Summary of background data: Locally harvested autogenous bone graft eliminates possible donor site morbidity and has all the important basic bone graft properties such as osteoinductivity, osteogenicity and osteoconductivity. Its usage was reported to be adequate to achieve fusion but none had quantifies the amount of local bone graft harvested.
Methods: Total of 40 AIS patients were recruited in the study. All posterior spinal fusion surgeries were performed by the same dual surgeons and same anesthetist with a single observer collecting and measuring bone grafts harvested. The bone grafts harvested from each respective posterior element (spinous processes, laminas, facets and transverses processes) and measured accordingly.
Results: There were 36 females and 4 males. Amongst cases recruited, there were 32% Lenke 1, 28% Lenke 2, 8%Lenke 3, 22%Lenke 5 and 10% Lenke 6. Total thoracic levels involved were 333, whereas lumbar levels were 81. The mean total weight of bone graft obtained per case was 36.5 ± 13.7 g. The total weight of lumbar bone graft to the number of lumbar fusion levels (4.5 ± 1.2 g/fusion level) was significantly higher than the total weight of thoracic bone graft to the number of thoracic fusion levels (3.2 ± 1.2 g/fusion level). The amount of bone graft was obtained was highest from lumbar spinous process (42%), followed by thoracic spinous process (32%), lumbar lamina (29%), lumbar facet (28%), thoracic lamina (25%), thoracic facet (22%), and thoracic transverse process (21%).
Conclusions: Lumbar vertebra provided more bone graft than thoracic vertebra. Spinous processes contributed the highest amount of local bone graft in the thoracic and lumbar spine.
Methods: A retrospective review was performed of all diplegic and quadriplegic patients with unilateral hip displacement treated with either bilateral or unilateral hip reconstructive surgery. Radiographic parameters [migration percentage (MP), pelvic obliquity angle (POA) and migration percentage difference (MPD)] and changes in functional ability (sitting, standing and walking) were evaluated and compared between the 2 groups. Failure was defined as post-operative MP>40%, POA>5° and MPD>30%.
Results: Eighteen patients had unilateral hip reconstruction and 42 patients had bilateral hip reconstruction. Mean age of 87 months and 90 months and means follow-up of 38 months and 40 months respectively. Post-operative MP was significant in both groups. However, of 18 patients in unilateral hip reconstruction group, 33.3% of patients had contralateral hip subluxation and 22.2% of patients had hip failure on the operated hip; compared to only one of 42 patients had hip failure and no contralateral hip problem in the other group. For assessment of pelvic symmetry, MPD was significantly improved in both group but POA was only significant in bilateral group. Overall functional improvement was significant in patients with bilateral hip reconstruction compared to unilateral group.
Conclusion: Bilateral hip reconstruction in unilateral displacement had shown to have better outcome in correcting unstable hip and pelvic asymmetry, thus provide good sitting balance and improvement in overall functional outcome.
METHODS: A series of 400 consecutive patients (416 hips) who underwent navigated (Brainlab) cementless Total Hip Arthroplasty (THA) in 2022 (Corail or Actis stem DePuy Synthes) via a direct anterior approach (DAA) was analyzed. Preoperative data were collected based on patients' demographics, radiographic information [critical trochanteric angle (CTA), centrum collum diaphyseal (CCD) angle, greater trochanter overhang, femoral neck resection angle, femoral neck resection height and Door classification], and these were correlated with the postoperative stem position. Univariable and multivariable linear regression were carried out to determine significant factors that contribute to varus and valgus stem malalignment.
RESULTS: With the DAA approach, 56.5 % of stems were placed in an optimal neutral position, 38.4 % were in acceptable position of 0.1°-2° varus/valgus and only 5 % had a deviation larger than 2° varus/valgus. The critical trochanteric angle (CTA) was statistically significant in determining varus stem placement whereas centrum collum diaphyseal angle (CCD) was found to affect valgus stem malpositioning. All other factors have shown no relevant effect on stem placement using stepwise regression method.
CONCLUSION: In DAA, 95 % of stems were found in a varus/valgus position of 2° or less. In pre-operative measurement, only femoral morphology (e.g. CTA & CCD) were found to be relevant, affecting varus/valgus stem malposition. All other tested modifiable and non-modifiable factors had no significant effect. Therefore, pre-OP templating including measurement of CTA and CCD, intra-operative assessment as well as proper operative techniques are paramount to prevent excessive varus/valgus mal-position of femoral stem in DAA.
METHODS: This multicentric multinational retrospective study, includes 24 countries from five different regions (Asia Pacific, South Eastern Africa, Western Africa, Latin America, and Middle East). Patients who developed orthopedic surgical site infection between January 2021 and December 2022 were included. Demographic details, bacterial profile of surgical site infection, and antibiotic sensitivity pattern were documented.
RESULTS: 2038 patients from 24 countries were included. Among them 69.7 % were male patients and 64.1 % were between 20 and 60 years. 70.3 % patients underwent trauma surgery and instrumentation was used in 93.5 %. Ceftriaxone was the most common preferred in 53.4 %. Early SSI was seen in 55.2 % and deep SSI in 59.7 %. Western Africa (76 %) and Asia-Pacific (52.8 %) reported a higher number of gram-negative infections whereas gram-positive organisms were predominant in other regions. Most common gram positive organism was Staphylococcus aureus (35 %) and gram-negative was Klebsiella (17.2 %). Majority of the organisms showed variable sensitivity to broad-spectrum antibiotics.
CONCLUSION: Our study strongly proves that every institution has to analyse their surgical site infection microbiological profile and antibiotic sensitivity of the organisms and plan their surgical antimicrobial prophylaxis accordingly. This will help to decrease the rate of surgical site infection, prevent the emergence of multidrug resistance and reduce the economic burden of treatment.