General Orthopaedics

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Ahmed Halloum Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark

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Søren Kold Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark

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Jan Duedal Rölfing Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark

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Ahmed A Abood Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark
Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard, Aarhus, Denmark

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Ole Rahbek Interdisciplinary Orthopaedics, Aalborg University Hospital, Hobrovej, Aalborg, Denmark

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Purpose

  • The objective of this scoping review was to describe the extent and type of evidence of using guided growth to correct rotational deformities of long bones in children.

Methods

  • This scoping review was conducted in accordance with the JBI methodology for scoping reviews. All published and unpublished studies investigating surgical methods using guided growth to perform gradual rotation of long bones were included.

Results

  • Fourteen studies were included: one review, three clinical studies, and ten preclinical studies. In the three clinical studies, three different surgical methods were used on 21 children. Some degree of rotation was achieved in all but two children. Adverse effects reported included limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. Of the ten preclinical studies, two were ex vivo and eight were in vivo. Rotation was achieved in all preclinical studies. Adverse effects reported included implant extrusions, LLD, articular deformities, joint stiffness and rebound of rotation after removal of tethers. Two of the studies reported on histological changes.

Conclusions

  • All studies conclude that guided growth is a potential treatment for rotational deformities of long bones. There is great variation in animal models and surgical methods used and in reported adverse effects. More research is needed to shed light on the best surgical guided growth method, its effectiveness as well as the involved risks and complications. Based on current evidence the procedure is still to be considered experimental.

Level of evidence

  • 4

Open access
Yvet Mooiweer Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

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Lina Roling School of Medicine and Health Sciences, Carl von Ossietzky University, Oldenburg, Germany

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Margaret Vugrin Preston Smith Library, Texas Tech University Health Sciences Center, Lobbock, Texas, USA

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Lena Ansmann Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Germany
Chair of Medical Sociology, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR) Faculty of Medicine, University of Cologne, Oldenburg, Germany

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Martin Stevens Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

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Gesine H Seeber Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
University Hospital of Orthopedics and Trauma Surgery Pius-Hospital, Medical Campus University of Oldenburg, Oldenburg, Germany

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Purpose

  • The association between preoperative expectations and treatment outcomes in total hip arthroplasty (THA) or total knee arthroplasty (TKA) is still unclear. Therefore the aim is to examine the association between preoperative outcome expectations, process expectations, and self-efficacy, and the postoperative outcomes overall outcome, pain, function, stiffness, satisfaction, and quality of life following THA/TKA.

Methods

  • A systematic review with narrative synthesis was conducted. PubMed, EMBASE, PsycINFO, CINAHL and Cochrane Library were searched from inception to October 17, 2022. Included were prospective longitudinal cohort studies published in English, German, or Dutch, with an adult population undergoing THA/TKA, and including at least one measure of preoperative expectations and the postoperative outcomes mentioned earlier. Two independent reviewers screened the retrieved articles for eligibility, a third solved disagreements. Risk of bias (RoB) was assessed using the QUIPS tool.

Results

  • Of the 50 included studies, 38 had high RoB and 12 moderate RoB. Unadjusted results suggest a positive association between preoperative outcome expectations and overall outcome in the medium and long term, and between self-efficacy and change in ‘overall outcome’ in the long term. Adjusted results suggest positive associations between outcome expectations and function and between self-efficacy and overall outcome in the medium term, and for outcome expectations with pain and change in pain, respectively, and self-efficacy and stiffness in the long term.

Conclusions

  • Preoperative expectations show a possible positive association with specific outcome measures, such as pain or function. For future research, it is advised to link matching specific expectations with specific outcomes.

Open access
Pierre Hoffmeyer University Hospitals of Geneva, Switzerland

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Shaho Hasan Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands

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Peter van Schie Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands

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Bart L Kaptein Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands

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Jan W Schoones Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands

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Perla J Marang-van de Mheen Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
Department of Safety & Security Science, Delft University of Technology, Delft, The Netherlands

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Rob G H H Nelissen Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands

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Background

  • Loosening is a major cause for failure of total hip and total knee arthroplasties (THAs/TKAs). Preemptive diagnostics of asymptomatic loosening could open strategies to prevent gross loosening. A multitude of biomarkers may discriminate between loosened and stable implants, but it is unknown which have the best performance. The present systematic review aimed to assess which biomarkers have shown the most promising results in discriminating between stable and aseptic loosened THAs and TKAs.

Methods

  • PubMed, Embase, Web of Science, Cochrane Library, and Academic Search Premier were systematically searched up to January 2020 for studies including THA/TKA and biomarkers to assess loosening. Two reviewers independently screened records, extracted data, and assessed the risk of bias using the ICROMS tool to classify the quality of the studies.

Results

  • Twenty-eight (three high-quality) studies were included, reporting on a median of 48 patients (interquartile range 28–69). Serum and urine markers were evaluated in 22 and 10 studies, respectively. Tumor necrosis factor α and osteocalcin were significantly higher in loosened compared with stable implants. Urinary N-terminal telopeptide had significantly elevated levels in loosened prostheses.

Conclusion

  • Several serum and urine markers were promising in discriminating between loosened and stable implants. We recommend future studies to evaluate these biomarkers in a longitudinal fashion to assess whether progression of loosening is associated with a change in these biomarkers. In particular, high-quality studies assessing the usability of these biomarkers are needed.

Open access
Myles C Murphy Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia

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Christopher Latella School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia
Neurophysiology Research Laboratory, School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia

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Ebonie K Rio La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
Australian Ballet, Southbank, Victoria, Australia
Victorian Institute of Sport, Albert Park Victoria, Australia

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Janet L Taylor School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia
Neurophysiology Research Laboratory, School of Medical and Health Sciences, Centre for Human Performance, Edith Cowan University, Joondalup, Western Australia, Australia

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Stephanie Martino Cubus Physio Zug, Zug, Switzerland

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Colin Sylvester Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia

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William Hale Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia

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Andrea B Mosler Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia

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Purpose

  • The aim of the study was to quantify motor cortex descending drive and voluntary activation (VA) in people with lower-limb OA compared to controls.

Methods

  • A systematic review and meta-analysis according to the PRISMA guidelines was carried out. Seven databases were searched until 30 December 2022. Studies assessing VA or responses to transcranial magnetic stimulation (TMS; i.e. motor evoked potential, intracortical facilitation, motor threshold, short-interval intracortical inhibition, and silent period) were included. Study quality was assessed using Joanna Briggs Institute criteria and evidence certainty using GRADE. The meta-analysis was performed using RevMan inverse variance, mixed-effect models.

Results

  • Eighteen studies were included, all deemed low-quality. Quadriceps VA was impaired with knee OA compared to healthy controls (standardised mean difference (SMD) = 0.84, 95% CI = −1.12–0.56, low certainty). VA of the more symptomatic limb was impaired (SMD = 0.42, 95% CI = −0.75–0.09, moderate certainty) compared to the other limb in people with hip/knee OA. As only two studies assessed responses to TMS, very low-certainty evidence demonstrated no significant difference between knee OA and healthy controls for motor evoked potential, intracortical facilitation, resting motor threshold or short-interval intracortical inhibition.

Conclusions

  • Low-certainty evidence suggests people with knee OA have substantial impairments in VA of their quadriceps muscle when compared to healthy controls. With moderate certainty we conclude that people with hip and knee OA had larger impairments in VA of the quadriceps in their more painful limb compared to their non-affected/other limb.

Open access
Pascal-André Vendittoli Personalized Arthroplasty Society
Surgery Department, Hôpital Maisonneuve-Rosemont, Montreal University, Montreal, Québec, Canada
Clinique orthopédique Duval, 1487 Boul des Laurentides, Laval

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Charles Riviere Personalized Arthroplasty Society
Bordeaux Arthroplasty Research Institute - Clinique du Sport Bordeaux-Mérignac 04-06 rue Georges Negrevergne, Mérignac, France

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Michael T Hirschmann Personalized Arthroplasty Society
Department of Orthopedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland
Clinical Research Group Michael T. Hirschmann, Regenerative Medicine & Biomechanics, University of Basel, Basel, Switzerland

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Stefano Bini Personalized Arthroplasty Society
Department of Surgery, University of California, San Francisco, California, USA

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  • Although hip and knee joint replacements provide excellent clinical results, many patients still do not report the sensation and function of a natural joint. The perception that the joint is artificial may result from the anatomical modifications imposed by the surgical technique and the implant design. Moreover, the joint replacement material may not function similarly to human tissues.

  • To restore native joint kinematics, function, and perception, three key elements play a role: (i) joint morphology (articular surface geometry, bony anatomy, etc.), (ii) lower limb anatomy (alignment, joint orientation), and (iii) soft tissue laxity/tension.

  • To provide a ‘forgotten joint’ to most patients, it is becoming clear that personalizing joint replacement is the key solution. Performing a personalized joint replacement starts with patient selection and preoperative optimization, followed by using a surgical technique and implant design aimed at restoring the patient’s native anatomy, creating optimal implant-to-bone stress transfer, restoring the joint’s native articular range of motion without imposed limitations, macro- and micro-stability of the soft tissues, and a bearing whose wear resistance provides lifetime survivorship with unrestricted activities. In addition, the whole perioperative experience should follow enhanced recovery after surgery principles, favoring a rapid and complication-free recovery.

  • As a new concept, some confusion may arise when applying these personalized surgery principles. Therefore, the Personalized Arthroplasty Society was created to help structure and accelerate the adoption of this paradigm change. This statement from the Society on personalized arthroplasty will serve as a reference that will evolve with time.

Open access
Anne Lübbeke Division of Orthopaedic Surgery & Traumatology, Geneva University Hospitals and University of Geneva, Switzerland
Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK

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Christophe Combescure Division of Clinical Epidemiology, Geneva University Hospitals and University of Geneva, Switzerland

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Christophe Barea Division of Orthopaedic Surgery & Traumatology, Geneva University Hospitals and University of Geneva, Switzerland

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Amanda Inez Gonzalez Division of Orthopaedic Surgery & Traumatology, Geneva University Hospitals and University of Geneva, Switzerland

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Keith Tucker Chair Orthopaedic Data Evaluation Panel, UK

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Per Kjærsgaard-Andersen Center for Adult Hip and Knee Reconstruction, Department of Orthopaedics, South Danish University, Vejle Hospital, Denmark

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Tom Melvin School of Medicine, Trinity College Dublin, Ireland

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Alan G Fraser Department of Cardiology, University Hospital of Wales, Cardiff, UK

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Rob Nelissen Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands

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James A Smith Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK

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Purpose

  • The objective of this systematic review was to give an overview of clinical investigations regarding hip and knee arthroplasty implants published in peer-reviewed scientific medical journals before entry into force of the EU Medical Device Regulation in May 2021.

Methods

  • We systematically reviewed the medical literature for a random selection of hip and knee implants to identify all peer-reviewed clinical investigations published within 10 years before and up to 20 years after regulatory approval. We report study characteristics, methodologies, outcomes, measures to prevent bias, and timing of clinical investigations of 30 current implants. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

  • We identified 2912 publications and finally included 151 papers published between 1995 and 2021 (63 on hip stems, 34 on hip cups, and 54 on knee systems). We identified no clinical studies published before Conformité Européene (CE)-marking for any selected device, and no studies even up to 20 years after CE-marking in one-quarter of devices. There were very few randomized controlled trials, and registry-based studies generally had larger sample sizes and better methodology.

Conclusion

  • The peer-reviewed literature alone is insufficient as a source of clinical investigations of these high-risk devices intended for life-long use. A more systematic, efficient, and faster way to evaluate safety and performance is necessary. Using a phased introduction approach, nesting comparative studies of observational and experimental design in existing registries, increasing the use of benefit measures, and accelerating surrogate outcomes research will help to minimize risks and maximize benefits.

Open access
Yangqi Xu Department of Surgery, Melbourne Medical School, University of Melbourne, Victoria, Melbourne, Australia

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Tony B Huang Department of Surgery, Melbourne Medical School, University of Melbourne, Victoria, Melbourne, Australia

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Michael A Schuetz Jamieson Trauma Institute, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Queensland University of Technology (QUT), Brisbane, Queensland, Australia

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Peter F M Choong Department of Surgery, Melbourne Medical School, University of Melbourne, Victoria, Melbourne, Australia
Department of Orthopaedics, St. Vincent’s Hospital, Fitzroy, Victoria, Australia

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the ICARAUS group
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the ICARAUS group

  • Prosthetic joint infection (PJI) is one of the most devastating complications for a patient following arthroplasty.

  • This scoping review aims to evaluate the burden of PJI on individual patients and the healthcare system regarding the mortality rate, patient-reported quality of life, and healthcare resource utilisation.

  • Patients with PJI have up to a five-fold higher mortality rate than those who have undergone an uninfected primary arthroplasty. There is an increased use of ambulatory aids and reduced joint function scores in patients with PJI. Global quality of life is poorer, specifically measured by the EQ-5D. Direct hospitalisation costs are two- to five-fold higher, attributed to surgery and prostheses, antibiotics, and a prolonged inpatient stay.

  • There is an immense clinical and health economic burden secondary to PJI worldwide. This is expected to rise exponentially due to the increasing number of primary procedures and an ageing population with comorbidities

  • Improving preventative and treatment strategies is imperative for patients and the healthcare system.

Open access
Hua Luo Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Congcong He Department of Psychology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Yong Zhao Department of Orthopedics, Shanghai Fengxian District Central Hospital, Shanghai, China

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Guangyong Yang Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Hainan Hong Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China

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Purpose

  • Septic arthritis (SA) is an intra-articular infection caused by purulent bacteria and the only effective method is surgical intervention. Two-stage arthroplasty is considered the gold standard treatment for SA, but recent studies have found that single-stage arthroplasty can achieve the same efficacy as two-stage arthroplasty. This study aimed to compare the efficacy of single- vs two-stage arthroplasty in the treatment of (acute or quiescent) SA.

Methods

  • The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature on the treatment of SA using single- and two-stage arthroplasty from the date of database inception to November 10, 2022. Data on reinfection rates were expressed as odds ratios and 95% CIs.

Results

  • Seven retrospective studies with a total of 413 patients were included. Pooled analysis showed no difference in the reinfection rate between single- and two-stage arthroplasty. Subgroup analysis found no difference between the single- and two-stage arthroplasty groups in the incidence of purulent infection of the hip and knee. Cumulative meta-analysis showed gradual stabilization of outcomes.

Conclusions

  • Based on our meta-analysis of available retrospective studies, we found no significant difference in reinfection rates between single- and two-stage arthroplasty for SA. Further prospective cohort studies are needed to confirm our results, although our meta-analysis provides important insights into the current literature on this topic.

Open access
Michael de Buys Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa

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Krisantha Moodley Emergency Department, ER Consulting, Johannesburg, South Africa

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Josip Nenad Cakic Department Orthopaedic Surgery, Life Fourways Hospital, Johannesburg, South Africa

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Jurek R T Pietrzak Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa

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  • Peri-prosthetic joint infections (PJIs) following total joint arthroplasty (TJA) are associated with higher treatment costs, longer hospital admissions and increased morbidity and mortality.

  • Colonization with Staphylococcus aureus is an independent and modifiable risk factor for PJIs and carriers of S. aureus are ten times more likely than non-carriers for post-operative infections.

  • Screening and targeted decolonization, vs universal decolonization without screening, remains a controversial topic.

  • We recommend a tailored approach, based on local epidemiological patterns, resource availability and logistical capacity.

  • Universal decolonization is associated with lower rates of SSI and may reduce treatment costs.

Open access