prevention

Background

Issues

 

Host

Wound

Operating room environment

Antibiotics

Operative technique

Post operative

 

Host

 

Immunocompromised

RA (0.9 v 2.2%)

Psoriasis

DM (6%)

Poor nutrition

Obesity

UTI

Prednisone

Previous operation

Previous infection

Age

Wound Problems

TKR Wound ComplicationIncidence

 

10 -15%

 

Include

- marginal necrosis

- wound slough

- sinus tract formation

- dehiscence

- haematoma

- oozing knee wound

 

Blood supply

 

Anterior knee has no muscles to supply vessels directly 

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

Myositis Ossificans

Definition

 

Pathological bone formation in soft tissues

 

Epidemiology

 

In elbow

- 3% of trauma

- 89% if head injury + trauma

 

Types

 

Completely different

 

1.  Myosisitis Ossificans Circumscripta

- post traumatic

- more common

- recognised as a consequence of neurological injury

 

DVT Prevention

 

ANZ Working Party on the Management and Prevention of Venous Thromboembolism 2007

 

Note

 

Top 6 conditions associated with DVT

- stroke

- THR

- multi trauma

- TKR

- hip fracture

- spinal cord injury

 

Not one of the 12 doctors was an orthopaedic surgeon

 

Agents

 

Heparin / LMWH / fondaparinux

- confirmed effectiveness

 

Tetanus

 

Definition

 

Acute disease

- characterised by generalized rigidity & convulsions

- caused by exotoxins/neurotoxins produced in Clostridia Tetani infections

 

Epidemiology

 

Annual world mortality is 1 million

 

West 15-100/year

 

Aetiology / Pathology

 

Clostridium Tetani

- anaerobic

- spore-bearing Gram positive Bacillus