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APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2022
Biofilm infections involving orthopedic implants are a global problem. They contribute to severe complications and mortality, as well as increased use of antibiotic treatments and development of antibiotic‐resistant microorganisms. More than 1 million hip and knee arthroplasties are performed each year in the United States. These hard‐to‐treat infections lead to patient distress, increased morbidity, and high financial costs to both patients and healthcare systems. There is a need to improve the diagnosis of such biofilm infections to allow for earlier detection and treatment. Current diagnostics rely on clinical signs for infections such as loss of function, fever, rubor, patient history of the predisposing condition, persisting infection, failure of antibiotic treatment, and documentation of antibiotic failure. Below, we present a framework which outlines the data gaps in the conventional laboratory techniques used in clinical diagnostics; we also discuss promising novel diagnostic methods which are currently used solely in research. It is critical to assess these novel infection diagnostic techniques and address the data gaps and clinical hesitance preventing application in a clinical setting. Additionally, the combination of conventional and novel diagnostic technologies would streamline the diagnostic process of biofilm infections associated with orthopedic implants.
Microsurgery · 2024
AbstractReconstruction of knee defects still represents a challenge for reconstructive surgeons. After an extensive resection, the primary aim is to reach a stable result, while maintaining a good range of motion and aesthetic unity. The use of pedicled perforator‐based flaps makes it possible to achieve these goals. Many are the flaps that can be used in this region, and the pedicle medial sural artery perforator (mSAP) flap is considered among one of the first‐choice techniques. The purpose of this case report is to describe for the first time the use of pedicled mSAP flap to cover a lateral knee defect. A 79‐year‐old patient underwent extensive excision of sarcoma on the lateral side of the left knee, with removal of distal portion of the vastus lateralis muscle and portion of the biceps femoris tendon. The resulting defect from the excision measured 10 cm × 10 cm. To cover the postero‐inferior part of the defect we decided to use a mSAP flap, with a skin paddle 10 cm × 5 cm, which was tunneled posteriorly to the popliteal artery and vein in order to reach the affected site. We then used a lower medial thigh perforator (pLMT) flap with a 15 cm × 5 cm skin paddle, rotated by 90° in a propeller fashion to cover the antero‐superior portion of the defect. The decision to use two flaps was justified by the fact we wanted to close the donor areas with direct suturing for a better aesthetic result. The post‐operative course was regular with only a small wound dehiscence that had healed by secondary intention. At 6 months postoperatively, the patient showed a complete active range of motion of the knee joint and absolute aesthetic satisfaction with flaps donor site and knee shape. A review of literature is also provided, with a specific focus on the different procedures for soft tissue defects reconstruction around the knee. According to our experience, the pedicle of the MSAP flap may be safely used as an additional reconstructive option for lateral knee defects.
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025
Introduction: Several types of polyethylene liners have been developed to address the specific needs of patients' anatomy within total knee arthroplasty (TKA). In modern TKA, the posterior-stabilized (PS) and the cruciate-retaining (CR) designs are the most common, with the medial congruent (MC) design becoming more popular. The MC total knee arthroplasty has a posterior dwell point allowing for more flexion. The purpose of this study was to determine differences in patient-reported outcomes (PROMs) or postoperative outcomes between these three TKAs. Methods: Patients who underwent a primary, elective, unilateral TKA between June 2021 and July 2023 were identified. Demographics and perioperative and postoperative outcomes were extracted from the medical record. PROMs from 624 patients were obtained through a digital engagement platform. A P value ≤0.05 was considered statistically significant. Results: Patients were subdivided into three groups; 111 PS-TKA, 278 CR-TKA, and 235 MC-TKAs. Most implants were Zimmer (71.5%) and were cemented (92.9%). Patients in the CR group were predominantly male (P = 0.003) and had a lower body mass index (P < 0.001). No differences were seen in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores at any time point (preoperative: P = 0.073; 12 weeks: P = 0.144; 6 months: P = 0.666; 1 year: P = 0.622). A similar percentage of patients met the minimal clinically important difference (P = 0.480), and Forgotten Joint Scores were equivalent (P = 0.930). Patient physical therapy parameters (Timed Up and Go test [P = 0.779] and ambulation distance [P = 0.103]), inpatient pain levels (at rest: P = 0.101, with activity: P = 0.052), or morphine milligram equivalents dosed (P = 0.608) were comparable. No differences were seen in 30-day complications. Conclusion: This study fails to demonstrate a difference in PROMs, functional parameters, or complications between the PS-TKAs, CR-TKAs, and MC-TKAs. All three constructs perform similarly in the immediate postoperative period. Because equivalent outcomes occur with each polyethylene, implant choice should be left to physician preference.
Source PubMed · Recherche par auteur (homonymes possibles, vérifier l'affiliation).
Microsurgery · 2024 · Review
Alban A, Meroni M, Fuchs B, Scaglioni MF
APMIS : acta pathologica, microbiologica, et immunologica Scandinavica · 2022 · Journal Article
Ronin D, Boyer J, Alban N, Natoli RM, et al.
Microsurgery · 2024 · Review
Alban A, Meroni M, Fuchs B, Scaglioni MF
Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025 · Journal Article
Gunda B, Goldberg L, Alban A, Strecker S, et al.