Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review.

The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.

Comparison of five different fluoroscopic methods for identifying the MPFL femoral footprint.

PURPOSE: The success of medial patellofemoral ligament (MPFL) reconstruction is closely linked to the precise positioning of the femoral tunnel. Intraoperative fluoroscopy is commonly utilized to identify the MPFL footprint. This study aimed to ascertain the most accurate fluoroscopic method among the five previously described methods used to determine the MPFL femoral footprint. MATERIALS AND METHODS: Using 44 well-preserved dry femur bones, the MPFL femoral insertion site was demarcated using anatomical bony landmarks, namely the center of the saddle sulcus between the medial epicondyle, adductor tubercle and gastrocnemius tubercle. Fluoroscopic true lateral knee images were acquired and measurements taken, referencing established methods by Schottle et al., Redfern et al., Wijdicks et al., Barnett et al., and Kaipel et al. The distance between anatomic and fluoroscopic MPFL footprints was then measured on digital fluoroscopic images. The accuracy of the locations was compared using a margin of error of 5 and 7 mm. RESULTS: The Schottle method consistently emerged superior, showcasing the smallest mean distance (3.2 ± 1.2 mm) between the anatomic and radiographic MPFL footprints and a high in-point detection rate of 90.9% under 5 mm criteria. While the Redfern method displayed perfect accuracy (100%) within the 7 mm criteria, the Schottle method also performed 97.7% accuracy. CONCLUSIONS: For intraoperative identification of the MPFL footprint using fluoroscopy, the Schottle method is the most consistent and accurate among the assessed methods. Thus, its accuracy in detecting the MPFL footprint makes it recommended for MPFLR to ensure optimal outcomes. LEVEL OF EVIDENCE: Level IV, cadaveric study.

Peroneus longus tendon autograft versus allograft in revision ACLR: A retrospective comparison.

PURPOSE: The use of peroneus longus tendon (PLT) autografts in primary anterior cruciate ligament reconstruction (ACLR) has increased recently, but there is a lack of research on its use in revision ACLR. This study aimed to compare the clinical outcomes and complications between revision ACLR using allografts and PLT autografts. MATERIALS AND METHODS: Fifty-nine patients who underwent arthroscopic revision of ACLR with complete clinical follow-ups between 2012 and 2021 were retrospectively reviewed. Allograft was used in 44 of these patients, and PLT autograft was used in 15 of them. Lysholm knee score, Tegner activity score, Lachman, and anterior drawer tests were performed after a mean follow-up of 60months (range: 19-116). The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to evaluate the donor ankle functions. Clinical outcomes and complications were compared between groups. RESULTS: Both groups showed significantly improved functional outcomes compared to their preoperative assessments. However, both groups had similar clinical results at the final follow-up, including Lysholm knee score, Tegner activity scale, knee range of motion, return to sports, time to return to daily activities, and rate of re-rupture. No major complications were seen in any of the patients. The AOFAS score was 99.13±2.64 in the PLT autograft group without loss of ankle muscle strength, deformity, instability, and permanent iatrogenic neurovascular injuries. The cumulative cost of the allograft group was significantly higher than the PLT autograft group. CONCLUSIONS: The PLT autograft might be an alternative autograft option to allografts due to similar clinical outcomes, low donor site morbidity, and reduced cost in ACLR revisions, especially if the primary ACLR was performed using grafts harvested around the knee. LEVEL OF EVIDENCE: III; retrospective comparative study.

Validity and reliability of hallux valgus angle measurement on smartphone digital photographs.

BACKGROUND: This prospective study aimed to test the reliability and validity of hallux valgus angle (HVA) measurement on smartphone digital photographs compared with the standard radiographic evaluation. METHODS: Twenty Seven female patients (45 feet) with forefoot deformity were evaluated with weight-bearing anteroposterior foot radiographs and smartphone photographs. Radiographic hallux valgus angle (rHVA) was measured on digital radiographs. Two different photographic HVA measurement methods were used. In the first, the longitudinal axes of the first metatarsal and proximal phalanx were determined, and the angle between these axes was measured (pHVA), similar to the radiographic method. In the other method, the angle of the margo medialis pedis was measured on the photograph (pMMP). Two independent observers performed all measurements twice on two different occasions. Reliability analysis was performed using the interclass correlation coefficient. Agreement between the measurements was tested using Bland-Altman analysis. RESULTS: The repeated rHVA, pHVA and pMMP measurements showed excellent intra and inter-observer reliability, with ICC values above 0.900. The mean rHVA, pHVA, and pMMP were statistically similar (p:0.929, 27.03°±8.7°, 27.11°±8.8° and 26.5°±9.0° respectively). The mean difference between the rHVA and pHVA was - 0.07°±5.1° (range, --9.67 to 9.56°), and the mean difference between the rHVA and pMMP was 0.53°±4.4° (range, -9.76° to 8.22°). There was a strong positive correlation between both photographic methods and radiographic measurements (rho = 0.809, p = 0.001 and rho = 0.872, p = 0.001). In the Bland Altman plot, the upper and lower LOAs (95%CI) ranged from - 10.11° to 9.93° for rHVA and pHVA, and from - 8.26° to 9.33° for rHVA and pMMP. Linear regression analysis showed a proportional bias for pHVA but not for the pMMP (p:0.010 versus p:0.633, respectively). The range of the mean difference (prediction interval) between the pMMP and rHVA was 17.59° and 20° for pHVA and rHVA. Simple linear regression showed that the rHVA was predicted by the following equation: rHVA = 4.73 + 0.84 × pMMP (r2 = 0.761, p < 0.001). CONCLUSIONS: Although measuring HVA through smartphone photographs is reliable, it is not a valid prediction method. LEVEL OF EVIDENCE: Level II, diagnostic assessment.

Complications of peroneus longus tendon harvesting: a retrospective review of 82 cases.

OBJECTIVE: Peroneus longus tendon (PLT) has become a reliable autologous graft option for various ligament reconstructions. But there are potential risks and complications associated with its use as a graft. This retrospective study aimed to examine the complications and donor site morbidity following PLT harvesting. PATIENTS AND METHODS: A retrospective review was performed on an institutional digital patient database, and all patients who underwent ligament reconstruction using PLT autograft were identified. Intraoperative, early, and late complications were reviewed using digital patient notes and patients underwent a complete physical examination during their final follow-up. Ankle function was assessed using the AOFAS score, and manual ankle muscle testing was performed on both sides. Sural nerve iatrogenic injury was evaluated with a dermatomal light touch examination. Cosmetic satisfaction due to incision scar and footwear complaints were also assessed. RESULTS: 82 patients (74 male, eight female) with a mean age of 31.9 ± 10.4 years (range, 16-66) were included in the final analysis. The mean follow-up time was 46.6 ± 30.3 months (range, 6-109). The mean AOFAS score for the donor side was 98.7 ± 3.3 (range, 87-100), and the contralateral side score was 100, with manual muscle testing graded as 5 in all movements and similar to the contralateral side. Fifteen patients (18.3%) had hypoesthesia over the dorsolateral aspect of the foot distal to the incision scar, two patients (2.4%) had hyperalgesia over the distal incision scar, and one patient (1.2%) had mild ankle instability. There were two cases (2.4%) of compartment syndrome, both of which were treated with fasciotomy and had complete regression of symptoms after 5 days. One patient (1.2%) had a transient peroneal nerve injury and foot drop that resolved in the sixth month. CONCLUSIONS: The results of this retrospective study suggest that harvesting the PLT is associated with a high rate of complications and donor site morbidity. The most common complication was hypoesthesia around the lateral side of the foot, although the ankle functions were not affected significantly. Two cases of compartment syndrome and one transient peroneal nerve injury were observed. Care should be taken while harvesting PLT autograft, and it should be kept in mind that peroneal nerve injury might occur. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Intermittent pedicle screw application provides better kyphosis restoration in adolescent idiopathic scoliosis for Lenke type 1 and type 2 curves.

PURPOSE: There is still no consensus on the optimum pedicle screw density required for the desired thoracic kyphosis restoration in adolescent idiopathic surgery (AIS). The aim of this study to evaluate the effect of pedicle screw density on thoracic kyphosis restoration in AIS surgery. METHODS: The data of 106 patients from two centers that operated for Lenke type 1 and 2 AIS were retrospectively reviewed. Two groups were constituted according to the pedicle screw density: intermittent pedicle screw constructs (IPSC) (n = 52 patients) and consecutive pedicle screw construct (CPSC) (n = 54 patients) groups. The preoperative and at least 24-month follow-up radiographs and SRS-22 scores were evaluated. The Cobb angle of the main and concomitant curves in the coronal plane and the sagittal plane were measured and compared. RESULTS: The mean follow-up period for the IPSC and CPSC groups was 72.3 ± 37.2 and 62.9 ± 28.8 months, respectively. In the SRS-22 questionnaire, there was no significant difference between the two groups in terms of self-image/appearance domain scores (p = 0.466), but better results were obtained in the IPSC group in terms of treatment satisfaction domain scores (p = 0.010) and better thoracic kyphosis restoration was achieved in IPSC group radiologically for Lenke type 1 curves with - 81.4 ± 81.4% in the IPSC group and 6.8 ± 83.8% in the CPSC group (p < 0.001). CONCLUSION: It was considered that better thoracic kyphosis restoration could be achieved with the less lordotic effect of IPSC in Lenke type 1 curves. Although the current situation had a significant impact on radiological outcomes, its effect on SRS-22 scores was limited.

Influence of Surface Forces on Membrane Separations.

This Special Issue of Membranes, entitled "Influence of Surface Forces on Membrane Separation", is published in honour of Professor Victor Mikhailovich Starov, Doctor of Science in Chemistry, Fellow of the Royal Society of Chemistry [...].

Photocatalytic, self-cleaning and antibacterial properties of Cu(II) doped TiO2.

In the study, sol-gel based TiO2 nanoparticles (NPs) were doped by Cu(II), and the surface of cotton fabric was coated with Cu-doped TiO2 NPs to develop self-cleaning and antibacterial properties. Coffee stains were introduced on the modified cotton fabric and under suntest illumination; a decrease in the color of coffee stain was followed over time via K/S value to determine self-cleaning performance. The photocurrent in a photoelectrocatalytic reactor was measured to evaluate the photocatalytic effect of Cu(II) doping. TiO2 NPs showed self-cleaning and antibacterial effects under UV-illuminated conditions. However, no effects were observed under dark (non-illuminated) conditions. The modified textiles with Cu(II) doped TiO2 NPs showed antibacterial activity against E. coli under light and dark conditions. Under the 2 h illumination period, fluctuating color changes were observed on the raw cotton fabric, and stains remained on the fabric while 78% and 100% color removals were achieved in the cotton fabrics coated by Cu doped TiO2 NPs in 1 h and 2 h, respectively.

Recovery of Biologically Treated Textile Wastewater by Ozonation and Subsequent Bipolar Membrane Electrodialysis Process.

The Bipolar Membrane Electrodialysis process (BPMED) can produce valuable chemicals such as acid (HCl, H2SO4, etc.) and base (NaOH) from saline and brackish waters under the influence of an electrical field. In this study, BPMED was used to recover wastewater and salt in biologically treated textile wastewater (BTTWW). BPMED process, with and without pre-treatment (softening and ozonation), was evaluated under different operational conditions. Water quality parameters (color, remaining total organic carbon, hardness, etc.) in the acid, base and filtrated effluents of the BPMED process were evaluated for acid, base, and wastewater reuse purposes. Ozone oxidation decreased 90% of color and 37% of chemical oxygen demand (COD) in BTTWW. As a result, dye fouling on the anion exchange membrane of the BPMED process was reduced. Subsequently, over 90% desalination efficiency was achieved in a shorter period. Generated acid, base, and effluent wastewater of the BPMED process were found to be reusable in wet textile processes. Results indicated that pre-ozonation and subsequent BPMED membrane systems might be a promising solution in converging to a zero discharge approach in the textile industry.

Desalination and Detoxification of Textile Wastewater by Novel Photocatalytic Electrolysis Membrane Reactor for Ecosafe Hydroponic Farming.

In this study, a novel photoelectrocatalytic membrane (PECM) reactor was tested as an option for the desalination, disinfection, and detoxification of biologically treated textile wastewater (BTTWW), with the aim to reuse it in hydroponic farming. The anionic ion exchange (IEX) process was used before PECM treatment to remove toxic residual dyes. The toxicity evaluation for every effluent was carried out using the Vibrio fischeri, Microtox® test protocol. The disinfection effect of the PECM reactor was studied against E. coli. After PECM treatment, the 78.7% toxicity level of the BTTWW was reduced to 14.6%. However, photocatalytic desalination during treatment was found to be slow (2.5 mg L-1 min-1 at 1 V potential). The reactor demonstrated approximately 52% COD and 63% TOC removal efficiency. The effects of wastewater reuse on hydroponic production were comparatively investigated by following the growth of the lettuce plant. A detrimental effect was observed on the lettuce plant by the reuse of BTTWW, while no negative impact was reported using the PECM treated textile wastewater. In addition, all macro/micronutrient elements in the PECM treated textile wastewater were recovered by hydroponic farming, and the PECM treatment may be an eco-safe wastewater reuse method for crop irrigation.

Chloride or sulfate? Consequences for ozonation of textile wastewater.

Ozonation of chloride-rich textile wastewater is a common pretreatment practice in order to increase biodegradability and therefore meet the discharge limits. This study is the first to investigate ozone-chloride/bromide interactions and formation of hazardous adsorbable organic halogens (AOX) in real textile wastewater. Initially effect of ozonation on chloride-rich real textile wastewater samples were investigated for adsorbable organic halogens (AOX) formation, biodegradability and toxicity. After 15 min of ozonation, maximum levels of chlorine/bromine generation (0.3 mg/l) and AOX formation (399 mg/l) were reached. OUR and SOUR levels both increased by approximately 58%. Daphnia magna toxicity peaked at 100% for 10 min ozonated sample. Considering adverse effects of ozonation on chloride-rich textile industry effluents, we proposed replacement of NaCl with Na2SO4. Comparative ozonation experiments were carried out for both chloride and sulfate containing synthetic dyeing wastewater samples. Results showed that use of sulfate in reactive dyeing increased biodegradability and decreased acute toxicity. Although sulfate is preferred over chloride for more effective dyeing performance, the switch has been hampered due to sodium sulfate's higher unit cost. However, consideration of indirect costs such as contributions to biodegradability, toxicity, water and salt recovery shall facilitate textile industry's switch from chloride to sulfate.

Disinfection and formation of disinfection by-products in a photoelectrocatalytic system.

In this study, disinfection and formation of disinfection by-products (DBPs) were studied in a photoelectrocatalytic (PEC) treatment system. Disinfection performance of titanium dioxide (TiO(2)) in the PEC system was determined through Escherichia coli (E. coli) inactivation. Humic acid (HA) was used as a model organic compound and its removal was monitored by total organic carbon (TOC) measurements using 410 nm (color) and 254 nm (UV(254)) wavelengths. Trihalomethanes (THMs) were measured for the evaluation of DBPs formation during PEC treatment of chloride and HA mixture. It was found that unlike photocatalytic treatment, THMs might form in the PEC system. To investigate the effects of anions on the PEC treatment, chloride (Cl(-)), sulfate (SO(4)(2-)), phosphoric acid (H(2)PO(4)(-))/hydrogen phosphate (HPO(4)(2-)) and bicarbonate (HCO(3)(-)) ions were added separately to the HA and bacterial suspensions. Presence of H(2)PO(4)(-)/HPO(4)(2-) and HCO(3)(-) ions resulted in inhibitory effects on both HA degradation and E. coli inactivation, which were also examined in the photoanode. It was observed that the presence of HA had a strong inhibitory effect on the disinfection of E. coli.

Photocatalytic and photoelectrocatalytic humic acid removal and selectivity of TiO(2) coated photoanode.

In this study, photocatalytic (PC) and photoelectrocatalytic (PEC) treatment methods were comparatively investigated as a possible means of removing humic acid (HA) following absorbance at 254 nm (UV(254)) and total organic carbon (TOC) analysis. The enhanced HA degradation rates were obtained in the PEC system over the conventional PC process under acidic, neutral and alkaline conditions. Preliminary and binary experiments were performed to determine the selectivity of the photoanode in terms of HA and chloride oxidation. TOC, chlorine and photocurrent parameters proved that HA was selectively removed before chlorine generation. The inhibitory effect of carbonate ions on the performance of photoanode was also studied under different pH values.

The effect of pre-ozone oxidation on acute toxicity and inert soluble COD fractions of a textile finishing industry wastewater.

The present work evaluates pre-ozonation for removal of acute toxicity, color and COD as well as reduction of inert soluble COD fractions in two wastewater samples (S1 and S2) taken from a textile finishing industry, located in Istanbul (Turkey). The wastewater samples were oxidized at original pH of 8.6-8.8 under 18.5-24 mg/L of applied ozone doses. Acute toxicity was monitored using Daphnia magna. The results showed that pre-ozonation improved the biodegradability and reduced the acute toxicity. Acute toxicity in raw wastewaters was reduced by 80-90% using 129-200 mg/L transferred ozone (TrO(3)) concentrations. At this point, 86-96% of color, 33-39% of soluble COD and 57-64% of total COD were removed from wastewaters. Both color and COD parameters were found related to the acute toxicity of the wastewater. Pre-ozonation decreased the inert soluble COD fraction (S(I)) of raw wastewater while soluble product formation (S(P)) increased slightly (5-10 mg/L). However, residual COD (the sum of S(I) and S(P)) remained below discharge limit.

Bromate formation on the non-porous TiO2 photoanode in the photoelectrocatalytic system.

The increasing use of ozone in water disinfection processes has been the focus of considerable concern in regards to inorganic disinfection by product formation of bromate in waters containing bromide. Due to the public health risk caused by the presence of bromate as a suspected carcinogen, attention had been addressed to the conditions under which bromate is formed. In this study, photoanodic bromine generation and bromate (BrO(3)(-)) formation were investigated using a TiO(2) electrode in a photoelectrocatalytic (PEC) treatment process. The separation of anodic and cathodic reactions in the PEC system resulted in a pH decrease from 9.3 to 3.0 in the photoanode compartment and an increase to 11.0 in the cathode compartment. Under a photo-illumination intensity of 5.7 m W cm(-2) UV, a biasing potential of +1.0V vs SCE, a pH of 6.0 and at a NaBr concentration of 1.0 x 10(-2) M, active bromine formation increased over time with 2.4 x 10(-6) M min(-6) rate and reached a steady-state concentration of 1.44 x 10(-4) M in 60 min. Bromate formation was detected after a lag-period of 15 min and exhibited a continuous increasing trend with respect to irradiation time. No bromate formation was observed below pH 6.5 whereas an increasing bromate concentrations and pH up to pH=8.5 were noted.

Acute toxicity removal in textile finishing wastewater by Fenton's oxidation, ozone and coagulation-flocculation processes.

This study evaluates the effectiveness of Fenton's oxidation (FO) process and ozone (O3) oxidation compared with a coagulation-flocculation (CF) process to remove effluent toxicity as well as colour and COD from a textile industry wastewater. Daphnia magna was used to test acute toxicity in raw and pre-treated wastewater. The operational parameters for each process were determined on the basis of complete toxicity removal. The FO process removed COD at a higher rate (59%) than O3 (33%) while colour removal was similar (89% and 91%, respectively). The CF process removed both COD and colour at rates similar to the FO process. A colour range of 150-250 platin-cobalt (Pt-Co) unit was assessed for toxicity.

Photoelectrocatalytic production of active chlorine on nanocrystalline titanium dioxide thin-film electrodes.

The production of chlorine and hypochlorite is of great economical and technological interest due to their large-scale use in many kinds of commercial applications. Yet, the current processes are not without problems such as inevitable side reactions and the high cost of production. This work reports the photoelectrocatalytic oxidation of chloride ions to free chlorine as it has been investigated by using titanium dioxide (TiO2) and several metal-doped titanium dioxide (M-TiO2) material electrodes. An average concentration of 800 mg L(-1) of free chlorine was obtained in an open-air reactor using a TiO2 thin-film electrode biased at +1.0 V (SCE) and illuminated by UV light. The M-doped electrodes have performed poorly compared with the pure TiO2 counterpart. Test solutions containing 0.05 mol L(-1) NaCl pH 2.0-4.0 were found to be the best conditions for fast production of free chlorine. A complete investigation of all parameters that influence the global process of chlorine production by the photo electrocatalytic method such as applied potential, concentration of NaCl, pH solution, and time is presented in detail. In addition, photocurrent vs potential curves and the reaction order are also discussed.

Behavior of bromide in the photoelectrocatalytic process and bromine generation using nanoporous titanium dioxide thin-film electrodes.

In this study, the photoelectrocatalytic behavior of bromide and generation of bromine using TiO2 was investigated in the separate anode and cathode reaction chambers. Our results show that the generation of bromine begins around a flatband potential of -0.34 V vs. standard calomel electrode (SCE) at pH 3.0 under UV illumination and increases with an increase in positive potential, finally reaching a steady-state concentration at 1.0 V vs. SCE. Maximum bromine formation occurs over the range of pH 4-6, decreasing sharply at conditions where the pH>7.