scholarly journals The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery — a case control follow-up study and algorithmic approach

Author(s):  
Benjamin Thomas ◽  
Maria Benedikt ◽  
Ali Alamri ◽  
Florian Kapp ◽  
Rainer Bader ◽  
...  
2020 ◽  
Author(s):  
Benjamin Thomas ◽  
Maria Benedikt ◽  
Ali Alamri ◽  
Florian Kapp ◽  
Rainer Bader ◽  
...  

Abstract Background Antibiotic-loaded (particularly gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. In light of a complete lack in literature, the objective was to assess the clinical relevance of gentamicin allergy for failure of cemented total knee arthroplasties in 25 out of 250 patients with positive patch test reactions to gentamicin and otherwise unexplained symptoms by evaluating benefits from revision with change to gentamicin-free cement. Methods 15 of these 25 patients and their treating orthopaedic surgeons agreed to a re-assessment. They were surveyed regarding interim course of therapy and symptoms, including re-assessment of the Knee Injury and Osteoarthritis Outcome Score (KOOS), and underwent follow-up clinical and radiographic investigations. The initial use of gentamicin-loaded BC was reaffirmed by review of the primary implantation operative reports and respective implant passports. Primary and follow-up KOOS scores were analyzed regarding benefits from revision surgery by comparing nine patients with revision to six without revision. Results Mean follow-up time was 38 months. The entirety of patients experienced an improvement of self-reported symptoms, with revision surgery (i.e. switching to gentamicin-free BC or uncemented total knee arthroplasty) yielding significantly greater improvement (p=0.031): the nine revised patients reported a significant symptom relief (p=0.028), contrary to the six unrevised patients (p=0.14). Interestingly, the decision to proceed with revision surgery was significantly correlated with higher symptom severity (p=0.05). Conclusion In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.


2020 ◽  
Author(s):  
Benjamin Thomas ◽  
Maria Benedikt ◽  
Ali Alamri ◽  
Florian Kapp ◽  
Rainer Bader ◽  
...  

Abstract Background: Antibiotic-loaded (particularly gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. In light of a complete lack in literature, the objective was to assess the clinical relevance of gentamicin allergy for failure of cemented total knee arthroplasties in 25 out of 250 patients with positive patch test reactions to gentamicin and otherwise unexplained symptoms by evaluating benefits from revision with change to gentamicin-free cement.Methods: 15 of these 25 patients and their treating orthopaedic surgeons agreed to a re-assessment. They were surveyed regarding interim course of therapy and symptoms, including re-assessment of the Knee Injury and Osteoarthritis Outcome Score (KOOS), and underwent follow-up clinical and radiographic investigations. The initial use of gentamicin-loaded BC was reaffirmed by review of the primary implantation operative reports and respective implant passports. Primary and follow-up KOOS scores were analyzed regarding benefits from revision surgery by comparing nine patients with revision to six without revision.Results: Mean follow-up time was 38 months. The entirety of patients experienced an improvement of self-reported symptoms, with revision surgery (i.e. switching to gentamicin-free BC or uncemented total knee arthroplasty) yielding significantly greater improvement (p=0.031): the nine revised patients reported a significant symptom relief (p=0.028), contrary to the six unrevised patients (p=0.14). Interestingly, the decision to proceed with revision surgery was significantly correlated with higher symptom severity (p=0.05).Conclusion: In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.


Author(s):  
Camilla Toulmin

This book describes the choices open to farming families in the Sahelian village of Kala, in central Mali. Life in this drought-prone region is harsh and full of risk to health, crops, and livestock, yet there are also opportunities open to the hard-working, audacious and lucky, bringing considerable returns if the timing is right. Three inter-related themes underlie the analysis of production and investment decisions faced by households; the role of risk, the long timeframe within which decisions are made, and the close links between economic performance and household size and organisation. Climatic variability and demographic uncertainty lie at the heart of domestic structures; the extreme vulnerability faced by single individuals means people cluster in large kin-based groups, pooling risks and providing protection. The very limited development of labour markets means that households rely almost entirely on their own members for their workforce, and generating the capital needed for investing in ploughs, wells, carts and livestock must stem from a good year’s grain surplus and migration earnings. Based on field-research over the period 1980-82, this study illustrates a successful response to making ends meet in a land abundant region, despite high risks of drought. A follow-up study of this village was published in 2020: Land, Investment, and Migration. Thirty-five years of village life in Mali (OUP).


2020 ◽  
Vol 16 (4) ◽  
pp. 581-589 ◽  
Author(s):  
Elionora Peña ◽  
Assumpta Caixàs ◽  
Concepción Arenas ◽  
Mercedes Rigla ◽  
Sara Crivillés ◽  
...  

1992 ◽  
Vol 41 (1) ◽  
pp. 304-309
Author(s):  
Go Maeda ◽  
Masakazu Kondo ◽  
Norio Shinohara ◽  
Koichiro Yokoyama ◽  
Koji Najima ◽  
...  

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