Phenolphthalein used to assess permeability of antibiotic-laden polymethylmethacrylate: a pilot study.

Elution of antibiotics from polymethylmethacrylate laden with antibiotics is dependent on the permeability of the polymethylmethacrylate. Increasing polymethylmethacrylate permeability by adding fillers has been suggested to increase antibiotic elution but the resulting increase in permeability has not been assessed directly. A simple method to assess polymethylmethacrylate permeability is proposed.

Is aseptic loosening truly aseptic?

Surgeons who treat osteomyelitis or infected implants think that microorganisms can live on and around implanted biomaterials and necrotic bone without clinical manifestations of infection. Gristina and Costerton, in their seminal work, suggested that such bacteria persist within biofilms and that they are often overlooked when diagnosis is based on standard microbiologic culture techniques. Subsequent studies using specialized techniques including sonication to remove adherent bacteria and direct detection using various forms of microscopy have confirmed that bacteria are present in many culture-negative cases.

A guide to reduce allogeneic transfusions in elective orthopaedic surgery.

The principles and techniques used to reduce or eliminate blood transfusions can be applied to the standard practice of orthopaedic surgery. The overall goal is to enable orthopaedic surgeons who are interested in reducing allogeneic transfusions to find a method that fits their practice.

Early detection of bone infection and differentiation from post-surgical inflammation using 2-deoxy-2-[18F]-fluoro-D-glucose positron emission tomography (FDG-PET) in an animal model.

Diagnosing bone infection in the context of post-surgical inflammation is problematic since many of the early signs of infection are similar to normal post-surgical changes. We used a rabbit osteomyelitis model to evaluate the use of 2-deoxy-2-[(18)F]-fluoro-d-glucose positron emission tomography (FDG-PET) as a means of detecting post-operative infection in the context of post-surgical inflammation. Comparisons were made between infected and non-infected rabbits in which infection with Staphylococcus aureus was initiated at the time of surgery.

Nightly enteral nutrition support of elderly hip fracture patients: a pilot study.

Objectives: Assess whether postoperative nightly enteral nutrition support improves outcomes of elderly patients with an acute hip fracture

Design: Randomized controlled trial.

Setting: A University and a Department of Veteran's Affairs Hospital

Subjects: Adults >64 years of age who underwent surgical repair of an acute hip fracture.

Interventions: Subjects randomized to the control (Ctrl) group received standard care while the treatment (Tx) group received standard care plus up to 1,375 Kcal [5,755 kJ/d] of nasoenteral tube feedings each night.

The current status of material used for depot delivery of drugs.

The ideal local antibiotic delivery system has not been created. Antibiotic-laden bone cement has become the gold standard in the treatment of infected orthopaedic implants and there are confirmatory laboratory and clinical data that support the use of these materials. Heat-stable antibiotics elute from antibiotic-laden bone cement and do not have a notable influence on the compressive strengths of bone cement if the antibiotics are used in appropriate amounts.

The effect of glycine filler on the elution rate of gentamicin from acrylic bone cement: a pilot study.

Elution of antibiotics from acrylic bone cement (polymethylmethacrylate [PMMA]) is dependent on the access of fluid to the depths of the cement that contains the antibiotic. Commercially prepared antibiotic beads that are porous have higher elution rates than hand-mixed, nonporous antibiotic PMMA mixtures. To increase the elution of gentamicin from hand-mixed PMMA, glycine was added as a filler to produce porosity.

A consensus statement on empiric therapy for suspected gram-positive infections in surgical patients.

Background: Multidrug resistance among gram-positive pathogens in tertiary and other care centers is common. A systematic decision pathway to help select empiric antibiotic therapy for suspected gram-positive postsurgical infections is presented.

Data Sources: A Medline search with regard to empiric antibiotic therapy was performed and assessed by the 15-member expert panel.

Allograft reconstruction for extensor mechanism rupture after total knee arthroplasty: 4.8-year follow-up.

Three patients who experienced extensor mechanism rupture after total knee arthroplasty underwent reconstruction using an allograft consisting of quadriceps tendon, patella, patellar tendon, and tibial tubercle. All patients who failed initial attempts to repair the extensor mechanism disruption achieved pain relief at average 4.8-year follow-up.

Surgical hand scrub practices in orthopaedic surgery.

The purpose of this study was to determine whether the practice of surgical hand scrubbing among orthopaedic surgeons, faculty, residents, and nurses met the institution's recommended 5-minute scrub policy and how often a 2-minute surgical hand scrub was used. Forty-eight subjects' hand scrub times were recorded discreetly for a total of 125 observations. All individuals scrubbed for a mean of 2.

The effect of sampling method on the elution of tobramycin from calcium sulfate.

Release rate is a critical property of all drug delivery vehicles, including antibiotic-laden bioerodibles. In vitro elution studies, used to evaluate release rates, use different sampling methods, including changing the entire amount of buffer and partial exchanges each day. Two groups of 10% calcium sulfate-tobramycin pellets were eluted in 20 mL of buffer for 30 days.

Detecting bacterial colonization of implanted orthopaedic devices by ultrasonication.

Glycocalyx-producing bacteria have been observed on orthopaedic devices that were removed for reasons other than infection. It has been suggested that the bacteria adhere to foreign surfaces within a biofilm and elude standard culture techniques. The authors adapted previously used ultrasonication protocols that disrupt the surface biofilm before culturing removed orthopaedic devices from patients without clinical evidence of infection.

The treatment of experimental osteomyelitis by surgical debridement and the implantation of calcium sulfate tobramycin pellets.

Calcium sulfate was used as a biodegradable delivery system for the administration of antibiotics in musculoskeletal infection. New Zealand white rabbits were infected with Staplylococcus aureus, debrided, and randomized to one of four treatment groups: calcium sulfate pellets with 10% tobramycin sulfate, placebo calcium sulfate pellets and IM tobramycin, placebo calcium sulfate pellets, or debridement. Serum and wound exudate tobramycin concentrations and serum calcium levels were measured.