Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Average total weight of surgical waste and CO2 carbon footprint of orthopedic surgery in France, estimated on the basis of a representative panel","authors":"","doi":"10.1016/j.otsr.2024.103910","DOIUrl":"10.1016/j.otsr.2024.103910","url":null,"abstract":"<div><h3>Background</h3><div>Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO<sub>2</sub> footprint generated by these wastes and extrapolate the figure at the national scale.</div></div><div><h3>Hypothesis</h3><div>Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO<sub>2</sub> emission.</div></div><div><h3>Materials and methods</h3><div><span><span><span>It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, </span>arthroscopic procedures<span> (shoulder, knee), nerve release, forefoot </span></span>osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO</span><sub>2</sub> equivalent (KgEqCO<sub>2</sub>). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the <em>VisuChir</em> tool.</div></div><div><h3>Results</h3><div>A total of 937<!--> <!-->kg of waste were produced for the 140 procedures, amongst which 514<!--> <!-->kg of ICW (54.8%) and 423<!--> <!-->kg of HW (45.2%). The overall median waste weight was 5.9<!--> <!-->kg (Q1: 4.4, Q3: 8.1), ranging from 1.8<!--> <!-->kg to 18.3<!--> <!-->kg. The overall median waste weight for HW was 2.8<!--> <!-->kg (Q1: 2.5, Q3: 3.4), ranging from 1.8<!--> <!-->kg to 17.8<!--> <!-->kg. The overall median waste weight for ICW was 3.8<!--> <!-->kg (Q1: 2.7, Q3: 4.8), ranging from 0.8<!--> <!-->kg to 7.2<!--> <span>kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r</span> <!-->=<!--> <!-->−0.47, <em>p</em> <!--><<!--> <!-->10<sup>−4</sup>. The total median estimated carbon footprint was 4.3<!--> ","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141089070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dedicated locking plate reduces non-union risk in open ankle fusion in obese patients","authors":"","doi":"10.1016/j.otsr.2024.103901","DOIUrl":"10.1016/j.otsr.2024.103901","url":null,"abstract":"<div><h3>Introduction</h3><div>Obesity is a growing public health concern. In ankle osteoarthritis, non-conservative treatment in advanced stages consists in ankle fusion, or else total ankle replacement, for which obesity is a relative contraindication. One of main complications of ankle fusion is non-union. Devascularization, obesity and fixation material are all factors involved in postoperative non-union, and have to be taken into account in surgical strategy for reliable results. The objective of this study was to compare the rate of ankle non-union in obese patients using quadruple screwing or a dedicated locking plate. The hypothesis was that the locking plate limits the risk of non-union in this population.</div></div><div><h3>Methods</h3><div>All patients were obese (BMI<!--> <!-->&gt;<!--> <!-->30<!--> <!-->kg/m²) and presented ankle osteoarthritis with<!--> <!-->&gt;<!--> <!-->10° intra-articular deformity. The approach and joint preparation were performed via an anteromedial approach. Group S was composed of 32 patients, operated on by quadruple screwing; group P comprised 10 patients operated on using a dedicated locking plate. The main endpoint was a significant difference in the rate of non-union between the 2 groups. The secondary endpoint was improvement in pre- and 6-month postoperative AOFAS score.</div></div><div><h3>Results</h3><div>Group S presented 31% non-union (10/32) and group P 0% (0/10) (<em>p</em> <!-->&lt;<!--> <!-->0.05). Postoperative AOFAS score was significantly higher in group P: 67.8<!--> <!-->±<!--> <!-->10.4 [range, 40–92] vs. 83.1<!--> <!-->±<!--> <!-->8.0 [range, 64–92] (<em>p</em> <!-->&lt;<!--> <!-->0.05).</div></div><div><h3>Conclusion</h3><div>The dedicated anterior locking plate is a technique of choice for ankle fusion in obese patients with intra-articular deformity<!--> <!-->&gt;<!--> <!-->10°, to limit the risk of non-union.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140853597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Original surgical technique for the treatment of patellofemoral instability after failure of conservative treatment","authors":"","doi":"10.1016/j.otsr.2023.103657","DOIUrl":"10.1016/j.otsr.2023.103657","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Acute patellar dislocation<span> is a common but serious injury that can significantly impact a patient's functional prognosis. The objective of this retrospective study is to evaluate the clinical outcomes of arthroscopic medial patellofemoral ligament (MPFL) reconstruction and </span></span>plication<span> of the medial patellar retinaculum using suture anchors in adolescent patients with first-time acute patellar dislocation (APD) and MPFL insertion injury.</span></div></div><div><h3>Hypothesis</h3><div>Tightening repair of the medial retinaculum complex can result in favorable clinical and functional outcomes in this patient population.</div></div><div><h3>Materials and methods</h3><div>A total of 84 adolescent patients with first-time APD and with an average age of 15.5 years (10-22) were included in the study. Of these patients, 61 (7 male and 54 female) underwent arthroscopic suture anchor plication for medial patellar retinaculum, while the other 23 were successfully treated non-operatively. Radiographic outcomes, including the congruence angle (CA), lateral patellofemoral angle (LPA), and patellar tilt angle (PTA), were evaluated preoperatively and at the last follow-up visit in the surgical group. Functional outcomes were assessed using the Lille Patello-Femoral Score, Lysholm Score, and Kujala Score at the same time points. In addition, the surgical and non-operative treatment success groups were compared in terms of both radiographic and functional outcomes.</div></div><div><h3>Results</h3><div><span>Mean follow-up was 40.9 months (24–60). Fifty-nine knees showed excellent or good results postoperatively, 2 patients had a recurrent patellar subluxation. The Lille Patello-Femoral Score was 96.9</span> <!-->±<!--> <!-->4.7 at the last follow-up. The subjective Lysholm Score and Kujala Score improved significantly, from 58.6 to 91.9 and from 60.4 to 88.9, respectively. The radiographic CA, LPA and PTA improved significantly, from 19.8<!--> <!-->±<!--> <!-->2.1° to –6.7<!--> <!-->±<!--> <!-->1.7°, from –7.4<!--> <!-->±<!--> <!-->2.2° to 5.7<!--> <!-->±<!--> <!-->1.8° and from 23.8<!--> <!-->±<!--> <!-->2.9° to 12.3<!--> <!-->±<!--> <!-->2.3°, respectively. There was no statistically significant difference in functional and radiographic assessments between the success with non-operative treatment group and the surgery group.</div></div><div><h3>Conclusion</h3><div>The results of this study suggest that arthroscopic MPFL insertion reconstruction and plication using suture anchors, which is less invasive and improves patella stability, can lead to favorable clinical and functional outcomes in adolescent patients with first-time acute patellar dislocation and insertion injury. This treatment approach should be considered as a viable option for this patient population.</div></div><div><h3>Level of evidence</h3><div>IV; monocentric retrospective descriptive study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9856454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three-dimensional printing technique aids screw insertion into the sustentaculum tali of the internal fixation of intra-articular calcaneal fractures","authors":"","doi":"10.1016/j.otsr.2024.103835","DOIUrl":"10.1016/j.otsr.2024.103835","url":null,"abstract":"<div><h3>Introduction</h3><div>Treating complex calcaneus fractures<span> remains challenging. This study evaluated the influence of 3D printing and simulation on precision screw insertion into the calcaneus sustentaculum tali (ST).</span></div></div><div><h3>Hypothesis</h3><div>3D printing and simulation improve the treatment for calcaneal fracture.</div></div><div><h3>Patients and methods</h3><div>This retrospective cohort study included 85 patients admitted with 93 Sanders type II–IV intra-articular fractures from January 2015 to June 2020. Multi-slice computed tomography (MSCT) images were used in the conventional group, and MSCT data were used to construct a 3D model of the calcaneus to simulate screw insertion and verify parameter accuracy in the 3D group.</div></div><div><h3>Results</h3><div>The designed parameters (upward and backward oblique angles and screw-path length) were similar to the actual values in the 3D group (<em>p</em> <!-->=<!--> <!-->0.428,0.287,0.585) but not in the conventional group (<em>p</em> <!-->=<!--> <!-->0.01,0.002,0.023). The Maryland foot functional score, accuracy rate, and average screw number were higher and operative time was shorter in the 3D group (<em>p</em> <!-->=<!--> <!-->0.005,0.007,0.000,0.000).</div></div><div><h3>Discussion</h3><div>Preoperative simulation using the 3D printing model helped guide the screws into the ST more accurately, lending better-quality treatment for Sanders type II–IV calcaneal fractures.</div></div><div><h3>Level of proof</h3><div>III; Retrospective case-control study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided thermal radiofrequency ablation of the genicular nerves after total knee replacement","authors":"","doi":"10.1016/j.otsr.2024.103858","DOIUrl":"10.1016/j.otsr.2024.103858","url":null,"abstract":"<div><div><span>The rate of refractory chronic pain after total knee replacement (TKR) is 20–25%, with no identifiable etiology in 6% of cases. Without an etiologic diagnosis, the surgeon is unlikely to consider revision, but pain poses a therapeutic challenge for achieving satisfaction and an acceptable </span>quality of life<span>. Genicular nerve radiofrequency ablation (GNRFA) was recently developed as a non-drug analgesic option. It is minimally invasive and safe, with few adverse effects, opening a new perspective for management of refractory chronic pain after TKR.</span></div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between losartan potassium prescription and postoperative outcomes following total knee arthroplasty: A TriNetX analysis","authors":"","doi":"10.1016/j.otsr.2024.103851","DOIUrl":"10.1016/j.otsr.2024.103851","url":null,"abstract":"<div><h3>Background</h3><div><span><span><span>Total knee arthroplasty (TKA) is a common surgical procedure performed to alleviate pain and improve functional outcomes in patients with </span>knee osteoarthritis and </span>rheumatoid arthritis<span><span> who have failed conservative treatments. Arthrofibrosis has been extensively studied due to its negative impact on TKA outcomes. </span>Losartan, an </span></span>angiotensin receptor blocker<span><span> (ARB), has the potential to improve TKA outcomes by inhibiting TGF-β and decreasing fibrosis<span>. This study aims to analyze a large-scale, real-world healthcare database to investigate the association between losartan potassium<span> prescription and postoperative outcomes such as readmissions, ED visits, and the need for </span></span></span>MUA<span> or revision TKA.</span></span></div></div><div><h3>Hypothesis</h3><div>Based on previous literature and the nature of ARBs, it is expected that the addition of losartan will aid in better outcomes for patients following a primary TKA.</div></div><div><h3>Patients and methods</h3><div><span>In this retrospective observational study, the TriNetX Research Network (TriNetX) database was queried as of June 21, 2023. All patients who underwent a primary total knee arthroplasty (TKA) prior to June 21, 2022 were included. Patients were then divided into two cohorts by whether they had an active losartan potassium prescription within the year prior to their surgery to within 90</span> <!-->days postoperatively. Patients were then propensity-matched to eliminate differences in demographics and comorbidities.</div></div><div><h3>Results</h3><div><span>Losartan TKA patients were 1.18 [OR: 0.85 (95% CI: 0.79–0.90), </span><em>p</em> <!-->&lt;<!--> <!-->0.001] times less likely to be readmitted within 90<!--> <!-->days and were 1.15 (OR: 0.87 (95% CI: 0.79–0.96); <em>p</em> <!-->=<!--> <span>0.009) times less likely to undergo a manipulation under anesthesia (MUA) within the 1-year postoperative period. There were no statistically significant differences in rates of emergency department (ED) visits at 90</span> <!-->days postoperatively or revision TKAs at 1<!--> <!-->year postoperatively.</div></div><div><h3>Discussion</h3><div>In conclusion, patients with an active losartan prescription prior to TKA had a significantly lower likelihood of readmission within 90<!--> <!-->days and a lower likelihood of undergoing MUA within the 1-year postoperative period compared to patients not taking losartan. This presents an opportunity for further clinical investigation to explore the value of losartan in TKA.</div></div><div><h3>Level of evidence</h3><div>III; an observational cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femoral trochlear groove cartilage damage after open-wedge high tibial osteotomy is associated with the change in patellar height relative to the femoral condyle","authors":"","doi":"10.1016/j.otsr.2024.103898","DOIUrl":"10.1016/j.otsr.2024.103898","url":null,"abstract":"<div><h3>Background</h3><div>Medial open-wedge high tibial osteotomy<span><span> (OWHTO) is performed for isolated medial compartment osteoarthritis<span> or osteonecrosis of the knee and correction of </span></span>varus deformity<span> of the full lower extremity. OWHTO may induce sagittal parameter changes, including these in the tibial posterior slope (TPS), patellar height (PH), and patellofemoral joint problems. This study aimed to identify radiographic parameters associated with patellofemoral cartilage damage after OWHTO.</span></span></div></div><div><h3>Hypothesis</h3><div>The patellofemoral joint cartilage worsens after OWHTO and is adversely affected by PH changes.</div></div><div><h3>Patients and methods</h3><div>Twenty patients (25 knees) who underwent primary OWHTO and subsequent implant removal surgery, including second-look arthroscopy for evaluation of the patellofemoral cartilage condition were enrolled. The patients were received 12 to 35 months of postoperative follow-up, and categorized into two groups according to whether patellofemoral cartilage damage worsened. TPS and PH parameters, including the Insall–Salvati, Blackburne–Peel, Caton–Deschamps, and modified Blumensaat (MBI) indices, were measured on lateral knee radiographs. The hip-knee-ankle and medial proximal tibial angles were measured using an anteroposterior radiograph of the full lower extremity. The extent of change from preoperative to postoperative (Δ) was calculated for all indices.</div></div><div><h3>Results</h3><div>Eleven knees (44%) had worsening cartilage conditions in the femoral trochlear groove, with<!--> <!-->&gt;<!--> <!-->1-degree of deterioration in the International Cartilage Repair Society grade. The radiographic measure for predicting patellofemoral cartilage deterioration was ΔMBI (95% confidence interval [CI]: 3.53<!--> <!-->×<!--> <!-->10^–14–0.812, <em>p</em> <!-->=<!--> <!-->0.047). PF cartilage damage tended to progress in ΔMBI<!--> <!-->&lt;<!--> <!-->–0.145. The postoperative TPS and HKAA in patients with deterioration in patellofemoral cartilage damage was greater than that in patients without deterioration in patellofemoral cartilage damage (<em>p</em> <!-->=<!--> <!-->0.037 and 0.038, respectively).</div></div><div><h3>Discussion</h3><div>The patellofemoral cartilage damage tends to progress after OWHTO. ΔMBI is a factor for predicting worsening patellofemoral cartilage condition. However, attention should be paid to the excessive posterior slope as high TPS and valgus alignment as valgus HKAA because intraoperative control of MBI is impossible.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is an excessively high posterior tibial slope a predisposition to knee injuries in children? Systematic review of the literature.","authors":"Céline Klein, Riadh Rahab, Thomas Rouanet, François Deroussen, Julien Demester, Richard Gouron","doi":"10.1016/j.otsr.2024.104033","DOIUrl":"10.1016/j.otsr.2024.104033","url":null,"abstract":"<p><strong>Background: </strong>The literature agrees that an increased posterior tibial slope (PTS) increases the risk of anterior cruciate ligament (ACL) rupture in adults. However, there is no consensus on the average normal value and it varies with growth. We carried out a systematic review of the literature to answer 4 questions faced with an increase in PTS in children: METHOD: We conducted a systematic review of the literature in accordance with PRISMA criteria. The inclusion criteria were all studies analyzing the association between increased PTS and the occurrence of knee disease in patients, the majority of whom were under 18 years of age or had immature skeletons. For each study, we recorded the demographic characteristics of the patients, the type of measurements performed, the PTS values and the association between the PTS value and the occurrence of pathology.</p><p><strong>Results: </strong>A total of 294 studies were identified. After analysis, 11 studies were included (n = 1173 patients). Six studies examined the association between PTS and anterior cruciate ligament (ACL) rupture (n = 5) or recurrence of rupture (n = 1). Two studies investigated the association between tibial slope and proximal tibial fracture and 3 studies investigated the association between tibial slope and growth disease (Osgood Schlatter (OSD) or osteochondritis dissecans of the knee). Of the 5 ACL studies, all studies found a significant increase in PTS in patients with ACL rupture (range min 2.1 ° max 4.3 °) compared with healthy subjects. Concerning growth lesions, 3 studies found an increased PTS in patients with OSD or osteochondritis. The studies concerning fractures of the proximal end of the tibia also found an increase in PTS.</p><p><strong>Conclusions: </strong>This review highlighted the potential link between an abnormally high PTS value and the occurrence of knee pathologies in children, in particular ACL rupture. Children with a high PTS and an ACL rupture will require longer-term follow-up and should be warned of the greater risk of re-rupture.</p><p><strong>Level of evidence: </strong>IV; systematic review.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the GeneXpert® MRSA/SA SSTI Test in Periprosthetic Joint Infections: Rate of failure, Outcomes and Risk Factors.","authors":"Jean-Thomas Leclerc, Marie Titécat, Theo Martin, Julien Dartus, Sophie Putman, Pierre Martinot, François Demaeght, Caroline Loïez, Philippe-Alexandre Faure, Gilles Pasquier, Julien Girard, Alain Duhamel, Eric Senneville, Henri Migaud","doi":"10.1016/j.otsr.2024.104032","DOIUrl":"https://doi.org/10.1016/j.otsr.2024.104032","url":null,"abstract":"<p><strong>Background: </strong>The GeneXpert® MRSA/SA SSTI test allows early detection of methicillin-resistant staphylococci in intraoperative samples of prosthetic joint infections (PJI) in order to stop early broad-spectrum antibiotics.</p><p><strong>Questions/purpose: </strong>(1) What is the rate of false-negative GeneXpert® MRSA/SA SSTI test results? (2) Does a false-negative GeneXpert® MRSA/SA SSTI test result increase the risk of treatment failure for the patient with a PJI? (3) What are the risk factors of a false-negative result?</p><p><strong>Method: </strong>A retrospective study was carried out to compare all GeneXpert® assays to conventional cultures in prosthetic joint infections from April 1^st, 2012 to October 1^st, 2016. False-negative (FN) results (absence of methicillin-resistant staphylococci (MRS) with GeneXpert® test, but presence in the culture) were identified. We compared the rate of treatment failure between FN results and other test results and we established the risk factors of having a FN result.</p><p><strong>Results: </strong>Among the 612 GeneXpert® results, the rate of FN results was 3.6 % (22/612). We found a significant increase in treatment failures for prosthetic joint infection with a FN result with 14 treatment failures (14/22) compared to 198 treatment failures (198/590) in the other test results (OR, 2.1; 95 % CI, 1.3-3.4, p = 0.0019). Not considering suppressive antibiotics as a treatment failure, we found no significant difference in the rate of treatment failures between the false-negative tests and the other tests (OR, 1.36; 95 % CI, 0.66-2.81, p = 0.41). Tobacco use (OR, 3.8; 95 % CI, 1.4-10.3, p = 0.004), ASA classification (OR, 2,4; 95 % CI, 0.9-6.9, p = 0.064), history of infection in the joint (OR, 3.2; 95 % CI, 1.2-9.6, p = 0.007), chronic infections (OR, 3.2; 95 % CI, 0.8-17.5, p = 0.01) and polymicrobial infections (OR, 3.2; 95 % CI, 1.1-9.2, p < 0.0001) were risk factors for a FN result.</p><p><strong>Conclusion: </strong>GeneXpert® tests in prosthetic joint infections showed a low rate of FN results. An increased risk of treatment failures was observed in FN results only when long-term use of suppressive antibiotics was considered as treatment failure.</p><p><strong>Level of evidence: </strong>III; Diagnostic retrospective case control study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Which treatment in acetabular fractures of the elderly: Osteosynthesis, osteosynthesis-THA or orthopedic treatment? 2-years retrospective outcomes of a therapeutic algorithm.","authors":"Omar Rajillah, Antoine Piercecchi, Guillaume Girardot, Emmanuel Baulot, Marie Lebaron, Pierre Martz","doi":"10.1016/j.otsr.2024.104031","DOIUrl":"10.1016/j.otsr.2024.104031","url":null,"abstract":"<p><strong>Introduction: </strong>Acetabular fractures account for 7% of osteoporotic fractures, with an epidemiological peak between 75 and 80 years of age. The aim of this study is to evaluate the results of treatment of these fractures in a population aged over 65.</p><p><strong>Hypothesis: </strong>Surgical treatment would lead to better survival and functional outcomes in the management of acetabular fractures in subjects aged over 65.</p><p><strong>Material and methods: </strong>Patients over 65 years of age treated for acetabular fracture between January 2017 and May 2020 were included in this retrospective single-center study and divided into three treatment groups: osteosynthesis, osteosynthesis-THA (Osteosynthesis-THA) and orthopedic treatment. The choice of treatment was made according to an algorithm that considered the patient's co-morbidities, autonomy and bone lesions. The primary endpoint was patient survival at 12 and 24 months' follow-up.</p><p><strong>Results: </strong>94 patients (mean age 78.5 +/-8.4 years) were included: 29 patients treated with orthopedic therapy, 46 patients with osteosynthesis and 19 patients with osteosynthesis-THA. Mean follow-up was 32.7+/-14.9 months. Mortality rates were higher in the orthopedic and osteosynthesis-THA groups (20.7% and 21.1% respectively). Patients in the orthopedic and osteosynthesis-THA groups showed excess mortality, with hazard ratios (HR) of 3.4 ([1.02; 11.3], p < 0.05) and 3.3 ([0.9; 12.3], p = 0.08) respectively, compared with those treated with osteosynthesis. Mean PMA at 2 years, mean Harris score at 2 years and Parker score were significantly higher in the operated groups. The rate of conversion to THA (THA) was higher in the orthopedic treatment group (27.6%). The complication rate was 24% (11/46) for the osteosynthesis group, 42% (8/19) for the osteosynthesis-THA group.</p><p><strong>Discussion: </strong>Applying our decision algorithm, orthopedic treatment is inferior to surgical treatment in terms of survival and functional results, with a higher re-intervention rate for THA than treatment with osteosynthesis. This study confirms the place of osteosynthesis, with higher functional scores, lower complication and revision rates, and a positive effect on mortality.</p><p><strong>Level of evidence: </strong>IV; Retrospective cohort study.</p>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}