α-defensin is a biomarker which has been described as having
a high degree of accuracy in the diagnosis of periprosthetic joint
infection (PJI). Current meta-analyses are based on the α-defensin
laboratory-based immunoassay rather than the quick on-table lateral
flow test kit. This study is the first meta-analysis to compare the
accuracy of the α-defensin laboratory-based immunoassay and the
lateral flow test kit for the diagnosis of PJI. A systematic review was performed according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Inclusion criteria were all clinical studies where the diagnosis
of PJI was uncertain. All studies selected used the Musculoskeletal
Infection Society (MSIS) or modified MSIS criteria. Two independent
reviewers reviewed the studies and extracted data. A meta-analysis
of results was carried out: pooled sensitivity, specificity, positive
and negative likelihood ratio, heterogeneity and areas under curves
are reported.Aims
Materials and Methods
This study sought to determine the medium-term
patient-reported and radiographic outcomes in patients undergoing
surgery for hallux valgus. A total of 118 patients (162 feet) underwent
surgery for hallux valgus between January 2008 and June 2009. The
Manchester-Oxford Foot Questionnaire (MOXFQ), a validated tool for
the assessment of outcome after surgery for hallux valgus, was used
and patient satisfaction was sought. The medical records and radiographs
were reviewed retrospectively. At a mean of 5.2 years (4.7 to 6.0)
post-operatively, the median combined MOXFQ score was 7.8 (IQR:0
to 32.8). The median domain scores for pain, walking/standing, and social
interaction were 10 (IQR: 0 to 45), 0 (IQR: 0 to 32.1) and 6.3 (IQR:
0 to 25) respectively. A total of 119 procedures (73.9%, in 90 patients)
were reported as satisfactory but only 53 feet (32.7%, in 43 patients)
were completely asymptomatic. The mean (SD) correction of hallux
valgus, intermetatarsal, and distal metatarsal articular angles was
18.5° (8.8°), 5.7° (3.3°), and 16.6° (8.8°), respectively. Multivariable
regression analysis identified that an American Association of Anesthesiologists
grade of >
1 (Incident Rate Ratio (IRR) = 1.67, p-value = 0.011)
and recurrent deformity (IRR = 1.77, p-value = 0.003) were associated
with significantly worse MOXFQ scores. No correlation was found
between the severity of deformity, the type, or degree of surgical
correction and the outcome. When using a validated outcome score
for the assessment of outcome after surgery for hallux valgus, the
long-term results are worse than expected when compared with the
short- and mid-term outcomes, with 25.9% of patients dissatisfied
at a mean follow-up of 5.2 years. Cite this article:
Total hip replacement can be performed successfully via a number of approaches. A patient's time to discharge following a THR is influenced by many factors. The anterior hip approach has recently been popularised as a true muscle sparing approach. This study looked at the association between operative approach (anterior, lateral or posterior), and length of hospital stay. A retrospective review was conducted at Western Health, Victoria of 113 consecutive THRs performed at 3 hospitals (Footscray, Sunshine and Williamstown) by 16 surgeons over a 12 month period. The data was collected from the prospective information entered into the digital database ‘Sunray’ and a review of the postoperative notes in order to perform a retrospective audit. Statistical analysis included analysis of variance and pair-wise comparisons. Surgeons performed the surgery as clinically warranted, and no alteration was made of standard postoperative care or physiotherapy. Of the 113 patients audited, the anterior approach for THR was found to be associated with a shorter length of stay in hospital when compared to both posterior approach (p=.0039) and lateral approach (p = .0512). The average length of stay after elective THR replacement was 6.9 days. The average length of stay for each approach was 4.3 days, 8.4 days and 6.4 days for anterior, posterior and lateral approach respectively. No significant difference was associated between operative approach and age. Anterior approach to THR was associated with a shorter length of hospital stay.
The closed management of fractures and the application of plasters remains a core component of orthopaedic trauma management. A prospective audit was undertaken to analyse the quality of plasters presenting from various sources to the Fracture Clinic Plaster Technicians. A prospective audit was conducted of 120 consecutive cases that presented to the Plaster Technicians at Western Health which had plasters applied by other institutions or other departments. The plasters were assessed on a number of criteria for adequacy and appropriateness using a standardised questionnaire and set guidelines. 63% of plasters applied were found to be deficient, inadequate or needed improvement. Of those applied by Theatre doctors, only 20% were appropriate. Of plasters applied by Emergency doctors only 10% were appropriate and those applied by General Practitioners were consistently deficient. Only trained plaster technicians had an acceptable rate of >90%. A large portion of the errors were due to incorrect moulding, joint position and fracture alignment. Improperly applied plasters lead to increased morbidity, require reapplication or unnecessary operative procedures due to loss of position. Ongoing education and review is critical to address this situation, and a national online database is being designed and implemented to monitor this situation nationally.
