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Zouitni A, van Oldenrijk J, Bos PK, Croughs PD, Yusuf E, Veltman ES. Evaluating the Clinical Relevance of Routine Sonication for Periprosthetic Hip or Knee Joint Infection Diagnosis. Antibiotics (Basel) 2024; 13:366. [PMID: 38667042 PMCID: PMC11047521 DOI: 10.3390/antibiotics13040366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/29/2024] Open
Abstract
Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty. PJI screening and conventional cultures may be inconclusive. Sonication fluid culturing stands out as a valuable adjunct technique for PJI diagnosis. This study aims to determine the clinical relevance of routine sonication for all (a)septic revisions. All patients who underwent (partial) hip or knee revision arthroplasty between 2012 and 2021 were retrospectively reviewed. We formed three groups based on the European Bone and Joint Society PJI criteria: infection confirmed, likely, and unlikely. We analyzed clinical, laboratory, and radiological screening. Sensitivity and specificity were calculated for synovial fluid (preoperative), tissue, and sonication fluid cultures. We determined the clinical relevance of sonication as the percentage of patients for whom sonication confirmed PJI; 429 patients who underwent (partial) revision of hip or knee arthroplasty were included. Sensitivity and specificity were 69% and 99% for synovial fluid cultures, 76% and 92% for tissue cultures, and 80% and 89% for sonication fluid cultures, respectively. Sonication fluid cultures improved tissue culture sensitivity and specificity to 83% and 99%, respectively. In 11% of PJIs, sonication fluid cultures were decisive for diagnosis. This is applicable to acute and chronic infections. Sonication fluid cultures enhanced the sensitivity and specificity of PJI diagnostics. In 11% of PJI cases, causative pathogens were confirmed by sonication fluid culture results. Sonication fluid culture should be performed in all revision arthroplasties.
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Affiliation(s)
- Anas Zouitni
- Department of Orthopedic Surgery and Sports Medicine, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Jakob van Oldenrijk
- Department of Orthopedic Surgery and Sports Medicine, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - P. Koen Bos
- Department of Orthopedic Surgery and Sports Medicine, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Peter D. Croughs
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Erlangga Yusuf
- Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Ewout S. Veltman
- Department of Orthopedic Surgery and Sports Medicine, Erasmus Medical Center, dr. Molenwaterplein 40, 3015 GD Rotterdam, The Netherlands
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2
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Xu J, Veltman ES, Chai Y, Walter WL. Accuracy of acetabular component alignment with surgical guidance systems during hip arthroplasty. SICOT J 2023; 9:12. [PMID: 37144949 PMCID: PMC10161875 DOI: 10.1051/sicotj/2023010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. This study aimed to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan. METHODS We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and an optical navigation system (ONS). Acetabular component anteversion and inclination were measured on a post-operative CT. RESULTS The average age of the patients was 64 years (range: 24-92) and the average BMI was 27 kg/m2 (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the postoperative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was a significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversions (p < 0.001) and inclination (p = 0.02). CONCLUSIONS We found that both inertial and optical navigation systems allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement. LEVEL OF EVIDENCE Therapeutic Level II.
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Affiliation(s)
- Joshua Xu
- University of Sydney, Sydney, New South Wales, Australia - Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia - Tom Reeve Academic Clinic, Ground Floor Kolling Building, 10 Westbourne Street, St Leonards, NSW 2065, Australia
| | - Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Yuan Chai
- University of Sydney, Sydney, New South Wales, Australia
| | - William L Walter
- University of Sydney, Sydney, New South Wales, Australia - Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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3
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Bourgonjen YP, Hooning van Duyvenbode JFF, van Dijk B, Nurmohamed FRHA, Veltman ES, Vogely HC, van der Wal BCH. Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study. J Bone Jt Infect 2021; 6:379-387. [PMID: 34745845 PMCID: PMC8564768 DOI: 10.5194/jbji-6-379-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction: Two-stage revision surgery is the most frequently performed
procedure in patients with a chronic periprosthetic joint infection (PJI).
The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies.
The aim of this study was to retrospectively evaluate the infection
eradication rate in patients with chronic PJI treated with two-stage
revision surgery of the hip or knee in primary and re-revision cases.
Methods: All patients treated with a two-stage revision for chronic PJI
between 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at last
follow-up. Successful eradication is specified as no need for subsequent
revision surgery or suppressive antibiotic treatment.
Results: Forty-seven patients were treated with a two-stage revision.
Infection eradication was achieved in 36 out of 47 cases. Thirty-eight
patients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27–186) months. For hip and
knee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in
29 out of 38 cases and after re-revision in 7 out of 9 cases. Conclusion: In this study, the infection eradication rate for two-stage
revision surgery after PJI of the hip and knee in primary and re-revision
cases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infection
eradication rates at long-term follow-up of 128 (27–186) months.
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Affiliation(s)
- Yorrick P Bourgonjen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Ewout S Veltman
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
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Nurmohamed FRHA, van Dijk B, Veltman ES, Hoekstra M, Rentenaar RJ, Weinans HH, Vogely HC, van der Wal BCH. One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty - a retrospective cohort study. J Bone Jt Infect 2021; 6:91-97. [PMID: 34084696 PMCID: PMC8129908 DOI: 10.5194/jbji-6-91-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Debridement, antibiotics and implant retention (DAIR) procedures are effective treatments for acute postoperative or acute hematogenous periprosthetic joint infections. However, literature reporting on the effectiveness of DAIR procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI) (PJI-related revision arthroplasty) is scarce. The aim of this study is to retrospectively evaluate the infection control after 1 year of a DAIR procedure in the case of an early postoperative infection either after primary arthroplasty or after PJI-related revision arthroplasty. Materials and methods: All patients treated with a DAIR procedure within 3 months after onset of PJI between 2009 and 2017 were retrospectively included. Data were collected on patient and infection characteristics. All infections were confirmed by applying the Musculoskeletal Infection Society (MSIS) 2014 criteria. The primary outcome was successful control of infection at 1 year after a DAIR procedure, which was defined as the absence of clinical signs, such as pain, swelling, and erythema; radiological signs, such as protheses loosening; or laboratory signs, such as C-reactive protein (CRP) ( < 10 ) with no use of antibiotic therapy. Results: Sixty-seven patients were treated with a DAIR procedure (41 hips and 26 knees). Successful infection control rates of a DAIR procedure after primary arthroplasty ( n = 51 ) and after prior PJI-related revision arthroplasty ( n = 16 ) were 69 % and 56 %, respectively ( p = 0.38 ). The successful infection control rates of a DAIR procedure after an early acute infection ( n = 35 ) and after a hematogenous infection ( n = 16 ) following primary arthroplasty were both 69 % ( p = 1.00 ). Conclusion: In this limited study population, no statistically significant difference is found in infection control after 1 year between DAIR procedures after primary arthroplasty and PJI-related revision arthroplasty.
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Affiliation(s)
| | - Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ewout S Veltman
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marrit Hoekstra
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob J Rentenaar
- Department of Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - H Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
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Veltman ES, Moojen DJF, Poolman RW. Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip. World J Orthop 2020; 11:595-605. [PMID: 33362995 PMCID: PMC7745492 DOI: 10.5312/wjo.v11.i12.595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Two-stage revision arthroplasty with an antibiotic-loaded spacer is the treatment of choice in chronically infected total hip arthroplasties. Interval spacers can be functional articulating or prefabricated. Functional results of these spacers have scarcely been reported.
AIM To compare retrospectively the patient reported outcome and infection eradication rate after two-stage revision arthroplasty of the hip with the use of a functional articulating or prefabricated spacer.
METHODS All patients with two-stage revision of a hip prosthesis at our hospital between 2003 and 2016 were included in this retrospective cohort study. Patients were divided into two groups; patients treated with a functional articulating spacer or with a prefabricated spacer. Patients completed the Hip Osteoarthritis Outcome Score and the EQ-5D-3L (EQ-5D) and the EQ-5D quality of life thermometer (EQ-VAS) scores. Primary outcomes were patient reported outcome and infection eradication after two-stage revision. The results of both groups were compared to the patient acceptable symptom state for primary arthroplasty of the hip. Secondary outcomes were complications during spacer treatment and at final follow-up. Descriptive statistics, mean and range are used to represent the demographics of the patients. For numerical variables, students’ t-tests were used to assess the level of significance for differences between the groups, with 95% confidence intervals; for binary outcome, we used Fisher’s exact test.
RESULTS We consecutively treated 55 patients with a prefabricated spacer and 15 patients with a functional articulating spacer of the hip. The infection eradication rates for functional articulating and prefabricated spacers were 93% and 78%, respectively (P > 0.05). With respect to the functional outcome, the Hip Osteoarthritis Outcome Score (HOOS) and its subscores (all P < 0.01), the EQ-5D (P < 0.01) and the EQ-VAS scores (P < 0.05) were all significantly better for patients successfully treated with a functional articulating spacer. More patients in the functional articulating spacer group reached the patient acceptable symptom state for the HOOS pain, HOOS quality of life and EQ-VAS. The number of patients with a spacer dislocation was not significantly different for the functional articulating or prefabricated spacer group (P > 0.05). However, the number of dislocations per patient experiencing a dislocation was significantly higher for patients with a prefabricated spacer (P < 0.01).
CONCLUSION Functional articulating spacers lead to improved patient reported functional outcome and less perioperative complications after two-stage revision arthroplasty of an infected total hip prosthesis, while maintaining a similar infection eradication rate compared to prefabricated spacers.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, OLVG, Amsterdam 1091AC, Netherlands
| | | | - Rudolf W Poolman
- Department of Orthopaedic Surgery and Joint Research, OLVG, Amsterdam 1091AC, Netherlands
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6
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Veltman ES, Lenguerrand E, Moojen DJF, Whitehouse MR, Nelissen RGHH, Blom AW, Poolman RW. Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients. Acta Orthop 2020; 91:794-800. [PMID: 32698642 PMCID: PMC8023957 DOI: 10.1080/17453674.2020.1794096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The optimal type and duration of antibiotic prophylaxis for primary arthroplasty of the hip and knee are subject to debate. We compared the risk of complete revision (obtained by a 1- or 2-stage procedure) for periprosthetic joint infection (PJI) after primary total hip or knee arthroplasty between patients receiving a single dose of prophylactic antibiotics and patients receiving multiple doses of antibiotics for prevention of PJI. Patients and methods - A cohort of 130,712 primary total hip and 111,467 knee arthroplasties performed between 2011 and 2015 in the Netherlands was analyzed. We linked data from the Dutch arthroplasty register to a survey collected across all Dutch institutions on hospital-level antibiotic prophylaxis policy. We used restricted cubic spline Poisson models adjusted for hospital clustering to compare the risk of revision for infection according to type and duration of antibiotic prophylaxis received. Results - For total hip arthroplasties, the rates of revision for infection were 31/10,000 person-years (95% CI 28-35), 39 (25-59), and 23 (15-34) in the groups that received multiple doses of cefazolin, multiple doses of cefuroxime, and a single dose of cefazolin, respectively. The rates for knee arthroplasties were 27/10,000 person-years (95% CI 24-31), 40 (24-62), and 24 (16-36). Similar risk of complete revision for infection among antibiotic prophylaxis regimens was found when adjusting for confounders. Interpretation - In a large observational cohort we found no apparent association between the type or duration of antibiotic prophylaxis and the risk of complete revision for infection. This does question whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.
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MESH Headings
- Anti-Bacterial Agents/administration & dosage
- Antibiotic Prophylaxis/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Cefazolin/administration & dosage
- Cefuroxime/administration & dosage
- Dose-Response Relationship, Drug
- Duration of Therapy
- Female
- Humans
- Male
- Middle Aged
- Netherlands/epidemiology
- Outcome and Process Assessment, Health Care
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/epidemiology
- Prosthesis-Related Infections/prevention & control
- Prosthesis-Related Infections/surgery
- Reoperation/methods
- Reoperation/statistics & numerical data
- Risk Adjustment/methods
- Risk Adjustment/statistics & numerical data
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dirk Jan F Moojen
- Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospital Bristol NHS Foundation Trust and University of Bristol, UK
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Ashley W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospital Bristol NHS Foundation Trust and University of Bristol, UK
| | - Rudolf W Poolman
- Department of Orthopaedic and Trauma Surgery, Joint Research, OLVG, Amsterdam, the Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Hoekstra M, Veltman ES, Nurmohamed RF, van Dijk B, Rentenaar RJ, Vogely HC, van der Wal BC. Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection. J Bone Jt Infect 2020; 5:128-132. [PMID: 32566451 PMCID: PMC7295643 DOI: 10.7150/jbji.45006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Diagnosis of periprosthetic joint infection (PJI) can be troublesome. Sonication can be a helpful tool in culturing bacteria that are difficult to detect with standard tissue cultures. Aim of this study is to evaluate the clinical importance of our standardized sonication protocol in detecting periprosthetic joint infection. Materials and methods: All patients with revision surgery of a hip or knee prosthesis between 2011 and 2016 were retrospectively reviewed and divided in two groups: clinically suspected of infection or not suspected of infection. For both tissue culture and implant sonication, calculations of sensitivity and specificity were performed. Clinical relevance of sonication was evaluated by calculating in which percentage of patients' sonication influenced clinical treatment. Results: 226 patients with revision of a total hip prosthesis (122 patients) or a total knee prosthesis (104 patients) were included. Sensitivity of perioperatively taken tissue cultures was 94.3% and specificity was 99.3%. For sonication sensitivity was 80.5% and specificity was 97.8%. In the infection group eight patients (9%) with only one positive tissue culture and a positive sonication fluid culture with the same pathogen were found. Interpretation: Although sensitivity and specificity of sonication was lower compared to tissue cultures, periprosthetic joint infection could only be established in 8 patients (9%) suspected of infection because of a positive result of the sonication fluid culture. Sonication leads to clinically relevant changes in treatment and seems therefore to be a helpful diagnostic tool in clinical practice.
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Affiliation(s)
- Marrit Hoekstra
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, the Netherlands
| | - Ewout S. Veltman
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, the Netherlands
| | | | - Bruce van Dijk
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, the Netherlands
| | - Rob J. Rentenaar
- Department of Clinical Microbiology, University Medical Centre Utrecht, the Netherlands
| | - H. Charles Vogely
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, the Netherlands
| | - Bart C.H. van der Wal
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, the Netherlands
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Veltman ES, Moojen DJF, van Ogtrop ML, Poolman RW. Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee. World J Orthop 2019; 10:348-355. [PMID: 31750083 PMCID: PMC6854054 DOI: 10.5312/wjo.v10.i10.348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/14/2019] [Accepted: 09/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Periprosthetic joint infections (PJIs) are frequently caused by coagulase-negative Staphylococci (CoNS), which is known to be a hard-to-treat microorganism. Antibiotic resistance among causative pathogens of PJI is increasing. Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis. We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.
AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.
METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included. Patients with CoNS infection were included in the study, including polymicrobial cases. Primary outcome was infection eradication at final follow-up.
RESULTS Forty-four patients were included in the study. Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee. At final follow-up after a mean of 37 mo, recurrent or persistent infection was present in eleven patients.
CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance. Infection eradication rate of 70%-80% may be achieved.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden 2333ZA, Netherlands
| | - Dirk Jan F Moojen
- Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
| | - Marc L van Ogtrop
- Department of Medical Microbiology, OLVG, Amsterdam 1091AC, Netherlands
| | - Rudolf W Poolman
- Department of Orthopaedic and Trauma Surgery, OLVG, Joint Research OLVG, Amsterdam 1091AC, Netherlands
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Veltman ES, Moojen DJF, Ogtrop MLV, Poolman RW. Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee. World J Orthop 2019. [DOI: 10.5312/wjo.v10.i10.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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van der Valk MR, Veltman ES, Assink J, Veen MR. Synovial chondromatosis of the hip, a case report and literature review. J Orthop 2019; 16:249-253. [PMID: 30923422 DOI: 10.1016/j.jor.2019.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/17/2019] [Indexed: 12/31/2022] Open
Abstract
A case of giant synovial chondromatosis of the hip with extra-articular localisation in the ileopectineal bursa is presented and the literature concerning this condition is reviewed. Synovial chondromatosis is a rare condition of unknown aetiology. A literature search was performed to identify studies describing outcome after surgical treatment of synovial chondromatosis of the hip. Thirteen studies including two hundred-ninety patients could be included. Mean follow-up was fifty-six months. Seven out of two hundred-ninety developed a complication after surgical resection of the lesion. Recurrence rate of synovial chondromatosis is about 19%. Malignant transformation of synovial chondromatosis to chondrosarcoma is extremely rare. No wound infections were reported and avascular necrosis of the femoral head occurred in one patient who was treated with dislocation of the hip during surgery. After resection of synovial chondromatosis excellent functional outcome can be expected.
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Affiliation(s)
- Mara R van der Valk
- Department of Orthopaedic and Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
| | - Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
| | - Joeri Assink
- Department of Radiology, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
| | - M Remmelt Veen
- Department of Orthopaedic and Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
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Chotanaphuti T, Courtney PM, Fram B, In den Kleef NJ, Kim TK, Kuo FC, Lustig S, Moojen DJ, Nijhof M, Oliashirazi A, Poolman R, Purtill JJ, Rapisarda A, Rivero-Boschert S, Veltman ES. Hip and Knee Section, Treatment, Algorithm: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S393-S397. [PMID: 30348575 DOI: 10.1016/j.arth.2018.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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12
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Aalirezaie A, Abolghasemian M, Busato T, Dennis D, Ghazavi M, Holst DC, Kelly M, Kissin YD, Kuijpers M, Lange J, Lichstein P, Moojen DJ, Poolman R, Schreurs BW, Velázquez Moreno JD, Veltman ES. Hip and Knee Section, Treatment, Two-Stage Exchange: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S439-S443. [PMID: 30348583 DOI: 10.1016/j.arth.2018.09.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Sorel JC, Veltman ES, Honig A, Poolman RW. The influence of preoperative psychological distress on pain and function after total knee arthroplasty: a systematic review and meta-analysis. Bone Joint J 2019; 101-B:7-14. [PMID: 30601044 DOI: 10.1302/0301-620x.101b1.bjj-2018-0672.r1] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS We performed a meta-analysis investigating the association between preoperative psychological distress and postoperative pain and function after total knee arthroplasty (TKA). MATERIALS AND METHODS Pubmed/Medline, Embase, PsycINFO, and the Cochrane library were searched for studies on the influence of preoperative psychological distress on postoperative pain and physical function after TKA. Two blinded reviewers screened for eligibility and assessed the risk of bias and the quality of evidence. We used random effects models to pool data for the meta-analysis. RESULTS Six prospective cohort studies, with a total of 1525 patients, were included. The random effects models showed significantly poorer outcomes in patients who preoperatively had elevated scores on the pain catastrophizing scale, worse 36-Item Short-Form Health Survey (SF-36) mental health score, symptoms of anxiety and/or depression, and somatization dysfunction. After 12 months, the standard mean difference for pain was -0.74 (95% confidence interval (CI) -1.04 to -0.44) and -0.56 (95% CI -0.80 to -0.32) for function. CONCLUSION Preoperative pain catastrophizing, mental distress, symptoms of anxiety and/or depression, and somatoform disorders appear to adversely affect pain and function after TKA. Some patients undergoing TKA may therefore need psychological support to improve the outcome and quality of life.
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Affiliation(s)
- J C Sorel
- Department of Orthopaedic Surgery and Traumatology, Joint Research OLVG, Amsterdam, The Netherlands
| | - E S Veltman
- Department of Orthopaedic Surgery and Traumatology, Joint Research OLVG, Amsterdam, The Netherlands
| | - A Honig
- Department of Psychiatry, OLVG, Amsterdam and VU Medical Center, Amsterdam, The Netherlands
| | - R W Poolman
- Department of Orthopaedic Surgery and Traumatology, Joint Research OLVG, Amsterdam, The Netherlands
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Veltman ES, Moojen DJF, Nelissen RG, Poolman RW. Antibiotic Prophylaxis and DAIR Treatment in Primary Total Hip and Knee Arthroplasty, A National Survey in The Netherlands. J Bone Jt Infect 2018; 3:5-9. [PMID: 29291158 PMCID: PMC5744190 DOI: 10.7150/jbji.20259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To prevent postoperative infection the use of systemic antibiotic prophylaxis is common ground. Type of antibiotic used and duration of prophylaxis are subject to debate. In case of suspected early periprosthetic infection a debridement, antibiotics and implant retention (DAIR) procedure is treatment of first choice. This study evaluated the antibiotic prophylaxis and DAIR treatment protocols nationwide as well as reporting of these DAIR procedures to the national joint registry. METHODS All institutions that performed total hip or knee arthroplasty were contacted to complete a 16-question online survey. Questions included availability of a protocol, type and duration of antibiotic prophylaxis used and tendency to register infectious complications in the Dutch Arthroplasty Register. RESULTS All ninety-nine consulted institutions responded to this survey. All but one institutions have a standardized hospital based protocol for antibiotic prophylaxis in primary total hip or knee arthroplasty. Cefazolin was antibiotic prophylaxis of choice in ninety-four institutions for both primary hip and knee arthroplasty. In ten institutions one preoperative gift of antibiotic prophylaxis was administered. A protocol describing treatment when suspecting early periprosthetic joint infection was present in seventy-one institutions. When performing a DAIR procedure modular parts were exchanged in seventy institutions in case of a hip prosthesis and in eighty-one institutions in case of a knee prosthesis. Sixty-three institutions register DAIR procedures in the Dutch Arthroplasty Register. INTERPRETATION In contradiction to the results of a recent study in Great Britain, we have found only little variety in availability of protocols and in the type of antibiotic used as prophylaxis in primary total hip and knee arthroplasty in The Netherlands. Not every institution has a protocol for treatment in suspicion of early infection. Although mobile parts are exchanged in the majority of cases, there appears to be an underreporting of DAIR procedures in the Dutch Arthroplasty Register.
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Affiliation(s)
- Ewout S Veltman
- Department of orthopaedic surgery, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Dirk Jan F Moojen
- Department of orthopaedic surgery, Joint Research, OLVG, Amsterdam, the Netherlands
| | - Rob Ghh Nelissen
- Department of orthopaedic surgery, Leiden University Medical Centre, the Netherlands
| | - Rudolf W Poolman
- Department of orthopaedic surgery, Joint Research, OLVG, Amsterdam, the Netherlands
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Veltman ES, Hofstad CJ, Witteveen AGH. Are current foot- and ankle outcome measures appropriate for the evaluation of treatment for osteoarthritis of the ankle?: Evaluation of ceiling effects in foot- and ankle outcome measures. Foot Ankle Surg 2017; 23:168-172. [PMID: 28865585 DOI: 10.1016/j.fas.2016.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 02/16/2016] [Accepted: 02/25/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many PROMs used for evaluation of ankle osteoarthritis are not validated for this purpose. We hypothesize that frequently used PROMs have an early ceiling or floor effect. METHODS We prospectively collected data from patients with ankle osteoarthritis between 2011 and 2013. At baseline visit patients completed the Foot and Ankle Outcome Score, the Ankle Osteoarthritis Score, the American Orthopaedic Foot and Ankle Society scale, a visual analogue scale for pain and quality of life. Outcomes were analyzed for floor or ceiling effects. RESULTS 197 patients were included in the study. A floor effect was present for the AOFAS and VAS for pain in all groups. Floor and ceiling effect are absent for the FAOS outcome measure for all groups. CONCLUSIONS Physicians should be aware of floor or ceiling effects when evaluating treatment using patient reported outcome measures. The FAOS outcome measure lacks early ceiling or floor effects.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic Surgery, St. Maartenskliniek, Nijmegen, The Netherlands.
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Heijink A, Kodde IF, Mulder PG, Veltman ES, Kaas L, van den Bekerom MP, Eygendaal D. Radial Head Arthroplasty. JBJS Rev 2016; 4:01874474-201610000-00003. [DOI: 10.2106/jbjs.rvw.15.00095] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Veltman ES, Steller EJA, Wittich P, Keizer J. Lateral subtalar dislocation: Case report and review of the literature. World J Orthop 2016; 7:623-627. [PMID: 27672576 PMCID: PMC5027018 DOI: 10.5312/wjo.v7.i9.623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/23/2016] [Accepted: 07/18/2016] [Indexed: 02/06/2023] Open
Abstract
A case of complicated lateral subtalar dislocation is presented and the literature concerning this injury is reviewed. Subtalar joint dislocations are rare and often the result of a high-energy trauma. Complications include avascular necrosis of the talus, infection, posttraumatic osteoarthritis requiring arthrodesis and chronic subtalar instability. Negative prognostic factors include lateral and complicated dislocations, total talar extrusions, and associated fractures. A literature search was performed to identify studies describing outcome after lateral subtalar joint dislocation. Eight studies including fifty patients could be included, thirty out of 50 patients suffered a complicated injury. Mean follow-up was fifty-five months. Ankle function was reported as good in all patients with closed lateral subtalar dislocation. Thirteen out of thirty patients with complicated lateral subtalar joint dislocation developed a complication. Avascular necrosis was present in nine patients with complicated injury. Four patients with complicated lateral subtalar dislocation suffered deep infection requiring treatment with antibiotics. In case of uncomplicated lateral subtalar joint dislocation, excellent functional outcome after closed reduction and immobilization can be expected. In case of complicated lateral subtalar joint dislocation immediate reduction, wound debridement and if necessary (external) stabilisation are critical. Up to fifty percent of patients suffering complicated injury are at risk of developing complications such as avascular talar necrosis and infection.
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Veltman ES, Halma JJ, de Gast A. Longterm outcome of 886 posterior malleolar fractures: A systematic review of the literature. Foot Ankle Surg 2016; 22:73-7. [PMID: 27301724 DOI: 10.1016/j.fas.2015.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/31/2015] [Accepted: 05/02/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The objective of the present study was to review the current data on the long-term outcomes of posterior malleolar fractures, with special emphasis on the role of the type of treatment, surgical approach, and reduction and internal fixation. METHODS The search was limited to skeletally mature patients. Major databases were searched from 1978 to 2014 to identify studies relating to functional outcome, subjective outcome, and radiographic evaluation at least 2 years after either surgical or conservative treatment of posterior malleolar fractures. RESULTS Of 68 initially relevant studies, 19 met our inclusion criteria. A total of 886 fractures were identified in 885 patients. The mean sample size-weighted follow-up period was 3.7 years. Comparable results are achieved when comparing open reduction and internal fixation to conservative treatment for posterior malleolar fractures. DISCUSSION Current consensus suggests posterior malleolar fragments comprising of >25% of the distal tibial plafond as seen on a true lateral radiograph and fragments with more than 2mm dislocation require open reduction and internal fixation of the fragment. The current consensus on treatment of posterior malleolar fractures is neither supported nor disapproved by the available evidence.
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Affiliation(s)
- Ewout S Veltman
- Clinical Orthopedic Research Center Midden Nederland, Utrecht, The Netherlands.
| | - Jelle J Halma
- Department of Orthopedic Surgery, Diakonessenhuis Utrecht, The Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center Midden Nederland, Utrecht, The Netherlands; Department of Orthopedic Surgery, Diakonessenhuis Utrecht, The Netherlands
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Louwerens JKG, Veltman ES, van Noort A, van den Bekerom MPJ. The Effectiveness of High-Energy Extracorporeal Shockwave Therapy Versus Ultrasound-Guided Needling Versus Arthroscopic Surgery in the Management of Chronic Calcific Rotator Cuff Tendinopathy: A Systematic Review. Arthroscopy 2016; 32:165-75. [PMID: 26382637 DOI: 10.1016/j.arthro.2015.06.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/17/2015] [Accepted: 06/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE The objectives of this comprehensive quantitative review of the treatment of calcific tendinopathy of the rotator cuff were to investigate if there is a sustainable positive effect on outcomes after treatment with high-energy extracorporeal shockwave therapy (ESWT) or ultrasound (US)-guided needling and to compare these results with those of treatment with arthroscopic surgery. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to conduct this review. A systematic literature search was conducted in December 2014 to identify relevant clinical articles in peer-reviewed journals with at least 6 months' follow-up. Each article was scored using the Coleman Methodology Score. The primary endpoints were functional outcome and radiologic change in the size of the calcific deposit. RESULTS Twenty-two studies were included (1,258 shoulders). The mean Coleman Methodology Score for the included studies was 77.1 ± 9.1. Overall, good to excellent clinical outcomes were achieved after treatment with either high-energy ESWT, US-guided needling, or arthroscopic surgery, with an improvement in the Constant-Murley score ranging between 26.3 and 41.5 points after 1 year. No severe side effects or long-term complications were encountered. CONCLUSIONS Patients can achieve good to excellent clinical outcomes after high-energy ESWT, US-guided needling, and arthroscopy for calcific tendinopathy of the shoulder. Side effects and post-treatment complications should be taken into account when a decision is being made for each individual patient. Physicians should consider high-energy ESWT and US-guided needling as minimally invasive treatment options when primary conservative treatment fails. Arthroscopy can safely be used as a very effective but more invasive secondary option, although the extent of deposit removal and the additional benefit of subacromial decompression remain unclear. LEVEL OF EVIDENCE Level IV, systematic review of Level I, II, and IV studies.
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Affiliation(s)
- Jan K G Louwerens
- Research Center Linnaeus Institute, Spaarne Hospital, Hoofddorp, Netherlands; Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands.
| | - Ewout S Veltman
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Hospital, Hoofddorp, Netherlands
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Veltman ES, Doornberg JN, Eygendaal D, van den Bekerom MPJ. Static progressive versus dynamic splinting for posttraumatic elbow stiffness: a systematic review of 232 patients. Arch Orthop Trauma Surg 2015; 135:613-7. [PMID: 25764510 DOI: 10.1007/s00402-015-2199-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The elbow is prone to stiffness after trauma. To regain functional elbow motion, several conservative and surgical treatment options are available. Nonoperative treatment includes physical therapy, intra-articular injections with corticosteroids, and a static progressive or dynamic splinting program. The objective of this study was to perform a comprehensive review of the literature to evaluate the best current evidence for nonoperative treatment options for posttraumatic elbow stiffness. METHODS We performed a search of all studies on nonoperative treatment for elbow stiffness in human adults. All articles describing nonoperative treatment of elbow stiffness, written in the English, German, French or Dutch language, including human adult patients and with the functional outcome reported were included in this study. RESULTS Eight studies (including 232 patients) met our eligibility criteria and were included for data analysis and pooling. These studies included one randomized controlled trial and seven retrospective cohort studies. Static progressive splinting was evaluated in 160 patients. The average pre-splinting range of motion of all elbows was 72°, which improved by 36° after splinting to an average post-splinting arc of motion of 108°. Dynamic splinting was evaluated in 72 patients with an average pre-splinting range of motion of 63°. The average improvement was 37° to an average post-splinting arc of motion of 100°. CONCLUSIONS Both dynamic orthoses and static progressive splinting show good results for the treatment of elbow stiffness, regardless of etiology. The choice for one treatment over the other is based on the preference of the surgeon and patient. We recommend to continue nonoperative treatment with dynamic or static bracing for 12 months or until patients stop making progression in range of elbow motion.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic Surgery, Spaarne hospital, Hoofddorp, The Netherlands,
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21
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Veltman ES, Vos FJ, Meis JF, Goosen JH. Debridement, antibiotics and implant retention in early postoperative infection with Pseudomonas aeruginosa. J Infect 2015; 70:307-9. [DOI: 10.1016/j.jinf.2014.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/01/2014] [Indexed: 11/30/2022]
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Veltman ES, van den Bekerom MPJ, Doornberg JN, Verbeek DO, Rammelt S, Steller EP, Schepers T. Three-dimensional computed tomography is not indicated for the classification and characterization of calcaneal fractures. Injury 2014; 45:1117-20. [PMID: 24530220 DOI: 10.1016/j.injury.2014.01.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/24/2013] [Accepted: 01/21/2014] [Indexed: 02/02/2023]
Abstract
This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging. A consecutive series of 38 fractures in 36 patients, treated at a level II trauma centre between 2005 and 2008, were evaluated in two rounds by five observers. We measured the inter- and intraobserver reliability for the Sanders', Zwipp and Essex-Lopresti classification systems using the kappa values as described by Cohen. The intraclass correlation coefficient as described by Shrout and Fleiss was used to analyze inter- and intra-observer reliability of the angles of Böhler and Gissane. Usage of 2D-CT imaging interobserver reliability was fair for the Sanders' and Zwipp classifications and for measurement of the angle of Gissane, and it was moderate for measurement of the Essex-Lopresti classification system and measurement of the angle of Böhler. With the addition of 3D-CT imaging, the interobserver reliability was fair for the Sanders', Zwipp and Essex-Lopresti classification systems. The intraobserver reliability was fair for measurement of the angle of Gissane and it was moderate for the Sanders', Zwipp and Essex-Lopresti classification systems and for the measurement of the angle of Böhler. The addition of three-dimensional CT imaging did not increase inter- and intraobserver reliability for the classification of calcaneal fractures. Authors commented they experienced no additional benefit from 3D-CT imaging for the assessment of calcaneal fractures.
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Affiliation(s)
| | | | - Job N Doornberg
- Academic Medical Center Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands
| | | | - Stefan Rammelt
- Universitätsklinikum "Carl Gustav Carus", Dresden, Germany
| | | | - Tim Schepers
- AMC Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands
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Veltman ES, Lindenhovius ALC, Kloen P. Improvements in elbow motion after resection of heterotopic bone: a systematic review. Strategies Trauma Limb Reconstr 2014; 9:65-71. [PMID: 24934800 PMCID: PMC4122684 DOI: 10.1007/s11751-014-0192-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 06/04/2014] [Indexed: 10/31/2022] Open
Abstract
Complex elbow trauma, severe burn, or a closed head injury render patients at risk for developing heterotopic ossification around the elbow. When heterotopic ossification restricts elbow motion, some patients request surgical resection. We performed a systematic review of the literature to analyze improvement in elbow motion after resection of heterotopic ossification around the elbow. We found that, on average, etiology had little impact on outcome after resection of heterotopic ossification. Resection of heterotopic bone generally leads to improvement of elbow function.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopedic Surgery, Secretariaat Orthopedie, G4-221, Academic Medical Center Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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Veltman ES, Doornberg JN, Stufkens SAS, Luitse JSK, van den Bekerom MPJ. Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg 2013; 52:486-90. [PMID: 23663876 DOI: 10.1053/j.jfas.2013.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Indexed: 02/03/2023]
Abstract
The objective of the present study was to review the current data on the long-term outcomes of calcaneal fractures, with special emphasis on the role of the type of treatment, surgical approach, and reduction and internal fixation. The search was limited to skeletally mature patients. Major databases were searched from 1978 to 2011 to identify studies relating to functional outcome, subjective outcome, and radiographic evaluation at least 2 years after either surgical or conservative treatment of calcaneal fractures. Of 59 initially relevant studies, 25 met our inclusion criteria. A total of 1,730 fractures were identified in 1,557 patients. The mean sample size-weighted follow-up period was 4.6 years. The findings from the present review support current clinical practice that displaced calcaneal fractures are treated surgically from 1 level I evidence study, 1 level II, and multiple studies with less than level II evidence, with open reduction and internal fixation as the method of choice. If the fracture is less complex, percutaneous treatment can be a good alternative according to current level 3 and 4 retrospective data.
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Affiliation(s)
- Ewout S Veltman
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
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25
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Affiliation(s)
- E S Veltman
- Department of Surgery, The Academic Medical Center at the University of Amsterdam, Amsterdam, the Netherlands
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Hoornenborg D, Veltman ES, Oldenburger F, Bramer JAM, Schaap GR. A patient with scapular Ewing sarcoma; 5-year follow-up after extracorporeal irradiation and re-implantation of the scapula, a case report. J Bone Oncol 2013; 2:30-2. [PMID: 26909269 PMCID: PMC4723359 DOI: 10.1016/j.jbo.2012.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 12/16/2022] Open
Abstract
In 2007 a 9½-year-old boy was treated with resection, extracorporeal irradiation and re-implantation of the right scapula. He also received chemotherapy. During five year follow-up shoulder function remained largely intact. Subtotal resorption of the scapula occurred, leaving only the glenohumeral joint intact. Sensibility and strength are intact. To date there is no sign of local or metastatic recurrence.
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Affiliation(s)
- Daniel Hoornenborg
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Ewout S Veltman
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Foppe Oldenburger
- Department of Radiotherapy, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Jos A M Bramer
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
| | - Gerard R Schaap
- Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1100 DD Amsterdam, the Netherlands
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Mallee WH, Veltman ES, Doornberg JN, Blankevoort L, van Dijk CN, Goslings JC. [Variations in management of suspected scaphoid fractures]. Ned Tijdschr Geneeskd 2012; 156:A4514. [PMID: 22805789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This study evaluated the daily clinical practice for management of patients with suspected scaphoid fractures in hospitals in the Netherlands and compared it with recommendations from the current literature. DESIGN Questionnaire-based investigation. METHOD Doctors working in emergency departments in hospitals in the Netherlands were asked to complete an 8-question survey including questions on diagnostic strategies, treatment type and the time between different steps in the management policy. RESULTS Doctors from 90 of the 100 hospitals approached completed the questionnaire. A total of 71 of these 90 hospitals had an established protocol. In the other 19 it depended on the preference of the treating doctor. In 75 hospitals a follow-up outpatient clinic appointment was made for within 10 days. In 70 hospitals X-rays were repeated before additional imaging investigation. CT was the most frequently used additional investigation in 35 hospitals, followed by bone scintigraphy (12) and MRI (2). No additional investigation was carried out in 11 hospitals and when X-rays showed no abnormalities treatment was implemented on the basis of clinical evaluation. In 72 hospitals the wrist was immobilised with a lower-arm plaster cast including the thumb. Lower-arm plaster cast not including the thumb was used in 1 hospital. CONCLUSION There is a great deal of variation in diagnosis and treatment of patients with a suspected scaphoid fracture within hospitals in the Netherlands. Furthermore, management policy in most hospitals is not in keeping with the most recent recommendations. Evidence-based guidelines are required in order to limit over-diagnosis and unnecessary immobilisation.
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Affiliation(s)
- Wouter H Mallee
- Academisch Medisch Centrum, Afd. Orthopedie, Amsterdam, the Netherlands.
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