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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_9 | Pages 100 - 100
1 May 2016
Onishi H Tsukamoto M Okabe S Mori T Uchida S Murata Y Moridera K Hirano F Ikei D Kamegawa S Akinori S
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Introduction

The purpose of this study was to introduce our perioperative prophylaxis method for infection and clarify surgical site infection rate in our patients performed total hip arthroplasty (THA).

Method

Two hundred and eighty four THA (including revision 18 cases) performed by single surgeon between Oct. 2007 and Jan. 2013 were evaluated. The mean age of patients was 65.7 years old. The male to female ratio was 46 to 238. BMI was 23.6. Ninety patients (32%) were compromised host suffering from diabetes mellitus, rheumatoid arthritis, autoimmune disease, history of malignant tumor, hemodialysis or skin disease at surgical site respectively. At preoperative period, we checked decayed tooth, alveolar pyorrhea, hemorrhoids, and leg skin condition. In addition, we examined culture of nasal cavity. At the day of surgery, patient took a shower just before entering surgical room. All of THA was performed in clean room NASA class 100. Surgeons and assistant nurse put on nonwoven fabric gown, space suit and double rubber gloves. We wiped surgical site leg by gauze impregnated by 0.5% chlorhexidine alchohol to eliminate skin bacteria twice just before surgeons scrubbing hands. Surgical site was covered by povidone iodine containing drape. Surgeons or nurse changed gloves when glove was broken at each time. We cleaned surgical field by pulse washer whenever necessary. We did not use drain except for 5 revision THAs. Regarding to prophylactic antibiotics usage, we administered cefcapene pivoxil orally the day before surgery. Drip infusion antibiotics (PIPC: until Oct. 2008, CEZ: after Oct. 2008) was administered at the period of 30 min. before surgery and 4 hours after surgery in case of prolonged surgical time (4 hours >). Skin closure was performed by staple and covered by gauze until May 2010. After that, we used surgical tape and transparent water proof sheet. After finishing surgery, antibiotic was administered 8 hours interval at surgery day and 12 hours interval for additional two days. In case multi-drug resistant bacteria (MRSA, MRSE) was positive in nasal culture, we applied mupirocin ointment to nasal cavity for 3 days before surgery and administered vancomycin (from Aug. 2011) or linezolid (from 2012) for prophylactic antibiotics in perioperative period.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 518 - 518
1 Oct 2010
Hirano F Fujii H Mori T Nakamura T Ohnishi H Okabe S Tanaka S Tsurukami H Uchida S
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Purpose: There is no report concerning about long-term comparison result of high placed cementless cup stability with or without screws for developmental dysplasia of the hip. The aim of this study was to ascertain whether or not there are any differences in high placed cementless cup stability with or without screws at the mean 10-year (6–14) follow-up period.

Method: We divided 109 hip-cases who underwent identical cementless total hip arthoplasty system (Mallory – Head : Biomet Inc.) to two groups: 57 cups with screw (screw group) and 52 cups without screw (no screw group). No case in both group underwent bulk bone graft for acetabular roof. Radiographic signs of cup instability were defined as the development of radiolucent line (> 2mm) or migration (> 4mm). Degree of subluxation by Crowe classification, cup size and cup abduction angle were also measured.

Results: In both groups, there was no significant difference in terms of degree of subluxation (each grade’s %) (screw vs no screw = I (68, 73), II (21, 25), III (11,0), IV (0, 2)), age (yrs) (58, 60), cup size (mm) (46, 47) and cup abduction angle (49, 47). In screw group, one case was revised by replacing only polyethylene insert due to excessive ware. No case in both group showed any sign of component instability.

Conclusion: High placed Mallory-Head type cementless cup without screws showed stable radiographic fixation as well as cup with screws at mean 10 years follow-up period.