Mental disorders in particular depression and anxiety have been reported to be prevalent among patients with spinal pathologies. Goal of the current study was to analyze the relationship of Zung pre- and post-op score to other PROs and length of stay. Secondary outcomes included revision surgery and post-operative infections. Data from the international multicenter prospective spine degenerative surgery data repository, DegenPRO v1.1 (AO Spine Knowledge Forum Degenerative) were utilized. Patients undergoing cervical or lumbar procedure were included. Patient's demographics, Charlson Comorbidity Index, surgical information, Zung score, NDI, pain related PROs and EQ-5D, and complications at surgery and at various post-op time periods. Except for hospital duration, data were analyzed, using multivariable mixed linear models. A robust linear regression model was used to assess the association between Zung score and hospital duration. All models were adjusted for gender and age. 42 patients had Zung score administered. Among those patients 22 (52%) were within normal range, 18 (43%) were mildly and 2 (5%) severely depressed. 62% of the patients had a lumbar pathology with fusion procedures being the most common. Median EQ-5D (3L) score at surgery was significantly higher (0.7, IQR: 0.4-0.7) for patients within normal range than for those with mild (0.4, IGR: 0.3-0.7) or severe depression (0.3, IQR: 0.3-0.3, p-value: 0.05). Compared to patients within normal Zung range, mixed models, indicated lower EQ-5D (3L) score values and higher values for neck and arm pain at surgery with both PROs and EQ-5D (3L) improving in patients with depression over the follow-up time. No association was found between Zung score and hospital length of stay. The initial analysis showed that 43% of the patients were mildly depressed and mainly male patients. Zung score was correlated with post-operative improvements in EQ-5D and arm and neck pain PROs.
Prosthetic joint infection (PJI) is the most common cause of arthroplasty failure. However, infection is often difficult to detect by conventional bacterial cultures, for which false-negative rates are 23% to 35%. In contrast, 16S rRNA metagenomics has been shown to quantitatively detect unculturable, unsuspected, and unviable pathogens. In this study, we investigated the use of 16S rRNA metagenomics for detection of bacterial pathogens in synovial fluid (SF) from patients with hip or knee PJI. We analyzed the bacterial composition of 22 SF samples collected from 11 patients with PJIs (first- and second-stage surgery). The V3 and V4 region of bacteria was assessed by comparing the taxonomic distribution of the 16S rDNA amplicons with microbiome sequencing analysis. We also compared the results of bacterial detection from different methods including 16S metagenomics, traditional cultures, and targeted Sanger sequencing.Objectives
Methods
Prosthetic joint infection (PJI) diagnosis is a major challenge in orthopaedics, and no reliable parameters have been established for accurate, preoperative predictions in the differential diagnosis of aseptic loosening or PJI. This study surveyed factors in synovial fluid (SF) for improving PJI diagnosis. We enrolled 48 patients (including 39 PJI and nine aseptic loosening cases) who required knee/hip revision surgery between January 2016 and December 2017. The PJI diagnosis was established according to the Musculoskeletal Infection Society (MSIS) criteria. SF was used to survey factors by protein array and enzyme-linked immunosorbent assay to compare protein expression patterns in SF among three groups (aseptic loosening and first- and second-stage surgery). We compared routine clinical test data, such as C-reactive protein level and leucocyte number, with potential biomarker data to assess the diagnostic ability for PJI within the same patient groups.Objectives
Methods
The objective of this study is to determine an optimal antibiotic-loaded
bone cement (ALBC) for infection prophylaxis in total joint arthroplasty
(TJA). We evaluated the antibacterial effects of polymethylmethacrylate
(PMMA) bone cements loaded with vancomycin, teicoplanin, ceftazidime,
imipenem, piperacillin, gentamicin, and tobramycin against methicillin-sensitive Objectives
Methods
Two-stage reconstructive technique has been proved to be a safe and effective method in the treatment of deep infection of hip joint implants. Between stages, however, the patients may be uncomfortable with limited mobility and activity because the joint function is severely restricted by the removal of the infected prosthesis and a thorough debridement. Furthermore, the delayed reimplantation procedure after a Girdlestone-like surgery is often complicated by shortening, bone loss, and dislocation due to scar formation, disuse osteoporosis, and distorted tissue planes. We reported the technical details of a new method to make a cement-on-cement prosthesis as a temporary spacer for the period between resection and reimplantion. The doughy cement, mixed with antibiotics, was introduced into a metal mold made with the shape of a unipolar prosthesis to form the femoral component. Several large K-wires were placed in the mold in advance to act as strut support in order to prevent late fracture of the cement prosthesis. The remained cement was put into the acetabular cavity and molded into a hemispherical shape with a retrieved unipolar prosthesis of identical femoral head size. After consolidation of the cement, the femoral component was taken out from the metal mold and implanted into the femoral canal with fixation by antibiotic-loaded cement on the proximal portion. Between the year 1999 and 2000, we have treated 42 infected hip implants by this technique with few complications. This new molding method has been a routine procedure in our practice. We believe it to be a simple, safe, and inexpensive way to eradicate local infection and provide comfort and mobility for the patient and an easier reimplantation procedure for the surgeon.
The periacetabular osteotomies are effective but technically demanding surgical procedures in the treatment of adult dysplastic hips. We developed a modified technique which combines the two most popular surgeries: the rotational acetabular osteotomy (RAO), and the Bernese osteotomy. Transtrochanteric approach was used in our new spherical osteotomy and provided a good surgical exposure for redirecting the acetabulum with minimal complications. This article describes the surgical procedures in detail and reports the preliminary results in the first 32 hips. As the experiences are encouraging in terms of technical ease and reproducibility, the authors feel that this new osteotomy with transtrochanteric exposure is an ideal choice of surgery in treating residual hip dysplasia in the adult. Key words: osteotomy, periacetabular, hip dysplasia, adult.
