Two-Step Total Hip Arthroplasty in Deep Periprosthetic Infection

Modern notions about surgical techniques for the treatment of deep purulent processes in the zone of hip implant are presented. In 13 cases surgical sanitation without implant removal was performed. In case of implant loosening treatment tactics was determined by the possibility of total revision arthroplasty. In 76 patients with periprosthetic infection surgical sanitation was aimed at inflammation arrest and restoration of extremity weight bearing after compelled implant removal. In 44 patients resection arthroplasty with formation of neoarthrosis by Girdlestone was performed. In 17 cases a two-step surgical intervention with implantation of antibiotic impregnated cement spacer followed by revision arthroplasty was used. Clinical, microbiologic and immunologic criteria of favourable treatment outcome with minimum risk of inflammatory process relapse were determined.

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Use of Spacers for the Treatment of Deep Periprosthetic Infection of Hip and Knee Joints

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto201320318-24 ◽

2013 ◽

Vol 20 (3) ◽

pp. 18-24

Author(s):

V. Yu Murylyov ◽

M. Yu Kholodaev ◽

Ya. A Rukin ◽

A. V Lychagin ◽

V. V Karpov ◽

...

Keyword(s):

Periprosthetic Infection ◽

Revision Arthroplasty ◽

Deep Infection ◽

Implant Removal ◽

Knee Joints ◽

High Efficacy ◽

Infectious Process ◽

Hip Implant

Experience in treatment of 27 patients with deep periprosthetic infection is presented. In 17 patients infectious process was localized in the zone of hip implant, in 10 patients — in the zone of knee implant. Sanitation without implant removal was performed in 2 cases of early deep infection. Two-step revision arthroplasty was performed in 25 patients with late deep infection. First the implant was removed and spacer was inserted, then spacer was changed for a revision implant. In 12 patients individual articulating spacers with antibiotics were used. No relapse was noted in 23 patients at terms up to 58 months. Thus, two-step revision arthroplasty with application of spacers showed its high efficacy in treatment of patients with late deep periprosthetic infection.

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Surgical management of dorsal scapular luxation in three dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-16-05-0066 ◽

2017 ◽

Vol 30 (01) ◽

pp. 75-80 ◽

Cited By ~ 2

Author(s):

Selena Tinga ◽

Erin Porter ◽

Daniel Lewis ◽

Stephen Jones

Keyword(s):

Clinical Presentation ◽

Surgical Intervention ◽

Weight Bearing ◽

Surgical Techniques ◽

Long Term Results ◽

Traumatic Rupture ◽

Long Term Outcomes ◽

Excellent Outcome ◽

Supplementary Material

SummaryScapular luxation is an uncommon cause of forelimb lameness in dogs and cats. Traumatic rupture of the serratus ventralis muscle allows the scapula to displace dorsally during weight-bearing. Specific documentation regarding clinical presentation and surgical techniques is limited, with no medium- to long-term results of surgical intervention in dogs described. Presented here are three cases of scapular luxation in dogs, treated with a modified surgical technique. Clinical outcome was considered good to excellent, with resolution of lameness and abnormal scapular motion in all three dogs. Medium-and long-term outcomes were assessed in two of the dogs, with an excellent outcome in both cases.Supplementary Material to this article is available online at https://doi.org/10.3415/VCOT-16-05-0066

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Knee arthrodesis as a salvage method for septic TKA failure

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2019-0002 ◽

2019 ◽

Vol 2 (1) ◽

pp. 3-8

Author(s):

Traian Ciobanu ◽

Ioan Mihau Japie ◽

Octavian Nutiu ◽

Alexandru Papuc ◽

Dragos Radulescu ◽

...

Keyword(s):

External Fixation ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Surgical Techniques ◽

Revision Arthroplasty ◽

Ilizarov Method ◽

Cement Spacer ◽

Knee Arthrodesis ◽

Knee Amputation ◽

Prosthetic Implants

AbstractPeriprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.

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Thrombolysis in Arterial Occlusion

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615565 ◽

1999 ◽

Vol 82 (S 01) ◽

pp. 109-111 ◽

Cited By ~ 3

Author(s):

Raymond Verhaeghe

Keyword(s):

Clinical Practice ◽

Thrombolytic Therapy ◽

Hemorrhagic Stroke ◽

Surgical Intervention ◽

Bypass Graft ◽

Surgical Techniques ◽

Arterial Occlusion ◽

Second Step ◽

Severe Bleeding ◽

Initial Management

SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

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Endoscopic sphenoidotomy

ORL ro ◽

10.26416/orl.31.2.2016.137 ◽

2016 ◽

Vol 2 (1) ◽

pp. 34-36

Author(s):

I. Bulescu ◽

C. Ioniţă ◽

A. Coman ◽

A. Panfiloiu ◽

Andreea Nicoleta Costache ◽

...

Keyword(s):

Surgical Intervention ◽

Surgical Techniques ◽

Endoscopic Technique ◽

Detailed Knowledge

Given the progress of endoscopic surgical techniques detailed knowledge of nasosinusal local anatomy is an essential clinical request for surgeons. In this paper, the aim of the authors is to illustrate the surgical endoscopic technique of sphenoidotomy and to provide a step-by-step description of the main stages of the surgical intervention.

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Non-constrained implant arthroplasty for the distal radioulnar joint

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417693177 ◽

2017 ◽

Vol 42 (4) ◽

pp. 415-421 ◽

Cited By ~ 1

Author(s):

B. D. Adams ◽

J. L. Gaffey

Keyword(s):

Surgical Techniques ◽

Distal Radioulnar Joint ◽

Implant Loosening ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Radioulnar Joint ◽

Ulnar Head ◽

Strenuous Activity

A variety of surgical techniques are used to treat the arthritic distal radioulnar joint, which is influenced by aetiology and previous procedures. Four types of ulnar head arthroplasty exist: total ulnar head, partial ulnar head, unlinked total distal radioulnar joint, and linked distal radioulnar joint. Although long-term outcome studies are sparse, short-term clinical and biomechanical studies have shown encouraging results, leading to expanded indications. Based on our experience and a literature review, patients are advised that pain is improved but minor pain is common after strenuous activity. Ulnar neck resorption is common, however, implant loosening is rare. Sigmoid notch erosion is concerning, but appears to stabilize and not affect outcome. A partial ulnar head replacement that retains bony architecture and soft tissue restraints may have benefit over a total ulnar head in appropriate patients. If appropriate selection criteria are met, ulnar head replacement typically produces reliable results, with low revision.

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Retention of prosthetic articulating spacer after infected hip arthroplasty as a semipermanent implant: A case report

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491719864115 ◽

2019 ◽

Vol 26 (2) ◽

pp. 105-107

Author(s):

Michelle Hilda Luk ◽

Fu Yuen Ng ◽

Henry Fu ◽

Ping Keung Chan ◽

Chun Hoi Yan ◽

...

Keyword(s):

Case Report ◽

Total Hip Replacement ◽

Hip Arthroplasty ◽

Hip Replacement ◽

Cement Spacer ◽

Implant Loosening ◽

Second Stage ◽

Joint Infections ◽

Articulating Spacer

Prosthesis with antibiotic-loaded acrylic cement was designed as a temporary articulating cement spacer in a two-stage procedure before definitive reimplantation for the treatment of periprosthetic joint infections. It is designed to remain in situ for about 6–12 weeks, until evidence of infection is controlled before reimplantation of a definitive total hip replacement. This study presents a case of a patient with prosthetic articulating spacer retention for 6 years, previously performed for an infected unipolar hemiarthroplasty for which he refused second-stage reimplantation. He remains relatively asymptomatic with no evidence of infection, implant loosening, or fracture. The patient is able to walk with a frame with minimal hip pain.

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AngelChik Device Removal and Revisional Fundoplication

Journal of the Nuffield Department of Surgical Sciences ◽

10.37707/jnds.v2i2.118 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Hannah Chase ◽

Sotiris Mastoridis ◽

Nicholas Maynard

Keyword(s):

Surgical Intervention ◽

Clinical Care ◽

Surgical Techniques ◽

Developed Countries ◽

Late Complications ◽

Biliary Leak ◽

Proactive Approach ◽

Uncertain Evidence ◽

Lower Oesophagus ◽

The Uk

Gastro-oesophageal reflux disease (GORD) is a common condition in developed countries with an increasing incidence in the UK, currently estimated at 5 per 1000 person-years. Risk factors for GORD include Helicobacter pylori infection, obesity, alcohol consumption, smoking and genetic predisposition. Surgical management is performed in chronic, severe cases of GORD, refractory to medical management. There are a variety of interventional surgical techniques available and the patient in this case had placement of an AngelChik Device (AD) 30 years ago. This is now a historic device due to associated complications and this patient had it removed with revisional treatment of the patient’s GORD with Nissen Fundoplication. The patient experienced multiple post-surgical complications, namely biliary leak from the central port, pulmonary embolism and pneumonia. Following description of the case, this report will discuss the increasing incidence of late complications of AD and propose a proactive approach to these patients going forwards. It will also discuss the current uncertain evidence of a new surgical intervention called magnetic sphincter augmentation (MSA) of the lower oesophagus that has similar principles to the mechanism of an AD. From this it will emphasise that more stringent and worldwide collaboration is required when bringing a new medical device into clinical care.

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