MRSA-free Elective Orthopaedic Surgery. A Dedicated Elective Orthopaedic Ward Free from MRSA Alexandra Hospital, Redditch, UK

2005 ◽  
Vol 15 (3) ◽  
pp. 171-176
Author(s):  
A. Datta ◽  
A. Gardner ◽  
K. Bell
Keyword(s):  
Infection Rate ◽  
High Volume ◽  
Deep Infection ◽  
Healthcare Associated Infection ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Hip Replacements ◽  
Great Scrutiny ◽  
Orthopaedic Ward ◽  
Healthcare Associated

Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at £1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny. The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control. Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03). The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002. We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency. We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease.

scholarly journals Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260146
Author(s):  
Helen Mary Badge ◽  
Tim Churches ◽  
Justine M. Naylor ◽  
Wei Xuan ◽  
Elizabeth Armstrong ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
High Volume ◽  
Deep Infection ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Post Surgery ◽  
Increased Risk ◽  
Adjusted Logistic Regression ◽  
One Year

Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

scholarly journals Validity of patient-reported complications after total hip and knee arthroplasty

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880249 ◽  
Author(s):  
Kinh Luan Thanh Dang ◽  
Helen Badge ◽  
Ian A Harris
Keyword(s):  
Knee Arthroplasty ◽  
High Volume ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Patient Reports ◽  
Replacement Surgery ◽  
Telephone Interviews ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty ◽  
High Level

Background: Evaluating the effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) often relies on accurate patient reporting of postoperative complications. Despite this, there is little research regarding the accuracy of patient reports. We aimed to determine the accuracy of patient-reported significant complications after THA and TKA. Methods: Patients were recruited prior to undergoing primary hip or knee arthroplasty at 19 high-volume hospitals. After surgery, follow-up of patients via telephone interviews at 35, 90 and 365 days recorded surgical outcomes including readmission, reoperation and venous thromboembolism (VTE). Patient-reported complications were verified via medical record audits and liaison with surgeons, general practitioners or other health professionals. Surgical and demographic information and patient-reported and verified complications were entered into a database. Patient-reported and verified complications were compared for readmission, reoperation and VTE. Results: The sample included 150 of 1811 patients who reported a total of 242 significant complications. Of the 242 patient-reported complications, 224 (92.6%) were correct (true positive). The type of complication had variable levels of accuracy in patient reports. Readmission to hospital was accurately reported by 90.2% (129/143) of patients. Reoperation (including any manipulations under anaesthesia, joint washouts, reductions of dislocated joints and revisions) was accurately reported by 98.7% (75/76) of patients. VTE was accurately reported by 86.7% (20/23) of patients. Conclusion: A high level of accuracy in patient-reported experience of complications was demonstrated following THA and TKA. Patient-reported complications may be reliably used for post-operative surveillance of joint replacement surgery.

scholarly journals Early Experiences with Indigenous Medicated Spacers in the Management of Infected Hip Prosthesis.

2013 ◽  
Vol 11 (1) ◽  
pp. 32-36
Author(s):  
Pankaj Chand ◽  
Suchil Rana Magar ◽  
Bishnu Babu Thapa ◽  
Bachhu Ram KC ◽  
Amit Joshi ◽  
...  
Keyword(s):  
Hip Prosthesis ◽  
Revision Arthroplasty ◽  
Recurrent Infection ◽  
Cost Effective ◽  
Deep Infection ◽  
Two Stage ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Walking Capacity ◽  
Postoperative Dislocation

Introduction: Joint replacement surgery, has become one of the most frequent prosthetic surgeries over the past decades due to its success in restoring function to disabled arthritic individual. A two-stage revision arthroplasty is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results of three infected hips with the interim use of an indigenous cemented prosthesis along with gentamycin impregnated cement beads were assessed with a two stage revision. Methods: Three consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of a previous infection, with retained implants, were followed clinically and radiographically for an average of 15 months. Following removal of implants and debridement (first stage), an indigenous medicated prosthesis along with antibiotic coated cement beads were implanted, for an interim phase of six - eight weeks aft er which a new prosthesis was placed ( second stage ).In this period antibiotics ( both intravenous and oral) were administered to the patients. Results: In a mean follow up period of 15 months, there is no evidence of recurrent infection in all three patients, as of now. The use of antibiotic coated cement prosthesis along with gentamycin mixed cement beads was associated with a satisfactory hip score, and better walking capacity in the interim period, a lower transfusion requirement at the time of reimplantation, and no postoperative dislocation. Conclusions: Locally prepared medicated spacer and gentamycin coated beads help in eradicating hip infection, besides being more cost effective. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/32-36 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7765

scholarly journals Conformable and robust force sensors to enable precision joint replacement surgery

2021 ◽  
Author(s):  
Liam Ives ◽  
Alizee Pace ◽  
Fabian Bor ◽  
Qingshen Jing ◽  
Tom Wade ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Force Feedback ◽  
Complex Geometry ◽  
Weight Bearing ◽  
High Sensitivity ◽  
Force Sensor ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Surgical Tool ◽  
Hip Replacements

Balancing forces within weight-bearing joints such as the hip during joint replacement surgeries is essential for implant longevity. Minimising implant failure is vital to improve patient wellbeing and alleviate pressure on healthcare systems. With improvements in surgery, hip replacement patients are now often younger and more active than in previous generations, and their implants correspondingly need to survive higher stresses. However, force balancing currently depends entirely on surgical skill: no sensors can provide quantitative force feedback within the small, complex geometry of the hip joint. Here, we solve this unmet clinical need by presenting a thin and conformable microfluidic force sensor, which is compatible with the standard surgical process. We optimised the design using finite element modelling, then incorporated and calibrated our sensor in a model hip implant. Using a bespoke testing rig, we demonstrated high sensitivity at typical forces experienced during hip replacements. We anticipate that these sensors will aid implant positioning, increasing the lifetime of hip replacements, and represent a powerful new surgical tool for a range of orthopaedic procedures where force balancing is crucial.

scholarly journals A prospective study on the risk of glove fingertip contamination during draping in joint replacement surgery

2014 ◽  
Vol 96 (6) ◽  
pp. 434-436 ◽  
Author(s):  
D Makki ◽  
K Deierl ◽  
A Pandit ◽  
S Trakru
Keyword(s):  
Prospective Study ◽  
Joint Replacement ◽  
Dominant Hand ◽  
Coagulase Negative Staphylococci ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Total Knee Replacements ◽  
Hip Replacements ◽  
Total Knee ◽  
A Prospective Study

Introduction The aim of this prospective study was to investigate the risk of contamination of surgical gloves during preparation and draping in joint replacement surgery. Methods During 46 hip and knee replacement procedures, the gloves of orthopaedic consultants (n=5) and registrars (n=3) were assessed for contamination immediately after draping by impression of gloved fingers on blood agar. Contamination was evaluated by the surgeon’s grade, the type of procedure, the role of the assistant and the dominance of the hand. Results A total of 125 pairs of top gloves were examined (79 pairs from registrars and 46 pairs from consultants). Bacterial contamination was isolated on 19 pairs (15.2%) (16 pairs from registrars and 3 pairs from consultants, p=0.04). Coagulase negative staphylococci were the main isolates and contamination was considered low in all cases (1–5 colonies). Contamination was seen more on the dominant hand (16 gloves from dominant hands and 6 from non-dominant hands, p=0.04), on the index finger and thumb. More contaminated gloves were seen in hip arthroplasty procedures (16 pairs from total hip replacements vs 3 pairs from total knee replacements, p=0.02). Conclusions Contamination of glove fingertips during draping in joint replacement procedures is more likely to occur among junior surgeons, in hip rather than knee arthroplasty procedures and on the dominant hand. It is therefore essential that surgeons of different grades replace gloves used in draping to avoid exposing patients to the risk of infection.

scholarly journals Prevention of deep infection in joint replacement surgery

2010 ◽  
Vol 81 (6) ◽  
pp. 660-666 ◽  
Author(s):  
Esa Jämsen ◽  
Ove Furnes ◽  
Lars B Engesæter ◽  
Yrjö T Konttinen ◽  
Anders Odgaard ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Deep Infection ◽  
Joint Replacement Surgery ◽  
Replacement Surgery

scholarly journals Reopening of elective total joint replacement surgery in a high-volume single-specialty hospital within a COVID-19 epicenter

2021 ◽  
Vol 5 ◽  
pp. 13-13
Author(s):  
Taryn E. LeRoy ◽  
Raminta V. Theriault ◽  
Nathan J. Sinz ◽  
Gabriel S. Perrone ◽  
Christopher J. Fang ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
High Volume ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Specialty Hospital

scholarly journals Low Post-Arthroplasty Infection Rate is Possible in Developing Countries: Long-Term Experience of Local Vancomycin Use From A High-Volume Tertiary Knee Center in Iran

2020 ◽  
Author(s):  
Mohammad Naghi Tahmasebi ◽  
Fardis Vosoughi ◽  
Arash Sharafat Vaziri ◽  
Mohamad Tahami ◽  
Majid Khalilizad ◽  
...  
Keyword(s):  
Early Detection ◽  
Infection Rate ◽  
High Volume ◽  
Deep Infection ◽  
Routine Practice ◽  
Female Ratio ◽  
Joint Infections ◽  
Superficial Wound ◽  
Vancomycin Powder ◽  
One Year

Abstract Background: Significant research has been carried out for prevention and also early detection of post-TKA infections. Regarding prevention, utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the pertinent literature. Regarding early detection, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of primary TKA in a high-volume tertiary knee center in Iran, during which intrawound vancomycin powder was used as a routine practice at the end of TKA surgeries. Also, new criteriae are proposed to detect suspected superficial post-TKA infections. Methods: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2011 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than one year were excluded from the study. All patient received vancomycin (powder, 1gr) before water-tight closure of the joint capsule. Results: Altogether, 1710 patients were included in the study. Patients were mostly women (male to female ratio: 1 to 4), with a mean age of 64.99 (SD=11.49) years. The overall infection rate was 2.16% (37 of 1710 patients), including 5 periprosthetic deep joint infections and 32 suspected superficial wound infections. Of the 32 suspected superficial infections that were treated with a one-week course of oral antibiotics, all reported disappearance of symptoms, but 2 cases returned with late deep infection. All in all, 7 patients (0.41%) underwent two-stage knee arthroplasty due to deep joint infections. Conclusions: Our experience shows that by utilizing intrawound vancomycin for 7 years as a routine practice along with other measures, we were able to reach relatively low rates of deep post-TKA infections. Howbeit, randomized controlled trials are required to clarify the effect of intrawound vancomycin on post-TKA infection rate.

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