A Retained Stitch in Time Saves 9 - But Does it Increase the Risk of Deep Prosthetic Infection?

2017 ◽  
Vol 27 (6) ◽  
pp. 564-566
Author(s):  
Bola Akinola ◽  
Ben Quansah ◽  
Theodore Gouliouris ◽  
Andrew D. Carrothers
Keyword(s):  
Pilot Study ◽  
Hip Replacement ◽  
Infection Prevention ◽  
Posterior Approach ◽  
Fungal Growth ◽  
Senior Author ◽  
Soft Tissue Repair ◽  
Prevention Measure ◽  
Positive Growth ◽  
Skin Contamination

Introduction During the posterior approach to the hip, the short external rotators are detached and secured with stay sutures. At the time of definitive closure, some surgeons incorporate the initial sutures into their repair while others discard for fresh sutures, presumably as an infection prevention measure. We have conducted a pilot study to investigate whether the incorporation of the primary stay sutures may constitute an infection risk to the patient undergoing a total hip replacement through the posterior approach. Materials and methods The pilot study was conducted between August 2014 and June 2015. A pair of suture specimens were sent from 25 patients to microbiology, 1 set of primary stay sutures and 1 set of control sutures. All operations were carried out by the senior author through a posterior approach. Results All specimens were analysed for bacterial and fungal growth, using extended cultures. 1 set of primary sutures had a positive growth, likely from skin contamination; 1 set of control sutures also had a positive growth, likely from environmental contamination. Conclusions Our pilot study suggests that the practice of incorporating the primary stay sutures for definitive soft tissue repair of the short external rotators, rather than exchanging them for new sutures, can be deemed safe.

Tension-free closure with capsular lengthening in mini posterior total hip replacement

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 3-9
Author(s):  
Nicola Santori
Keyword(s):  
Soft Tissue ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Tissue Repair ◽  
Posterior Approach ◽  
Dislocation Rate ◽  
Soft Tissue Repair ◽  
Tension Free ◽  
Total Hip ◽  
Free Closure

Purpose: Choice of the best mini invasive surgical approach for total hip replacement remains a controversial topic. The posterior approach is traditionally associated with a higher dislocation rate and the obligation of postoperative restrictions. Soft tissue repair reduces the risk of dislocation yet, posterior closure it is often challenging because of capsular and external rotator contractures. In this article, an original procedure of capsular lengthening and tension-free closure is described and the results of a retrospective single surgeon series of minimally invasive posterior total hip replacement (THR) with capsular repair are presented. Methods: A total of 925 mini posterior total hip replacements performed between 2009 and 2015 were retrospectively reviewed. 2 original types of capsulorrhaphy to decrease tension of the repaired tissues were employed. Absence of posterior envelope stretch during flexion and internal rotation was confirmed intraoperatively with a dynamic test. No postoperative restrictions were used. Results: Capsular lengthening with 1 of the described techniques was required in over 50% of cases for a tension-free closure. 3 patients dislocated in the 867 reviewed procedures (0.35%), 1 requiring revision for instability (0.11%). Conclusions: This soft tissue repair technique after mini posterior approach THR is technically easy, provides a tension-free closure and a low dislocation rate.

SHALL IT BE BETTER, AS AN APPROACH FOR THR, POSTERIORLY OR LATERALLY; A CLINICO-FUNCTIONAL AND GAIT ANALYTICAL OUTCOME ANALYSIS, IN A PROSPECTIVE STUDY, IN THE SOUTH-INDIAN POPULATION.

2021 ◽  
pp. 71-75
Author(s):  
Arun Kumar C ◽  
Ganashree S ◽  
Arivoli S ◽  
Aswath C A ◽  
Rakesh Kumar B ◽  
...  
Keyword(s):  
Prospective Study ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Lateral Approach ◽  
Harris Hip Score ◽  
South Indian Population ◽  
Total Hip ◽  
South Indian

Introduction: Hip resurfacing arthroplasty (HRA) or Total hip replacement (THR), as it is popularly called, attempts to mollify these basic clinical problems, in patients with a hip arthritic problem, which may be of a sequela to age-related degeneration, osteonecrosis, systemic disorder like Rheumatoid arthritis (RA) or Ankylosing spondylosis (AS) or as a result of trauma and or an old infection. The basic pathology, is an unfavourable and abrading hip diarthrodial joint. The endeavour of the study was, to establish the efcacy of the Posterior vs Lateral approach for THA/THR, by studying their outcomes in primary THR. This prospective study was undertaken at Che Materials And Methods: ttinad Hospital and Research Institute (CARE), Kelambakkam, Chengalpattu district, Tamilnadu, In the Department of Orthopaedics from Jan 2017 to Dec 2020 (48 months). The Functional outcome of hip surgery was measured using the Harris Hip Score, Oxford hip score and the WOMAC. Rivermead visual gait analysis (RVGA) method was used post-operatively to assess the gait. The Biomechanical outcomes of Abductor Gait Component, were individually assessed by EMG studies. The Harris Hip Score, The Oxford Hip S Results: core and WOMAC score, when the lateral approach was compared to the posterior approach pre-op and post-op in the 12 months minimum follow-up period, the laterally approached group faired better. The VAS score was equivocal. The comprehensive RVGA assessment also showed marginally better results for the laterally approached group as was the case with the Trendelenburg test score. The EMG studies for the Gluteus Maximus, Medius and the lateral rotators of hip also favoured the outcomes for the laterally approach hips. The supremacy of the Lateral Approach, ove Conclusion: r Posterior Approach, cannot be adjudged in a short-term follow-up study. It is thus opined that the Lateral Approach may be statistically and data wise superior, but the patient satisfaction, which is a major factor, is almost the same in both the approach groups. The follow-up needs to be atleast for a decade for us to be able to come to any meaningful conclusion. With regards to surgery like the Total hip replacement, which have a longevity factor exceeding 10 years, studies have to be followed up for periods in excess of 10 years.

scholarly journals Development and Comparison of Complementary Methods to Study Potential Skin and Inhalational Exposure to Pathogens During Personal Protective Equipment Doffing

2019 ◽  
Vol 69 (Supplement_3) ◽  
pp. S231-S240 ◽  
Author(s):  
Jennifer Therkorn ◽  
David Drewry ◽  
Jennifer Andonian ◽  
Lauren Benishek ◽  
Carrie Billman ◽  
...  
Keyword(s):  
Pilot Study ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Recovery Efficiency ◽  
Breathing Zone ◽  
Tracer Method ◽  
Fluorescent Tracer ◽  
Air Sampler ◽  
Airborne Contamination ◽  
Skin Contamination

Abstract Background Fluorescent tracers are often used with ultraviolet lights to visibly identify healthcare worker self-contamination after doffing of personal protective equipment (PPE). This method has drawbacks, as it cannot detect pathogen-sized contaminants nor airborne contamination in subjects’ breathing zones. Methods A contamination detection/quantification method was developed using 2-µm polystyrene latex spheres (PSLs) to investigate skin contamination (via swabbing) and potential inhalational exposure (via breathing zone air sampler). Porcine skin coupons were used to estimate the PSL swabbing recovery efficiency and limit of detection (LOD). A pilot study with 5 participants compared skin contamination levels detected via the PSL vs fluorescent tracer methods, while the air sampler quantified potential inhalational exposure to PSLs during doffing. Results Average PSL skin swab recovery efficiency was 40% ± 29% (LOD = 1 PSL/4 cm2 of skin). In the pilot study, all subjects had PSL and fluorescent tracer skin contamination. Two subjects had simultaneously located contamination of both types on a wrist and hand. However, for all other subjects, the PSL method enabled detection of skin contamination that was not detectable by the fluorescent tracer method. Hands/wrists were more commonly contaminated than areas of the head/face (57% vs 23% of swabs with PSL detection, respectively). One subject had PSLs detected by the breathing zone air sampler. Conclusions This study provides a well-characterized method that can be used to quantitate levels of skin and inhalational contact with simulant pathogen particles. The PSL method serves as a complement to the fluorescent tracer method to study PPE doffing self-contamination.

scholarly journals A prospective clinical pilot study on the effects of a hydrogen peroxide mouthrinse on the intraoral viral load of SARS-CoV-2

2020 ◽  
Vol 24 (10) ◽  
pp. 3707-3713
Author(s):  
Maximilian J. Gottsauner ◽  
Ioannis Michaelides ◽  
Barbara Schmidt ◽  
Konstantin J. Scholz ◽  
Wolfgang Buchalla ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Clinical Trials ◽  
Viral Load ◽  
Pilot Study ◽  
High Risk ◽  
Infection Prevention ◽  
Healthcare Professionals ◽  
Patient Contact ◽  
Rt Pcr ◽  
Virus Culture

Abstract Objectives SARS-CoV-2 is mainly transmitted by inhalation of droplets and aerosols. This puts healthcare professionals from specialties with close patient contact at high risk of nosocomial infections with SARS-CoV-2. In this context, preprocedural mouthrinses with hydrogen peroxide have been recommended before conducting intraoral procedures. Therefore, the aim of this study was to investigate the effects of a 1% hydrogen peroxide mouthrinse on reducing the intraoral SARS-CoV-2 load. Methods Twelve out of 98 initially screened hospitalized SARS-CoV-2-positive patients were included in this study. Intraoral viral load was determined by RT-PCR at baseline, whereupon patients had to gargle mouth and throat with 20 mL of 1% hydrogen peroxide for 30 s. After 30 min, a second examination of intraoral viral load was performed by RT-PCR. Furthermore, virus culture was performed for specimens exhibiting viral load of at least 103 RNA copies/mL at baseline. Results Ten out of the 12 initially included SARS-CoV-2-positive patients completed the study. The hydrogen peroxide mouthrinse led to no significant reduction of intraoral viral load. Replicating virus could only be determined from one baseline specimen. Conclusion A 1% hydrogen peroxide mouthrinse does not reduce the intraoral viral load in SARS-CoV-2-positive subjects. However, virus culture did not yield any indication on the effects of the mouthrinse on the infectivity of the detected RNA copies. Clinical relevance The recommendation of a preprocedural mouthrinse with hydrogen peroxide before intraoral procedures is questionable and thus should not be supported any longer, but strict infection prevention regimens are of paramount importance. Trial registration German Clinical Trials Register (ref. DRKS00022484)

A new approach to infection prevention: A pilot study to evaluate a hand hygiene ambassador program in hospitals and clinics

2020 ◽  
Vol 48 (3) ◽  
pp. 246-248
Author(s):  
David J. Birnbach ◽  
Taylor C. Thiesen ◽  
Lisa F. Rosen ◽  
Maureen Fitzpatrick ◽  
Kristopher L. Arheart
Keyword(s):  
Pilot Study ◽  
Hand Hygiene ◽  
Infection Prevention ◽  
New Approach
Sign in / Sign up

Export Citation Format

Share Document