A Novel Technique to Preserve Range of Motion in Two-Stage Revision of Infected Total Knee Arthroplasty.

A novel technique to preserve range of motion in two-stage revision of infected total knee arthroplasty.

Int Orthop. 2013 Apr 16;
Carulli C, Villano M, Civinini R, Matassi F, Nistri L, Innocenti M

PURPOSE: Two-stage revision represents the gold standard in the treatment of infected total knee arthroplasty. Different techniques have been proposed, mostly not preserving range of motion. An articulated antibiotic-loaded cement spacer made in association with two unicompartmental implants has been used as an alternative to a static spacer in an effort to retain as much movement as possible between the stages in young, high-demand patients with preserved ROM. METHODS: We evaluated nine consecutive patients with a mean age of 66.5 years. The second stage was performed after lab tests returned to normal and culture proved negative. Mean follow-up was 4.6 years. RESULTS: Mean ROM from a preoperative value of 105.6° was 103.5° after the first stage, and improved to 110.0° after the definitive implant. Mean Knee Society score was 27.6 preoperatively improving to 86.4 points postoperatively. WOMAC score showed that six patients were very satisfied with the overall result of their reimplanted knee, three subjects were somewhat satisfied. No recurrence of infection, no significant radiolucent lines or osteolysis were recorded at clinical and radiological follow-up and the patients were satisfied with the outcome. CONCLUSIONS: Results indicated that this technique may ensure the advantages of a static spacer, but allow a greater ROM and better functional recovery. It may be considered as a viable option in selected cases even though the higher costs of two unicompartmental implants should be considered in the light of other aspects, such as prolonged hospital stay and rehabilitation in revision of infected total knee arthroplasty. HubMed – rehab


[External Quality Assurance in Inpatient Medical Rehabilitation and Prevention Centers for Mothers, Fathers and Children: Comparative Outcome Quality Analyses across Rehabilitation/Prevention Centers.]

Gesundheitswesen. 2013 Apr 15;
Lukasczik M, Gerlich C, Musekamp G, Saupe-Heide M, Löbmann R, Vogel H, Neuderth S

To date, there are no programs for external quality assurance for inpatient prevention and rehabilitation programs for mothers, fathers and children. Instruments for outcome quality assessment were evaluated with the goal of determining their ability to document differences between prevention/rehabilitation centers in quality-relevant outcome parameters. Referring to the ICF, relevant outcome variables were specified and operationalized using established questionnaires. Data from 45 inpatient prevention and rehabilitation centers for mothers, fathers and children were analyzed using multilevel modeling with risk adjustment. Intra-class correlations were computed to determine in which parameters differences between institutions could be found. The percentage of variability accounted for by patient vs. institution characteristics was computed while statistically controlling for relevant confounders. For prevention centers, substantial variation on the institutional level was found in 9 out of 15 parameters. Almost all institutions did not deviate significantly from the grand mean of the respective parameter. For rehabilitation centers, significant variability was found in 2 out of 10 parameters. The differences between most institutions remained within a range of expectable variability. The results imply that comparative analyses across hospitals are better suited to identify institutions with low quality rather than establish quality-based rankings of institutions. HubMed – rehab


[Simplifying Post-Treatment Rehabilitation Claim Forms.]

Gesundheitswesen. 2013 Apr 15;
Ballüer K, Rohland D, Seger W, Egen C, Tecklenburg A, Gutenbrunner C

Many different claim forms are used when starting rehabilitation following inpatient treatment, resulting in high administrative overheads for hospital staff, financial institutions and government agencies as well as patient allocation inefficiencies. We describe the problems ensuing on multiple and incompatible claim forms. On the basis of a survey of extant forms, we describe the content of a unified claim form that can be accepted by all insurers and which is optimised for hospital use. A model procedure for the development of a nationwide unified claim form allows for the assessment of the task’s complexity and duration. Nevertheless, quality of care and efficiency considerations support a recommendation of standardisation of rehabilitation claim forms. On this basis the authors appeal to all relevant health-care players to enter into the enterprise of standardisation and to pursue this goal -consistently. HubMed – rehab


Influence of fracture type and surgeon experience on the emission of radiation in distal radius fractures.

Arch Orthop Trauma Surg. 2013 Apr 16;
Kraus M, Röderer G, Max M, Krischak G, Gebhard F, Riepl C

INTRODUCTION: Ionising radiation is a potential risk for potentially exposed personnel. Only a few studies have examined the factors contributing to the emission of radiation in orthopaedic trauma procedures. We hypothesize that the experience of the surgeon and the fracture type influence the emission of radiation intraoperatively. METHODS: In a retrospective analysis, we examined 100 consecutive distal radius fractures receiving a volar plate osteosynthesis. The following parameters were documented: demographic data, plate system, fracture type, duration of the surgical procedure and duration of the emission of radiation, the experience level of the surgeon and the first assisting surgeon. RESULTS: Of all included patients (74 female), 48 had a type A, 7 a type B and 45 a type C fracture. The duration of radiation was longer for type C fractures [1.04 min (min)] in comparison to type A fractures (0.88 min) (P = 0.8152). In the type C subgroup, the highest amount of radiation was required for type C3 fractures (1.6 min), which was significantly more in comparison to type A (P = 0.0460) and type C1 fractures (P = 0.0089). The intraoperative emission of radiation (P = 0.00141) and the procedure time (P = 0.0006) depended on the experience of the surgical team. CONCLUSION: The emission of radiation during this procedure depends on the fracture type and the experience of the surgical team. Operating theatre personnel should be aware of the higher emission rates during the treatment of type C fractures and in teaching hospitals with inexperienced team members. HubMed – rehab