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Why it is important for an orthopaedic surgeon to know about imaging modalities in peri-prosthetic assessment Imaging is one essential part in the work-up of patients with total joint replacements. Although the actual scans are not done by the
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Because of the risk of bacterial biofilm infections, prophylactic use of antibiotics in orthopaedic procedures involving the implantation of large prosthesis systems is considered mandatory.
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A strategy based on the rationale that local antibiotics released from bone cement or other carriers establish a second antibacterial frontline in and around the prosthesis is considered complementary to the administration of systemic antibiotics.
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Although less common as a consequence of the initially very high drug concentrations of local antibiotics in the tissues, a selection process of previous high resistance bacteria may occur, leading to antibiotic resistance.
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The use of antibiotic combinations in bone cement is generally accepted to improve antibiotic efficacy and minimizes the treatment failure risk due to antibiotic resistance. This is important in septic revisions and/or in patients at particularly high risk of infection.
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On an individual basis, the benefit of a lower infection probability with combined systemic and local antibiotic application should outweigh the risk of the selection of more resistant bacteria. Each prevented infection means that a complex and extended antibiotic therapy with risk of resistance development over time has been avoided.
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On an epidemiological level there is no clinical evidence that the routine use of bone cement impregnated with appropriate bactericidal antibiotics promotes the widespread development of antibiotic resistance and thereby puts the successful treatment of a prosthetic joint infection at higher risk.
Cite this article: EFORT Open Rev 2019;4:576-584. DOI: 10.1302/2058-5241.4.180104
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in orthopaedic surgery over the last 6 years, alluding to the importance of peri-operative nutritional assessment and optimisation in TJA patients ( 8 ). Assessment of malnutrition is a key component in the pre-operative evaluation in TJA ( 9 , 10
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National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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allocated and the number of inadvertent complications that occurred as a result of this practice. Evidence synthesis is the bringing together of all the available evidence that meets a predetermined quality assessment and combining, pooling or describing
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
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National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
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, biomedical engineers, manufacturers, health technology assessment (HTA) specialists, regulators, notified bodies, device data custodians, toxicologists, materiovigilance, and pharmaco-epidemiology specialists, and potentially others. Fragmentation has made it
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Introduction Clinical outcome assessment serves both internal quality controls such as for the individual clinician or hospital, as well as external quality controls like joint registers, insurance assessments and wider society. It provides
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aid clinical decision-making, yet there is no uniform comorbidity reporting method within the area of hip and knee reconstruction to standardize their assessment. The utility of such comorbidity assessments may aid in appropriate risk stratification of
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aspect in this context is the ‘risk assessment’ based on a worst-case scenario, which forms the basis for the required pre-clinical testing and the approval of a product. If the risks are not really predictable as with completely new implant designs, the
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(ISS), Rome, Italy Institutes for health technology assessment • Austrian Institute for Health Technology Assessment (AIHTA), Vienna, Austria • Fundación Pública Andaluza Progreso y Salud / Andalusian Health Technology Assessment Unit (AETSA), Seville
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CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Instituto de Biomedicina (IBIOMED). Universidad de León, León, Spain
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Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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identification of patients with MoM-THR, they enable assessment of the prevalence of MoM bearings and they enable monitoring of the incidence of revision surgery. The purpose of this paper is to determine the prevalence of MoM-THR in European registries, to
