To evaluate a panel of peripheral blood and synovial fluid biomarkers for the identification of periprosthetic joint infection PJI. Peripheral blood and synovial fluid measurements of CD64, IL-1a, IL-1b, IL-6, IL-8, IL-10, IL-17, Alpha Defensin and CRP were made on samples collected from patients with suspected PJI using a combination of flow cytometry (CD64), ELISA (Alpha Defensin) and MSD Electrochemiluminescence (IL-1a, IL-1b, IL-6, IL-8, IL-10, IL-17). Receiver operating characteristic (ROC) curves which combine sensitivity and specificity were created for each marker using GraphPad PRISM statistical software. The diagnosis of infection was based on MSIS major criteria.Aim
Method
The interaction between surgical lighting and laminar airflow
is poorly understood. We undertook an experiment to identify any
effect contemporary surgical lights have on laminar flow and recommend
practical strategies to limit any negative effects. Neutrally buoyant bubbles were introduced into the surgical field
of a simulated setup for a routine total knee arthroplasty in a
laminar flow theatre. Patterns of airflow were observed and the
number of bubbles remaining above the surgical field over time identified.
Five different lighting configurations were assessed. Data were analysed
using simple linear regression after logarithmic transformation.Aims
Materials and Methods
The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile. A retrospective analysis was undertaken of all hemiarthroplasties within our trust from April 2008 to December 2014. We identified all patients in this time period who acquired a deep SSI from the trust SSI surveillance database. The infecting organisms and susceptibility patterns were collated for each cement.Aim
Method
Symptomatic treatment of ankle osteoarthritis (OA) with corticosteroid injections is well established. Hyaluronic acid is also reported as an effective symptomatic treatment for ankle OA but these two treatments have not been compared directly. A prospective randomised controlled trial in patients with symptomatic ankle osteoarthritis. Twenty patients per group were required based on a significance level of 0.05, and a drop out rate of 5%. Patients were blindly allocated to the treatment or control group. Injections were carried out by the clinician in the outpatient department. Treatment group received Ostenil 20 mg and control group received Depomedrone 40 mg (both as single injections). The treatment arm was allocated by computer generated block randomization to match treatment allocation with grade of arthritis. The primary outcome measure was the change in Visual Analogue Scale (VAS) pain score at 6 months. Secondary outcome was the change in AOFAS score at 6 months. Research ethics committee approval was obtained.Introduction:
Methods:
Deep infection is a potentially catastrophic complication of joint replacement surgery. Early intervention in suspected prosthetic joint infection in the form of aggressive Debridement and targeted Antibiotics can lead to successful Implant Retention (DAIR). In our centre, we adopt an aggressive approach to suspected prosthetic joint infection, working in a multi-disciplinary team with microbiologists and an infection surveillance team to identify and treat suspected infected cases at the earliest opportunity. To evaluate the efficacy of the treatment of prosthetic joint infection with DAIR.INTRODUCTION
OBJECTIVES
There were 70000 people admitted to hospital with fractured hips in 2007 and the incidence is rising by 2% each year. Hip fractures represent significant morbidity and mortality to patients and cost the NHS £1.8 billion annually. In 2008 the British Orthopaedic Association Standards for Trauma (BOAST) issued a 14-point guideline to be followed for the management of hip fractures. The aim was to improve secondary prevention of osteoporosis, reduce the falls risk and further fractures. This aimed to provide better care to improve the outcomes for patients and reduce the burden of hip fractures on society. The aim of the audit was to see if the BOAST guidelines are met before and after the transition to a level 1 MTC (Major Trauma Centre) and to measure any impact the change had. Methods: Prospective data was collected for three months in 2010, 2011 and 2012. 94 case notes were reviewed and compared to the outcomes laid out in the BOAST guidelines to see if standards were met. Overall adherence to the guideline's recommendations was high throughout the 3 sample months. For each of the 3 sample months 100% adherence was seen in all of the following criteria: further imaging if x-rays unclear, appropriate analgesia, pre-op assessment, seniority of surgeon, orthogeriatrician involvement, seniority of surgeons and submission to the National Hip Fracture Database. The main common area where adherence was less than 100% was with A and E breaches (i.e. greater than 4 hours referral to the ward). Despite relocation and transition to a level 1 MTC, the management of fractured neck of femur patients compared to the BOAST guidelines remained of a high standard. Further improvements have also been made since moving to the new hospital site where shortcomings in management have been identified. Improvements from year one to three include prophylactic antibiotics and warfarin reversal; there is now a new trust protocol in place for warfarin reversal in the case of hip fractures. Elsewhere adherence to the guidelines remains high across the sample months. Confirming that despite moving to a level 1 status the trauma team continues to be performing well and managing this group appropriately. In January 2012 BOAST published a second version of the hip fracture guidelines: A and E breaches were removed from the guidelines. There have also been several new additions to the guidelines, which prompt a further re-audit in the future.
Aseptic loosening is the most common mode of failure of massive endoprostheses. Introduction of Hydroxyapatite coated collars have reduced the incidence of aseptic loosening. However bone growth is not always seen on these collars. The aims of our study were to determine the extent of osseous integration of Hydroxyapatite coated collars, attempt a grading system for bone growth and to determine the effect of diagnosis, surgical technique and adjuvant therapy on bone growth.Introduction
Objectives
We aimed to determine the extent of osseous integration of the hydroxyapatite collars of tumour endoprostheses implanted in our unit. We identified 57 patients who had massive endoprostheses implanted over the last six years and reviewed clinical records and x-rays. There were 20 proximal femoral, 23 distal femoral, 6 proximal tibial, 8 proximal humeral and 1 distal humeral replacements. Patients fell into three groups: 1.Primary bone tumours, 2. Metastatic bone tumours and 3. Non-tumour indicationsIntroduction
Methods
