PubMed · 12269405
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A Seth Greenwald. 2002. Current concepts in joint replacement.. https://doi.org/10.3928/0147-7447-20020901-03
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In the year 2000 the rate of infection after arthroplasty in our hospital was 9.75% and methicillin-resistant Staphylococcus aureus (MRSA) was the organism in 33% of the infected joints. In an attempt to overcome this unacceptable situation, we changed our prophylaxis regime over a period of 6 months. This involved modifying the precautionary measures for preventing surgical infections, active prophylaxis against any nasal reservoir of infection in joint implant patients, the control of health care personnel, the strict application of standard and contact precautions in all patients with MRSA, and the use of teicoplanin as prophylaxis during this 6-month period. This resulted in a definite decrease in the incidence of orthopaedic wound infections by MRSA, while the level of MRSA infection elsewhere in the hospital remained constant. Only one infection was detected during this 6-month trial, and this beneficial effect was maintained during the following 6 months. Since then, only sporadic new infections have been detected. Patients with arthroplasties performed during the study were followed for 12 months, and no new cases of MRSA infection were detected.
Although still a technology in its infancy, nuclear replacement promises a potential alternative to arthrodesis for patients with discogenic back pain. It is ideally suited to those patients presenting early in the degenerative cascade with minimal to no arthritic changes or disc collapse. The physical nature of the implants seeks to restore the visco-elastic, biomechanical, and fluid characteristics of the natural disc, thus reducing pain while maintaining motion and function.
The author introduces a novel concept, namely the partial wrist prosthesis. This new technique combines a proximal row carpectomy with resurfacing of the lunate fossa of the radius and the head of the capitate. Results of the first 13 cases are reported with a mean follow-up of 32.7 months (13-72 m). This prosthesis can be used in degenative arthritis of the wrist instead of total fusion.