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Veterinary Medicine and Science Jul 2022The frequency of surgical site infection (SSI) following orthopaedic implant placement in horses has been reported but not compared with respect to specific antibiotic...
BACKGROUND
The frequency of surgical site infection (SSI) following orthopaedic implant placement in horses has been reported but not compared with respect to specific antibiotic protocols administered.
OBJECTIVES
To determine factors associated with SSI in horses undergoing proximal interphalangeal joint (PIPJ) arthrodesis including perioperative antibiotic protocols.
METHODS
Records were evaluated (2010-2019), and horses undergoing PIPJ arthrodesis were identified. Patient signalment, supervising surgeon, reason for surgery, limb, implants placed, anaesthetic time, duration casting/coaptation postoperatively, antibiotic regimen and incidence/onset SSI were recorded. Bayesian and frequentist logistic regressions were used to estimate the contribution of covariates to infection occurrence.
RESULTS
Fifty-four PIPJ arthrodeses were performed. SSI occurred in 2/54 (3.7%) on day 15,30. Arthrodesis was performed most commonly for osteoarthritis (33/54, 61.1%), fracture (11/54, 20.4%), and subluxation (5/54, 9.3%). Perioperative systemic antibiotics were administered 1-3 days (15/54, 27.8%) or > 3 days (39/54, 72.2%). Antibiotic protocols included cefazolin/gentamicin (20/54, 37%), cefazolin/gentamicin/doxycycline (14/54, 25.9%) and potassium penicillin/gentamicin (10/54, 18.5%). Regional limb perfusion was performed preoperatively 31/54 (57.4%) and postoperatively 7/54 (13%). Survival to dismissal was 98.1% (53/54 horses) with one horse euthanized due to support limb laminitis. No association was identified between antibiotic selection or duration (1-3 vs. > 3 days), pre-operative regional antibiotic perfusion, intraoperative antibiotic lavage or anaesthetic time (< or > 3 h) and SSI; however, modelling was complicated by quasi-complete or complete separation of the data. Bayesian analysis (but not frequentist analysis) indicated an association between post-operative regional antibiotic perfusion and SSI. Limitations include the retrospective nature of data collection and the low rate of infection overall.
CONCLUSIONS
The prevalence of SSI in this population was lower than that in previous reports of equine orthopaedic internal fixation. There was no difference in SSI rate in cases administered systemic antibiotics for 1-3 days or >3 days, or for those horses that did or did not receive preoperative regional antibiotic perfusion.
Topics: Animals; Anti-Bacterial Agents; Arthrodesis; Bayes Theorem; Cefazolin; Forelimb; Gentamicins; Horse Diseases; Horses; Retrospective Studies; Surgical Wound Infection
PubMed: 35594487
DOI: 10.1002/vms3.839 -
Orthopaedics & Traumatology, Surgery &... Sep 2010The aim of this work is to describe a percutaneous technique of first metatarsophalangeal (MTP1) joint fusion and to assess its preliminary results. Thirty-two...
UNLABELLED
The aim of this work is to describe a percutaneous technique of first metatarsophalangeal (MTP1) joint fusion and to assess its preliminary results. Thirty-two percutaneous MTP1 joint arthrodeses were analysed in a prospective continuous series including 30 patients of mean age 66 years old. The indications for arthrodesis of the MTP1 joint were symptomatic hallux rigidus or hallux rigido-valgus in most of the cases. All patients underwent the same percutaneous procedure, as a one-day surgery for 26 cases. Clinical results were assessed using the functional AOFAS forefoot scoring system both preoperatively and at last follow-up. Radiographical analysis was focused on positioning and quality of the arthrodesis. No patient was lost to follow-up and the mean follow-up was 18 months. The functional AOFAS score improved in all cases from a mean 36/100 preoperatively to a mean 80/100 postoperatively (p=0.02). In 30 cases, patients were satisfied or very satisfied with their final outcome, one patient was disappointed and one was dissatisfied. Satisfied or very satisfied patients could wear normal shoes after a mean 50-day period. Fusion was radiographically obtained in 31 cases out of 32. The mean postoperative dorsi flexion of the MTP1 joint arthrodesis was 21° (min: 15°, max: 35°). One patient developed a deep surgical site infection, 3 weeks after the procedure. Percutaneous MTP1 joint fusion is a simple surgical technique that can achieve similar results to open techniques for MTP1 fusions, with very simple postoperative care requirements. Indications for percutaneous MTP1 joint arthrodesis are large and only major bone defects or severe osteoporosis can be considered as contraindications.
LEVEL OF EVIDENCE
Level IV.
Topics: Adult; Aged; Aged, 80 and over; Arthrodesis; Female; Follow-Up Studies; Hallux Rigidus; Hallux Valgus; Humans; Male; Metatarsophalangeal Joint; Middle Aged; Minimally Invasive Surgical Procedures; Patient Satisfaction; Postoperative Care; Postoperative Complications; Prospective Studies; Surgical Instruments; Weight-Bearing
PubMed: 20627766
DOI: 10.1016/j.otsr.2010.01.011 -
Der Orthopade Apr 1996Because of progressive development in the field of knee arthroplasty, currently there are fewer indications for primary knee arthrodesis. Primary knee arthrodesis is... (Review)
Review
Because of progressive development in the field of knee arthroplasty, currently there are fewer indications for primary knee arthrodesis. Primary knee arthrodesis is indicated in acute or chronic infections in which conservative treatment has failed, monoarticular arthritis in young patients if total knee replacement is not suitable, unstable knee joints caused by poliomyelitis or other neuromuscular disease, neuropathic joint disease, in salvage of the extremities with tumors of the distal femur and proximal tibia, and to obtain length in femur dysplasia. The operation technique with a modified Charnley compression fixator is described. Fifteen patients (100%) treated by this double-frame fixator have had a solid arthrodesis 13.6 weeks after surgery. We found 5 pin infections and had to reset 2 Steinmann pins.
Topics: Adult; Arthrodesis; Bone Plates; External Fixators; Female; Humans; Knee Joint; Male; Radiography
PubMed: 8692568
DOI: No ID Found -
The Journal of Trauma Dec 2007The purpose of this study was to evaluate the clinical and radiographic outcomes of patients who underwent tibiotalar arthrodesis between 1997 and 2003 for tibiotalar...
BACKGROUND
The purpose of this study was to evaluate the clinical and radiographic outcomes of patients who underwent tibiotalar arthrodesis between 1997 and 2003 for tibiotalar arthritis. The cause was predominantly posttraumatic arthritis secondary to tibial plafond fracture (n = 15) or talar body fracture (n = 2).
METHODS
We retrospectively evaluated a consecutive series of 20 patients with 21 arthritic tibiotalar joints. Radiographs, clinical notes, scheduled visits, and telephone interviews were used to obtain outcome data after tibiotalar arthrodesis using a custom blade plate. The American Orthopedic Foot and Ankle Society Ankle Hindfoot Score quantified clinical outcomes in this study.
RESULTS
Sixteen patients with 17 ankle arthrodeses were available after a mean follow-up period of 37.3 months. There were no postoperative wound complications or infections. There were no nonunions identified within the study. The mean American Orthopedic Foot and Ankle Society Ankle Hindfoot Score was 78.25 (range, 65-92). The average time to fusion was 3.9 months.
CONCLUSIONS
Tibiotalar arthrodesis using a custom blade plate and a lateral approach is a reliable therapy for aseptic posttraumatic arthritis.
Topics: Adult; Aged; Ankle Joint; Arthritis; Arthrodesis; Equipment Design; Female; Humans; Male; Middle Aged; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 18212650
DOI: 10.1097/01.ta.0000239254.77569.79 -
Hand Surgery & Rehabilitation Jun 2022Trapeziometacarpal joint osteoarthritis is a common degenerative disease. Arthrodesis is a widespread historical surgical technique to treat this pathology, providing...
Trapeziometacarpal joint osteoarthritis is a common degenerative disease. Arthrodesis is a widespread historical surgical technique to treat this pathology, providing pain relief and stability and strength of the thumb. Nevertheless, pantrapezial arthritis and non-union are not uncommon complications, leading in some cases to revision surgery. No gold-standard procedure has been described for revision of trapeziometacarpal arthrodesis failure. We describe two cases of failed arthrodesis treated with trapeziectomy and suspension ligamentoplasty, a well-known, biological, low-cost, successful, and easy-to-perform procedure.
Topics: Arthrodesis; Humans; Osteoarthritis; Reoperation; Thumb; Trapezium Bone
PubMed: 35476953
DOI: 10.1016/j.hansur.2022.02.013 -
European Journal of Nuclear Medicine... Dec 2023To evaluate the value of SPECT/CT (single photon emission computed tomography/computed tomography) in foot and ankle arthrodesis and development of secondary...
OBJECTIVE
To evaluate the value of SPECT/CT (single photon emission computed tomography/computed tomography) in foot and ankle arthrodesis and development of secondary osteoarthritis in the adjacent joints.
MATERIALS AND METHODS
SPECT/CT of 140 joints in the foot and ankle (34 upper ankle (UA), 28 lower ankle (LA), 27 talonavicular (TN), 12 calcaneo-cuboidal (CC), and 39 other smaller joints after arthrodesis in 72 patients were evaluated retrospectively regarding fusion grade in CT (0 = no fusion, 1 = < 50% fusion, 2 = > 50% fusion, 3 = complete fusion) and radiotracer uptake (0 = no uptake, 1 = mild uptake, 2 = moderate uptake, 3 = high uptake) on SPECT/CT. Severity of osteoarthritis (1 = mild, 2 = moderate, 3 = severe) and radiotracer uptake grade in adjacent joints was also assessed. In 54 patients, clinical information about interventions in the follow-up was available.
RESULTS
According to the SPECT/CT, arthrodesis was successful (grade 2 or 3 CT fusion and grade 0 or 1 uptake) in 73% (25/34) of UA joints, 71% (20/28) of LA joints, 67% (18/27) TN, 100% (12/12) CC joints, and 62% (24/39) of other smaller joints. In 12 joints, there were discrepant findings in SPECT/CT (fusion grade 2 and uptake grade 2 or 3 (n = 9); or, fusion grade 0 or 1 and uptake grade 1 (n = 3)). The fusion rate 6-12 months after arthrodesis was 42% (14/33), 59% (20/34) after 13-24 months, and 89% (65/73) after more than 24 months, respectively. Average radiotracer uptake in arthrodesis decreased with age: 6-12 months: 1.60, 12-24 months: 1.32, > 24 months: 0.38. There was a significant negative correlation between radiotracer uptake grade and CT fusion grade. Osteoarthritis was observed in 131 adjacent joints. During the post scan follow-up, additional arthrodeses were performed in 33 joints, of which 11 joints were re-arthrodesis and 22 were new arthrodeses in osteoarthritic adjacent joints. All these 11 joints with failed arthrodesis had grade 0 of CT fusion and grade 2 or 3 of radiotracer uptake. All 22 adjacent joints with osteoarthritis, which subsequently underwent arthrodesis, had grade 2 or 3 radiotracer uptake, and the primary arthrodesis joints were healed and fused in all these cases.
CONCLUSION
Bone SPECT/CT is a valuable hybrid imaging tool in the evaluation of foot and ankle arthrodesis and gives additional useful information about the development of secondary osteoarthritis in the adjacent joints with higher value for the assessment of secondary osteoarthritis. A practical four-type classification ('Lucerne Criteria') combining metabolic and morphologic SPECT/CT information for evaluation of arthrodesis joints has been proposed.
Topics: Humans; Infant; Retrospective Studies; Ankle; Treatment Outcome; Osteoarthritis; Arthrodesis; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 37676502
DOI: 10.1007/s00259-023-06421-y -
The Journal of Foot and Ankle Surgery :... May 2019Naviculocuneiform (NC) joint arthrodesis is an effective procedure to treat pain and provide stability to the medial column. Various forms of fixation have been...
Naviculocuneiform (NC) joint arthrodesis is an effective procedure to treat pain and provide stability to the medial column. Various forms of fixation have been described for NC arthrodesis. Despite this, the available literature is scant and questions remain regarding nonunion rate and contributory factors. A systematic review of the literature was undertaken to determine the rate of nonunion for NC joint arthrodesis. Seven studies involving 139 NC joint arthrodeses met inclusion criteria. The nonunion rate was 6.5% at a weighted mean follow-up of 73.2 months. There is insufficient evidence to provide a practice guideline based on the current literature. Adequately powered prospective clinical trials comparing well-matched patient groups with long-term follow-up are required to limit systematic error and enhance external validity. Specific outcomes measures should include union, functional assessment, complications, and cost-benefit analysis.
Topics: Arthrodesis; Humans; Incidence; Tarsal Bones; Tarsal Joints
PubMed: 30876812
DOI: 10.1053/j.jfas.2018.09.014 -
Foot & Ankle 1983Three hundred nine McKeever arthrodeses for treatment of the painful hallux were performed on 234 patients at the Mayo Clinic from 1955 to 1980. Two hundred six cases...
Three hundred nine McKeever arthrodeses for treatment of the painful hallux were performed on 234 patients at the Mayo Clinic from 1955 to 1980. Two hundred six cases were contacted, and 71 were personally examined and X-rayed. The average follow-up was 15 years (1 to 28 years). Ninety-one percent wore shoes within 2 months, 92% are painless, and 98% without other foot pathology are wearing dress shoes of their choosing. Complications, which consisted of failed fixation, infection, and recurrence of deformity, occurred in 8%. The screw fixation was removed in 30%. Eighty-six percent of the patients are satisfied.
Topics: Adolescent; Adult; Aged; Arthritis; Arthrodesis; Child; Female; Foot Deformities, Acquired; Hallux; Hallux Valgus; Humans; Male; Middle Aged; Pain; Pain Management; Shoes
PubMed: 6862327
DOI: 10.1177/107110078300300502 -
The Journal of Hand Surgery Nov 1988Many procedures have been described for treatment of unstable, deformed, or painful digital joints; most of these are various types of arthrodeses. These procedures have...
Many procedures have been described for treatment of unstable, deformed, or painful digital joints; most of these are various types of arthrodeses. These procedures have not been applied to children who have an open epiphysis for fear of damage to the growth plate. This study evaluates an arthrodesis technique that can be used for digital joint instability or deformity in skeletally immature patients. The diagnosis in most of the children in this series was related to non-traumatic congenital or developmental conditions. The joint most often fused was the thumb metacarpophalangeal joint. Results show a high rate of fusion with no interference in digital growth. Complications were minimal.
Topics: Adolescent; Arthrodesis; Child; Child, Preschool; Finger Joint; Humans; Infant; Male; Metacarpophalangeal Joint; Thumb
PubMed: 3225414
DOI: 10.1016/0363-5023(88)90263-8 -
The Journal of Bone and Joint Surgery.... Jun 1996We retrospectively reviewed the records of eighty-nine consecutive patients (ninety wrists) who had had a total arthrodesis of the wrist for the treatment of a...
We retrospectively reviewed the records of eighty-nine consecutive patients (ninety wrists) who had had a total arthrodesis of the wrist for the treatment of a post-traumatic disorder at one center. Fifty-six patients (fifty-seven wrists) had the arthrodesis with plate fixation, and thirty-three patients (thirty-three wrists) had the arthrodesis with a variety of other techniques. The average age of the patients at the time of the arthrodesis was forty-two years, and the dominant wrist was treated in forty-two patients. Fifty-six (98 per cent) of the fifty-seven wrists that had been fixed with a plate had a successful union at an average of 10.3 weeks postoperatively. Twenty-seven (82 per cent) of the thirty-three wrists that had been treated with other methods had a successful union at an average of 12.2 weeks postoperatively. The difference in the rates of union between the wrists fixed with a plate and those treated with alternative techniques was significant (p = 0.009; Fisher exact test). A total of thirty-nine complications were associated with twenty-nine (51 per cent) of the fifty-seven arthrodeses with plate fixation. Sixteen (41 per cent) of the complications (thirteen wrists) resolved with non-operative treatment. Twenty-six (79 per cent) of the thirty-three arthrodeses with alternative methods of fixation were associated with a total of twenty-nine complications. Twenty-three (79 per cent) of those complications (twenty wrists) resolved with non-operative treatment. The difference between the rate of complications associated with the arthrodeses with plate fixation and that associated with the arthrodeses with alternative methods of fixation was significant (p = 0.03; Fisher exact test).
Topics: Adult; Arthrodesis; Bone Plates; Female; Humans; Ilium; Male; Medical Records; Postoperative Complications; Radiography; Range of Motion, Articular; Retrospective Studies; Transplantation, Autologous; Wrist Injuries
PubMed: 8666608
DOI: 10.2106/00004623-199606000-00013