Antibiotic prophylaxis after total joint replacements (Authors' reply to Letters to the Editor)

Reply to Comment in Hong Kong Med J. 2010 Aug;16(4):320published_or_final_versio

A review of the clinical approach to persistent pain following total hip replacement

published_or_final_versio

Review Article: Osteophytes

An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.published_or_final_versio

Subchondral bone proteomics in osteoarthritis: Current status and perspectives

published_or_final_versio

Use of health status measurement scales among arthritis patients with low educational level

published_or_final_versio

Local Application of Strontium in a Calcium Phosphate Cement System Accelerates Healing of Soft Tissue Tendon Grafts in Anterior Cruciate Ligament Reconstruction: Experiment Using a Rabbit Model

Background: The healing of soft tissue tendon graft within the bone tunnel in anterior cruciate ligament (ACL) reconstruction is known to be slower than that of bone-patellar tendon-bone graft. There are attempts in accelerating the healing of the graft within the bone tunnel. One of the methods is the use of strontium-enriched calcium phosphate bone cement (Sr-CPC). The early result in animal study was encouraging, though it was not known whether the accelerated healing was solely due to the effect of the strontium within the cement, or due to the calcium phosphate cement (CPC) itself. Hypothesis: There would be differences between a strontium-enriched calcium phosphate cement (Sr-CPC) and a conventional calcium phosphate cement (CPC) in terms of the effect on soft tissue tendon graft healing within the bone tunnels in anterior cruciate ligament (ACL) reconstruction. Study Design: Controlled laboratory study. Methods: Thirty single bundle ACL reconstruction procedures were performed in 15 rabbits with the use of an Achilles tendon allograft. The graft on the left limb was coated with Sr-CPC, while that on the right limb was coated with CPC. Three animals were sacrificed for histological and histomorphometric analysis at 3, 6, 9, 12 and 24 weeks post-operation. Results: In the Sr-CPC group, early Sharpey fiber formation was present at 6 weeks post-operation while early remodeling of a graft-fibrocartilage-bone junction was noted at 12weeks. In the CPC group, early Sharpey fiber formation was only found at 9 to 12 weeks post-operation. At 24 weeks, a direct enthesis was found in both groups. According to histomorphometric score, graft healing in the Sr-CPC group took place 3 weeks faster than that in the CPC group at and before 12 weeks, but there was no difference at 24 weeks. Conclusion: The local application of strontium in a CPC system leads to accelerated graft healing within the bone tunnels. Clinical Relevance: The use of Sr-CPC to enhance graft-bone healing may improve the clinical results of ACL reconstruction using soft tissue tendon graft. Keywords: anterior cruciate ligament (ACL); strontium; calcium phosphate cementpostprin

Outcome measures of chronic arthritis in Hong Kong: comparison of the AIMS2 (Chinese) and WHO quality of life - brief form (WHOQOL-BREF) (HK)

published_or_final_versio

Intra-operative spinal chord monitoring

Spinal surgery carries a small but definite risk of damaging the spinal chord. Early detection and correction of any reversible insult to the chord is important. An intra-operative 'wake-up' test has been used to monitor the chord function for more than 20 years. However, it has its limitations and disadvantages. Advances in electronics have facilitated the development and clinical application of electrophysiological methods in assessing the integrity of the spinal chord during surgery. It is now possible to monitor the spinal chord during surgery using various evoked potentials techniques.published_or_final_versio

Why do Hong Kong patients need total hip arthroplasty? An analysis of 512 hips from 1998 to 2010

published_or_final_versio

Antibiotic prophylaxis after total joint replacements

Objectives: To review the latest evidence on antibiotic prophylaxis for patients with total joint replacements to prevent prosthesis infections. Data sources: Literature search of Medline and PubMed until June 2009. Study selection: Studies of patients with total joint replacements from around the world, studies concerning antibiotic prophylaxis, as well as chemoprophylaxis guidelines from orthopaedic associations were searched. Data extraction: Literature review, original articles, case reports, best practice guidelines. Data synthesis: With the rising incidence of patients with total joint replacements, subsequent deep infection of the implants is a rare but dreaded complication which has immense physiological, psychological, financial, and social implications. Guidelines from urologists, gastroenterologists, and dental surgeons attempt to identify high-risk patients who may be more susceptible to prosthetic joint infections. These patients are provided with prophylactic antibiotics before any invasive procedure that may cause bacterial seeding to prosthetic joints. Most orthopaedic associations around the world adopt a similar policy to provide prophylaxis to cover any anticipated chance of bacteraemia. The American Association of Orthopaedic Surgeons adopts the most cautious approach in which all patients with total joint replacements who undergo any procedure that breaches a mucosal surface receive prophylactic antibiotics. Conclusion: The guidelines from the American Association of Orthopaedic Surgeons seem to have an all-encompassing policy when it comes to providing prophylactic antibiotics. Nonetheless, physicians must still exercise their judgement and customise the treatment to each patient. The benefits of prophylactic antibiotics must be balanced against the risks of drug side-effects and the emergence of antibiotic resistance.published_or_final_versio