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These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.

\"Phantom Limbs and Body Integrity Identity Disorder discusses the conditions of Phantom Limb Syndrome and Body Integrity Identity Disorder together for the first time, exploring examples from literature, film, and psychoanalysis to re-ground theories of the body in material experience\"-- Provided by publisher.

Fundamentals of Revision Hip Arthroplasty: Diagnosis, Evaluation, and Treatment is a unique and very timely book designed for surgeons who are beginning to more commonly encounter hip revisions in their practice.

Category: Ankle Introduction/Purpose: Nowadays, the talar prosthesis has been designed for its size and shape based on the data of its contralateral talus. However, little is known about the discrepancy of the sizes between right and left tali. The present study was to demonstrate the difference between right and left talar sizes in the matched pairs of cadaveric specimens. Methods: A total of twenty four tali as twelve matched pairs of tali were collected in this study. All tali were measured with a Vernier caliper which provided the data for further analyzed regarding the talar size. The data was calculated to demonstrate the difference between right and left talar sizes in a matched pair method included the general size of talus. There was a talus which was not used in the data calculation due to its crystal deposition from an underlying disease of a cadaver. Results: In overall, an average talar length (TaL) was 53.5 millimeters (mm). An average talar dome height (TaH) was 31.2 mm. An average talar body width (TaW) was 41.3 mm. The average anterior trochlear width (TrAW), middle trochlear width (TrMW), posterior trochlear width (TrPW), and trochlear length (TrL) were 31.8, 31.2, 28.3, and 30.7 mm. Based on eleven matched pairs of tali, the paired T-test showed the significant difference of TaH (P-value: 0.019), TrMW (P-value: 0.027), and TrPW (P-value: 0.016) between right and left tali. Conclusion: The present study demonstrated the discrepancy of right and left talar sizes about three important parameters in the matched pairs of tali. Talar prosthesis template may be necessary to use other method to determine its size for the prosthesis manufacturing in addition to the utilization of measured profiles from the contralateral talus.

BackgroundCardiac surgeons at our hospital asked the pharmacy for a new device to reduce bleeding during aortic suture. HEMO-SEAL (ETHICON) suture offers a decrease in the ratio of needle-to-suture diameters that would reduce needle-hole bleeding. This device is more expensive than an equivalent classic suture. According to the only study available from ETHICON, a 67% reduction in bleeding was observed with this technology.PurposeThe purpose of this work was to compare in vitro a classic suture and a HEMO-SEAL (HS) suture.Material and methodsWe used two equivalent sutures: a classic and a HS suture of the same diameter (USP 5/0), with identical needle characteristics (tip geometry, curvature, length). First, we compared the two sutures with a binocular loupe. Then, we developed an experimental model to compare the bleeding with the two sutures. We created a circuit with water sent at a pressure of 90 mmHg into a vascular prosthesis in which we passed each suture model without making a knot. We collected the water that flowed from the holes in our suture through our prosthesis over 5 min. Then, we compared the weight of water collected with the two sutures. A sample size of n=6 was completed for each group. Results are expressed in terms of mean ±standard deviation.ResultsThe two sutures both strictly look the same with the binocular loupe, except the region at the needle attachment of the HS suture, which had a smaller diameter. The average weight of the water collected was 28 g (±5) and 8 g (±1) for the classic suture and HS suture, respectively. We obtained a 71% reduction with the HS suture (p<0.05). Despite this important difference, we identified biases such as: we did not use blood but water, pressure at 90 mmHg and we did not make a real knot.ConclusionThe HS suture really seems to reduce needle-hole bleeding. In order to get as close as possible to the in vivo conditions, it would be interesting to repeat tests with anastomoses performed by a surgeon. Furthermore, clinical impact of this reduction in bleeding remains to be assessed.References and/or acknowledgementshttps://www.ncbi.nlm.nih.gov/pubmed/?term=needle+to+suture+ration%2C+as+well+as+suture+material#No conflict of interest.

[...]their characteristics change with time and vary between individuals. [...]it is a time consuming process to evaluate prostheses using such preparations.

Background Osseointegrated percutaneous implants provide direct anchorage of the limb prosthesis to the residual limb. These implants have been used for the rehabilitation of transhumeral amputees in Sweden since 1995 using a two-stage surgical approach with a 6-month interval between the stages, but results on implant survival, adverse events, and radiologic signs of osseointegration and adaptive bone remodeling in transhumeral amputees treated with this method are still lacking. Questions/purposes This study reports on 2- and 5-year implant survival, adverse events, and radiologic signs of osseointegration and bone remodeling in transhumeral amputees treated with osseointegrated prostheses. Methods Between 1995 and 2010, we performed 18 primary osseointegrated percutaneous implants and two implant revisions in 18 transhumeral amputees; of those, 16 patients were available for followup at a minimum of 2 years (median, 8 years; range, 2–19 years). These include all transhumeral amputees who have received osseointegrated prostheses and represented approximately 20% of the all transhumeral amputees we evaluated for potential osseointegration during that time; general indications for this approach included transhumeral amputation resulting from trauma or tumor, inability to wear or severe problems wearing a conventional socket prosthesis, eg, very short residual limb, and compliant patients. Medical charts and plain radiographs were retrospectively evaluated. Results The 2- and 5-year implant survival rates were 83% and 80%, respectively. Two primary and one revised implant failed and were removed because of early loosening. A fourth implant was partially removed because of ipsilateral shoulder osteoarthritis and subsequent arthrodesis. The most common adverse event was superficial infection of the skin penetration site (15 infections in five patients) followed by skin reactions of the skin penetration site (eight), incomplete fracture at the first surgery (eight), defective bony canal at the second surgery (three), avascular skin flap necrosis (three), and one deep implant infection. The most common radiologic finding was proximal trabecular buttressing (10 of 20 implants) followed by endosteal bone resorption and cancellization (seven of 20), cortical thinning (five of 20), and distal bone resorption (three of 20). Conclusions The implant system presented a survivorship of 83% at 5 years and a 38% 5-year incidence of infectious complications related to the skin penetration site that were easily managed with nonoperative treatment, which make it a potentially attractive alternative to conventional socket arm prostheses. Osseointegrated arm prostheses have so far only been used in transhumeral amputations resulting from either trauma or tumor. Their use has not been tested and is therefore not recommended in transhumeral amputations resulting from vascular disease. This method could theoretically be superior to socket prostheses, especially in transhumeral amputees with very short residual humerus in which the suspension of a conventional prosthesis is difficult. Comparative studies are needed to support its potential superiority. Moreover, the radiological findings in this study need to be followed over time because some of them are of uncertain long-term clinical relevance. Level of Evidence Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Current techniques for the identification of the infecting organism in prosthetic-joint (e.g., hip or knee) infection remain insensitive. In this study of 331 surgeries involving prosthetic joint replacement, a new technique that sonicates the removed artificial joint is found to be more sensitive in identifying the infecting organism than are standard culture techniques. In surgeries involving prosthetic joint replacement, a new technique that sonicates the removed artificial joint is found to be more sensitive in identifying the infecting organism than are standard culture techniques. In the United States, 638,000 patients underwent hip or knee replacement in 2003. 1 Although they may improve the quality of life, these procedures are associated with complications, including aseptic failure and prosthetic-joint infection. 2 It is important to distinguish prosthetic-joint infection from other causes of joint failure, because its management is different. 3 Nonmicrobiologic methods developed for diagnosing native-joint infection use different criteria from those used to diagnose prosthetic-joint infection. 4 Microbiologic diagnosis of prosthetic-joint infection may also require different criteria from those used for the microbiologic diagnosis of native-joint infection. Most clinicians and laboratory workers culture periprosthetic tissue (hereafter referred to as . . .

Summary Periprosthetic joint infections are a devastating complication after arthroplasty and are associated with substantial patient morbidity. More than 25% of revisions are attributed to these infections, which are expected to increase. The increased prevalence of obesity, diabetes, and other comorbidities are some of the reasons for this increase. Recognition of the challenge of surgical site infections in general, and periprosthetic joint infections particularly, has prompted implementation of enhanced prevention measures preoperatively (glycaemic control, skin decontamination, decolonisation, etc), intraoperatively (ultraclean operative environment, blood conservation, etc), and postoperatively (refined anticoagulation, improved wound dressings, etc). Additionally, indications for surgical management have been refined. In this Review, we assess risk factors, preventive measures, diagnoses, clinical features, and treatment options for prosthetic joint infection. An international consensus meeting about such infections identified the best practices and further research needs. Orthopaedics could benefit from enhanced preventive, diagnostic, and treatment methods.