Joint needle aspiration compared to tissue samples in septic arthritis of the native knee

Culturing the causative infectious agent is the only definitive method of diagnosing septic arthritis and can be identified by culturing synovial fluid or tissue cultures obtained by surgery. The aim of this study is to compare the cultures of joint needle aspiration with the tissue cultures obtained by surgery. 52 patients treated under a suspicion of a septic arthritis of the knee were retrospectively reviewed. In 84% tissue cultures were equal to joint needle aspiration. Median Gächter classification was 1.0 (range 1-3). 60% of the patients underwent multiple procedures. All patients were successfully treated with 2.0 (range 1-6) arthroscopies. Our results showed that if a patient with a clinical suspicion of septic arthritis is treated, starting antibiotic therapy prior to surgery can be considered. Arthroscopic surgery must be the treatment of choice in Gächter stage 1 to 3, although it might be necessary to perform multiple procedures

Safety of blood reinfusion after local infiltration analgesia with ropivacaine in total knee arthroplasty

Objective: The authors hypothesized that it is safe to combine local infiltration analgesia (LIA) in total knee arthroplasty (TKA) with a retransfusion drain since ropivacaine concentrations would not exceed the arterial toxicity threshold concentrations of 4.3 mg/L for total and 0.56 mg/L for unbound ropivacaine. Materials and methods: 22 patients scheduled for primary TKA were included. During surgery three peri-articular injections with ropivacaine (300 mg) were given. Plasma and shed blood samples were taken at 0, 1, 3, 6, 7, and 24 hours postoperatively. Results: At 6 hours postoperatively, the total ropivacaine plasma concentration ranged from 0.26 to 1.53 mg/L and unbound ropivacaine from 0.03 to 0.12 mg/L. At 7 hours, the total ropivacaine plasma concentration ranged from 0.19 to 1.71 mg/L and unbound ropivacaine from 0.02 to 0.09 mg/L. In the collected shed blood, a total of 0.27 to 12.8 mg (median 3.73 mg) unbound ropivacaine was present. Reinfusion would lead to an addition of 3.73 mg (median) unbound ropivacaine that would be reinfused into the patient. The calculated (modeled) estimation regarding the maximum unbound ropivacaine plasma concentration showed a median value of 0.114 mg/L (IQR: 0.09, 0.12 mg/L). All concentrations were well below reported toxicity thresholds. Conclusions: The combination of LIA and reinfusion presented herein are considered safe. However, differences in pain protocol lead to changes in the safety evaluation. Compared with previous studies, the technique of administration is of greater importance for the effect on unbound ropivacaine because of unknown mechanisms. © 2014 Dustri-Verlag Dr. K. Feistle

Limit allogeneic blood use with routine re-use of patient's own blood: a prospective, randomized, controlled trial in total hip surgery.

There are risks related to blood incompatibility and blood-borne diseases when using allogeneic blood transfusion. Several alternatives exist today, one of which, used for autologous blood salvage perioperatively, is the Sangvia Blood Management System. This study was designed to investigate the efficacy of the system and to add data to previously reported safety results.Two hundred sixteen patients undergoing primary or revision total hip arthroplasty (THA) were enrolled in this randomized, controlled, assessor-blinded multicenter study. Randomization was either autologous blood transfusion (Sangvia group) or no use of autologous blood (Control group), both in combination with a transfusion protocol for allogeneic transfusion. Patients were followed during hospital stay and at two months after discharge. The primary outcome was allogeneic blood transfusion frequency. Data on blood loss, postoperative hemoglobin/hematocrit, safety and quality of life were also collected. The effectiveness analysis including all patients showed an allogeneic blood transfusion rate of 14% in both groups. The efficacy analysis included 197 patients and showed a transfusion rate of 9% in the Sangvia group as compared to 13% in the Control group (95%CI -0.05-0.12, p = 0.5016). A mean of 522 mL autologous blood was returned in the Sangvia group and lower calculated blood loss was seen. 1095 mL vs 1285 mL in the Control group (95%CI 31-346, p = 0.0175). No differences in postoperative hemoglobin was detected but a lower hematocrit reduction after surgery was seen among patients receiving autologous blood. No relevant differences were found for safety parameters or quality of life.General low use of allogeneic blood in THA is seen in the current study of the Sangvia system used together with a transfusion protocol. The trial setting is under-powered due to premature termination and therefore not able to verify efficacy for the system itself but contributes with descriptive data on safety.Clinicaltrials.gov NCT00822588

All (serious) adverse events coded according to WHO-ART.

<p>Number of patients with 1, 2 or 3 reported adverse events per system organ class.</p>1<p>System organ class according to WHO Adverse Reaction Terminology (WHO-ART) was used for coding by means of Primary System according to the Adverse Event Dictionary Version 029 (equivalent to MedDRA).</p>2<p>Reported AEs were dizziness, headache, nausea, myoclonus, vertigo, restless legs, and needling sensation during transfusion.</p>3<p>Body as a whole – general disorders include for example postoperative complications (e.g. wound seroma and/or redness and hip joint dislocation), peripheral edema, pain and death.</p>4<p>There was one reported death in the Control group, which occurred 13 days after discharge.</p

Patients characteristics.

<p>BMI = Body Mass Index.</p>1<p>Mann-Whitney U/Wilcoxon rank sum test: Exact Sig. (2-tailed) was used to give an indication of the size of chance imbalances between the treatment groups.</p

Reported serious¹ adverse events.

1<p>Serious definition according to ICH/Good Clinical Practice as any untoward and unintended response that results in death, is immediately life-threatening, requires in-subject hospitalization or prolongation of existing hospitalization, results in persistent or significant disability or incapacity, is a congenital abnormality or birth defect or is an important medical event that may jeopardize the patient or may require medical intervention to prevent one of the outcomes listed above.</p

Study patient flow and definition of analysis sets.

<p>Study patient flow and definition of analysis sets.</p

Hb and Hct change from screening per treatment group (PP analysis set).

1<p>Mann-Whitney U/Wilcoxon rank sum test: Exact Sig. (2-tailed)), 95% CI based on independent sample t-test, equal variances assumed.</p