Joan Leal

The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees.

BACKGROUND The use of antibiotic-loaded cement is believed to prevent infection in primary total knee arthroplasty, but there is a lack of randomized studies to support this concept. The aim of this study was to evaluate the use of an antibiotic-loaded cement to reduce the infection rate in primary total knee arthroplasty. METHODS This is a prospective randomized study with 2948 cemented total knee arthroplasties, in which bone cement without antibiotic was used in 1465 knees (the control group) and a bone cement loaded with erythromycin and colistin was used in 1483 knees (the study group). All patients received the same systemic prophylactic antibiotics. The patients were followed for a minimum of twelve months. The rate of infection was analyzed according to the criteria of the Centers for Disease Control and Prevention. RESULTS The rate of deep infection (1.4% in the control group and 1.35% in the study group; p = 0.96) and the rate of superficial infection (1.2% and 1.8%, respectively; p = 0.53) were similar in both groups. The factors related to a higher rate of deep infection in a multivariate analysis were male sex and an operating time of >125 minutes. CONCLUSIONS The use of erythromycin and colistin-loaded bone cement in total knee arthroplasty did not lead to a decrease in the rate of infection when systemic prophylactic antibiotics were used, a finding that suggests that the use of antibiotic-loaded bone cement would not be indicated in the general population. Further research is needed to assess whether its use is recommended for patients with a higher risk of infection.

Correlation Study Between KSS, WOMAC and SF-36 Scores in Patients Undergoing Total Knee Arthroplasty in a Spanish Speaking Population

The aim of this study was to determine whether it is necessary to use the KSS, WOMAC and SF-36 scales in a Spanish speaking population. These 3 questionnaires were administered to 1000 consecutive patients in the TKA preoperative period. Pearsons correlation coefficient and coefficient of determination were obtained. 196 patients were excluded. A poor correlation was obtained comparing the different items of the different scores with each other. Only in 3 out of different comparisons performed was a Pearsons correlation r>0.5 obtained. The worst results were obtained comparing the two knee specific tests (SF-36 vs WOMAC) and the best ones comparing SF-36 and WOMAC scores. Based on these results, the use of the three tests in the TKA preoperative period is recommended in a Spanish speaking population.

Sealing of the intramedullar femoral canal in a TKA does not reduce postoperative blood loss: A randomized prospective study

BACKGROUND Sealing of the femoral canal, usually with autologous bone, is a surgical procedure that is often performed during TKA surgery to decrease blood loss in the postoperative period. However, evidence as to the effectiveness of this surgical procedure is not conclusive. The objective of this study was to assess the effectiveness of this surgical action in reducing postoperative blood loss and the blood transfusion rate. METHODS A randomized prospective study that included 201 TKAs divided into three groups (67 in each one) was carried out. The three groups were; A) bone graft sealing, B) cement sealing and C) unsealed canal. All groups were comparable with regard to pre and intra-operative data. The haemoglobin decrease at 2, 24 and 72 h was compared to the preoperative haemoglobin value. Subsequently, blood drainage at 12 and 24h and the rate of blood transfusion were also assessed. The different complications that arose were reported. RESULTS No statistical differences were obtained with regard to blood drainage at 12h (p=0.102) and 24h (p=0.542), the haemoglobin value decrease at 72 h (p=0.95) and the number of blood transfusions (p=0.597) in the three groups studied. CONCLUSION There was no significant difference, whether sealing the femoral canal with a bone graft, cement or when it was left unsealed, in decreasing blood loss or blood transfusion requirements in the postoperative period. LEVEL OF EVIDENCE Therapeutic type I.

Knee Arthroplasty in Klippel-Trenaunay Syndrome: A Case Presentation with 5 years follow-up

Klippel-Trenaunay syndrome (KTS) is a triad of cutaneous hemangiomas, varicose veins, and localized hypertrophy of soft tissue and bone. Orthopedic surgical intervention may be required for the management of localized limb-length discrepancy or joint arthropathy, especially in the lower limb. We describe the management of a 33-year-old patient with a diagnosis of KTS and severe knee arthropathy. After treatment with a posterostabilized, cemented total knee arthroplasty, his range of motion was improved and at 5 years follow-up the clinical outcome was good. We are not aware of any previous reports on the prosthetic management of knee arthropathy in KTS. Precise preoperative diagnosis and analysis of the vascular abnormalities must be undertaken and the case discussed with vascular surgical colleagues as part of the preoperative planning process.

Good Outcome After Meniscal Repair Using an All-Inside Suturing System in Combination with High-Frequency Biostimulation

The reported hypercellular response in meniscal tissues seen within a few weeks after radiofrequency meniscectomy suggests that the meniscal tissue may repair itself when exposed to this technology.

Peri-operative Management in TKA

Total knee arthroplasty (TKA) has become the standard of care for patients with end-stage knee osteoarthritis (OA) and is one of the most frequently performed Orthopaedic procedures. Better knowledge of some complications that may occur in the TKA peri-operative period as they are infection, blood loss, thromboembolic events, and pain might allow for better management of the procedure from start to finish.

Update on Anterior Cruciate Ligament Reconstruction in Spain. Survey Using an Electronic Questionnaire

Abstract Objective The aim of this study was to know what were the preferences of the Spanish surgeons about different aspects of anterior cruciate ligament (ACL) reconstruction. Material and methods In February 2009, 910 surveys regarding some technical aspects of ACL reconstruction was mailed to surgeons who perform this kind of surgery in Spain. The survey had 8 questions: number of ACL reconstructions per year, two clinical cases, what kind of graft was preferred, the use of simple or double bundle reconstruction, the time and the amount of tension to apply to the hamstrings during ACL reconstruction and finally, some aspects about the creation of the femoral tunnel. Results A total of 102 responses were received. Most of them (66%) had between 5–20 years of experience. A 60.3% of them performed between 10–50 procedures per year. The first choice graft in both clinical cases was autologous hamstring tendons (62% and 64%). The transtibial technique (71.8%) and the single bundle technique (79.1%) were preferred. Discussion The management of the ACL injuries remains unclear. Like in other countries with available ACL registries, autologous hamstrings have increased their use for ACL reconstruction. However, there is not consensus in some aspects of the technique. Conclusion The preferred technique for ACL reconstruction in this group was the transtibial technique with single bundle and using autologous hamstring tendons.