Fereidoon Mojtahed Jaberi, MD; Hooman Abbasi, MD; Nasrin Saki; Amir Lotfazar; Ahmad Ensafdaran, MD; Soraya Saki; Mehrad Mojtahed Jaberi
Abstract
Background: This study presents a modification of tibial inlay technique in posterior cruciate ligament (PCL) reconstruction and evaluates the structural properties of tibial side fixation of the graft, comparing tibial inlay technique and a new modification, that is interference screw fixation of tibial ...
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Background: This study presents a modification of tibial inlay technique in posterior cruciate ligament (PCL) reconstruction and evaluates the structural properties of tibial side fixation of the graft, comparing tibial inlay technique and a new modification, that is interference screw fixation of tibial side of the graft in suggested supine position which is more applicable, with less potential intraoperative neurovascular complications.Methods: Forty fresh calf knees that were prepared from 20 healthy 3 years old calves which were between 200 and 220 kg were the subject of this study. The tibias were separately used simulating tibial side PCL reconstruction with tibial tuberosity-patellar tendon–patellar bone graft. Tibial side of the graft was fixed using two cancellous screws in 20 tibiae and with interference screw in obliquely oriented canal in another 20 tibiae. Load-to-failure test was carried out on ten samples from each group. The remaining samples were used for cycling loading. Structural properties of each group were compared.Results: No significant differences were observed between two methods at load-to-failure test but mean elongation at 1,000 cycles of new modification was significantly lower than tibial inlay technique.Conclusion: In this biomechanical experimental study there found no significant differences between two methods at load-to-failure tests. Maximum load (N) was different between the tibial inlay method and the modified method but the difference was not statistically significant. Yield load and linear stiffness and deformation at the yield point were also not different between the two methods. The only important difference between the two methods was at cyclic loading test where the mean elongation at 1,000 cycles of the modified technique group was significantly lower than tibial inlay technique (p < /em>= .01).
Fereidoon M Jaberi, MD; Javad Parvizi, MD; C. Thomas Haytmanek, BS; Ashish Joshi, MD; James Purtill, MD
Abstract
Background: The association between wound drainage and subsequent periprosthetic infection is well known. However, the most appropriate treatment of wound drainage is not well understood. Methods: We retrospectively reviewed the records of 10325 patients (11785 procedures), among whom 300 patients (2.9%) ...
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Background: The association between wound drainage and subsequent periprosthetic infection is well known. However, the most appropriate treatment of wound drainage is not well understood. Methods: We retrospectively reviewed the records of 10325 patients (11785 procedures), among whom 300 patients (2.9%) developed persistent (greater than 48 hours postoperatively) wound drainage. Wound drainage stopped spontaneously between 2 and 4 days in 217 patients treated with local wound care and oral antibiotics. The remaining 83 patients (28%) underwent further surgery.Results: A single débridement resulted in cessation of drainage without subsequent infection in 63 of 83 patients (76%), whereas 20 (24%) patients continued to drain and underwent additional treatment (repeat débridement, resection arthroplasty, or long-term antibiotics). Timing of surgery and the presence of malnutrition predicted failure of the first débridement. There were no differences between the success and failure groups with regard to all other examined parameters, including demographic or surgical factors.Conclusions: We found patients who underwent débridement at a mean of 5 days following the onset of drainage were more likely to be infection free at one year postoperatively compared to patients who underwent debridement at a delayed time (mean, 10 days). Our data confirmed that malnourished patients (serum transferrin less than 200 mg/dL, serum albumin less than 3.5 g/dL, or total than 1500/mm3) undergoing total joint arthroplasty are lymphocyte count less more likely to develop deep infection and require further treatment after irrigation and débridement. Based on these findings, we recommend early (within 7 days) surgery for persistent wound drainage in general, and particularly for those with malnutrition
