| 1. |
- Sebastian, Sujeesh, et al.
(författare)
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Extended local release and improved bacterial eradication by adding rifampicin to a biphasic ceramic carrier containing gentamicin or vancomycin
- 2022
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Ingår i: Bone & joint research. - 2046-3758. ; 11:11, s. 787-802
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: There is a lack of biomaterial-based carriers for the local delivery of rifampicin (RIF), one of the cornerstone second defence antibiotics for bone infections. RIF is also known for causing rapid development of antibiotic resistance when given as monotherapy. This in vitro study evaluated a clinically used biphasic calcium sulphate/hydroxyapatite (CaS/HA) biomaterial as a carrier for dual delivery of RIF with vancomycin (VAN) or gentamicin (GEN).METHODS: The CaS/HA composites containing RIF/GEN/VAN, either alone or in combination, were first prepared and their injectability, setting time, and antibiotic elution profiles were assessed. Using a continuous disk diffusion assay, the antibacterial behaviour of the material was tested on both planktonic and biofilm-embedded forms of standard and clinical strains of Staphylococcus aureus for 28 days. Development of bacterial resistance to RIF was determined by exposing the biofilm-embedded bacteria continuously to released fractions of antibiotics from CaS/HA-antibiotic composites. RESULTS: Following the addition of RIF to CaS/HA-VAN/GEN, adequate injectability and setting of the CaS/HA composites were noted. Sustained release of RIF above the minimum inhibitory concentrations of S. aureus was observed until study endpoint (day 35). Only combinations of CaS/HA-VAN/GEN + RIF exhibited antibacterial and antibiofilm effects yielding no viable bacteria at study endpoint. The S. aureus strains developed resistance to RIF when biofilms were subjected to CaS/HA-RIF alone but not with CaS/HA-VAN/GEN + RIF. CONCLUSION: Our in vitro results indicate that biphasic CaS/HA loaded with VAN or GEN could be used as a carrier for RIF for local delivery in clinically demanding bone infections.Cite this article: Bone Joint Res 2022;11(11):787-802.
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| 2. |
- W-Dahl, Annette, et al.
(författare)
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Timing of preoperative antibiotics for knee arthroplasties : Improving the routines in Sweden
- 2011
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Ingår i: Patient Safety in Surgery. - : Springer Science and Business Media LLC. - 1754-9493. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: A slight increase in revisions for infected joint arthroplasties has been observed in the Nordic countries since 2000 for which the reasons are unclear. However, in 2007 a Swedish study of the timing for prophylactic antibiotics in a random sample of knee arthroplasties found that only 57% of the patients had received the antibiotic during the optimal time interval 45-15 minutes before surgery. The purpose of the report was to evaluate the effect of measures taken to improve the timing of prophylactic antibiotics.Findings: Reporting this finding to surgeons at national meetings during 2008 the Swedish Knee Arthroplasty Register (SKAR) introduced a new report form from January 2009 including the time for administration of preoperative antibiotics. Furthermore, the WHO's surgical checklist was introduced during 2009 and a national project was started to reduce infections in arthroplasty surgery (PRISS). The effect of these measures was found to be positive showing that in 2009, 69% of the 12,707 primary knee arthroplasties were reported to have received the prophylaxis within the 45-15 min time interval and 79% of the first 7,000 knee arthroplasties in 2010. A survey concerning the use of the WHO checklist at Swedish hospitals showed that 73 of 75 clinics had introduced a surgical checklist.Conclusions: By registration and bringing back information to surgeons on the state of infection prophylaxis in combination with the introduction of the WHO checklist and the preventive work done by the PRISS project, the timing of preoperative prophylactic antibiotics in knee arthroplasty surgery was clearly improved.
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| 3. |
- Yuan, X, et al.
(författare)
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Roentgen single-plane photogrammetric analysis (RSPA.) A new approach to the study of musculoskeletal movement.
- 2002
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Ingår i: Journal of Bone and Joint Surgery: British Volume. - 2044-5377 .- 0301-620X. ; 84:6, s. 908-914
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Tidskriftsartikel (refereegranskat)abstract
- We present a new approach for the accurate reconstruction of three-dimensional skeletal positions using roentgen single-plane photogrammetric analysis (RSPA). This technique uses a minimum of three markers embedded in each segment which allow continuous, real-time, internal skeletal movement to be measured from single-plane images, provided that the precise distance between the markers is known. A simulation study indicated that the error propagation in this approach is influenced by focus position, object position, the number of control points, the accuracy of the previous measurement of the distance between markers and the accuracy of image measurement. For reconstruction of normal movement of the knee with an input measurement error of SD = 0.02 mm, the rotational and translational differences between reconstructed and original movement were less than 0.27 degrees and 0.9 mm, respectively. Our results showed that the accuracy of RSPA is sufficient for the analysis of most movement of joints. This approach can be applied in combination with force measurements for dynamic studies of the musculoskeletal system.
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| 4. |
- Kjellson, Fred, et al.
(författare)
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Bone cement X-ray contrast media: A clinically relevant method of measuring their efficacy.
- 2004
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Ingår i: Journal of Biomedical Materials Research. Part B - Applied Biomaterials. - : Wiley. - 1552-4981 .- 1552-4973. ; 70B:2, s. 354-361
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Tidskriftsartikel (refereegranskat)abstract
- It is important to compare different contrast media used in bone cement according to their ability to attenuate X-rays and thereby produce image contrast between bone cement and its surroundings in clinical applications. The radiopacity of bone cement is often evaluated by making radiographs of cement in air at an X-ray tube voltage of 40 kV. We have developed a method for ranking contrast media in bone cement simulating the clinical situation, by (1) choosing the same X-ray tube voltage as used in clinical work, and (2) using a water phantom to imitate the effects of the patients' soft tissue on the X-ray photons. In clinical work it is desirable to have low radiation dose, but high image contrast. The voltage chosen is a compromise, because both dose and image contrast decrease with higher voltage. Three contrast media (ZrO2, BaSO4, and Iodixanol) have been compared for degree of "image contrast." Comparing 10 wt % contrast media samples at an X-ray tube voltage of 40 kV, ZrO2 produced higher image contrast than the other media. However, at 80 kV, using a water phantom, the results were reversed, ZrO2 produced lower image contrast than both BaSO4 and Iodixanol. We conclude that evaluations of contrast media should be made with voltages and phantoms imitating the clinical application. (C) 2004 Wiley Periodicals, Inc.
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| 5. |
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| 6. |
- Löfvendahl, Sofia, et al.
(författare)
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Rörelseorganens sjukdomar
- 2007
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Ingår i: Läkartidningen. - 0023-7205. ; 104:19, s. 1490-1491
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Tidskriftsartikel (refereegranskat)abstract
- Well-functioning data registration systems require high competence both in the technical systems used for handling data and in the statistical methodology used for analysis. Consequently, The Swedish Association of Local Authorities and Regions and The National Board of Health and Welfare started the Swedish National Competence Centre for Musculoskeletal disorders, with the purpose for this institution to act as a support centre for quality registration in orthopaedic health care. For health care to be comparable nationwide, a consensus in the choice of treatment for each disorder is required. However, since significant variation in the frequency of elective surgical and non-surgical treatments can be seen between both clinics and different geographical areas, this does not seem to be the case. Groups from the orthopedic profession have therefore, together with NKO, developed evidence based guidelines for the treatment of hip and knee joint osteoarthritis, disc herniation, spinal stenosis, back pain, meniscus lesions, cruciate ligament injuries and also for shoulder and foot disorders. In addition NKO has developed methodology for the assessment of disease severity in patients receiving hip and knee joint arthroplasty. Knowledge of the current indications for hip and knee joint arthroplasty is essential in trying to explain regional differences in the choice of treatment.
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| 7. |
- Alonso-Vazquez, A, et al.
(författare)
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Initial stability of ankle arthrodesis with three-screw fixation. A finite element analysis
- 2004
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Ingår i: Clinical Biomechanics. - : Elsevier BV. - 0268-0033. ; 19:7, s. 751-759
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Compare the initial stability at the fusion site of ankle arthrodesis fixed with two and three screws. Design. Finite element models of ankle arthrodesis were developed from computed tomography images. Two-screw constructs were augmented with a third screw in different orientations and Subjected to loads likely to affect the ankle postoperatively. Background More stable fixation seems to increase the chance of fusion, as it minimises the motion between the tibiotalar interfaces. Methods. Non-linear elastic finite element analyses were performed in external torsion and dorsiflexion. The micromotions at the tibiotalar interface were computed to compare the two- and three-screw fixation in intact and flat-cut arthrodesis. Results. Adding a third screw reduced the micromotions at the fusion site. Inserting the third screw anteriorly predicted lower peak micromotions than inserting the screw posteriorly, except for the intact arthrodesis tested in dorsiflexion. Three-screw intact arthrodesis predicted lower peak micromotions than flat-cut arthrodesis. Conclusions. Better stability was predicted for three-screw ankle arthrodesis. In flat-cut arthrodesis, a third screw inserted anteriorly performed better than a posterior screw. In intact arthrodesis, a posterior screw seemed a better option when flexion stability was the main concern. Even with three-screw fixation, the configuration of the first two-crossed screws may still be important to improve the stability at the fusion site. Relevance The optimal number and placement of screws in ankle arthrodesis has yet to be determined. The differences in stability predicted between various screw configurations and Surface preparation techniques presented here may be the difference between success and failure. (C) 2004 Elsevier Ltd. All rights reserved.
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| 8. |
- Alonso-Vazquez, A, et al.
(författare)
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The effect of bone quality on the stability of ankle arthrodesis. A finite element study
- 2004
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Ingår i: Foot & Ankle International. - 1944-7876. ; 25:11, s. 840-850
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite uniform operating techniques, lack of fusion still occurs after ankle arthrodesis. Differences in the biological healing potential may be a factor but the mechanical performance of the arthrodesis construct because of varying bone quality also may be important. Internal compression techniques are preferred because of higher union rates, shorter fusion times, and fewer complications. A three-screw configuration has been shown to be more stable than a two-screw configuration, but it is not obvious when it should be used. Methods: Three-dimensional finite element models of intact and flat-cut ankle arthrodeses were built, using two and three screws in different configurations. Poor bone quality was simulated by decreasing Young's modulus of the bone. The constructs were loaded in torsion and dorsiflexion, and micromotions at the fusion site were measured. Results: Bone quality had a marked effect on the stability at the arthrodesis site. Inserting two screws at 30 degrees relative to the longitudinal axis of the tibia in an intact arthrodesis seemed the best option, especially as bone quality worsened. The addition of a third screw increased the stability at the arthrodesis site. Conclusions: Overall, intact joint surfaces and three-screw fixation, with the lateral and medial screws inserted produced the most stable arthrodesis constructs when bone quality was poor. Clinical Relevance. Ankle arthrodeses are technically demanding because of the shape and small size of the talus. Preoperative planning is an absolute necessity to determine placement and number of screws. This study shows that poor bone quality decreases the stability of the arthrodesis constructs, suggesting that an attempt should be made to create the most stable three-screw configuration. Finite element models can be used as an effective preoperative tool for planning screw number and placement.
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