Bacterial Contamination Control with Sodium Hypochlorite and Jet Lavage Irrigation in a Severe Stage 4 Pelvic Pressure Injury: A Case Report.

This case report reviews the effect of combining a 250-cc bottle of standard antimicrobial, buffered sodium hypochlorite with a surgical method, low-pressure jet lavage irrigation in the outpatient setting to control difficult wound contamination. A 73-year-old man had been in treatment for over 8 years, undergoing at least 18 surgical wound debridement procedures for an extensive undermined pelvic pressure injury involving the sacrum, ischium, and greater trochanter. Cultures and polymerase chain reaction diagnostics revealed a multibacterial presence.

Jet Lavage Irrigation Resolves Stage 4 Pelvic Pressure Injury Undermining.

Objective: Patients with stage 4 pelvic pressure injuries that have large, undermined cavities are at high risk for treatment failure and often fall into the category of palliative care. This case series identified five cases where treatment had stalled, and surgical reconstructive options were limited. Jet lavage irrigation in the outpatient setting was assessed as a treatment alternative.

Bacterial Autofluorescence Digital Imaging Guides Treatment in Stage 4 Pelvic Pressure Injuries: A Preliminary Case Series.

Pelvic pressure injuries in long-term care facilities are at high risk for undetected infection and complications from bacterial contamination and stalling of wound healing. Contemporary wound healing methods must address this problem with mechanical debridement, wound irrigation, and balanced dressings that reduce bacterial burden to enable the normal healing process. This study evaluated the impact of bacterial autofluorescence imaging to indicate wound bacterial contamination and guide treatment for severe stage 4 pelvic pressure injuries.

Failure of Healing in Chronic Diabetic Wounds: A Case Report.

Stalled healing in chronic wounds is a challenging problem for providers and remains multifactorial in etiology. Older adults with insulin-dependent diabetes are at very high risk. In this case report, two patients with large nonhealing wounds were considered for treatment with daily jet lavage irrigation in an attempt to remove the inflammatory products of their respective chronic wounds and eliminate the persisting biofilm bacteria.

Low-Contact-Stress Knee Arthroplasty: Past History or Ahead of Time?

Low-contact-stress mobile-bearing (MB) total knee arthroplasty (TKA) can rely on a long history. Its concept comprises a combination of high condylar congruency and compensatory bearing rotation to promote load sharing. However, other MB designs have become available, and critical points have been raised about the benefit of MB in general.

Measuring tibial component rotation of TKA in MRI: What is reproducible?

Purpose: Correct rotational alignment of components is crucial for the success of total knee arthroplasty (TKA). Defining landmarks on the tibia that allow for reproducible measurement of component rotation seems to be more challenging than on the femoral side. This study compares the reproducibility of three different measurement techniques.

How precise is computer-navigated gap assessment in TKA?

Background: Methods to improve gap balancing in total knee arthroplasty (TKA) include the development of calibrated distractors and various devices to determine the distances of the gaps. However, few studies have validated the accuracy or precision of computer navigation to determine these measurements, especially gaps created after bone cuts have been made; doing so would be important, because optimal surgical technique relies on appropriate gap spacing.

Questions/purposes: We investigated the ability of a new image-free computer navigation surface registration protocol to measure gap distances in TKA.

Surgical treatment of hip abductor tendon tears.

Background: Greater trochanteric pain syndrome is a common orthopaedic condition related to underlying bursitis, but it may reflect gluteal tendinopathy with tendon disruption from the greater trochanter. Our goal was to evaluate our clinical experience with surgical repair of these tears.

Methods: We retrospectively evaluated a consecutive series of twenty-two patients (twenty-three hips) with a tear of the hip abductor tendons who underwent surgical reconstruction and were followed for a minimum of five years.

Multi-factorial analysis of time efficiency in total knee arthroplasty.

The objective of this retrospective review was to determine whether time efficiency could be gained by optimizing the navigation protocol based on a surgeon's specific technique and work flow. Three groups of 30 consecutive patients operated on by the same surgeon were studied. The groups were from three distinct periods between 2002 and 2008.

Six sigma analysis of minimally invasive acetabular arthroplasty: a preliminary investigation.

Minimally invasive techniques in THA may increase the difficulty of acetabular component insertion relative to the optimized position. We sought to determine the ability of eight surgeons to position an acetabular component placed using an anterior-lateral minimally invasive surgical (MIS) approach with conventional instruments or computer navigation using an optical imageless protocol compared with conventional true values determined by computed tomography (CT). We introduce a new approach, the Six Sigma process capability index, to assess outliers.

Long-term periprosthetic remodeling in THA shows structural preservation.

Although periprosthetic changes after THA have been well documented in short-term studies of less than 5 years, little is known about long-term changes. Long-term mineral changes must be evaluated against an unaffected limb control and for regional differences about a prosthesis. This study evaluated long-term periprosthetic remodeling using dual-energy x ray absorptiometry in a prospective study of patients who had noncemented THAs with a modular titanium alloy proximal-loading prosthesis.

Comparison of tibial rotation in fixed and mobile bearing total knee arthroplasty using computer navigation.

Tibial rotation is an important aspect of knee function and can be altered after total knee arthroplasty (TKA). These alterations include decreased internal rotation with knee flexion as compared to the normal state and paradoxical external rotation with flexion. Mobile bearing total knee prostheses may allow greater unconstrained tibial rotation.

Computer-assisted surgery: basic concepts.

Computer-assisted surgery has been advocated as a significant enabling technology that will enhance the surgical technique of various orthopaedic procedures. The computer becomes a sophisticated measuring tool, determining the three-dimensional spatial orientation of fiducial points, which may be established by a variety of referencing methods. These fiducial points or arrays may define a bone, an instrument, or a prosthesis.

Bone morphogenetic proteins in total hip arthroplasty, osteonecrosis and trauma surgery.

This review provides an overview of the use of bone morphogenetic proteins to enhance bone healing and bone graft incorporation in difficult defects created from failed total hip arthroplasties, osteonecrosis of the femoral head and trauma. Multiple publications have demonstrated that bone morphogenetic proteins are osteoinductive in preclinical trials (i.e.

Case report : femoral shaft fracture resulting from femoral tracker placement in navigated TKA.

Computer-assisted navigation is a surgical tool that may decrease malalignment outliers in TKA. With any new surgical technique, there is the possibility of unexpected complications that raise caution. We report two patients with displaced femoral fractures at optical tracker pin placement sites created for routine performance of navigated TKA.

Metrology and Standards Needs for Some Categories of Medical Devices.

With rapid advances in meso-, micro- and nano-scale technology devices and electronics, a new generation of advanced medical devices is emerging, which promises medical treatment that is less invasive and more accurate, automated, and effective. We examined the technological and economic status of five categories of medical devices. A set of metrology needs is identified for each of these categories and suggestions are made to address them.

Transepicondylar distal femoral pin placement in computer assisted surgical navigation.

Unlabelled: The use of optical tracking systems in computer assisted surgical navigation requires the rigid fixation of a dynamic reference base to the target bone to be navigated. This report presents the results of a new approach to optical tracker fixation in the distal femur. Four embalmed cadavers were evaluated for pin placement.