infection

F Complications

General

- haemarthrosis

- DVT

- infection

 

Swollen Knee Post ACL

 

Septic Arthritis

 

Infected ACL ClinicalInfected ACL

 

Incidence

Management

Incidence

 

Knee > Hip

- superficial position

- limited cover of well vascularised muscle 

- watershed area of skin blood supply anterior to the skin incision 

- much increased in fully constrained prosthesis 

 

Ideal < 1%

 

Risk Factors

 

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM

Prevention

Preoperative

 

Identify high risk groups

- immunocompromised

- diabetes

- RA

- malnutrition

 

Urine screen

- check for and treat UTi

 

Groin, nose, axilla swabs

- for MRSA

- if positive, treat

- need 3 consecutive free swabs

 

3 x chlorhexidine preoperative showers in 8 hours

 

Admit day of surgery

- check skin for lesions

Complications

Undercorrection /  loss of correction 

 

Most important factor in good results and duration of results

- must correct to 8o of valgus

- mechanical axis must pass through lateral joint line

 

HTO Insufficient Correction

 

Causes

- inadequate initial correction

Complications

Intraoperative glenoid fracture

 

Avoid by

- careful reaming and drilling osteoporotic bone

 

Management

1.  Rotate metaglene

- use locking screws to stabilise glenoid

2.  PA screws

- cannulated 4.0 mm screws

- inserted percutaneously from posterior

 

Haematomas

 

Great deal of dead space is created

- always use a drain

Arthroplasty

Indications

 

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

 

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

 

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

 

Acute unreconstructable fracture > 60

 

Investigation of Pain

Aetiology

 

Intrinsic

 

Infection

 

Loosening

 

Thigh pain in uncemented

- micro motion at distal end of stem

- modulus mismatch

 

Stress fracture / insufficiency fracture

- pubic rami, sacral

 

Intra-operative fracture

 

Prosthesis failure

 

Subtle instability

 

Extrinsic

Infected THR

Risk factors

 

Patient 

 

Advanced age

Immunosuppression - steroids / Rheumatoid / DM

Malnutrition - Lymphocyte count / Transferrin / Albumin

Vascular disease

Obesity

Poor skin i.e. psoriasis

Previous infection in joint

Infection elsewhere - i.e. UTi

Prolonged hospital admission

Revision surgery

 

Operative Factors

 

Preoperative

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