Organization of Bone Sarcoma Care:A Cross-Sectional European Study

Objective To assess organization of care in several bone sarcoma centers in Europe affiliated with the European Musculoskeletal Oncology Society (EMSOS) for comparison and to identify potential improvements in organization of care. Methods Data for this observational cross-sectional study was obtained through healthcare professionals affiliated to EMSOS. The authors formulated 10 questions regarding organization of care. The questions were focused on guidance, multidisciplinary decision-making, and data storage. A digital questionnaire was synthesized and included quality control. The digital questionnaire was sent to 54 representative members of EMSOS. We did not receive responses from 29 representative countries (53.7%) after one digital invitation and two digital reminders. Results We received data from 25 representatives of bone sarcoma centers from 17 countries across Europe (46.3%). Authorization to perform oncological care in a bone sarcoma center was government issued in 41.2% of cases and based on expertise without governmental influence in 52.9% of cases. In 64.7% of the countries, a national bone tumor guideline regarding for diagnosis and treatment is used in oncological care. A national bone tumor board for extensive case evaluation including classification and advice for treatment is available for 47.1% of the countries. All participating bone sarcoma centers have a mandatory local multidisciplinary meeting before the start of treatment; in 84.0% this meeting takes place once a week. During this multidisciplinary meeting a median of 15 cases (range, 4-40 cases) are discussed. In terms of storage of oncological data, a local registry is used in eight countries (47.1%). A national registry is used in eight countries (47.1%). Conclusions A national bone tumor board gives bone sarcoma centers with little adherence the opportunity to gain knowledge from a more experienced team. Centralization of care in a bone sarcoma center is important to lower incidences. The optimal size for a bone sarcoma center in terms of patient adherence is not known at present

LEAK study:design of a nationwide randomised controlled trial to find the best way to treat wound leakage after primary hip and knee arthroplasty

INTRODUCTION: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly successful treatment modalities for advanced osteoarthritis. However, prolonged wound leakage after arthroplasty is linked to prosthetic joint infection (PJI), which is a potentially devastating complication. On the one hand, wound leakage is reported as a risk factor for PJI with a leaking wound acting as a porte d'entrée for micro-organisms. On the other hand, prolonged wound leakage can be a symptom of PJI. Literature addressing prolonged wound leakage is scarce, contradictory and of poor methodological quality. Hence, treatment of prolonged wound leakage varies considerably with both non-surgical and surgical treatment modalities. There is a definite need for evidence concerning the best way to treat prolonged wound leakage after joint arthroplasty. METHODS AND ANALYSIS: A prospective nationwide randomised controlled trial will be conducted in 35 hospitals in the Netherlands. The goal is to include 388 patients with persistent wound leakage 9-10 days after THA or TKA. These patients will be randomly allocated to non-surgical treatment (pressure bandages, (bed) rest and wound care) or surgical treatment (debridement, antibiotics and implant retention (DAIR)). DAIR will also be performed on all non-surgically treated patients with persistent wound leakage at day 16-17 after index surgery, regardless of amount of wound leakage, other clinical parameters or C reactive protein. Clinical data are entered into a web-based database. Patients are asked to fill in questionnaires about disease-specific outcomes, quality of life and cost effectiveness at 3, 6 and 12 months after surgery. Primary outcome is the number of revision surgeries due to infection within a year of arthroplasty. ETHICS AND DISSEMINATION: The Review Board of each participating hospital has approved the local feasibility. The results will be published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NTR5960;Pre-results

Persistent Wound Drainage After Total Joint Arthroplasty: A Narrative Review

Background: Persistent wound drainage after total joint arthroplasty (TJA) is an important complication with potential substantial adverse consequences, in particular periprosthetic joint infection. Methods: This review evaluated the available literature regarding several issues in the field of persistent wound drainage after TJA and offers a classification of persistent wound drainage and an algorithmic approach to the decision-making process. Results: Available literature addressing the diagnosis and treatment of persistent wound drainage after TJA is scarce and an evidence-based clinical guideline is lacking. This is partially caused by the absence of a universally accepted definition of persistent wound drainage. In patients with persistent wound drainage, clinical signs and serological tests can be helpful in the diagnosis of a developing infection. Regarding the treatment of persistent wound drainage, nonsurgical treatment consists of absorbent dressings, pressure bandages, and temporary joint immobilization. Surgical treatment is advised when wound drainage persists for more than 5-7 days and consists of open debridement with irrigation and exchange of modular components and antimicrobial treatment. Conclusion: Based on this literature review, we proposed a classification and algorithmic approach for the management of patients with persistent wound drainage after TJA. Hopefully, this offers the orthopedic surgeon a practical clinical guideline by finding the right balance between overtreatment and undertreatment, weighing the risks and benefits. However, this classification and algorithmic approach should first be evaluated in a prospective trial. (C) 2018 The Author(s). Published by Elsevier Inc

Barriers and facilitators in large scale clinical trials:experiences based on the LEAK study

Objetivo: determinar el nivel de desgaste dentario según la actividad laboral en el personal de la Policía Nacional del Perú en noviembre y diciembre del 2010. Material y métodos: se evaluaron a 200 policías de dos unidades, División nacional de Operaciones Especiales (DINOES), y División Territorial Centro, que desempeñan actividades laborales policiales diferentes. Para evaluar la presencia de desgaste dentario se utilizó el índice de desgaste de Alexeev y Debetz de 6 escalas, que luego se catalogó en 3 niveles, leve, moderado y severo, el personal estuvo dentro de los parámetros de inclusión, habiéndosele informado del estudio, firmando un consentimiento y respondiendo un respectivo cuestionario de 8 preguntas, direccionadas a obtener información de los posibles factores de riesgo que presentaba el paciente. Resultados: los resultados fueron evaluados mediante la prueba estadística de Chi cuadrado por homogeneidad se encontró diferencias estadísticamente significativa entre los grupos estudiados, de los 200 policías evaluados, se encontró que el 97% del grupo de División Nacional de Operaciones Especiales presentaron desgaste dentario moderado, ninguno presentó desgaste leve, en cambio sólo el 25% del personal de División Territorial Centro presentó desgaste dental moderado y un 16% presentó desgaste leve. Conclusiones: el nivel de desgaste dentario según la actividad laboral fue mayor en la División Nacional de Operaciones Especiales (DINOES), a diferencia de División Territorial Centro

Higher randomization rates needed to successfully complete the LEAK study:progress report and solutions for current issues

Prolonged wound leakage after joint arthroplasty is reported as a symptom of prosthetic joint infection (PJI) and a risk factor for developing a PJI. However, evidence-based guidelines on the treatment and timing of treatment of prolonged wound leakage after joint arthroplasty are lacking. Hence, treatment of prolonged wound leakage varies considerably in the Dutch orthopaedic community. Therefore, Consortium Orthopaedic Research (CORE) initiated a nationwide randomized controlled trial in 38 hospitals throughout the Netherlands, in which patients with wound leakage 9-10 days after total hip and knee arthroplasty are randomly allocated to early surgical treatment (debridement, antibiotics and implant retention (DAIR) at day 9-10) or non-surgical treatment (pressure bandages, (bed) rest and wound care) / late surgical treatment (DAIR at day 16-17). In order to successfully complete this large multicenter RCT and improve our clinical care, higher randomization rates are needed. To motivate hospitals to participate in this study and stimulate orthopaedic surgeons to randomize patients we proposed several solutions for current issues and composed an online magazine to offer additional support (https://leak.orthopeden.org)