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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 1 - 1
1 Dec 2019
Vanhouteghem K Olyslaegers C Fortems Y van Eynde E Willems P van Schaeren J Vanherendael B
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Aim

Microbiological culture of intraoperative periprosthetic tissue samples (IPTS) is one of the main criteria in diagnosing prosthetic joint infections (PJI) as stated by different guidelines. The current techniques are labor-intensive, prone for contamination and show low sensitivity. The aim of this study was to evaluate the added value of beadmill processing of IPTS and culturing in blood culture bottles (BCBs) over the conventional method of standard agar and broth alone.

Method

We conducted a single-center prospective study from May 2017 to January 2018 at the GZA Hospitals, a secondary care hospital (1012 beds) in Antwerp, Belgium. IPTS from patients undergoing revision arthroplasty were consecutively processed. Each IPTS was aseptically divided in two equal parts: one was processed by direct inoculation on agar and in broths (non-homogenized method); the other was transferred in a sterile vial with saline solution and glass beads (EOLabs), homogenized using a mechanic cell disruptor for 30s (Disruptor genie, Scientific Industries), 2mL of the suspension was inoculated in (an)aerobic BCBs, agar plates and broths (homogenized method). Agar plates were incubated for 4d; broths and BCBs in BacT/Alert (bioMerieux) for 14d. Micro-organisms were identified using MALDI-TOF MS (Bruker). Sensitivity (Se) and specificity (Sp) were calculated against the IDSA definition of PJI for different culture sets: non-homogenized and agar/broth; homogenized processing and agar/broth, agar/broth/BCB, agar/BCB. Ethics committee approved the study.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 500 - 500
1 Oct 2010
Vingerhoeds B Fick D Middleton R Olyslaegers C Wainwright T
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Summary: This study of 1000 patients demonstrates how you can dramatically reduce hospital length of stay, improve clinical outcomes, and increase patient satisfaction if a patient-centred pathway approach is adopted.

Introduction: This study evaluates the effect of adopting a patient-centred approach on clinical outcomes, patient satisfaction and operational efficiency. By adopting standardised working practices, dramatic changes can be achieved to reduce patient length of stay (LOS) and consequently surgical capacity.

Methods: We prospectively studied the first 1000 patients who followed the new pathway (549 Total Knee Replacements, 20 Unicondylar Knee Replacements, 384 Total Hip Replacements and 47 Hip resurfacings). The pathway included an enhanced pre-assessment process. Admission dates were mutually agreed and a predicted discharge date of 4 days was provided. All patients attended a pre-operative education session. Patients were admitted on the day of surgery and followed an intensive physiotherapy program. The surgeons, surgical techniques, and discharge criteria all remained unchanged.

Results: The average length of stay was 4.1 days (St Dev 1.8). 80% of patients went home on or before day 4 post-operatively. This was accompanied by a decreased re-admission rate (1.8%), low complication rates for both hip replacement (Dislocation rate = 0.93%) and knee replacement (Knee MUA = 0.87%) and no cases of deep infection. Pre-operative patient reported outcome measures (WOMAC, SF-12 and Oxford) all improved post-operatively (P< 0.0001) and qualitative data from patients was extremely positive towards the new pathway.

Discussion: The decrease in LOS was dramatic and highly clinically significant. The mean LOS for patients prior to commencing this new pathway was 7.5 days (St Dev 5.7). High patient satisfaction rates indicate that by adopting a patient-centred approach, significant decreases to LOS can be achieved alongside improving the quality of care with a low complication and readmission rate.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 417 - 417
1 Sep 2009
Maret S Harshavardhana N Dhir A Sahu A Olyslaegers C Hartley R
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Purpose: To review the existing coding for knee surgery and ascertain its appropriateness & accuracy for surgical procedures, associated co-morbidities and complications.

Methods: A retrospective review of 100 consecutive knee surgeries (50 arthroplasties and 50 arthroscopies) performed between July-August 2007 was undertaken. The coding data excel sheet and comprehensive hospital records were analysed.

Results: The accuracy of primary procedural codes was 100% & 88% respectively for arthroplasty & arthroscopy. However this respectively fell down to 56 & 60% when the accuracy for entire description of surgical procedure was taken into consideration. The procedural codes did not specifically reflect the surgery performed and lacked reproducibility esp. for arthroscopies. In arthroplasties, patients had similar codes irrespective of whether they had patellar resurfacing or not. Co-morbidities were coded appropriately in 24% of arthroplasty & 36% of arthroscopy patients. The common co-morbidities missed were drug allergies, hypercholesterolemia, heart conditions (IHD, MI, AF, valvular pathologies) and h/o malignancy & deep vein thrombosis. Post-op adverse events were coded in only 2/5 arthroplasties (40%) and 0/3 arthroscopies (0%) respectively.

Conclusion: Coding is a universal language of communication amongst healthcare professionals. Its accuracy is important not just for reimbursement but also for data quality and audit. Coding database also serves as a powerful research tool. The financial implications with respect to generation of appropriate reimbursement i.e. healthcare resource group (HRG) codes (which are dictated by official population and census survey procedural [OPCS4.4] & international classification of diseases [ICD–10] co-morbidity codes) are discussed. The limitations of the existing coding system are highlighted and discussed. Literature emphasizes on the qualification of coders, legible & comprehensive documentation of surgeries & co-morbidities by treating physicians and regular interaction between coders and clinicians. Reimbursement for arthroscopy is less in the NHS unlike in BUPA where it is on par with open surgeries.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 406 - 406
1 Sep 2009
Olyslaegers C Wainwright TW Middleton RG
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Introduction: This study evaluates the effect on hospital length of stay (LOS) of patients receiving a total hip replacement (THR) as part of a patient centred approach. In order to meet the “18 week” target a pathway was developed by combining the latest research evidence with guidance from the NHS Institute for Innovation and Improvement.

Methods: We prospectively studied the first 134 THR patients who followed the new pathway. The pathway included an enhanced pre-assessment process. Admission dates were mutually agreed and a predicted discharge date of 4 days was provided. All patients attended a pre-operative education session. Patients were admitted on the day of surgery with staggered admission times and followed an intensive physiotherapy program. The surgeons, surgical techniques, and discharge criteria all remained unchanged.

Results: 100% of patients were admitted on the day of surgery and the average time between admission and start of surgery was 2hrs 41mins. All patients walked to theatre and 100% of patients received their first physiotherapy intervention within 18 hours post-operatively. The average length of stay was 3.85 days. 87% of patients went home on or before their predicted day of discharge. The patient feedback was excellent and satisfaction rates were very high. There were no alterations in surgical complication rates compared to before the pathway was introduced.

Discussion: This decrease in LOS was dramatic and highly clinically significant. The average LOS for THR patients prior to commencing this new pathway was 7.5 days. High patient satisfaction rates indicate that by adopting a patient centred approach, significant decreases to LOS can be achieved alongside improving the quality of care. Pressure to meet the “18 week” target provided an opportunity to improve working practice as well as increasing surgical capacity.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_I | Pages 65 - 65
1 Mar 2009
Olyslaegers C Defoort K Simon J Vandenberghe L
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Highly cross-linked polyethylene (XLPE) has been introduced in total hip arthroplasty in an effort to reduce polyethylene wear and the associated periprohetic osteolysis. Cross-linking is a procedure in which irradiation and subsequent heating stabilize the internal structure of PE. Most of the conventional PE’s used, are gamma irradiated in air or an inert environment with a dose level of no more than 25 to 50 kGy. By irradiating PE at a higher dose, optimally around 95–100 kGy, a definite reduction in wear rate has been achieved. History already provided us some mixed in vivo results regarding altered PE. Therefore, present time surgeons are cautious when it comes down to using a new PE.

Some short follow up in vivo studies already suggested reduced wear rates with XLPE in comparison to conventional PE. Our aim was to demonstrate these reduced wear rates in a 2-dimensional head penetration model using the DICOMeasure™ computerized edge detection method (GreyStone, France) and to perform a clinical comparison of both groups using the Harris Hip Score and SF-36 questionnaire.

Sixty hips with a Trilogy XLPE liner (Zimmer Co.) were age and BMI matched with a control group of twenty conventional Trilogy PE liners (Zimmer Co.).

No differences in clinical performance were seen, but a statistically significant reduction of 67% in steady state wear rate was observed in the XLPE group.

It is clear that, due to the reduction and stabilization of free radicals in polyethylene, a reduction in annual wear can be achieved.