The autoclaving and re-implantation of an infected prosthesis as a spacer during resection knee arthroplasty: a systematic review.

BACKGROUND: Hofmann et al., in 1995, first described an articulating spacer made by cleaning and autoclaving the original femoral component, which is then re-implanted with a new tibial polyethylene. This systematic review aims to assess the state of existing evidence on the intraoperative autoclaving and re-use of an infected prosthesis, as a spacer, during a two-stage revision following Periprosthetic Joint Infections (PJI). METHODS: A systematic review was conducted with methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Web of Science, Google Scholar and PubMed were searched from 1995 to April 2020 to identify relevant studies. RESULTS: Fourteen studies were included in this systematic review: two prospective case series; six retrospective comparative studies and six retrospective case series. The reviewed studies included 567 patients (571 knees): 394 patients treated with autoclaved components and 173 with a spacer made of new components. The cumulative re-infection rate in patients treated with re-used autoclaved components was 13.7% (54 re-infections in 394 patients), whereas in control patients the re-infection rate was 13.3% (23 re-infections in 173 patients). The final Range of Movement in patients treated using the autoclaved components as a spacer, compared with patients receiving static spacers, was significantly higher in three out of four comparative studies. CONCLUSION: There is a moderate level of evidence that the intraoperative autoclaving and re-use of an infected prosthesis as a spacer, during a knee resection arthroplasty, is an effective procedure in the management of knee PJI.

Revision Strategy of Symptomatic Lumbar Adjacent Segment Degeneration: Full Endoscopic Decompression versus Extended Posterior Interbody Fusion.

OBJECTIVE: We evaluated the clinical and imaging outcomes of full endoscopic lumbar decompression (FELD) compared with extended posterior lumbar interbody fusion (PLIF) for adjacent segment degeneration (ASD) after fusion surgery and developed a revision strategy. METHODS: The present retrospective study enrolled 65 patients with ASD who had undergone FELD (n = 31) or extended PLIF (n = 34) from January 2014 to January 2018. Clinical evaluations had been performed preoperatively and at 3, 12, and 24 months postoperatively and included the Oswestry disability index, Japanese Orthopaedic Association score for function assessment, and visual analog scale scores for pain. Imaging evaluations were performed preoperatively, immediately after surgery, and at the last follow-up examination. RESULTS: No significant differences were found in the baseline data between the FELD and PLIF groups (P > 0.05), except for the proportion of patients with radiographic adjacent segment instability (P < 0.05). The mean operative time, blood loss, and length of hospital stay were significantly decreased for the FELD group (P < 0.001). For patients with stable ASD, no significant differences were found in the clinical outcome between the 2 groups (P > 0.05). The PLIF group had significantly restored disc height after surgery (P < 0.05). For patients with unstable ASD, the low back and leg pain of the PLIF group were more significantly relieved compared with the FELD group within 3-24 months postoperatively (P < 0.05). The function of the PLIF group had significantly improved within 12 months postoperatively (P < 0.05). CONCLUSIONS: The use of FELD achieved satisfactory outcomes for the treatment of radiographic stable ASD, which were not worse than those with PLIF. With less trauma and faster recovery, FELD could be an alternative option.

Revision strategy for malunited tibial plateau fracture caused by failure of initial treatment.

OBJECTIVE: The aim of this study was to evaluate our treatment algorithm and results in revision surgery of malunited tibial plateau fracture after failure of initial treatment. METHODS: Our revision strategy was as follows: First, we determined the presence of any infection. Second, we determined whether the patient required total knee arthroplasty (TKA). Third, based on the characteristics of the tibial plateau fracture malunion, patients underwent one of the following surgical methods to achieve reduction: original fracture line osteotomy, tibial tubercle + original fracture line osteotomy, fibula head + original fracture line osteotomy, and metaphyseal open window reduction rod technique. The results was assessed with healing time, Rasmussen score, knee range of motion and complication rates. RESULTS: A total of 25 patients 16 men and 9 women; Mean age: 47.4 years (range: 35-63 years) underwent tibial plateau fracture revision operation. The time interval between the two surgeries was 2-24 months. The follow-up time was 12-30 months, and the operation time was 120-300 min. All patients received bone union at the last follow-up. The healing time was 3-6 months. The postoperative Rasmussen score was 19-29 (mean 23.8) compared with 14.4 points before the operation (p < 0.05). The postoperative knee joint activity was 60-110° (mean 95.0°), compared with 57.8° before the operation (p < 0.05). Six patients still had a 2-mm collapse on the articular surface, and 4 patients still had slight valgus (<5°). Except for 2 TKA cases, fracture reduction was excellent in 15 cases and good in 8 cases, with a good rate of 100%. Superficial wound infections occurred in 3 patients. CONCLUSION: Because revision of tibial plateau fracture malunion caused by failure of initial treatment is difficult, it is necessary to create a detailed surgical plan before the operation. Satisfactory clinical effects can be obtained if the correct revision strategy is used. The key to success is adopting a proper revision strategy according to the unique characteristics of the patient's tibial plateau fracture malunion. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Screening of pollution control and clean-up materials for river chemical spills using the multiple case-based reasoning method with a difference-driven revision strategy.

In-depth filtering of emergency disposal technology (EDT) and materials has been required in the process of environmental pollution emergency disposal. However, an urgent problem that must be solved is how to quickly and accurately select the most appropriate materials for treating a pollution event from the existing spill control and clean-up materials (SCCM). To meet this need, the following objectives were addressed in this study. First, the material base and a case base for environment pollution emergency disposal were established to build a foundation and provide material for SCCM screening. Second, the multiple case-based reasoning model method with a difference-driven revision strategy (DDRS-MCBR) was applied to improve the original dual case-based reasoning model method system, and screening and decision-making was performed for SCCM using this model. Third, an actual environmental pollution accident from 2012 was used as a case study to verify the material base, case base, and screening model. The results demonstrated that the DDRS-MCBR method was fast, efficient, and practical. The DDRS-MCBR method changes the passive situation in which the choice of SCCM screening depends only on the subjective experience of the decision maker and offers a new approach to screening SCCM.