Concepts for increasing gentamicin release from handmade bone cement beads.

Background And Purpose: Commercial gentamicin-loaded bone cement beads (Septopal) constitute an effective delivery system for local antibiotic therapy. These beads are not available in all parts of the world, and are too expensive for frequent use in others. Thus, orthopedic surgeons worldwide make antibiotic-loaded beads themselves.

Treating natural disaster victims is dealing with shortages: an orthopaedics perspective.

During natural disasters such as earthquakes or tsunamis, most of the casualties are known to suffer from musculoskeletal injuries. This leads to an enormous need of orthopaedic (surgical) implants such as osteosynthesis plates, which are difficult to provide in developing countries that rely on imported ones. One of the alternatives is utilization of local resources, but only after they have been proven safe to use, and meet the international standards set.

Copal bone cement is more effective in preventing biofilm formation than Palacos R-G.

Bone cements loaded with combinations of antibiotics are assumed more effective in preventing infection than bone cements with gentamicin as a single drug. Moreover, loading with an additional antibiotic may increase interconnectivity between antibiotic particles to enhance release. We hypothesize addition of clindamycin to a gentamicin-loaded cement yields higher antibiotic release and causes larger inhibition zones against clinical isolates grown on agar and stronger biofilm inhibition.

Digital versus analogue preoperative planning of total hip arthroplasties: a randomized clinical trial of 210 total hip arthroplasties.

The objective of this randomized clinical trial was to compare the clinical and technical results of digital preoperative planning for primary total hip arthroplasties with analogue planning. Two hundred and ten total hip arthroplasties were randomized. All plans were constructed on standardized radiographs by the surgeon who performed the arthroplasty the next day.

Should in the treatment of osteochondritis dissecans biodegradable or metallic fixation devices be used? A comparative study in goat knees.

Most of the metallic devices have to be removed, treating osteochondritis dissecans lesions. This animal study describes the biological and mechanical behavior of screws and pins, made of commercially available PGA/PLA and PLA96 and metallic screws and pins, used for fragment fixation. A sham operation served as control.

Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty.

Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not been reported previously after unicompartmental knee arthroplasty in the literature.

Recovery of gait after short-stay total hip arthroplasty.

Objective: To describe recovery of gait after total hip arthroplasty (THA) based on the assessment of spatiotemporal gait parameters determined with an ambulatory system.

Design: A 6-month inception cohort study.

Setting: Inpatient and outpatient setting in an academic hospital.

Transfer of bacteria between biomaterials surfaces in the operating room--an experimental study.

Bacterial adhesion to and transfer between surfaces is a complicated process. With regard to the success of biomaterials implants, studies on bacterial adhesion and transfer should not be confined to biomaterials surfaces in the human body, but also encompass surfaces in the operating room, where the origin of many biomaterials related infections is found. The purpose of this study was to quantify the transfer of Staphylococcus aureus, Staphylococcus epidermidis, and Propionibacterium acnes from one operating room material to another, while accounting for surface hydrophobicity and roughness, moistness and application of friction during transfer.

The combination of ultrasound with antibiotics released from bone cement decreases the viability of planktonic and biofilm bacteria: an in vitro study with clinical strains.

Objectives: Antibiotic-loaded bone cements are used for the permanent fixation of joint prostheses. Antibiotic-loaded cements significantly decrease the incidence of infection. The objective of this study was to investigate whether the viability of bacteria derived from patients with a prosthesis-related infection could be further decreased when antibiotic release from bone cements was combined with application of pulsed ultrasound.

Groningen orthopaedic exit strategy: Validation of a support program after total hip or knee arthroplasty.

Objective: Validation of the program theory of the Groningen orthopaedic exit strategy (GOES), a theory-driven program aiming to improve the rehabilitation of total hip and knee arthroplasty patients after shortened hospital stay. First part of the program theory is the action theory, hypothesising that the GOES treatment positively influences the mediating variables (self-efficacy, social support, pain-coping). The second part, the conceptual theory, hypothesis a positive relationship between these variables and the outcome variables (ADL functioning, physical activity behaviour, quality of life).

Biomechanical and surface physico-chemical analyses of used osteosynthesis plates and screws--potential for reuse in developing countries?

Reprocessing of single-use devices is an upcoming issue in the Western world, but has been for many years in developing countries. In developing countries, the number of bone fractures due to traffic or industrial accidents is high. Patients often need an osteosynthesis with plates and screws, but most patients, however, cannot afford this because of the costs involved and have to rely on the application of used plates and screws.

Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis.

Study Design: The natural history of patients with idiopathic scoliosis was analyzed radiographically and electromyographically in a prospective longitudinal study.

Objectives: To identify changes in geometric variables and the sequence in which these changes occur during curve progression in the natural history of patients with idiopathic scoliosis. In addition, to study the relationship between several geometric variables and electromyographic (EMG) measurements to determine their predictive value as risk factors to curve progression of the scoliotic deformity.

Antimicrobial efficacy of gentamicin-loaded acrylic bone cements with fusidic acid or clindamycin added.

The increasing gentamicin resistance among bacteria in septic joint arthroplasty has stimulated interest in adding a second antibiotic into gentamicin-loaded bone cement. A first aim of this in vitro study is to investigate whether addition of fusidic acid or clindamycin to gentamicin-loaded bone cement has an additional antimicrobial effect against a collection of 38 clinical isolates, including 16 gentamicin-resistant strains. A modified Kirby-Bauer test, involving measurement of the inhibition zone around antibiotic-loaded bone cement discs on agar plates, was used to investigate whether adding a second antibiotic has an additional antimicrobial effect.

Patient satisfaction at and after discharge. Effect of a time lag.

Objective: Patient satisfaction is an important outcome measure for evaluating the quality of medical care. It is remarkable that consistently high satisfaction ratings have been reported over the last 30 years. There are indications that the time point of administration of a patient satisfaction questionnaire has an influence on satisfaction ratings.

The influence of ultrasound on the release of gentamicin from antibiotic-loaded acrylic beads and bone cements.

Gentamicin-loaded acrylic beads are loosely placed in infected bone cavities, whereas gentamicin-loaded acrylic bone cement is used as a mechanical filler in bone to anchor prosthetic components. Both drug delivery systems are used to decrease infection rates by gentamicin release. The objective of this study is to investigate the effects of pulsed ultrasound on gentamicin release from both materials.

A Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale (SER): a first impression on reliability and validity.

Self-efficacy is a relevant factor during rehabilitation after total hip or knee arthroplasty. Research was done into the reliability and validity of a Dutch translation of the Self-Efficacy for Rehabilitation Outcome Scale (SER). One hundred and forty-one persons filled in the SER questionnaire and the Self-Efficacy Expectation Scale (SES) as a control scale.

Perioperative contamination in primary total hip arthroplasty.

Unlabelled: All surgical procedures have the risk of microbial contamination. However, procedures in which prosthetic materials are involved have a high risk for future infectious problems because of the protection offered by the biofilm mode of growth. Studies of perioperative contamination have been done on involved surgical instruments, but whether these instruments transmit contamination to the prosthesis or future site of the prosthesis is not known.

Pseudomonas aeruginosa biofilm formation and slime excretion on antibiotic-loaded bone cement.

Background: Infection is an infrequent but serious complication of prosthetic joint surgery. These infections will usually not clear until the implant is removed and re-implantation has a high failure rate, especially when Pseudomonas aeruginosa is involved.

Material And Methods: We examined Pseudomonas aeruginosa biofilm formation on plain and gentamicin-loaded bone cement with confocal scanning laser microscopy (CSLM).

Comparison of analog and digital preoperative planning in total hip and knee arthroplasties. A prospective study of 173 hips and 65 total knees.

Introduction: Digital correction of the magnification factor is expected to yield more accurate and reliable preoperative plans. We hypothesized that digital templating would be more accurate than manual templating for total hip and knee arthroplasties.

Patients And Methods: Firstly, we established the interobserver and intraobserver reliability of the templating procedure.

Gentamicin-loaded bone cement with clindamycin or fusidic acid added: biofilm formation and antibiotic release.

The formation of staphylococcal biofilms on experimental bone cements, loaded with 0.5 or 1.0 g of active gentamicin and an additional equivalent amount of gentamicin, clindamycin, or fusidic acid was investigated.

The influence of cyclic loading on gentamicin release from acrylic bone cements.

Antibiotic-loaded acrylic bone cement is widely used in total joint replacement to reduce infections. Walking results in cyclic loading, which has been suggested to stimulate antibiotic release. The goal of this study is to compare antibiotic release from cyclically loaded bone cement with the release from unloaded bone cement.

A preliminary study on electromyographic analysis of the paraspinal musculature in idiopathic scoliosis.

The paraspinal muscles have been implicated as a major causative factor in the progression of idiopathic scoliosis. Therefore, the objectives of this preliminary study were to measure the electromyographic activity (EMG) of the paraspinal muscles to determine its relationship to progression of the scoliotic curve. Idiopathic scoliotic patients were selected and identified afterwards on curve progression.

The Groningen Orthopedic Exit Strategy (GOES): a home-based support program for total hip and knee arthroplasty patients after shortened hospital stay.

The number of total hip and knee arthroplasty patients in The Netherlands will increase progressively in the coming decades. A reaction to this trend is a shortening of hospital stays. This however should not result in uncertainty, lack of information and unnecessary medical consumption by patients at home.

Groningen Orthopaedic Social Support Scale: validity and reliability.

Background: Social support is an important factor in the rehabilitation process, as it has a positive influence on patients' health, functioning and recovery. In particular, perceived social support and instrumental support are important after total hip or knee arthroplasty. However, nursing staff often appear to estimate the amount of support available to patients by number of visitors.

The relation between electromyography and growth velocity of the spine in the evaluation of curve progression in idiopathic scoliosis.

Study Design: A prospective study in which patients with idiopathic scoliosis were examined longitudinally by radiographic and electromyographic measurements according to a protocol.

Objectives: To measure the growth velocity of the spine and the electromyographic ratio of the paraspinal muscles to determine their relation to progression of the scoliotic curve.

Summary Of Background Data: Several factors have been reported to be involved in the progression of idiopathic scoliosis.