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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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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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Cervical spine injuries are frequent and often caused by a blunt trauma mechanism. They can have severe consequences, with a high mortality rate and a high rate of neurological lesions.
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Diagnosis is a three-step process: 1) risk assessment according to the history and clinical features, guided by a clinical decision rule such as the Canadian C-Spine rule; 2) imaging if needed; 3) classification of the injury according to different classification systems in the different regions of the cervical spine.
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The urgency of treatment is dependent on the presence of a neurological lesion and/or instability. The treatment strategy depends on the morphological criteria as defined by the classification.
Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170076
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anaemia; no chronic obstructive pulmonary disease; no congestive heart failure; no cirrhosis; no venous thromboembolism; no spinal stenosis; no benign prostate hyperplasia; no chronic narcotics; and surgeon discretion); (3) social factors (risk assessment
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postoperative mobilisation or reduction of opoid medication. 5 Fall risk assessment and prevention Falls are a significant problem in older adults. Studies have shown that approximately 30% of people over 65 years of age in the community fall every
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considerations and current concepts of management . Eur J Trauma Emerg Surg 2011 ; 37 : 539 - 48 . 23 U S Department of Health and Human Services Task Force on Health Risk Assessment and Us Public Health . Bone health and osteoporosis: A report of the
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showed only transient and mild inflammatory reactions accompanied by focal superficial ulcerations and necrosis, which had been completely regenerated and re-epithelialized after seven days ( 133 ). Long-term risk assessment of monthly repeated oral CPP
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. A risk assessment model for chronic ankle instability: indications for early surgical treatment? An observational prospective cohort – study protocol . BMC Musculoskelet Disord 2018 ; 19 : 225 . 17. Guillo S Bauer T
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frailty index is an effective risk assessment tool in primary total knee arthroplasty . J Arthroplasty 2017 ; 32 : S177 – S182 . 60. Bellamy JL Runner RP Vu CCL Schenker ML Bradbury TL Roberson JR
Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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predicting transfusion after TKA Jo et al. conducted a level II evidence study to identify preoperative variables to create an ML model and to provide a web-based transfusion risk-assessment system for clinical use. The authors retrospectively reviewed
