scholarly journals Laminar air flow reduces particle load in TKA—even outside the LAF panel: a prospective, randomized cohort study

2020 ◽  
Author(s):  
Stephanie Kirschbaum ◽  
Hagen Hommel ◽  
Peggy Strache ◽  
Roland Horn ◽  
Roman Falk ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Protective Factor ◽  
Fine Particles ◽  
Air Flow ◽  
Operating Table ◽  
Level Of Evidence ◽  
Airborne Contamination ◽  
Total Knee ◽  
Major Increase ◽  
Laminar Air Flow

Abstract Purpose Released particles are a major risk of airborne contamination during surgery. The present prospective study investigated the quantitative and qualitative particle load in the operating room (OR) depending on location, time of surgery and use of laminar air flow (LAF) system. Methods The particle load/m3 was measured during the implantation of 12 total knee arthroplasties (6 × LAF, 6 × Non-LAF) by using the Met One HHPC 6 + device (Beckmann Coulter GmbH, Germany). Measurement was based on the absorption and scattering of (laser) light by particles and was performed at three different time-points [empty OR, setting up, ongoing operation) at 3 fixed measurement points [OR table (central LAF area), anaesthesia tower (marginal LAF area), surgical image amplifier (outside LAF area)]. Results Independent of time and location, all measurements showed a significantly higher particle load in the Non-LAF group (p < 0.01). With ongoing surgical procedure both groups showed increasing particle load. While there was a major increase of fine particles (size < 1 µm) with advancing activity in the LAF group, the Non-LAF group showed higher particle gain with increasing particle size. The lowest particle load in the LAF group was measured at the operating column, increasing with greater distance from the operating table. The Non-LAF group presented a significantly higher particle load than the LAF group at all locations. Conclusion The use of a LAF system significantly reduces the particle load and therefore potential bacterial contamination regardless of the time or place of measurement and therefore seems to be a useful tool for infection prevention. As LAF leads to a significant decrease of respirable particles, it appears to be a protective factor for the health of the surgical team regardless of its use in infection prevention. Level of evidence I.

FIELD MEASUREMENT OF AIRBORNE PARTICULATE MATTERS CONCENTRATION IN A HOSPITAL’S OPERATING ROOM

2015 ◽  
Vol 77 (30) ◽  
Author(s):  
Haslinda Mohamed Kamar ◽  
Nazri Kamsah ◽  
Wong Keng Yinn ◽  
Md. Nor Musa ◽  
Muhd Suhaimi Deris
Keyword(s):  
Operating Room ◽  
Field Measurement ◽  
High Efficiency ◽  
Air Flow ◽  
Operating Table ◽  
Particulate Matters ◽  
Site Infection ◽  
Airborne Particulate ◽  
Rest Condition ◽  
Laminar Air Flow

In a hospital operating room, adequate air flow and cleanliness are crucial to protect the patient from surgical site infection (SSI) during a procedure. The probability of the patient to get the infection is related to the concentration of bacteria carrying particles inside the room. This paper presents a field measurement study to quantify the concentration of particulate matters (PM) in a hospital operating room which complies with the ISO Class 7 requirements. The operating room was equipped with High Efficiency Particulate Air (HEPA) filters and a vertical laminar air flow (LAF) system. The measurements were conducted at three height levels from the floor namely 1.2 m, 1.8 m and 2.4 m. The data was logged at a rest condition, in accordance to the ISO 14644-1 requirements. A HPC300 particle counter was used to measure the concentrations of particulate matters namely PM0.5, PM1 and PM5. The results show that the concentrations of all particulate matters were higher at the height level of 1.2 m compared to other height levels. The concentration of PM0.5 was relatively higher than PM1 and PM5 in the vicinity of operating table.

scholarly journals Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

2021 ◽  
Author(s):  
Nicola Pizza ◽  
Stefano Di Paolo ◽  
Raffaele Zinno ◽  
Giulio Maria Marcheggiani Muccioli ◽  
Piero Agostinone ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Motor Task ◽  
Medial Compartment ◽  
Level Of Evidence ◽  
Contact Points ◽  
Sit To Stand ◽  
Medial Pivot ◽  
Total Knee

Abstract Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

scholarly journals Diagnosis and management of the infected total knee replacement: a practical surgical guide

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Akos Zahar ◽  
Martin Sarungi
Keyword(s):  
Surgical Management ◽  
Joint Infection ◽  
Level Of Evidence ◽  
Surgical Guide ◽  
Diagnosis And Management ◽  
Early Revision ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Total Knee ◽  
Key Steps

Abstract Purpose Prosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a significant burden in health care. Diagnosis and proper management are challenging. A standardised procedure for the diagnostic workup and surgical management provides clear benefits in outcome. Methods Several diagnostic protocols and definitions for PJI were established in recent years. Proper PJI diagnosis remains critical for success and for choosing the optimal treatment option. A distinct workup of diagnostic steps, the evaluation of the results in a multidisciplinary setup and the meticulous surgical management of the infection are the key factors of successful treatment. Results The management of PJI after TKA consists of early revision with debridement and implant retention (DAIR) in early cases or staged revision in late infections beyond 30 days postoperative or after onset of acute symptoms. The revision is performed as a two-stage procedure with the use of a fixed or mobile antibiotic spacer, or in selected cases as a single-stage operation with the use of local and systemic antibiotic treatment. Conclusions This paper reflects the opinion of two revision surgeons who follow the same protocol for diagnosis and treatment of PJI after TKA, highlighting the key steps in diagnosis and management. Level of evidence Expert’s opinion

Impact of different-sized laminar air flow versus no laminar air flow on bacterial counts in the operating room during orthopedic surgery

2011 ◽  
Vol 39 (7) ◽  
pp. e25-e29 ◽  
Author(s):  
Magda Diab-Elschahawi ◽  
Jutta Berger ◽  
Alexander Blacky ◽  
Oliver Kimberger ◽  
Ruken Oguz ◽  
...  
Keyword(s):  
Operating Room ◽  
Orthopedic Surgery ◽  
Air Flow ◽  
Bacterial Counts ◽  
Laminar Air Flow

scholarly journals Infection prevention in patients with cancer: microbiological evaluation of portable laminar air flow isolation, topical chlorhexidine, and oral non-absorbable antibiotics

1980 ◽  
Vol 84 (3) ◽  
pp. 457-465 ◽  
Author(s):  
A. S. D. Spiers ◽  
Sylvia F. Dias ◽  
J. A. Lopez
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Drug Therapy ◽  
Acute Leukaemia ◽  
Infection Prevention ◽  
Cytotoxic Chemotherapy ◽  
Prevention Of Infection ◽  
Patients With Cancer ◽  
Flow Apparatus ◽  
Laminar Air Flow ◽  
Nose And Throat

SUMMARYThe increasing use of intensive cytotoxic chemotherapy for patients with solid tumors enhances the risk of opportunistic infection to levels formerly seen only in patients with acute leukaemia, and prevention of infection is a major concern. A relatively simple regimen of isolation, topical antisepsis, and orally administered non-absorbable antibiltics was stuidied in 18 patients. Sixteen of 21 studies were performed using portable laminar ait flow apparatus and five with isolation only. All patients became severly neutropenic but there were no major infections. Microbiological results showed effective decontamination of the skin, which was maintained without recolonization or acquisition of new organisms. The ears, nose and throat were effectively decontaminated only when the regimen was intensified. Colonization with Pseudomonas aeruginosa, a major pathogen in compromised hosts, did not occur. The propective regimen is less expensive than regimens previously desribed, is acceptable to patients, and requires no modification of existing hospital rooms. It merits further evaluation in patients with common cancers who receive intensive cytotoxic drug therapy.

scholarly journals Intra-operative assessment of the vascularisation of a cross section of the meniscus using near-infrared fluorescence imaging

2021 ◽  
Author(s):  
Peter van Schie ◽  
Thies J. N. van der Lelij ◽  
Maxime Gerritsen ◽  
Ruben P. J. Meijer ◽  
Ewoud R. A. van Arkel ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Cross Section ◽  
Near Infrared ◽  
Level Of Evidence ◽  
Camera System ◽  
Near Infrared Fluorescence ◽  
Nirf Imaging ◽  
Total Knee ◽  
Operative Assessment ◽  
Near Infrared Fluorescence Imaging

Abstract Purpose The purpose of this study was to assess whether the vascularisation of the meniscus could be visualised intra-operatively using near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) in patients undergoing total knee arthroplasty (TKA). Methods The anterior horn (i.e., Cooper classification: zones C and D) of the meniscus that was least affected (i.e., least degenerative) was removed during TKA surgery in ten patients to obtain a cross section of the inside of the meniscus. Thereafter, 10 mg of ICG was injected intravenously, and vascularisation of the cross section of the meniscus was assessed using the Quest spectrum NIRF camera system. We calculated the percentage of patients in whom vascularisation was observed intra-operatively using NIRF imaging compared to immunohistochemistry. Results Meniscal vascularisation using NIRF imaging was observed in six out of eight (75%) patients in whom vascularisation was demonstrated with immunohistochemistry. The median extent of vascularisation was 13% (interquartile range (IQR) 3–28%) using NIRF imaging and 15% (IQR 11–23%) using immunohistochemistry. Conclusion This study shows the potential of NIRF imaging to visualise vascularisation of the meniscus, as vascularisation was observed in six out of eight patients with histologically proven meniscal vascularisation. Level of evidence IV.

scholarly journals PROFILE OF PATIENTS RECEIVING TOTAL KNEE ARTHROPLASTY: A CROSS-SECTIONAL STUDY

2017 ◽  
Vol 25 (5) ◽  
pp. 202-205 ◽  
Author(s):  
MARCELO JOSÉ CORTEZ BEZERRA ◽  
IGOR MAGALHÃES BARBOSA ◽  
THALES GONÇALVES DE SOUSA ◽  
LARISSA MEIRELES FERNANDES ◽  
DIEGO LEONARDO MENEZES MAIA ◽  
...  
Keyword(s):  
Medical Records ◽  
Severe Disease ◽  
Functional Limitation ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Lequesne Index ◽  
Total Knee ◽  
Epidemiological Profile

ABSTRACT Objective: To describe the epidemiological profile, presented deformities, associated comorbidities, and impact on quality of life in patients with knee osteoarthritis. This study was conducted in a philanthropic hospital in Fortaleza from 2014 to 2015. Methods: Data were collected from medical records, epidemiological forms, and by applying the Lequesne index questionnaire, which contains several questions related to pain, discomfort and functional limitation to assess the severity of symptoms. Results: Females were more prevalent (76.7%), as were patients over 65 years of age (61.6%) and non-whites (81.6%). As for comorbidities, 83.3% had hypertension and 31.7% had diabetes. Of the total, 76.5% cases were genu varum, and 23.5% genu valgum. According to the Lequesne index findings, 61.6% cases were “extremely severe,” and women had higher scores. Conclusion: Females were more prevalent and whites were less prevalent. The most frequent comorbidity was hypertension. Female and elderly patients have more severe disease according to Lequesne index score, and these findings were statistically significant. Level of Evidence II, Prospective Study.

scholarly journals Current Evidence for the Use of Laminar Flow in Reducing Infection Rates in Total Joint Arthroplasty

2015 ◽  
Vol 9 (1) ◽  
pp. 495-498 ◽  
Author(s):  
M James ◽  
W.S Khan ◽  
M.R Nannaparaju ◽  
J.S Bhamra ◽  
R Morgan-Jones
Keyword(s):  
Laminar Flow ◽  
Total Joint Arthroplasty ◽  
Air Flow ◽  
Joint Arthroplasty ◽  
Current Evidence ◽  
Air Particulate ◽  
Surgical Infections ◽  
Operating Theatres ◽  
Laminar Air Flow ◽  
Operative Wound

Since the introduction of laminar air flow in orthopaedic theatres by Sir John Charnley, it has widely become accepted as the standard during orthopaedic procedures such as joint arthroplasty. We present a review of available current literature for the use of laminar flow operating theatre ventilation during total joint arthroplasty and examines the effectiveness of laminar flow ventilated operating theatres in preventing post-operative wound infection. Results of our findings suggest that while bacterial and air particulate is reduced by laminar air flow systems, there is no conclusive effect on the reduction of post-operative wound infections following total joint arthroplasty. We conclude that a combination of strict aseptic technique, prophylactic antibiotics and good anaesthetic control during surgery remains crucial to reduce post-operative surgical infections.

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