Deep Infection Research Articles

Surgical correction of severe limb deformities with Yester biological procedures -Fifty cases with thirty fiveyears follow-up.

Although a severe limb deformity is rare, its management continues to be quite challenging. Various options have been described for correction. However, most of them are expensive, extensive and result in complications. Correction of severe deformities of the extremities has been suggested using the yester biological procedures with successful long term outcome. During the last five decades, 50 patients of challenging limb deformities were surgically managed by yester procedures which included corrective osteotomy, arthrodesis and Girdlestone arthroplasty. Eleven patients had upper limb deformity and 39 had lower limb deformity. Sixteen patients had congenital anomaly and 34 acquired. Twelve patients were non-walkers with multiple joint involvement. No metallic implant had been used in any case. No patient had repeat surgery. The age of the patients ranged from five-27years. Depending on the procedure adopted in a particular patient, all patients were examined periodically and regularly. The treatment time in a patient with multiple deformities ranged from six-12months. Out of the twelve non-walkers, eleven could ambulate after the management. Superficial infection was recorded in 27 patients. No deep infection was observed. A long follow-up of 35years has been available. A rare series of 50 patients with challenging deformities of the extremities has been reported. The patients had been managed with procedures like corrective osteotomy, arthrodesis and Girdlestone arthroplasty with acceptable outcome. After the management 11 out of 12 non-walkers could ambulate themselves. The described procedures are simple, biological, dependable, patient friendly and available at no cost.

Outcomes of the hexapod frame in 111 ‘high risk’ tibial fractures

AimsThe use of circular frames in the management of tibia fractures and deformity correction is well established in the literature. The Taylor Spatial Frame (TSF) is the most widely used hexapod device globally. However, the majority of published papers are small in patient numbers, contain primary and revision cases, and outcomes are therefore unclear. In this study we evaluate the clinical and radiological outcomes of patients with tibial fractures treated primarily with a TSF.MethodsPatients were identified from a prospective trauma database at a UK major trauma centre. An analysis of patient records and radiographs was performed for the study. Patient demographics, comorbidities, frame construct, time in frame, union rates, and complications of treatment were analyzed.ResultsBetween September 2009 and January 2020, 111 patients with tibial fractures managed primarily with a TSF were included. The majority of patients (86, 77.5%) sustained fractures to the tibial shaft, leaving nine plateau (8.1%) and 16 pilon fractures (14.4%). Of these, 55 (49.6%) were open and 56 (50.4%) were closed. Of the open fractures, seven were classified as Gustilo and Anderson grade 3A and 41 (74.5%) were classified as grade 3B. The overall union rate for primary TSF was 85%, with a mean time to union of 191 days (SD 90). A total of 15 patients (13.5%) required either open reduction and internal fixation (n = 6, 5.4%) or intramedullary nail (n = 9, 8.2%) to achieve bony union. Five patients (4.5%) developed a deep infection requiring invasive treatment. Two patients (1.8%) required an eventual amputation for an infected nonunion; both of these patients sustained an initially closed fracture. Overall limb salvage at two years was 98.2%.ConclusionThe TSF remains an established option in the surgical management of patients with complex injuries to the tibia, with good rates of limb salvage within this challenging patient subgroup.Cite this article: Bone Jt Open 2025;6(7):816–821.

Intraoperative vancomycin for preventing infection after open spine surgery: a systematic review and meta-analysis of randomized controlled trials.

The use of prophylactic intrasite vancomycin powder in spine surgery has been described as a possible method for infection prevention. Despite clinical guidelines encouraging the use of intraoperative vancomycin for infection prophylaxis, the evidence in support of such recommendations remains unclear. The primary objective of this meta-analysis was to evaluate the effect of intrawound vancomycin on deep and superficial surgical site infections (SSIs) following open spine surgery. The PubMed/MEDLINE, Embase, Scopus, and Google Scholar databases were searched from inception to October 2024 for randomized controlled trials that investigated the association between intrawound vancomycin use and infection following open spine surgery. The results were pooled using a restricted maximum-likelihood estimation random-effects model with inverse variance weighting and Hartung-Knapp adjustment to account for variation between studies. Seven randomized controlled trials with 2235 patients met the inclusion criteria. Of these, 1095 (49%) patients were randomized to receive intrawound vancomycin during open spine surgery. The overall rate of superficial and deep SSIs in the treatment group was 3.38%, compared with 4.08% in the control group. The overall rates of deep infection were 2.5% and 1.8% in the treatment and control groups, and the overall superficial infection rates were 0.9% and 1.8% in the treatment and control groups, respectively. In a random-effects model, intraoperative vancomycin was not associated with lower rates of SSI (risk ratio [RR] 0.89, 95% CI 0.47-1.67; p = 0.6; τ2 < 0.0001, I2 = 22%). In a subanalysis of patients who underwent instrumented spine surgery, vancomycin was also not significantly associated with decreased rates of SSI (RR 0.77, 95% CI 0.38-1.57; p = 0.47; τ2 = 0.2041, I2 = 33%), superficial infections (RR 0.59, 95% CI 0.22-1.57; p = 0.45; τ2 = 0, I2 = 0%), or deep infections (RR 1.37, 95% CI 0.78-2.40; τ2 = 0, I2 = 0%), nor was it associated with an increased risk of gram-negative/culture-negative infection (RR 0.99, 95% CI 0.47-2.06; τ2 = 0.107, I2 = 20%). Intraoperative vancomycin may not be associated with significantly decreased rates of superficial or deep SSI in patients undergoing open spine surgery. The role of intraoperative vancomycin in open spine surgery warrants further study in larger randomized controlled trials.

Orthoplastic management of Gustilo-Anderson Type IIIB/C open tibial fractures: a consecutive 10-year series from China level I trauma center.

Research on open tibiofibular fractures is limited. We compared clinical outcomes of Gustilo-Anderson type IIIB/C open tibial fractures using orthopedic and orthoplastic approaches, and identified poor prognosis predictors. The clinical data of 746 patients with Gustilo-Anderson type IIIB/C open tibial fractures (420 and 326 treated using the orthopedic and orthoplastic approach, respectively) were retrospectively analyzed. We evaluated infection rates, nonunion incidence, arthritis incidence, number of surgeries, fracture healing time, amputation rate, wound closure duration, and Lower Extremity Functional Scale (LEFS) score, and identified risk factors affecting prognosis. Significant differences in infection rates (deep infection, 8.0% vs. 29%; superficial infection, 8.0% vs. 41%; all P<0.001), nonunion incidence (11% vs. 2.5%, P<0.001), arthritis incidence (27% vs. 2.1%, P<0.001), number of surgeries (4.6±1.07 vs. 10.7±3.33, P<0.001), and wound coverage time (11.27±5.14 vs. 3.98±1.98, P<0.001) were observed between the groups. LEFS scores from 3months to 24months after injury were higher in the orthoplastic group. No difference in fracture healing time was observed (7.0±1.99 vs. 7.0±1.98, P=0.987). The orthoplastic group required a lower amount of bone graft when using intramedullary nail fixation (6.8±1.42 vs. 19.0±2.88, P<0.001). Smoking (odds ratio [OR], 0.24 for nonunion; 95% confidence interval [CI], 2.29-5.34; P=0.008 and OR, 0.26 for deep infection; 95% CI, 0.10-0.71; P=0.009), bone cement block formation (OR, 1.54; 95% CI, 2.06-4.73; P=0.007), and local antibiotic use (OR, 4.89; 95% CI, 1.93-12.37; P<0.001) were predictors of poor prognosis. The orthoplastic approach offers advantages in the treatment of Gustilo-Anderson type IIIB/C open tibial fractures. Smoking should be avoided, bone cement block molding should be actively adopted, and systemic and local antibiotics should be administered as early as possible. The Flap and Open Reduction Internal Fixation & Masquelet technique reduces the amount of bone graft without increasing deep infection risk.

Successful use of cefepime/zidebactam in deep-seated infections due to extensively drug-resistant Pseudomonas aeruginosa - a case series.

Successful use of cefepime/zidebactam in deep-seated infections due to extensively drug-resistant Pseudomonas aeruginosa - a case series.

The Dirty Truth About Resuscitative Endovascular Balloon Occlusion of the Aorta: A Descriptive Analysis of Infection Rates in a High-Risk Population.

Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a viable alternative to open aortic occlusion for hemorrhage control. It is often performed without maximal barrier precautions, and sterility is not consistently ensured. As REBOA usage increases, a knowledge gap exists in its infectious risks. We sought to characterize the type and incidence of infectious complications in patients undergoing REBOA. Patients and Methods: A retrospective review of all REBOA patients at an urban, American College of Surgeons-verified Level I Trauma Center was conducted from November 2016 to September 2023. The trauma registry was queried for all patients who underwent REBOA placement. Data pertaining to patient demographics and infectious complications were obtained for descriptive analysis. The medical record was then examined for the source of bacteremia and other infectious complications. Patients who did not survive beyond hospital day two were excluded. Results: Seventy patients met the inclusion criteria. The median age was 40.3 years (IQR 29.5), and patients were predominantly male (72.8%). The overall mortality rate was 19.1%. Among all patients, 37% (n = 26) developed pneumonia, 17% (n = 12) had a deep or organ-space surgical site infection (SSI), and 12.8% (n = 9) had a blood stream infection. None were bacteremic within 48 hours of REBOA placement. All blood stream infections could be associated with concurrent infections such as intra-abdominal sepsis, pneumonia, or soft tissue infection. No SSIs were identified at the site of vascular access. Conclusions: Our findings demonstrate a modest rate of infectious complications among patients undergoing REBOA placement, comparable with published historical data, but no evidence to suggest infectious complications directly related to REBOA placement. Although limited by small sample size and single-institution experience, this study serves as one of the first studies to describe the infection rates in patients undergoing REBOA. Further prospective multi-center studies are required to evaluate the true infectious risks associated with REBOA.

Short term outcomes of civilian ballistic distal humeral fractures compared with blunt open and closed distal humeral fractures.

The objective of this study was to assess outcomes of ballistic distal humeral fracture in comparison with open and closed distal humeral fractures sustained via blunt mechanisms. Retrospective cohort study. Academic Level I trauma center. Skeletally mature patients presenting with ballistic (17), blunt open (36), or blunt closed (94) distal humeral shaft fractures (AO/OTA 13A-C). Number of unplanned reoperations, intensive care unit admission, persistent ulnar nerve neuropathy, nonunion, superficial infection, deep infection, heterotopic ossification formation, hardware removal, and length of stay. A total of 147 distal humeral fractures that underwent operative fixation were included in the study. A group of 17 ballistic fractures and comparison groups of 36 open and 94 closed distal humeral fractures sustained via blunt mechanisms was identified. Compared with the blunt closed group, the ballistic group had a higher proportion vascular injury (p = 0.001), preoperative ulnar nerve injury (p < 0.001), and longer operative times (p = 0.007). Compared with the blunt open group, the ballistic group sustained a higher proportion of preoperative ulnar nerve injuries (p = 0.012), required less olecranon osteotomies (p = 0.045), and had fewer unplanned reoperations (p = 0.043). Ballistic distal humerus fractures sustain high rates of neurologic and vascular injury but have similar short term outcomes to blunt closed fractures. Prognostic Level III.

Patient Profile and Perioperative Care Practices Associated With the Absence of Deep Surgical Site Infections in Patients Following Coronary Artery Bypass Graft Surgery.

Postoperative surgical site infections (SSIs) are a significant concern in cardiac surgery. To characterize clinical and perioperative factors associated with the absence of deep SSIs in a cohort of patients who underwent coronary artery bypass grafting (CABG) surgery. A retrospective, single-center study was conducted, analyzing data from 214 patients between August 2023 and June 2024. Perioperative care measures included adherence to an established cardiothoracic SSI prevention bundle, consisting of preoperative chlorhexidine gluconate bathing, preoperative nasal decolonization, intraoperative antibiotics, and intraoperative and postoperative glycemic control. Adherence to the prevention bundle varied (82.7-98.6%). A statistically significant difference in postoperative glycemic control was observed between elective and urgent surgery cases. This study's findings highlight the potential effect of rigorous protocol adherence and the critical role of standardized nursing care in SSI prevention. Future research to optimize patient care and outcomes during and after CABG surgery is recommended.

The Spectrum of zoophilic dermatophytes

Zoophilic dermatophytes are fungi that mainly infect animals, but can also be transmitted to humans. Transmission usually occurs through direct contact with infected animals or contaminated materials such as animal hair, blankets or brushes. Zoophilic dermatophytes cause classic symptoms of tinea infections in humans: ring-shaped, reddened skin lesions with scaly edges and central paling. The inflammatory reaction is usually stronger with zoophilic pathogens than with anthropophilic fungi because the human defense system recognizes them as foreign more clearly. Children, animal owners, farmers or veterinarians are affected most frequently. Diagnosis is made by microscopic examination and fungal culture, and molecular diagnostics if necessary. Treatment requires topical antimycotics and in case of extensive or deep infections additional systemic therapy, e.g., with terbinafine or itraconazole. Simultaneous treatment of the infected animal and prevention of transmission is crucial to prevent reinfection. Hygiene measures and education are key prevention strategies.

Elastic Intramedullary Nailing in Adult Radius and Ulna Fractures: A Modern Minimal Invasive Approach to Internal Fixation

Background: Forearm fractures in adults have traditionally been treated with open reduction and internal fixation (ORIF) using plates and screws. This study evaluates elastic intramedullary nailing (EIN) as a minimally invasive alternative for the treatment of adult radius and ulna fractures Methods: Forty adult patients (24 males, 16 females; mean age 36.7 years) with diaphyseal fractures of the radius and/or ulna were treated with elastic intramedullary nailing between January 2022 and December 2023. Patients were followed for a mean of 14.3 months. Outcomes were assessed using time to union, Disabilities of the Arm, Shoulder and Hand (DASH) score, Anderson criteria, range of motion, grip strength, and complications. Results: Union was achieved in 38 patients (95%) at a mean time of 11.8 weeks. Two patients (5%) developed delayed union, which eventually healed without intervention. At final follow-up, the mean DASH score was 8.4. According to Anderson criteria, excellent results were achieved in 32 patients (80%), satisfactory in 6 patients (15%), and unsatisfactory in 2 patients (5%). The mean range of motion showed near-complete restoration of function with elbow flexion-extension arc of 143.5°, wrist flexion-extension arc of 135.7°, and forearm rotation arc of 164.3°. Complications were observed in 8 patients (20%), including superficial infection (5%), hardware irritation (7.5%), and transient nerve paresthesia (5%). No cases of deep infection, implant failure, or nonunion were recorded. Conclusion: Elastic intramedullary nailing is a safe and effective minimally invasive treatment option for selected adult radius and ulna fractures, offering excellent union rates, favorable functional outcomes, and a low complication profile. This technique may be considered as an alternative to conventional plating in appropriate cases, particularly when minimizing soft tissue dissection is desirable.

Admission prognostic nutritional index predicts prolonged hospitalization in severe odontogenic deep neck infections.

Severe odontogenic deep neck infections (DNIs) can be life threatening. This study investigated the nutritional status of affected patients and evaluated the usefulness of the Prognostic Nutritional Index (PNI) at admission in helping maxillofacial surgeons identify, at presentation, those likely to require extended hospitalization. A total of 112 patients treated for odontogenic deep neck abscesses and necrotizing soft tissue infections at five hospitals in Japan. Patients were included. Patients were categorized by length of hospitalization duration and factors associated with prolonged hospitalization were analyzed using propensity score matching to minimize bias. Spearman's rank correlation analysis was also performed to assess the relationship between PNI and hospitalization duration. Fifty patients (44.6%) required hospitalization for more than 14days. Multivariate analysis identified PNI ≤ 41.2 (odds ratio [OR] = 2.79) and the presence of abscesses in multiple deep neck spaces (OR = 2.76) as significant predictors of prolonged hospitalization. Propensity score analysis confirmed the significant association between PNI and length of hospitalization duration (P = 0.048). In addition, Spearman's rank correlation coefficient was r = - 0.471 (P < 0.001), indicating a moderate negative correlation. The admission PNI may serve as a useful adjunctive indicator for predicting prolonged hospitalization in patients with severe odontogenic DNIs, as it reflects both nutritional status and systemic inflammation.

Use of Antibiotic Eluting Calcium Sulfate Beads in High-Risk Primary Total Knee Arthroplasty.

Local delivery of high-dose antibiotics via absorbable calcium sulfate beads has been investigated as a treatment of prosthetic joint infection (PJI). We investigate this strategy as a prophylactic measure for high-risk patients undergoing primary total knee arthroplasty (TKA). A retrospective review of a single-surgeon consecutive series of primary TKA patients with identified risk factors for PJI development was performed. These patients were treated with calcium sulfate beads containing 1 g of vancomycin and 1.2 g of tobramycin per 10 cc, with 10 cc placed intraarticularly. Outcomes included PJI, wound complications, revision surgery, and medical complications. There were 114 knees in 103 patients, with 76 women (66.7%), a mean age of 66.8 years (range: 21-91), and a mean follow-up of 16 months (range: 3-55). The mean preoperative lifetime PJI risk based on the 2018 International Consensus Meeting on the PJI calculator was 11.3% (standard deviation: 16.3%, range: 0.9-94.3%). Risk factors included medical comorbidities, homelessness, chronic urinary tract infection, other PJI or septic arthritis history, or prior ipsilateral knee surgeries. One delayed PJI occurred 1 year postoperatively from presumed hematogenous seeding following dialysis. There were no other known deep infections. There were nine patients who had delayed wound healing with marginal skin necrosis-six resolved with wound care and three underwent superficial extraarticular surgical debridement. There was one patient who underwent aseptic revision for patellar instability and nine patients required manipulation under anesthesia for stiffness. There was one patient who died after readmission for cardiac arrhythmia and one patient had bilateral DVT. No cases of chronic PJI, persistent wound drainage, or postoperative hypercalcemia were identified. Prophylactic use of antibiotic-eluting calcium sulfate beads in primary TKA has resulted in low rates of early PJI in a high-risk cohort, warranting further prospective studies and investigation.

Deep Neck Space Infection as a complication of Transesophageal Echocardiogram for atrial flutter ablation

Deep Neck Space Infection as a complication of Transesophageal Echocardiogram for atrial flutter ablation

Expanding Access to Minor Hand Surgery Procedures in Underrepresented Patient Populations: Safety and Efficacy of a Minor Procedure Clinic in an Urban Safety-Net Hospital

Background:Minor hand surgeries are increasingly being performed in procedure rooms (PRs) rather than operating rooms (ORs). We aimed to determine the safety of PR-based hand surgeries at an urban safety-net hospital among an underserved patient population.Methods:An institutional review board–approved retrospective review of PR-based hand surgeries from January 2022 to February 2024 was conducted. Patient demographics, comorbidities, surgery details, and complications were collected. Fisher exact test analyses were conducted with significant P value <0.05. Data analyses for race and insurance type were excluded because of lack of heterogeneity (>99% underrepresented racial groups, 100% public insurance).Results:Of 202 surgical encounters, the most common surgeries were carpal tunnel release (n = 108, 46.4%), trigger finger release (n = 65, 27.9%), and mass excision (n = 37, 15.9%). Most patients (n = 184, 91.1%) had no postoperative complications. Among patients with postoperative complications, 90.5% were minor (i.e., pillar pain, catching/locking). The major postoperative complications included complex regional pain syndrome (n = 1, 0.5%) and deep surgical site infection (n = 1, 0.05%) requiring hospitalization for intravenous antibiotics and irrigation and débridement in the ORs. No other cases involved infection, hospitalization, or revision surgery. No intraoperative complications or death occurred. No significant difference was noted in postoperative complications based on language preference (P = 0.999).Conclusion:PR-based minor hand surgeries demonstrate low complication rates at an urban safety-net hospital, suggesting safety among this specific underserved population. Additional research should explore multicenter cohorts to identify complication risk factors and aid in surgical decision making for vulnerable groups.

Humeral Intramedullary Nailing Utilizing the Minimally Invasive Rotator-Interval Technique (MIR-IT) Improves Shoulder PROMs.

To assess whether patients treated with a Minimally Invasive Rotator-Interval Technique (MIR-IT) versus the traditional technique of splitting the rotator cuff (RTCS) for intramedullary nailing of humeral shaft fractures resulted in comparable post-operative clinical and patient-reported outcomes (PROM). Design: Retrospective Cohort Study. Level 1 Trauma Center. Patients >18yo with humeral shaft fractures (AO/OTA 12A-C) treated with IMN between 2015 and 2022. The primary outcome was differences in PROMs (ASES, Quick DASH, and Oxford Shoulder Score) between the MIR-IT and RTCS techniques. Secondary outcome measures included differences in rates of nonunion, superficial and deep surgical infections, wound dehiscence and iatrogenic nerve palsy between the two techniques. Seventy-one patients underwent humeral IMN (MIR-IT - 39; RTCS - 32). Fifty-five patients (MIR-IT- 30; RTCS-25) had radiographic and clinical follow up to union. Mean follow up was 7.5 months (range: 3.1-16.8 months). Patients did not vary significantly with regards to age (MIR-IT: 54.4 ± 22.4; RTCS: 55.1 ± 18.5 years, p=0.896), and gender (Males- MIR-IT: 46.7%, RTCS: 44%, p=0.843). There were no significant differences in nonunion (7.4% vs 4.0% p=1.0), superficial infection (3.6% vs 4% p=1.0) or iatrogenic nerve palsy (3.6% vs 4.0% p=1.0) between the MIR-IT and RTCS groups. There were no deep infections or wound dehiscences in either group. Forty-two patients had PROMs (MIR-IT -21; RTCS -21). Average time to PROMs collection was 35.7 months (MIR-IT: 34.2 months, RTCS: 37.1 months, p=0.682). There were significantly better ASES scores (82.7 vs 71.6 p=.015), Quick DASH scores (9.7 vs 21.0 p=.011) and Oxford Shoulder Scores (39.3 vs 33.9 p=.042) amongst patients treated with the MIR-IT. Humeral IMN utilizing the MIR-IT resulted in better shoulder PROMs compared to the RTCS technique, with similarly low surgical complication rates. Therapeutic Level II.

Impact of Deep Sternal Wound Infection on Long-Term Survival Based on Revascularisation Strategy: Results From the Polish National Registry.

Impact of Deep Sternal Wound Infection on Long-Term Survival Based on Revascularisation Strategy: Results From the Polish National Registry.

Discrete Increases in Length of Stay by Complication After Cardiac Surgery: Analysis of 29,544 Cases.

Discrete Increases in Length of Stay by Complication After Cardiac Surgery: Analysis of 29,544 Cases.

Comparative Evaluation of Functional Outcomes Following Surgical and Conservative Management of Distal Tibia Shaft Fractures: A Prospective Observational Study

Introduction:Distal tibia shaft fractures pose significant treatment challenges due to limited soft tissue coverage and suboptimal vascularity in the region. Selecting the most appropriate management strategy – whether surgical or conservative – remains a subject of ongoing debate, particularly in resource-limited settings.Materials and Methods:A prospective observational study was conducted at a tertiary care center in central India between October 2022 and April 2024, involving 70 skeletally mature patients with distal tibial shaft fractures. Patients were managed either conservatively or through surgical interventions, including intramedullary nailing (IMN), minimally invasive plate osteosynthesis (MIPO), or external fixation. Clinical outcomes were assessed at 6 weeks, 3 months, 6 months, and 12 months post-treatment using the Modified Johner and Wruhs criteria. Radiological union, weight-bearing progression, pain severity, and complication rates were also evaluated.Results:The majority of patients (92.9%) underwent surgical treatment, with IMN being the most frequently used modality (46.2%), followed by MIPO (30.8%) and external fixation (23%). Conservative management was employed in 7.1% of cases. At the 12-month follow-up, full weight-bearing was achieved in 83.3% of IMN, 80% of MIPO, and a variable proportion of external fixation patients. Radiological union with more than three cortices was observed in 90% of IMN and 75% of MIPO patients by 12 months. Overall, excellent-to-good functional outcomes were achieved in 78.6% of cases. Superficial and deep infections, as well as non-union, were more common with external fixation.Conclusion:IMN and MIPO demonstrated superior functional and radiological outcomes compared to external fixation and conservative methods. IMN, in particular, provided faster recovery with fewer complications, making it the preferred modality in appropriately selected cases.

Cementless Total Knee Arthroplasty Using an Ultraconforming Tibial Bearing: Outcomes at Minimum 5-Year Follow-Up.

Cementless fixation for primary total knee arthroplasty (TKA) continues to increase in the United States. However, compared to cemented TKA, reports on revision rates have been mixed. A confounding variable may include the tibial insert design. This study aimed to assess the minimum 5-year survivorship and outcomes of a cementless TKA using an ultracongruent (UC) articulation. A consecutive series of 242 cementless TKAs were implanted at two institutions between 2017 and 2019 using an UC kinematic tibial insert. Of the patients, 56% were men. The average age was 60 years. Patients were followed using Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and Knee Society clinical and radiographic scores. Preoperative and postoperative radiographs were classified according to the Coronal Plane Alignment of the Knee (CPAK) type. The average follow-up was 5.6 years (range, five to 7.5). At the final follow-up, KOOS-JR scores averaged 84.0. Knee Society scores averaged 94. Flexion averaged 116°. There were seven manipulations (2.9%), one patella fracture, and no deep infections. There were seven knees (2.9%) revised (three for flexion instability, one for pain, one for femoral fibrous ingrowth, one for distal femur fracture, and one for arthrofibrosis). At 5 years, survivorship free from aseptic loosening was 99.6%. Change in CPAK type did not correlate with final KOOS-JR, pain, University of California Los Angeles activity score, or satisfaction scores. Cementless TKA using this conforming design has provided excellent clinical results out to 5 years. Once initial component stability is achieved, the UC nature of this articulation does not appear to adversely influence the durability of implant fixation, regardless of whether the CPAK type was changed.

Chlorhexidine-alcohol versus Povidone-iodine plus Alcohol as Preoperative Antiseptic for Prevention of Surgical Site Infection in Caesarean Section: A Randomised Controlled Trial

Introduction: Caesarean Section (CS) is one of the most commonly performed surgical procedures worldwide, with its incidence steadily increasing. Surgical Site Infection (SSI) remains a significant complication, impacting maternal recovery and healthcare costs. Aim: To evaluate the efficacy of chlorhexidine-alcohol versus Povidone-Iodine (PI) plus alcohol in preventing SSI in patients undergoing CS. Materials and Methods: This Randomised Controlled Trial (RCT) was conducted in the Department of Obstetrics and Gynaecology from April 2024 to April 2025 at a tertiary care centre, Shri B.M. Patil Medical Hospital and Research Centre, Bijapur, Karnataka, India. A total of 208 pregnant women undergoing CS were enrolled and randomly assigned to two groups: Group A received preoperative skin preparation with chlorhexidine-alcohol, while Group B received PI followed by surgical spirit. Postoperative wound assessment was conducted on day 2, and wounds were cleaned and dressed using sterile Sterizone (a transparent film dressing with a silver lining). Follow-up inspections occurred on day 5, day 7, or at discharge whichever was later. In cases of wound discharge, swabs were sent for culture and sensitivity. Outcomes assessed included incidence of SSI, wound discharge, and need for additional interventions. Statistical analysis was conducted using John’s Macintosh Project (JMP)-Statistical Analysis System (SAS) software version 17. Continuous variables were compared using the independent t-test, and categorical data using the Chi-square test. A p-value&lt;0.05 was considered statistically significant. Results: The incidence of superficial SSI was significantly lower in the chlorhexidine group compared to the PI group (1.0% vs. 8.7%, p-value=0.018). Similarly, deep infections were less frequent in the chlorhexidine group (1.9% vs. 2.9%, p-value=0.018). There was no significant difference between groups regarding the types of organisms isolated (p=0.0966). Staphylococcus aureus was the most commonly isolated pathogen (1.9% in both groups). Conclusion: Chlorhexidine-alcohol demonstrated superior efficacy in reducing SSI compared to PI in patients undergoing CS. The present finding supports the use of chlorhexidinealcohol as the preferred preoperative antiseptic for caesarean deliveries.