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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three cases are presented and analyzed in which a Lippman Transfixion Hip Prosthesis had to be replaced because of the discomfort of the patient. In each case, there was evidence of wear between the head of the prosthesis and the flange. The different wear patterns indicated problems which exist in the alignment of component parts of the prosthesis. In each case there was low grade sepsis to which the debris may have contributed. Because of phagocytosis, amount of debris accumulation was difficult to evaluate. The factors which appear to have contributed to the amount of debris accumulation were: the length of time the prosthesis had been used; the degree of alignment and amount of debris which may be formed and is phagocytized; the degree of manufacturing control. The design of this prosthesis incorporated mechanical problems which are generally undesirable because of: the eventual deformation of the end of the pivot rod or hole in the head of the prosthesis: progressive loosening of the movement due to this and inherent malalignment; the difficulty in fabrication, assembly and installation of the prosthesis because of the multiplicity of parts; the difficulty in maintaining adequate control of surface finishes.
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PMID:Biomechanical considerations of multiple-component hip prostheses. Analysis of three failures of the Lippman transfixation hip prosthesis. 112 66

With the increasing availability of well-trained orthopaedic surgeons and pediatricians, early diagnosis and effective treatment of hip sepsis is now common. Despite these advances, poor results still occur. The principle of early surgical drainage and appropriate antibiotics must continue to be emphasized. Empiric surgical drainage in cases with equivocal aspiration results is advised. Postsurgical residual subluxation remains a significant problem in subacute cases with preoperative subluxation (lateralization) and is best avoided by an anterior approach for drainage, which can include adductor or psoas release, or both, followed by cast positioning of the hip to maintain reduction. Careful and thoughtful application of the recently accepted concept of early transition to oral antibiotics can significantly reduce the psychological and economic cost of hip sepsis treatment. Hip sepsis occasionally occurs in juveniles, adolescents, and teen-agers. Because of a low index of suspicion in this age group, diagnosis and treatment are often greatly delayed resulting in a poor outcome in many patients.
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PMID:Childhood hip sepsis: improving the yield of good results. 383 65

Gie and Ling have described a method for femoral component revision using compressed morselized cancellous allograft and a cemented collarless polished taper stem. The authors report their early experience with this technique. Of the first 67 patients who had femoral exchange by impaction grafting, 60 were alive 2 to 5 years after hip revision; 2 hips failed because of late sepsis, and 5 patients were decreased. In 56 individuals available for review, the Harris Hip Score average was 90 points, with > 80% reporting no pain. On radiograph, 48% of the stems showed an average of 2.8 mm of subsidence in the polymethylmethacrylate mantle, but only 7% of the cement graft composites had subsided in the cortical tube. Lucent lines were rare, and in 93% of revised femurs the radiographs showed evidence of graft incorporation and bone remodeling. There were 6 reoperations in the group: 3 for late fracture of the femoral shaft and 3 for cup exchange (2 chronically dislocating, 1 loose). No evidence for femoral component loosening was found in this group. Further study is necessary, but these preliminary findings give rise to cautious optimism that this is a reliable method for femoral revision, reconstruction, and reconstitution.
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PMID:Preliminary report of impaction grafting for exchange femoral arthroplasty. 755 25

Hip pain in children is always potentially serious. Different specialists see a different spectrum of hip diseases. Acute hip pain is usually referred to the surgeons, and the principal concern is to distinguish sepsis of the hip joint or pelvic bones from irritable hip: untreated sepsis can destroy the hip within days, but its presentation may be atypical or mild and investigations misleading. A reliable protocol for the management of acute hip pain in children is now available. Perthe's disease and slipped capital femoral epiphysis is usually evident on the initial radiograph. Hip disorders with a subacute or chronic presentation are usually referred to the paediatrician or rheumatologist. If examination shows restriction of hip movement or there are radiographic abnormalities, many will have a serious disorder requiring long-term management. The diagnosis is often apparent on the initial radiographs, although special imaging techniques may be needed. In a monoarticular presentation of juvenile arthritis, the hip radiograph will be normal but the diagnosis evident from other clinical features or blood investigations. Recognition of non-organic syndromes presenting with hip pain requires the exclusion of organic causes and an alertness to the incongruity of the physical signs.
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PMID:Differential diagnosis and management of hip pain in childhood. 788 44

The incidence of the major complications of operation have been studied prospectively in 1,722 patients with a proximal femoral fracture treated by either insertion of a hemiarthroplasty, internal fixation with a Dynamic Hip Screw (DHS) or multiple parallel screws. Major complications occurred in 8.0%. A special surgical "Hip Fracture Team" reduced the incidence of major complications from 12.5% to 5.0%. The most significant benefit from employment of the special team was in reducing the incidence of wound sepsis and of failure of fixation following the operative management of displaced intracapsular and extracapsular fractures. Assigning hip fracture surgery to designated personell will result in a significant reduction in morbidity.
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PMID:The value of a special surgical team in preventing complications in the treatment of hip fractures. 792 70

The difficulty in differentiating aseptic loosening from infection in painful total hip arthroplasty is well recognized. This prompted a review of the efficacy of the preoperative investigations used at the authors' institution. One hundred forty-four patients who underwent revision hip arthroplasty were reviewed. Seventy-two had sequential bone-gallium scan, and/or hip aspiration, and intraoperative Gram stain. These were compared to intraoperative culture as the gold standard. Twenty infected hips were detected on culture. For prediction of infection, the bone-gallium scan had a sensitivity of 38% and a specificity of 100%. Hip aspiration had a sensitivity of 57% and a specificity of 97%. The investigations combined gave a sensitivity of 64% and a specificity of 95%. Intraoperative Gram stain compared with subsequent culture yielded a sensitivity of 23% and a specificity of 100%. Uncemented hips were infected more frequently (47%) than cemented hips (9%), significant at P < .0001. It was concluded that bone-gallium imaging is not an effective method for investigating painful hip prostheses for sepsis and offers no additional advantage over hip aspiration. Intraoperative Gram stain also missed a large number of infections. Other modalities, such as indium-labeled-leukocyte imaging and capsular histologic examination, may be more efficacious. A significant difference in the number of infections found in cemented versus uncemented hips was shown, hence greater vigilance for infection is required when patients present with painful uncemented hip arthroplasties.
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PMID:Bone scan, gallium scan, and hip aspiration in the diagnosis of infected total hip arthroplasty. 830 Dec 79

Hip arthroplasty with an ipsilateral knee arthrodesis occurs infrequently but does raise concern regarding surgical technical difficulties, dislocation, sepsis, and long-term loosening. Sixteen patients were evaluated 7.5 years (average period) after surgery. Technical difficulties were not prohibitive. No dislocation or revision was necessary in any of the cases. Two patients died as a result of unrelated sepsis from an infected knee. Loosening and protrusio of the acetabulum occurred in two patients. Hip arthroplasty in patients with a fused knee does not incur undue risk of loosening or instability and can provide long-term good function and pain relief. Patients with multiple joint arthroplasties, in whom concurrent sepsis occurs, can have devastating results.
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PMID:Long-term evaluation of hip arthroplasty in patients with an ipsilateral knee arthrodesis. 847 9

In the era of successful total hip replacement, hip arthrodesis has become an infrequent surgical procedure. Current indications are severe deterioration of the hip joint with a painful, reduced range of motion in young patients, such as disorders subsequent to sepsis of the hip joint, slipped capital epiphysis, Perthes' disease and trauma with contraindications for a total joint replacement. Another important indication is paralysis or musculature loss. From 1980 to 1990, 20 consecutive patients underwent a hip arthrodesis with a cobra plate and were evaluated. None of the patients was lost for follow-up; complications occurred in 5 out of 25 cases (20%). All patients had radiographic evidence of union, 2 patients required re-osteosynthesis and bone grafting. In two cases infection occurred. In one case the position of the fused join went into abduction. Thirteen patients were able to walk free of pain; however, 5 patients were disappointed with the arthrodesis result because of the handicap involved with a fused hip. Hip arthrodesis using the cobra plate is a technically demanding operation, but immediate mobilization and partial weight bearing are facilitated. There is little risk of non-union compared to other surgical procedures. If the technique is correct functional problems will be rare.
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PMID:[Hip joint arthrodesis using the cobra plate. Indication, technique, outcome]. 869 66

Hip arthrodesis remains an option for treatment of severe arthritis in young persons resulting primarily from osteonecrosis, congenital dysplasia, and joint sepsis. The authors reviewed six patients who underwent fusions as young adults (average age: 30.8 years) with an average follow-up period of 11.7 years. Solid arthrodesis without infection was noted in all cases. Patients who worked returned to prior employment without limitation. All patients complained of symptomatic low back pain and felt ambulation was limited by ipsilateral knee pain. Five of six noted impaired sexual function; although childbearing was not affected in one case. Four of six were satisfied with the operation, but only three of six would undergo it again given the alternative of total joint arthroplasty.
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PMID:Hip fusion in young adults. 878 20

One hundred sixty-five patients underwent 171 preoperative aspiration arthrograms to evaluate a painful total hip arthroplasty. Intraoperative cultures and histologic specimens were obtained in all cases. Of the 166 aspirations where fluid was obtained, there were 140 true negative, 5 true positive, 18 false positive, and 3 false negative cultures. Sensitivity of hip aspiration to identify periprosthetic sepsis correctly was 50%; specificity was 88%. Hip aspiration with a 50% sensitivity rate lacks the ability to consistently predict those patients with occult periprosthetic sepsis. The routine use of aspiration in evaluation of a painful total hip is probably not indicated. Selective use in patients with a history of wound healing problems, radiographic changes, and elevated laboratory values should be considered.
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PMID:Aspiration as a guide to sepsis in revision total hip arthroplasty. 887 73


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