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The Paramount Importance of Ethics in Clinical Practice

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:1 | Dr. Nicholas Antao, Dr. Ashok Shyam

Author: Dr. Nicholas Antao [1], Dr. Ashok Shyam [2, 3]

[1] Hill Way Clinic, Hill N Dale Building, 4th Floor, Hill Road, Bandra West, Mumbai – 400050
[2] Sancheti Institute for Orthopaedics and Rehablitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India.

Address of Correspondence
Dr. Nicholas Antao
Head of Dept. of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093 India.
Email: narantao@gmail.com

The Paramount Importance of Ethics in Clinical Practice

The strongest endeavour that any human being going for itself is its own moral integrity and its own heart. Only Morality can give beauty & dignity to Life
-Albert Einstein

Ethics is derived from Greek word Ethos which means -the study of what is morally right and what is not. Oxford Dictionary defines it as “The science of morals, the department of study concerned with the principles and physics of human behaviour and conduct”. In a more practical sense by morals and ethics, it is meant the doctrine of a special kind of pleasure or displeasure which is felt by the human mind in contemplating certain courses of conduct, whereby they are felt to be right or wrong, and of a special desire to do the right things and avoid the wrong ones. We believe that it is an inbuilt and strong program which is evolved in human psyche over thousands of years of evolution and we agree with Einstein that it is what adds beauty and dignity to Life as a whole.
For ethical things that have a clear black and white definitions, there are laws of the land that uphold them. But for most day to day ethical issues, our own moral compass guides us. How does this impact clinical practice? This part has been specifically addressed in our guest editorial by Dr.Anukant Mittal. He has written about the MCI guidelines that apply to us as clinicians and also on moral issues. Dr KH Sancheti also in his walkathon, has spoken on how we should function keeping ethical things in mind for building our clinical practice.
We believe that at many places, we start to discount ethics early in career due to various social and financial reasons. We try to follow the current trends in ethics and since we see many following particular trends we believe it to the right one. This discounting of morals and ethics slowly becomes a habit and we start discounting them in other areas of life too and soon enough before we realise it becomes significant enough to affect our mental peace. At this stage, we take the defence of ignoring it and also rationalising it [by taking examples of peers and colleagues]. This vicious cycle once sets in; it is tough to break as it becomes completely invisible to us. Once in a while when certain things like violence against doctors happen or there is a talk on the degrading status of doctors in society, that we realise it. However, as a habit, we learn to ignore it and go with it for as long as possible. The journey of the medical profession that begins with very high ethical and moral standards in each of our minds thinks less and less of it as we grow in the profession.
We feel keeping a check on our ethical and moral on a regular basis in clinical practice would definitely help us in becoming better surgeons. It will not only help us in becoming more peaceful and hold our dignity but will also avoid incidences like patient violence.
We believe a more introspection is needed in this aspect from all of us.

Dr Nicholas Antao
Dr Ashok Shyam.

How to Cite this article: Antao N, Shyam AK. The Paramount Importance Of Ethics in ClinicalPractice. Journal of Clinical Orthopaedics July -Dec 2019; 4(2):1.

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Surgical Management of Surgical Site Infections in Orthopaedics

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:17-25 | Dr. Sitaram Prasad, Dr. Gautam Zaveri

Author: Dr. Sitaram Prasad [1], Dr. Gautam Zaveri [2]

[1] Department of Plastic Surgery, Fortis & Zen Hospitals, Mumbai.
[2] Department of Spine Surgery, Jaslok, Fortis & Zen Hospitals, Mumbai.

Address of Correspondence
Dr. Gautam Zaveri
Department of Plastic Surgery, Fortis & Zen Hospitals, Mumbai
Email: gautamzaveri1969@gmail.com

Abstract

Surgical site infections are a source of great misery to both patients and surgeons. The management requires a multipronged approach specially in orthopaedics. The current chapter outlines the various methods of source control when dealing with musculoskeletal infections.
Keywords: Surgical site infections, orthopaedics, management

References

1. Manna B, Morrison CA. Wound debridement. [Updated 2019 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507882/
2. Meyers B. Wound Management: Principles and Practice. 2nd edition. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2008
3. Owens B, White D, Wenke J. Comparison of irrigation solutions and devices in a contaminated musculoskeletal wound survival model. Journal of Bone and Joint Surgery. 2009;91(1):92-98.
4. Swezey L. 8 key steps to performing proper wound irrigation. Wound Source, 2014 Aug 29 at www.woundsource.com
5. Zimmerli W, Sendi P. Orthopedic biofilm infections. APIMS 2017 April; 125(4): 353-364
6. W.J. Metsemakers, Kuehl R, Moriarty TF, et al., Infection after fracture fixation: Current surgical and microbiological concepts, Injury (2016), http://dx.doi.org/10.1016/j.injury.2016.09.019
7. Doud Galli, S & Constantinides, M. Wound Closure Technique. Medscape. Updated April 2013
8. Myers, Betsy. (2008). Wound Management Principles and Practice. Pearson Prentice Hall. Upper Saddle River, New Jersey pg. 17-18
9. Swezey L. Types of wound closure. 2014 April. www.woundeducators.com
10. Simman R. Wound closure and reconstructive ladder in plastic surgery. J Am Col Certif Wound Spec. 2009 Jan; 1(1): 6–11
11. Bistolfi A, Massazza G, Verne E, et al. Antibiotic loaded cement in orthopaedic surgery. A review. International Scholarly Research Network ISRN Orthopedics Volume 2011, Article ID 290851, 8 pages doi:10.5402/2011/290851
12. Gogia JS, Meehan JP, DiCesare PE. Local antibiotic therapy in osteomyelitis. Seminars in plastic Surgery 2009; 23(2): 100- 107
13. Putnis S, Khan WS, Wong J M-L. Negative pressure wound therapy. A review of its uses in Orthopaedic trauma. Open Orthop J. 2014 June; 8: 142–147
14. Jones SM, Banwell PE, Shakespeare PG. Advances in wound healing:topical negative pressure therapy. Postgraduate Medical Journal 2005;81:353-357.
15. Sarabahi S. Recent advances in Topical wound care. In J Plastic Surg. 2012 May- Aug;45(2): 379-387
16. Dhivya S, Padma VV, Santhini E. Wound dressings- a review. Biomedicine (Taipei). 2015 Dec: 5(4): 22.

How to Cite this article: Prasad S, Zaveri G. Surgical Management of Surgical Site Infections in Orthopaedics. Journal of Clinical Orthopaedics July-Dec 2019;4(2):17-25.

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Diagnosis of Surgical Site Infection

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:12-16 | Dr. Manish Kothari

Author: Dr. Manish Kothari [1]

[1] Consultant Spine Surgeon, Jaslok Hospital & Research Centre, Mumbai

Address of Correspondence
Dr. Manish Kothari
Jaslok Hospital & Research Centre, Mumbai
E-mail: dr.manish.kothari@jaslokhospital.net

Abstract

Diagnosis of Surgical site infection is one of the most important factors that determines the further management of SSI. The diagnosis is based on various factors including clinical, laboratory investigations, Radiology, Bacteriology and molecular modalities. The current review summarises the salient features in all modalities.
Keywords: Surgical Site infection, Diagnosis.

References

1. Harrop JS, Styliaras JC, Ooi JC, Radcliff KE, Vaccaro AR, Wu C. Contributing factors to surgical site infections. J Am Acad Ortho Surg. 2012; 20(2):94-101.
2. WHO document on Global Guidelines For the Prevention of Surgical Site Infection. WHO Guidelines Development Group; Geneva, Switzerland; 2016;58-177
3. Guideline for Prevention of Surgical Site Infection (2017). Centre for disease control and prevention. https://www.cdc.gov/infectioncontrol/guidelines/ssi/index.html accessed 15th March 2019.
4. Simodynes, EE, Cochran, RM. Aeromonas hydrophila infection complicating an open tibial fracture. A case report. Clin OrthopRelat Res 1982; 171: 117–120
5. Levitsky KA, Hozack WJ, Balderston RA, et al. Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration. J Arthroplasty. 1991;6:237–244.
6. Schinsky MF, Della Valle CJ, Sporer SM, et al. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90:1869–1875. doi: 10.2106/JBJS.G.01255.
7. Spangehl MJ, Masri BA, O’Connell JX, et al. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999;81:672–683.
8. Bilgen O, Atici T, Durak K, et al. C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res. 2001;29:7–12.
9. Park KK, Kim TK, Chang CB, et al. Normative temporal values of CRP and ESR in unilateral and staged bilateral TKA. Clin OrthopRelat Res. 2008;466:179–188. doi: 10.1007/s11999-007-0001-x. [PMC free article]
10. Forster IW, Crawford R. Sedimentation rate in infected and uninfected total hip arthroplasty. Clin OrthopRelat Res. 1982;168:48–52.
11. Lee Y, McKechnie T, Doumouras AG, Handler C, Eskicioglu C, Gmora S, Anvari M, Hong D. Diagnostic Value of C-Reactive Protein Levels in Postoperative Infectious Complications After Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg. 2019 Mar 21
12. Aljabi Y, Manca A, Ryan J, Elshawarby A. Value of procalcitonin as a marker of surgical site infection following spinal surgery. The Surgeon. 2019 Apr 1;17(2):97-101.
13. Cyteval, C, Hamm, V, Sarrabère, MP. Painful infection at the site of hip prosthesis: CT imaging. Radiology 2002; 224(2): 477–483
14. Kohan, AA, Rubbert, C, Vercher-Conejero, JL. The impact of orthopedic metal artifact reduction software on interreader variability when delineating areas of interest in the head and neck. PractRadiat Oncol 2015; 5(4): e309–e315.
15. Cyteval, C, Bourdon, A. Imaging orthopedic implant infections. Diagn Interv Imaging 2012; 93(6): 547–557
16. Plodkowski,A.J., Hayter,C.L., Miller,T.T., Nguyen,J.T., Potter,H.G. Lamellated hyperintense synovitis: potential MR imaging sign of an infected knee arthroplasty. 2013/1; 1: 256-260
17. Talbot BS, Weinberg EP. MR imaging with metal-suppression sequences for evaluation of total joint arthroplasty. Radiographics. 2015 Nov 20;36(1):209-25.
18. Glaudemans, AWJM, Signore, A. FDG-PET/CT in infections: the imaging method of choice? Eur J Nucl Med Mol Imaging 2010; 37(10): 1986–1991.
19. Basu, S, Kwee, TC, Saboury, B. FDG-PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99)mTc-sulfur colloid bone marrow imaging in 88 prostheses. J Nucl Med 2014; 39(7): 609–615.
20. Schwotzer N, Wahl P, Fracheboud D, Gautier E, Chuard C. Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation. Journal of clinical microbiology. 2014 Jan 1;52(1):61-6.
21. Bémer, P.; Plouzeau, C.; Tande, D.; Léger, J.; Giraudeau, B.; Valentin, A.S.; Jolivet-Gougeon, A.; Vincent, P.; Corvec, S.; Gibaud, S.; et al. Evaluation of 16S rRNA gene PCR sensitivity and specificity for diagnosis of prosthetic joint infection: A prospective multicenter cross-sectional study. J. Clin. Microbiol. 2014, 52, 3583–3589.
22. Hartley, J.C.; Harris, K.A. Molecular techniques for diagnosing prosthetic joint infections. J. Antimicrob. Chemother. 2014, 69 (Suppl. 1), i21–i24.
23. Yano, M.H.; Klautau, G.B.; da Silva, C.B.; Nigro, S.; Avanzi, O.; Mercadante, M.T.; Salles, M.J.C. Improved diagnosis of infection associated with osteosynthesis by use of sonication of fracture fixation implants. J. Clin. Microbiol. 2014, 52, 4176–4182.
24. Yano, M.H.; Klautau, G.B.; da Silva, C.B.; Nigro, S.; Avanzi, O.; Mercadante, M.T.; Salles, M.J.C. Improved diagnosis of infection associated with osteosynthesis by use of sonication of fracture fixation implants. J. Clin. Microbiol. 2014, 52, 4176–4182.
25. Schinsky, M.F.; Della Valle, C.J.; Sporer, S.M.; Paprosky, W.G. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J. Bone Jt. Surg. Ser. A 2008, 90, 1869–1875.
26. Drago, L.; Signori, V.; De Vecchi, E.; Vassena, C.; Palazzi, E.; Cappelletti, L.; Romanò, D.; Romanò, C.L. Use of dithiothreitol to improve the diagnosis of prosthetic joint infections. J. Orthop. Res. 2013, 31, 1694–1699.
27. Al-Adsani A., Niazy M. N. ,Mohd M., Ewing’s sarcoma of the ilium mimicking sacroiliitis Rheumatology (1999) 38 (8): 792-793
28. Wang J, Wu X, Xi ZJ. Langerhans cell histiocytosis of bone in children: a clinicopathologic study of 108 cases. World J Pediatr. 2010 Aug;6(3):255-9.

How to Cite this article: Kothari M. Diagnosis of surgical site infection. Journal of Clinical Orthopaedics July-Dec 2019;4(2):12-16.

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Potpourri – Recent and relevant literature in 2019

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:57-60 | Rajendraprasad R Butala, Shikhar D Singh, Sachin Y Kale, Prasad Chaudhari, Sanjay Dhar, Prakash Samant

Author: Rajendraprasad R Butala [1], Shikhar D Singh [1], Sachin Y Kale [1], Prasad Chaudhari [1], Sanjay Dhar [1] , Prakash Samant [1]

[1] Department of Orthopaedics, Dr. DY Patil Medical College, Navi Mumbai

Address of Correspondence

Address of Correspondence

[1] Department of Orthopaedics, Dr. DY Patil Medical College, Navi Mumbai

Address of Correspondence
Dr. Shikhar D Singh,
Department of Orthopaedics, Dr. DY Patil Medical College
Sector 7, Nerul, Navi Mumbai, Maharashtra 400706
E-mail: drsinghshikhar@gmail.com

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF) is an effective treatment of intervertebral disc herniation. The zero-profile interbody fusion device, Zero-P was invented to reduce complications due to previously used anterior constructs. The present study investigates the outcome of surgical decompression and stabilization by anterior approach using Zero-P-Plate.
Methodology: We collected data of 22 patients of cervical disc prolapse with neurological deficits treated with ACDF using Zero-P implant. The patients were assessed pre-operatively and during follow up on outpatient basis at 2 weeks, 6 weeks, 12 weeks, 24 weeks and then on yearly basis for 2 years. The outcome was assessed based on Visual Analogue Scale (VAS) score, Nurick grading and Odom’s criteria and success of fusion.
Results: Radiculopathy was present in all patients pre-operatively. We observed that 77% of the patients had VAS score of 4 or higher pre-operatively, which reduced to 13% in the immediate post-operative period and 0% at the last follow up. Nurick grade 2 or higher was seen in 31% pre-operatively, a percentage which reduced to 0% in the post-operative period. Final clinical outcome using Odom’s criteria revealed excellent outcome in 87% of the patients and good outcome in 13%.
Conclusions: ACDF by Zero-P-Plate can be considered in treatment of patients with cervical disc prolapse with neurological deficit.
Keywords: Anterior cervical discectomy and fusion; Cervical disc disease; Intervertebral fusion device.

References

1. Smith GW, Robinson RA. The Treatment of Certain Cervical-Spine Disorders by Anterior Removal of the Intervertebral Disc and Interbody Fusion. The Journal of Bone & Joint Surgery. 1958;40-A(3):607–24.
2. Kaiser MG, Haid Jr RW, Subach BR, Barnes B, Rodts Jr GE. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002 Feb 1;50(2):229-38.
3. Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain. 1972 Jan 1;95(1):101-8.
4. Odom GL, Finney W, Woodhall B : Cervical disk lesions. J Am Med As-soc 166 : 23-28, 1958
5. Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F: A new zero-pro le implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 469:666–673, 2011
6. Njoku I, Alimi M, Leng LZ, Shin BJ, James AR, Bhangoo S, Tsiouris AJ, Härtl R. Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study. Journal of Neurosurgery: Spine. 2014 Oct 1;21(4):529-37.
7. Alimi M, Njoku I, Hofstetter CP, Tsiouris AJ, Kesavabhotla K, Boockvar J, Navarro-Ramirez R, Härtl R. Anterior cervical discectomy and fusion (ACDF): comparison between zero profile implants and anterior cervical plate and spacer. Cureus. 2016 Apr;8(4).
8. Duan Y, Yang Y, Wang Y, Liu H, Hong Y, Gong Q, Song Y. Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: a meta- analysis. J Clin Neurosci. 2016;33:11–18.
9. Lee MJ, Bazaz R, Furey CG, Yoo J. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech. 2005;18(5):406–9.

How to Cite this article: Deogaonkar K, Menon A, Zaveri G. Surgical Site Infections in Orthopaedics: Epidemiology & Microbiology. Journal of Clinical Orthopaedics July-Dec 2019;4(2):7-11.

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Idiopathic Tumour Calcinosis in Foot

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page: 61-63 | Tarun Verma, Abhishek Mishra, Gaurang Agarwal, Lalit Maini.

Author: Tarun Verma [1], Abhishek Mishra [2], Gaurang Agarwal [2], Lalit Maini [2].

[1] Department of Orthopaedics, Medical College, Baroda and Sir Sayajirao General Hospital Baroda, Gujarat
[2] Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi.

Address of Correspondence
Dr. Tarun Verma,
Permanent address: C-40, Omkar society, Maneja, Vadodara, Gujarat- 390013
E-mail: tarunamiabledpv@gmail.com

Abstract

Idiopathic tumoral calcinosis (TC) is a rare disorder characterized by the development of calcified masses within the periarticular soft tissues of large joints like hip, elbow, shoulder, and rarely foot. A variety of conditions causing heterotopic calcifications can mimic this disorder like chronic renal failure, hyperparathyroidism, vitamin D intoxication, milk alkali syndrome, scleroderma etc. Due to similar plain radiograph picture, it can also be confused with synovial chondromatosis. Biochemical, radiological investigations and biopsy are essential to establish the diagnosis. This article describes a case of idiopathic tumour calcinosis around 5th metatarso-phalangeal joint in a 20 years old female. It’s radiographic and MRI features, types and management options are discussed subsequently.
Keywords: Tumour calcinosis; heterotopic calcification; Normophosphatemic; synovial chondromatosis; white paste.

References

1. Tezelmann S, Siperstein A E, Duh QY, Clark O H (1993) Tumoral calcinosis: controversies in the etiology and alternatives in the treatment. Arch Surg 128: 737–45.
2. Chaabane S, Chelli-bouaziz M, Jelassi H, Mrad K, Smida M, Ladeb M F (2008) Idiopathic tumoral calcinosis, Acta Orthop Belg 74:837–45.
3. Martinez S (2002) Tumoral calcinosis: 12 years later. Semin Musculoskelet Radiol 6:331-39.
4. Rambani R, Dhillon MS, Aggarwal R (2003) Tumoral calcinosis with unusual presentation. A case report. Acta Orthop Belg 69:368–72.
5. Leung Y.Y., Lai R (2011) Tumoral calcinosis: a case report, J. Orthop. Surg. (Hong Kong) 19: 108–12.
6. Henry GI, Teven CM (2012) CASE REPORT idiopathic tumoral calcinosis of the nontraumatic thumb. Eplasty 12:e29.
7. Harkness JW, Peters HJ (1967) Tumoral Calcinosis — Report of Six Cases. J. Bone Joint Surg 49:721-731.
8. Mohamed S, Jong-Hun J, Weon-Yoo K (2007) Tumoral calcinosis of the foot with unusual presentation in an 11-year-old boy: A case report and review of literature. J Postgrad Med 53:247-9.

How to Cite this article: Verma T, Mishra A, Agarwal G, Maini L. Idiopathic Tumour Calcinosis in Foot. Journal of Clinical Orthopaedics July-Dec 2019;4(2):61-63.

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Anterior cervical discectomy and fusion with Zero-P-Plate in the treatment of cervical disc prolapse

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:57-60 | Rajendraprasad R Butala, Shikhar D Singh, Sachin Y Kale, Prasad Chaudhari, Sanjay Dhar, Prakash Samant

Author: Rajendraprasad R Butala [1], Shikhar D Singh [1], Sachin Y Kale [1], Prasad Chaudhari [1], Sanjay Dhar [1] , Prakash Samant [1]

[1] Department of Orthopaedics, Dr. DY Patil Medical College, Navi Mumbai

Address of Correspondence

[1] Department of Orthopaedics, Dr. DY Patil Medical College, Navi Mumbai

Address of Correspondence
Dr. Shikhar D Singh,
Department of Orthopaedics, Dr. DY Patil Medical College
Sector 7, Nerul, Navi Mumbai, Maharashtra 400706
E-mail: drsinghshikhar@gmail.com

Abstract

Introduction: Anterior cervical discectomy and fusion (ACDF) is an effective treatment of intervertebral disc herniation. The zero-profile interbody fusion device, Zero-P was invented to reduce complications due to previously used anterior constructs. The present study investigates the outcome of surgical decompression and stabilization by anterior approach using Zero-P-Plate.
Methodology: We collected data of 22 patients of cervical disc prolapse with neurological deficits treated with ACDF using Zero-P implant. The patients were assessed pre-operatively and during follow up on outpatient basis at 2 weeks, 6 weeks, 12 weeks, 24 weeks and then on yearly basis for 2 years. The outcome was assessed based on Visual Analogue Scale (VAS) score, Nurick grading and Odom’s criteria and success of fusion.
Results: Radiculopathy was present in all patients pre-operatively. We observed that 77% of the patients had VAS score of 4 or higher pre-operatively, which reduced to 13% in the immediate post-operative period and 0% at the last follow up. Nurick grade 2 or higher was seen in 31% pre-operatively, a percentage which reduced to 0% in the post-operative period. Final clinical outcome using Odom’s criteria revealed excellent outcome in 87% of the patients and good outcome in 13%.
Conclusions: ACDF by Zero-P-Plate can be considered in treatment of patients with cervical disc prolapse with neurological deficit.
Keywords: Anterior cervical discectomy and fusion; Cervical disc disease; Intervertebral fusion device.

References

1. Smith GW, Robinson RA. The Treatment of Certain Cervical-Spine Disorders by Anterior Removal of the Intervertebral Disc and Interbody Fusion. The Journal of Bone & Joint Surgery. 1958;40-A(3):607–24.
2. Kaiser MG, Haid Jr RW, Subach BR, Barnes B, Rodts Jr GE. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002 Feb 1;50(2):229-38.
3. Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain. 1972 Jan 1;95(1):101-8.
4. Odom GL, Finney W, Woodhall B : Cervical disk lesions. J Am Med As-soc 166 : 23-28, 1958
5. Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F: A new zero-pro le implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 469:666–673, 2011
6. Njoku I, Alimi M, Leng LZ, Shin BJ, James AR, Bhangoo S, Tsiouris AJ, Härtl R. Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study. Journal of Neurosurgery: Spine. 2014 Oct 1;21(4):529-37.
7. Alimi M, Njoku I, Hofstetter CP, Tsiouris AJ, Kesavabhotla K, Boockvar J, Navarro-Ramirez R, Härtl R. Anterior cervical discectomy and fusion (ACDF): comparison between zero profile implants and anterior cervical plate and spacer. Cureus. 2016 Apr;8(4).
8. Duan Y, Yang Y, Wang Y, Liu H, Hong Y, Gong Q, Song Y. Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: a meta- analysis. J Clin Neurosci. 2016;33:11–18.
9. Lee MJ, Bazaz R, Furey CG, Yoo J. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech. 2005;18(5):406–9.

How to Cite this article: Butala R R, Singh S D, Kale S T, Chaudhari P, Dhar S, Samant P. Anterior cervical discectomy and fusion with Zero-P-Plate in the treatment of cervical disc prolapse. Journal of Clinical Orthopaedics July-Dec 2019;4(2):57-60.

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Preventive Strategy for Surgical Site Infections in Orthopaedics

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:51-56 | Dr. Anoop C. Dhamangaonkar

Author: Dr. Anoop C. Dhamangaonkar [1]

[1] Department of Orthopaedics, LTMGH, Mumbai

Address of Correspondence
Dr. Anoop C. Dhamangaonkar,
Department of Orthopaedics, LTMGH, Mumbai

Abstract

Surgical site infections are serious complication of any surgery. There are many factors that affect the incidence of surgical site infections and if these factors are understood and controlled to a certain extent, it will help in reducing the incidence of SSIs. In current review, an overview of patient factors, Operative set up and intraoperative precautions are presented which will help in understanding and preventing SSIs.
Keywords: Surgical site infection, Orthoapedics, Prevention.

References

1. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ: Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am. 2008;90(1):62-9.
2. Hikata T, Iwanami A, Hosogane N, Watanabe K, Ishii K, Nakamura M, Kamata M, Toyama Y, Matsumoto M.: High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery. J Orthop Sci. 2014;19(2):223-8.
3. Abdallah DY, Jadaan MM, McCabe JP: Body mass index and risk of surgical site infection following spine surgery: a meta-analysis.Eur Spine J. 2013;22(12):2800-9.
4. Pahys JM, Pahys JR, Cho SK, Kang MM, Zebala LP, Hawasli AH, Sweet FA, Lee DH, RiewKD.Methods to decrease postoperative infections following posterior cervical spine surgery.J Bone Joint Surg Am. 2013 ;95(6):549-54.
5. Thomsen T, Tønnesen H, MøllerAM:Effect of preoperative smoking cessation interventions on postoperative complications and smoking cessation.Br J Surg. 2009;96(5):451-61.
6. Klein JD, Hey LA, Yu CS, Klein BB, Coufal FJ, Young EP, Marshall LF, Garfin SR. Perioperative nutrition and postoperative complications in patients undergoing spinal surgery. Spine 1996 ;21(22):2676-82.
7. Hawkins G, Stewart S, Blatchford O, Reilly J. Should healthcare workers be screened routinely for meticillin–resistant staphylococcus aureus? A review of the evidence. J Hosp Infect. 2011;77:285–289.
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27. Ritter M a, Eitzen H, French ML, Hart JB. The operating room environment as affected by people and the surgical face mask. Clin OrthopRelat Res.1975:147–50.
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30. Markel TA, Gormley T, Greeley D, Ostojic J, Wise A, Rajala J, et al. Hats off: a study of different operating room headgear assessed by environmental quality indicators. J Am Coll Surg. 2017; 225: 573–81.
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32. Roxburgh M, Gall P, Lee K. A cover up? Potential risk of wearing theatre clothing outside theatre. J PerioperPract. 2006 Jan;16(1):30-3, 35-41.
33. Breier A–C, Brandt C, Sohr D, Geffers C, Gastmeier P. Laminar airflow ceiling size: no impact on infection rates following hip and knee prosthesis. Infect Control Hosp Epidemiol. 2011;32:1097–1102.
34. Singh S, Reddy S, Shrivastava R. Does laminar airflow make a difference to the infection rates for lower limb arthroplasty: a study using the National Joint Registry and local surgical site infection data for two hospitals with and without laminar airflow. Eur J Orthop Surg Traumatol. 2017;27:261-5.
35. Brandt C, Hott U, Sohr D, Daschner F, Gastmeier P, Rüden H. Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery. Ann Surg. 2008;248:695–700.
36. Hooper GJ, Rothwell AG, Frampton C, Wyatt MC. Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten–year results of the New Zealand Joint Registry. J Bone Joint Surg Br. 2011;93:85–90.
37. Tayton ER, Frampton C, Hooper GJ, Young SW. The impact of patient and surgical factors on the rate of infection after primary total knee arthro- plasty: an analysis of 64,566 joints from the New Zealand Joint Registry. Bone Joint J. 2016;98–B:334–40.
38. Whyte W, Hodgson R, Tinkler J. The importance of airborne bacterial contamination of wounds. J Hosp Infect. 1982;3:123–35.
39. Sharp RJ, Chesworth T, Fern ED. Do warming blankets increase bacterial counts in the operating field in a laminar–flow theatre? J Bone Joint Surg Br. 2002;84:486–8.
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42. Haeberle HS, Navarro SM, Samuel LT, et al. No evidence of increased infec- tion risk with forced–air warming devices: a systematic review. Surg Technol Int. 2017;31:295–301.
43. Hussein JR, Villar RN, Gray AJ, Farrington M. Use of light handles in the laminar flow operating theatre––is it a cause of bacterial concern? Ann R Coll Surg Engl. 2001;83:353–4.
44. Dalstrom DJ, Venkatarayappa I, Manternach AL, Palcic MS, Heyse BA, Prayson MJ. Time–dependent contamination of opened sterile operating– room trays. J Bone Joint Surg Am. 2008;90:1022–1025.
45. Kaya I, Ugras A, Sungur I, Yilmaz M, Korkmaz M, Cetinus E. Glove perfora- tion time and frequency in total hip arthroplasty procedures. Acta Orthop TraumatolTurc. 2012;46:57–60.
46. Bible JE, Biswas D, Whang PG, Simpson AK, Grauer JN. Which regions of the operating gown should be considered most sterile? Clin OrthopRelat Res. 2009;467:825–830.
47. Abdelaziz H, Zahar A, Lausmann C, Gehrke T, Fickenscher H, Suero EM, et al. High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty. Int Orthop. 2018. doi:10.1007/s00264–018–3822–1.
48. Givissis P, Karataglis D, Antonarakos P, Symeonidis PD, Christodoulou A. Suction during orthopaedic surgery. How safe is the suction tip? Acta OrthopBelg 2008;74:531–533.
49. Greenough CG. An investigation into contamination of operative suction. J Bone Joint Surg Br. 1986;68:151–153.
50. Davis N, Curry A, Gambhir AK, Panigrahi H, Walker CR, Wilkins EG, et al. Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg Br. 1999;81:886–889.
51. Trikha V, Saini P, Mathur P, Agarwal A, Kumar SV, Choudhary B. Single versus double blade technique for skin incision and deep dissection in surgery for closed fracture: a prospective randomised control study. J Orthop Surg (Hong Kong). 2016;24:67–71.
52. Schindler OS, Spencer RF, Smith MD. Should we use a separate knife for the skin? J Bone Joint Surg Br. 2006;88:382–5.
53. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer Operative Time Results in a Higher Rate of Subsequent Periprosthetic Joint Infection in Patients Undergoing Primary Joint Arthroplasty.J Arthroplasty. 2019;34(5):947-953.

How to Cite this article: Dhamangaonkar A C. Preventive Strategy for Surgical Site Infections in Orthopaedics. Journal of Clinical Orthopaedics July-Dec 2019;4(2):51-56.

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Peri-proshthetic Joint Infection

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:45-50 | Shubhranshu S. Mohanty, Swapnil A. Keny

Author: Shubhranshu S. Mohanty [1], Swapnil A. Keny [1]

[1] Dept. of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.

Address of Correspondence
Dr. Shubhranshu S. Mohanty,
Dept. of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.
E-mail: drssmohanty@hotmail.com

Abstract

Prosthetic joint infections in one of the most serious complication of Joint Arthroplasty. Over the years the understanding and management of PJI has evolved. The current review presents and overviews of the recent advances in the field
Keywords: Prosthetic joint infection, arthroplasty.

References

1. Duff GR Lachiewicz PF, Kelley SS. Aspiration of the knee joint before revision arthroplasty. Clin Orthop Relal Res, 1996:132-9
2. Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006 Dec;88 Suppl 4:138-47. .
3. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008 Jul;466(7):1710-5.
4. Gristina AG, Costerton JW. Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 1984;15:517‑35.
5. Aggarwal VK, Rasouli MR, Parvizi J. Periprosthetic joint infection: Current concept. Indian J Orthop 2013;47:10-7.
6. Zmistowski B, Fedorka CJ, Sheehan E, Deirmengian G, Austin MS, Parvizi J. Prosthetic joint infection caused by gram‑negative organisms. J Arthroplasty 2011;26:104‑8.
7. Marculescu CE, Cantey JR. Polymicrobial prosthetic joint infections: risk factors and outcome. Clin Orthop Relat Res. 2008;466(6):1397–1404.
8. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013 May.1;95(9):775-82.
9. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008 Oct;23(7):984-91.
10. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011 Nov;469(11):2992-4.
11. Chun KC, Kim KM, Chun CH. Infection following total knee arthroplasty. Knee Surg Relat Res. 2013;25(3):93–99.
12. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am. 2003;85 Suppl 1:S75-80.
13. Spangehl MJ, Masri BA, O’Conneii JX, Duncan CP Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999:81:672-83.
14. Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008 Aug;90(8):1637-43.
15. Feldman DS, Lonner JH, Desai p Zuckerman JD. The role of intra operative frozen sections in revision total joint arthroplasty. J Bone Jomt Surg Am. 1995:77:1807-13.
16. Zywiel MG, Stroh DA, Johnson AJ, Marker DR, Mont MA. Gram stains have limited application in the diagnosis of infected total knee arthroplasty. Int J Infect Dis. 2011 Oct;15(10):e702-5.
17. Schoof B, Jakobs O, Schmidl S, et al. Fungal periprosthetic joint infection of the hip: a systematic review. Orthop Rev (Pavia). 2015;7(1):5748. Published 2015 Mar 31.
18. Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM, et al. Culture‑negative prosthetic joint infection. Clin Infect Dis 2007;45:1113‑9.
19. Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, Montori VM,West CP, Osmon DR, Berbari EF. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2012 Sep 19;94(18):1700-11.Review.
20. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: The utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011;93:2242‑8.
21. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, Steckelberg J,Osmon D. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010 Sep1;92(11):2102-9.
22. ungerford DS. Infected total knee arthroplasty treated by arthroscopic irrigation and débridement. J Arthroplasty. 2000 Jun;15(4):430-6.
24. Thakrar RR, Horriat S, Kayani B, Haddad FS. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J. 2019 Jan;101-B(1_Supple_A):19-24.
25. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J. 2013 Nov;95-B(11 Suppl A):77-83.
26. Lee YS, Chen AF. Two-Stage Reimplantation in Infected Total Knee Arthroplasty. Knee Surg Relat Res. 2018;30(2):107–114.

How to Cite this article: Mohanty S S, Keny S A. Peri-proshthetic Joint Infection. Journal of Clinical Orthopaedics July-Dec 2019;4(2):45-50.

(Abstract    Full Text HTML)   (Download PDF)

 

 

 

Translate this page into:

Peri-proshthetic Joint Infection

/in , /by

Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:45-50 | Dr. Shubhranshu S. Mohanty, Dr. Swapnil A. Keny

Author: Dr. Shubhranshu S . Mohanty [1], Dr. Swapnil A. Keny [1]

[1] Dept. of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.

Address of Correspondence
Dr. Shubhranshu S. Mohanty,
Dept. of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.
E-mail: drssmohanty@hotmail.com

Abstract

Prosthetic joint infections in one of the most serious complication of Joint Arthroplasty. Over the years the understanding and management of PJI has evolved. The current review presents and overviews of the recent advances in the field
Keywords: Prosthetic joint infection, arthroplasty.

References

1. Duff GR Lachiewicz PF, Kelley SS. Aspiration of the knee joint before revision arthroplasty. Clin Orthop Relal Res, 1996:132-9
2. Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006 Dec;88 Suppl 4:138-47. .
3. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008 Jul;466(7):1710-5.
4. Gristina AG, Costerton JW. Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 1984;15:517‑35.
5. Aggarwal VK, Rasouli MR, Parvizi J. Periprosthetic joint infection: Current concept. Indian J Orthop 2013;47:10-7.
6. Zmistowski B, Fedorka CJ, Sheehan E, Deirmengian G, Austin MS, Parvizi J. Prosthetic joint infection caused by gram‑negative organisms. J Arthroplasty 2011;26:104‑8.
7. Marculescu CE, Cantey JR. Polymicrobial prosthetic joint infections: risk factors and outcome. Clin Orthop Relat Res. 2008;466(6):1397–1404.
8. Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am. 2013 May.1;95(9):775-82.
9. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008 Oct;23(7):984-91.
10. Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011 Nov;469(11):2992-4.
11. Chun KC, Kim KM, Chun CH. Infection following total knee arthroplasty. Knee Surg Relat Res. 2013;25(3):93–99.
12. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg Am. 2003;85 Suppl 1:S75-80.
13. Spangehl MJ, Masri BA, O’Conneii JX, Duncan CP Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999:81:672-83.
14. Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008 Aug;90(8):1637-43.
15. Feldman DS, Lonner JH, Desai p Zuckerman JD. The role of intra operative frozen sections in revision total joint arthroplasty. J Bone Jomt Surg Am. 1995:77:1807-13.
16. Zywiel MG, Stroh DA, Johnson AJ, Marker DR, Mont MA. Gram stains have limited application in the diagnosis of infected total knee arthroplasty. Int J Infect Dis. 2011 Oct;15(10):e702-5.
17. Schoof B, Jakobs O, Schmidl S, et al. Fungal periprosthetic joint infection of the hip: a systematic review. Orthop Rev (Pavia). 2015;7(1):5748. Published 2015 Mar 31.
18. Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM, et al. Culture‑negative prosthetic joint infection. Clin Infect Dis 2007;45:1113‑9.
19. Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, Montori VM,West CP, Osmon DR, Berbari EF. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2012 Sep 19;94(18):1700-11.Review.
20. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: The utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011;93:2242‑8.
21. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, Steckelberg J,Osmon D. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010 Sep1;92(11):2102-9.
22. ungerford DS. Infected total knee arthroplasty treated by arthroscopic irrigation and débridement. J Arthroplasty. 2000 Jun;15(4):430-6.
24. Thakrar RR, Horriat S, Kayani B, Haddad FS. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J. 2019 Jan;101-B(1_Supple_A):19-24.
25. Gehrke T, Zahar A, Kendoff D. One-stage exchange: it all began here. Bone Joint J. 2013 Nov;95-B(11 Suppl A):77-83.
26. Lee YS, Chen AF. Two-Stage Reimplantation in Infected Total Knee Arthroplasty. Knee Surg Relat Res. 2018;30(2):107–114.

How to Cite this article: Mohanty S S, Keny S A. Peri-proshthetic Joint Infection. Journal of Clinical Orthopaedics July-Dec 2019;4(2):45-50.

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Surgical Site Infections in Orthopaedics: Epidemiology & Microbiology

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:7-11 | Dr. Kedar Deogaonkar, Aditya Menon, Gautam Zaveri

Author: Dr. Kedar Deogaonkar [1], Aditya Menon [2], Gautam Zaveri [3]

[1] Department of Spine Surgery, Jaslok Hospital & Research Centre.

Address of Correspondence
Dr. Gautam Zaveri,
Department of Spine Surgery, Jaslok Hospital & Research Centre
E-mail: gautamzaveri1969@gmail.com

Abstract

Surgical site infections are one of the most common nosocomial infections. understanding epidemiology and microbiology of SSI will help in defining the problem and developing stratergies for prevention and management
Keywords: Surgical Site infection, Diagnosis.

References

1. Harrop JS, Styliaras JC, Ooi JC, et al. Contributing factors to surgical site infections. J AAOS. 2012; 20(2):94-101
2. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, Am J Infect Control. 2004; 32:470- 85
3. Ercole FF, Chianca TCM. Infecção de sítiocirúrgico empacientes submetidos à artroplastia de quadril. Revista Latino-Am. Enfermagem. 2002; 10(2):157-65
4. Lima ALLM, Zumiotti AV, Uip DE, Silva JS. Fatorespreditivos de infecçãoempacientes com fraturasexpostasnos membros inferiores. Acta Ortop Bras. 2004; 12(1):23-39
5. Maksimovic J. Incidence of surgical site infections in the departments of orthopedics and traumatology. Vojnosanit Pregl. 2006; 63(8):725-9
6. Maksimovic J, Markovíc-Denic L, Bumbasrevic M, et al. Surgical site infections in orthopedics patients: prospective cohort study. Croat Med J. 2008; 49(1):58-65
7. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. NEJM. 2004; 351:1645-54
8. Achermann Y, Sahin F, Schwyzer HK et al. Characteristics and outcome of 16 periprosthetic shoulder joint infections. Infection 2013; 41: 613–20
9. Corvec S, Portillo ME, Pasticci BM et al. Epidemiology and new developments in the diagnosis of prosthetic joint infection. Int J Artif Organs 2012; 35: 923 34
10. Zimmerli W, Sendi P. Pathogenesis of implant-associated infection: The role of the host. SeminImmunopathol 2011; 33: 295–306
11. https://www.cdc.gov/hai/ssi/ssi.html accessed 21/07/19
12. Horan TC, Gaynes RP, Martone WJ, et al. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992; 13(10):606-608
13. Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. NEJM 2004; 351: 1645–54
14. Centers for Diseases Control and Prevention. The National Healthcare Safety Network Manual – NHSN. Patient Safety Component Protocol. Division of Healthcare Quality Promotion National Center for Preparedness, Detection and Control of Infectious Diseases Atlanta, GA, USA, 2009, 225.
15. https://www.medscape.com/answers/188988-82341/how-does-the-cdc-define-and-classify-surgical-site-infections-ssis accessed 21/07/19
16. Jaylakhsmi T, Kapil A, Sathpathy S, et al. AIIMS hospital infection control manual: All India institute of medical sciences, 2004
17. De Man FHR, Sendi P, Zimmerli W et al. Infectiological, functional, and radiographic outcome after revision for prosthetic hip infection according to a strict algorithm. Acta Orthop 2011; 82: 27–34
18. Jamsen E, Huhtala H, Puolakka T et al. Risk factors for infection after knee arthroplasty. A register-based analysis of 43149 cases. JBJS Am 2009; 91: 38–47
19. Das R, Singh A, Srivastava P, et al. Microbial Profile and Antibiotic Susceptibility Pattern of Surgical Site Infections in Orthopaedic Patients at a Tertiary Hospital in Bilaspur. Int J Sci Stud 2015;3(3):43-47
20. Amaradeep G, Shiva Prakah SS, Manjappa CN. Surgical site infections in orthopedic implant surgery and its risk factors: A prospective study in teaching hospital. Int J of OrthopSci 2017; 3(3): 169-172
21. Maksimovic J, Markovíc-Denic L, Bumbasrevic M, et al. Surgical site infections in orthopedics patients: prospective cohort study. Croat Med J. 2008; 49(1):58-65
22. Khan MS, Rehman S, Ali MA, et al. Infection in orthopedic implant surgery, its risk factors and outcome. J Ayub Med Coll Abbottabad, 2008; 20(1):23-5
23. Wassef MA, Hussein A, Abdul Rahman EM, El-Sherif RH. A Prospective Surveillance of Surgical Site Infections: Study for Efficacy of Preoperative Antibiotics Prophylaxis. Afr. J. Microbiol. Res. 2012; 6(12):3072-8
24. Singh R. Prevalence and Antibiotic Sensitivity Pattern of Bacteria Isolated from Nosocomial Infections in Orthopaedic Patients. J. Orthopaedics. 2010; 7(2):153-159
25. Borthakur B, Kumar S, TalukdarM, et al.Surgical site infection in orthopaedics. Int. J. Orthop. Sci., 2016; 2(3): 113-117
26. Anderson DJ, Sexton DJ, Kanafani ZA, et al. Severe surgical site infection in community hospitals epidemiology, key procedures and the changing prevelance of methicillin resistant Staphyloccocus aureus. Infect control hospl epidemiol. 2007; 28(9):1047-1053
27. Koch R, Becker K, Cookson B, et al. Methicillin resistant staphylococcus aureus burden of disease and control challenges in Europe. Euro Surviell, 15(41)
28. Esterhai J, Gelb I. Orthopaedic infection. OCNA 1991; 22:503-10
29. Wertheim HF, Melles DC, Vos MC, et al. The role of nasal carriage in staphylococcus aureus infections. Lancet infect dis. 2005, 5(12)
30. Rao N, Kim DH. Perioperative risk factors and patient optimization: risk assessment and prevention. In Hsu WK, McLaren AC, Springer BD, editors. Let’s discuss Surgical Site Infection.: J AAOS, 2015, 13-23
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How to Cite this article: Deogaonkar K, Menon A, Zaveri G. Surgical Site Infections in Orthopaedics: Epidemiology & Microbiology. Journal of Clinical Orthopaedics July-Dec 2019;4(2):7-11.

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