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School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Greece
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DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies.
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Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance.
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DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy.
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Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision.
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It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon’s responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies.
Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008
Orthopaedic Department, University General Hospital of Larissa, Greece
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Total knee arthroplasty (TKA) is a satisfactory procedure for end-stage knee joint pathology. However, there is a significant incidence of unsatisfied patients.
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In recent years conventional total knee arthroplasty surgical technique has been challenged and a modern trend to respect individual anatomy, alignment and soft tissue laxities has been developed.
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The indications, limits and outcomes of these modern techniques in selected patients are not well-defined.
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Modern technology (navigation, patient-specific instrumentation and robotics) has improved accuracy of the osteotomies but their effect on long-term outcomes is still unclear.
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A technique which respects individual anatomy, laxities and alignment in combination with an implant which is designed to incorporate contemporary knee kinematics, without the use of modern technology, is presented.
Cite this article: EFORT Open Rev 2020;5:663-671. DOI: 10.1302/2058-5241.5.190085
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Total hip arthroplasty (THA) is a very satisfactory surgical procedure for end-stage hip disorders.
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Implant modifications, such as large femoral heads to improve stability, porous metals to enhance fixation and alternative bearings to improve wear, have been introduced over the last decade in order to decrease the rate of early and late failures.
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There is a changing pattern of THA failure modes.
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The relationship between failure modes and patient-related factors, and the time and type of revision are important for understanding and preventing short and late failure of implants.
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The early adoption of innovations in either technique or implant design may lead to an increased risk of early failure.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170068
School of Health Sciences, Faculty of Medicine, University of Thessaly, Biopolis, Mezourlo Region, Larissa, Hellenic Republic
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Department of Traumatology and Orthopedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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Trauma, Emergency Surgery and Orthopaedics, Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Orthopaedic and trauma surgeons performing surgery in the COVID-19 pandemic environment faced problems with availability, use, rationing, modification, compliance and recycling of personal protection equipment (PPE).
Orthopaedic and trauma surgeons were not well informed concerning the use of PPE for aerosol-generating orthopaedic and trauma procedures.
Scientific bodies, health authorities and management have provided insufficient guidelines for the use of PPE in aerosol-generating orthopaedic and trauma procedures.
The availability of specific PPE for orthopaedic and trauma operating theatres is low.
Hospital management and surgeons failed to address the quality of operating theatre ventilation or to conform to recommendations and guidelines.
Operating theatre PPE negatively affected surgical performance by means of impaired vision, impaired communication, discomfort and fatigue.
Existing PPE is not adequately designed for orthopaedic and trauma surgery, and therefore, novel or modified and improved devices are needed.
