Study Design

A prospective cohort study was carried out looking at the functional outcome and post-procedure translational segmental instability after multi-level lumbar decompression using a Hinge osteotomy technique.

Antibiotic bone cement as a form of prophylaxis against deep infection for total hip joint replacements is widely used; however its efficacy has not been proven. This study aims to determine if the use of prophylactic antibiotic cement for primary total hip joint replacements in New Zealand reduces the risk of deep infection requiring revision.

Data from January 1999 to December 2007 were recovered from the New Zealand National Joint Registry. Proportional hazards regression analysis was used to study the relative revision risks or failure rates between those THJR which utilised antibiotic bone cement and those using plain bone cement.

Of the 32,646 hips included in the study 1376 were revised. The overall use of antibiotic and plain cement through this time period is relatively equal, with 18,863 (54.7%) receiving ABC compared to 16,295 (46.3%) hips receiving plain cement. The presence of antibiotics in bone cement was not found to affect whether the hip went on to get revised for deep infection (p =0.16). Nor was the type of operating theatre (p=0.13), the use of space suits (p=0.97), and the operative time (p=0.55). Younger age was found to be the most significant indicator for the need for revision for infection (p value 0.00014).

The induction of antibiotic resistance and the significant additional costs associated with antibiotic bone cement cannot be denied. While the literature supports the prophylactic use of antibiotic bone cement for patients at high risk of infection, the routine use in patients who have a low risk of infection may not be justified.

Introduction: The osteitis of the tibia still is a common problem in orthopaedic surgery. Long lasting treatment time and possible recurrent infections bring a lot of medical and social problems to the patient. We compared in this study a group being treated in the conventional way by bone grafting the defect with another group, which had an Ilizarov procedure to find out, which method brings better results for the patient.

Material and Methods: Each group consisted of 65 patients about the same age. The follow up time was averaged 7.5 years. The size of the defect was in the conventional group 2.5 cm in the Ilizarov group 6.4 cm. Patients were classified to the Cierny Mader Classifications in both groups. Each patient was examined at the time of follow up clinically and radiologically. Special topics were: Pain, job, social activity etc. Scores were evaluated using SF 36. More than this, a questionnaire was handed out to each patient which was filled out after the investigation and was mailed back from home, not to influence the patient during the investigation. These dates were scored by Nottingham Health Profile.

Results: Healing time with the Ilisarov group was longer on the total way, but related to 1 cm defect shorter. Time of hospitalization, number of operations were very similar in both groups. There were more leg length discrepancies and axis deviations in the Ilizarov group. Refering to the job 67% of the Ilizarov group, but only 48% of the conventional group returned to their original profession. Life quality (SF 36 and Nottingham Health Profile) testing was better in the Ilizarov group too. Recurrent infection was seen in the conventional group in 13.8%, in the Ilizarov group only in 9% including the pin track Osteitis. A recurrent infection in the callus distraction group was seen only in 1 case.

Conclusions: Ilizarov treated patients show better long tenn results, even if they are classified B-type hosts, according to the Cierny Mader Classification. They return earlier to work and demonstrate better life quality results. In future these results might even be better, if axis deviations and leg length discrepancies could be minimized. With host B patients the conventional treatment should not be favoured, Ilizarov procedure brings better results too.