Propionibacterium acnes infections in patients with idiopathic scoliosis: a case-control study and review of the literature.

Purpose:Surgical site infection (SSI) caused by Propionibacterium acnes is an infrequent but devastating complication after spinal fusion. The purpose of this study was to identify risk factors for SSI with Propionibacterium acnes after spinal fusion for juvenile and adolescent idiopathic scoliosis (JIS and AIS). Methods:A case-control study was performed. Each case was matched 2:1 for age, gender and diagnosis. Retrospective chart review was performed to obtain relevant demographic, surgical and clinical data for all cases and controls. Statistical analysis included paired t-test and McNemar test, as well as exact logistic regression and robust regression models. Results:This study included ten infection cases (eight AIS, two JIS) and 20 controls (16 AIS, four JIS). In total, six infected cases presented within two weeks of the index procedure (acute infection) and four infected cases presented more than one year from the index procedure (delayed infection). The most common presentation for acute infections was wound drainage, while back pain was more common in delayed infections. All infections were successfully treated with surgical irrigation and debridement and postoperative antibiotics. Hardware was removed for patients with delayed infections. The strongest risk factor for infection was increased requirement for blood transfusion, but it did not reach statistical significance. Conclusion:SSI with Propionibacterium acnes is an important complication after spinal fusion for idiopathic scoliosis. These infections can be successfully treated, but larger studies are needed to further identify risk factors and establish standardized guidelines for the treatment and prevention of this complication. Level of Evidence Level III

Cartilage restoration of patellofemoral lesions: a systematic review

Purpose This study aimed to systematically analyze the postoperative clinical, functional, and imaging outcomes, complications, reoperations, and failures following patellofemoral cartilage restoration surgery. Methods This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, EMBASE, and Cochrane Library databases were searched up to August 31, 2018, to identify clinical studies that assessed surgical outcomes of patellofemoral cartilage restoration surgery. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess study quality. Results Forty-two studies were included comprising 1,311 knees (mean age of 33.7 years and 56% males) and 1,309 patellofemoral defects (891 patella, 254 trochlear, 95 bipolar, and 69 multiple defects, including the patella or trochlea) at a mean follow-up of 59.2 months. Restoration techniques included autologous chondrocyte implantation (56%), particulated juvenile allograft cartilage (12%), autologous matrix-induced chondrogenesis (9%), osteochondral autologous transplantation (9%), and osteochondral allograft transplantation (7%). Significant improvement in at least one score was present in almost all studies and these surpassed the minimal clinically important difference threshold. There was a weighted 19%, 35%, and 6% rate of reported complications, reoperations, and failures, respectively. Concomitant patellofemoral surgery (51% of patients) mostly did not lead to statistically different postoperative outcomes. Conclusion Numerous patellofemoral restoration techniques result in significant functional improvement with a low rate of failure. No definitive conclusions could be made to determine the best surgical technique since comparative studies on this topic are rare, and treatment choice should be made according to specific patient and defect characteristics

Predictors of patient satisfaction after reverse shoulder arthroplasty

© 2019 Journal of Shoulder and Elbow Surgery Board of Trustees Hypothesis: The aims of this study were to determine patient satisfaction and to identify predictors of satisfaction after reverse shoulder arthroplasty (RSA). We hypothesized that the majority of patients would be satisfied after RSA and that patients with worse preoperative mental and physical health would be less satisfied. Methods: Satisfaction was assessed 2 years after primary RSA with domains for pain, work, activities, quality of life, and overall satisfaction. Preoperative and postoperative patient-reported factors were measured using the American Shoulder and Elbow Surgeons (ASES) shoulder score, Shoulder Activity Scale score, Short Form 12 (SF-12) mental and physical component summary scores, and visual analog scale (VAS) pain, fatigue, and general health scores. Pearson correlations were used to determine the relationship between patient-reported factors and satisfaction. Multivariate regression was performed to control for potential confounding variables. Results: A total of 161 patients were evaluated at 2 years postoperatively. Patients were “very satisfied” in an average of 3.3 of the 5 domains. Improvements in ASES, Shoulder Activity Scale, VAS pain, and SF-12 physical component summary scores were associated with higher satisfaction, with correlation coefficients ranging from 0.27 to 0.49. On multivariate analysis, patients with higher preoperative ASES scores were less satisfied after surgery (P = .005). In addition, patients with worse VAS fatigue (P = .011) and SF-12 mental (P = .034) and physical (0.011) component summary scores preoperatively had lower satisfaction. Conclusion: Improvements in pain and outcome scores are associated with increased satisfaction. Patients with higher shoulder function, worse physical health, and worse mental health prior to surgery are more likely to have lower satisfaction after RSA

Too clean, or not too clean: the hygiene hypothesis and home hygiene.

The 'hygiene hypothesis' as originally formulated by Strachan, proposes that a cause of the recent rapid rise in atopic disorders could be a lower incidence of infection in early childhood, transmitted by unhygienic contact with older siblings. Use of the term 'hygiene hypothesis' has led to several interpretations, some of which are not supported by a broader survey of the evidence. The increase in allergic disorders does not correlate with the decrease in infection with pathogenic organisms, nor can it be explained by changes in domestic hygiene. A consensus is beginning to develop round the view that more fundamental changes in lifestyle have led to decreased exposure to certain microbial or other species, such as helminths, that are important for the development of immunoregulatory mechanisms. Although this review concludes that the relationship of the hypothesis to hygiene practice is not proven, it lends strong support to initiatives seeking to improve hygiene practice. It would however be helpful if the hypothesis were renamed, e.g. as the 'microbial exposure' hypothesis, or 'microbial deprivation' hypothesis, as proposed for instance by Bjorksten. Avoiding the term 'hygiene' would help focus attention on determining the true impact of microbes on atopic diseases, while minimizing risks of discouraging good hygiene practice

Wednesday, September 26, 2018 2:00 PM – 3:00 PM Integrating Technology into Practice: 58. Validity of the Fundamental of Spinal Surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees

While all surgical disciplines require years of study to acquire knowledge and experience, surgical trainees must also develop the necessary psychomotor skills to perform surgical procedures. To date, there are limited validated tools to objectively assess trainees as they progress through their education. Pedicle screw placement is a demanding surgical skill set to learn and teach as challenges such as variations in pedicle morphology and spinal deformities can be encountered.  Available CT simulators for pedicle placement can be costly and hands on cadaver courses are limited by specimen availability. We sought to develop a cost-effective training tool that could be used by all orthopedic and neurosurgical residencies. Multicenter study (four academic institutions). Orthopedic and neurosurgery residents and spine attending surgeons are recruited. Outcomes measures include the scores for all three tasks and the time taken to complete the tasks. After IRB approval, a low cost spine simulator ($30.00) was created to test three main skill sets all pertaining to the task of placing a pedicle screw: ability to find appropriate trajectory, ability to navigate down the isthmus of a pedicle, and ability to recognize wall penetrations. Residents as well as spine attending surgeons were recruited to participate from four different institutions. Each participant was given three tasks to complete. Task 1 entails creation of the pedicle screw path with a standard gearshift probe, with the number of “cortical breaks” being recorded.  Task 2 entails testing the ability to palpate for the presence or absence of wall defects. Task 3 is the ability to determine the location of wall defects. The number of correct answers for task 2 and 3 are recorded. The ability to differentiate between surgical residents and master spine surgeons was obtained. In all tasks, spine attending surgeons scored higher than residents. Attending surgeons reported that FOSS simulator is a good tool which can be beneficial for training surgical residents in terms of tactile feedback and directionality of probe and pedicle placement. Moreover, the FOSS stimulator also allowed participants the ability to feel the difference between young cortical bone versus osteoporotic bone. Eighty-one percent of the spine attending surgeons reported that they would use this educational technology in the future for training purposes. Eighty-four percent of all residents, and 100% of PGY1 residents reported that they would use FOSS simulator for training. Recent published work has demonstrated the role of low cost tools for teaching and testing psychomotor skills in orthopedic surgery. Here, we developed the next tool to be used for spine surgery. FOSS is an invaluable asset as it will allow surgical trainees to engage and enhance their visual, auditory and proprioceptive feedback safely during pedicle screw placement outside of the operating room. This abstract does not discuss or include any applicable devices or drugs