Impact of Preoperative Quality of Life and Related Factors on the Development of Surgical Site Infections Following Primary Total Joint Arthroplasty: A Prospective Case-Control Study with a Five-Year Follow-Up.

Introduction: As surgical site infections (SSIs) after joint arthroplasty contribute to increased morbidity and mortality, they require further surgical intervention, prolonged hospitalisation, and antimicrobial treatment. The aim of our study is to examine the association between preoperative quality of life (QoL) and other predictive factors on the development of SSIs after primary arthroplasty. Methods: This is a prospective study that enrolled 56 patients with hip and knee primary osteoarthritis who underwent joint replacement. Data were collected from January to March 2017, including patient demographic characteristics, comorbidities, laboratory results, and perioperative clinical data. The patients' QoL was evaluated preoperatively by applying the knee injury and osteoarthritis outcome score (KOOS) and the hip disability and osteoarthritis outcome score (HOOS) for total knee replacement (TKR) and total hip replacement (THR), respectively. A 5-year follow-up was conducted to assess the clinical status of the patients. Results: 66.1% of patients underwent TKR, with 4.9 ± 1.2 days of hospitalisation, 16% of them required autologous blood transfusion, while 33.9% of patients were treated with THR, with 5.7 ± 1 days hospitalisation and 36.8 of them required this type of transfusion. 16 patients were diagnosed with SSIs, with the older of them (>65 years old) presenting lower probability (odds ratio: 0.13, 95% CI: 0.03-0.62) requiring treatment with additional antibiotics, while revision surgery was performed in 3 of these cases, following periprosthetic joint infection (PJI). Overall preoperative QoL was not statistically associated with SSIs, but low QoL scores were associated with higher rates of SSIs and increased levels of postoperative pain (p = 0.009 < 0.05). Conclusions: The duration of each operation (>90 min), the length of hospitalisation (>4 days), and the presence of comorbidities including hypothyroidism and recurrent urinary tract infections were associated with a high risk for SSIs following arthroplasties. On the contrary, this study revealed no association between other comorbidities, including heart coronary disease, hypertension, and diabetes mellitus, with close monitoring of plasma glucose and SSIs. Moreover, the younger the patients, the more likely they were to require treatment with antibiotics. Overall, high QoL index scores were mainly accompanied by low rates of postoperative SSIs and pain.

Operative treatment of athletic pubalgia in competitive athletes: a retrospective study.

BACKGROUND: Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15 year study reports outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. METHODS: All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients' satisfaction were evaluated. RESULTS: A total of 130 patients (115; 88.5% males and 15; 11.5% females) with a mean age of 26.7±7.5 years were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7±1.7. Three days postoperatively, the mean numeric pain scale was 3.4±1.5, showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27±3.02 weeks. Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up (mean 76.58±46.5 months), a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and two (1.5%) not satisfied with the outcome. CONCLUSIONS: Laparoscopic operative treatment in competitive athletes suffering from athletic pubalgia seems to offer rapid recovery, rapid return to sports, as well as very low complications rate and no recurrence.

Truncal Changes in Patients After Total Hip or Knee Arthroplasty: A Surface Topography Study.

Introduction Total hip and knee arthroplasty (THA/TKA) are among the most successful orthopedic operations performed, aiming at the alleviation of osteoarthritic pain. This report is a surface topography study that assesses the mechanism by which THA or TKA influences truncal parameters. This study represents the first time that surface topography has been used for the assessment of truncal parameters. Methods In total, 15 patients with THA, including nine women and six men, with a mean age of 65.07 ± 9.73 years (range: 47-80 years), and 23 patients with TKA were assessed preoperatively and four and 12 months postoperatively. These patients were also compared with a control group (CG) that included 25 individuals, including 12 women and 13 men, with a mean age of 69.28 ± 10.11 years (range: 55-86 years). The Diers Formetric four-D analysis system was used to calculate several truncal parameters in all planes. Results Data analysis revealed statistically significant differences in the kyphotic angle (°; 56.50→63.57, p < 0.05) and the pelvic obliquity (°; 3.40→1.93, p < 0.05) between measurements at baseline and 12 months after THA. Statistically significant differences were noted for the pelvic obliquity (°; 2.74→1.43, p < 0.05) between measurements at baseline and 12 months after TKA. Conclusions THA and TKA are causes of truncal morphological alterations. THA and TKA improved pelvic obliquity, contributing to correct the posture in the patients.