 76%, the positive predictive value 34%, and the negative predictive value was 98%. INTERPRETATION: The PCR technique cannot be recommended for the routine detection of prosthetic infection. The large number of false positive results may represent sample contamination, or bacterial presence related to low-virulence organisms, low bacterial load, or a strong host immune response.

Suction dressings in total knee arthroplasty--an alternative to deep suction drainage.

A new technique is described for dressing of surgical wounds in total knee arthroplasty that is a combination of a semi-permeable dressing and suction drainage. This technique has been used in 100 consecutive cases and drainage was collected in 92. The average volume was 198 ml (range 30 to 850 ml). There was no superficial or deep sepsis. Haematoma formation causing moderate soft tissue tension and some patient discomfort was noted in 9 knees. This form of postoperative wound management retains the nursing and hygiene advantages of deep suction drainage, whilst avoiding the patient discomfort and potential complication possibilities associated with deep internal drainage.

Fracture of the femoral component of a Brigham unicompartmental knee: a case report.

We report the failure of a femoral component in a unicompartmental knee replacement 6 years after implantation. The implant fractured 15 mm from the anterior tip, and scanning electron microscopy confirmed fatigue to be the cause of failure. The clinical and laboratory findings are presented, and the causes and implications of this mode of implant failure are discussed.

Fixation of Chevron trochanteric osteotomy with two wire loops in isolated acetabular component revision.

The use of two wire loops for fixation of the trochanteric fragment after Chevron osteotomy in revision THA achieves stable fixation with minimal hardware.

Rapid sequence quadruple joint replacement in a rheumatoid Jehovah's Witness.

We report the case of a wheelchair-bound rheumatoid Jehovah's Witness who underwent rapid sequence, staged, simultaneous ipsilateral hip and knee replacements. Using perioperative erythropoietin and postoperative blood salvage, all four joints were reconstructed without homologous blood transfusion. One year following surgery, the patient has achieved an independent functional status, and all four replaced joints remain painless.