Browsing by Author "Putnis, Sven"
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Item International Survey of Practice for Prophylactic Systemic Antibiotic Therapy in Hip and Knee Arthroplasty(2022) Parsons, Thomas; French, Jonathan; Oshima, Takeshi; Figueroa, Francisco; Neri, Thomas; Klasan, Antonio; Putnis, Sven(1) Background: Prophylactic systemic antibiotics are acknowledged to be an important part of mitigating prosthetic joint infections. Controversy persists regarding optimal antibiotic regimes. We sought to evaluate current international antibiotics guidelines for total joint arthroplasty (TJA) of the hip and knee. (2) Methods: 42 arthroplasty societies across 6 continents were contacted and their published literature reviewed. (3) Results: 17 societies had guidelines; of which 11 recommended an antibiotic agent or antibiotic class (10—cephalosporin; 1—cloxacillin); 15 recommended antibiotic infusion within an hour of incision and 10 advised for post-operative doses (8—up to 24 h; 1—up to 36 h; 1—up to 48 h). (4) Conclusions: Prophylactic antibiotic guidelines for TJA are often absent or heterogenous in their advice.Item Navigation in anterior cruciate ligament reconstruction: State of the art(2023) Figueroa, Francisco; Figueroa, David; Guiloff, Rodrigo; Putnis, Sven; Fritsch, Brett; Itriago, MinervaComputer navigation (CN) for anterior cruciate ligament (ACL) surgery has been used mainly for two purposes: to enhance the accuracy of tunnel position and to evaluate the kinematics of the ACL reconstruction (ACLR) and the stability achieved bydifferent surgical techniques.Many studies have shownthatnavigationmay improve the accuracy of anatomical tunnel orientation and position during ACL reconstructive surgery compared with normal arthroscopic tunnel placement, especially regarding the femoral side. At the same time, it has become the gold-standardmethod for intraoperative knee kinematic assessment, as it permits a quantitative multidirectional knee joint laxity evaluation. CN in ACL surgery has been associated with diverse problems. First, in most optic systems additional skin incisions and drill holes in the femoral bone are required for fixation of a reference frame to the femur. Second, additional radiation exposure and extra medical cost to the patient for preoperative planning are usually needed. Third, CN, due to additional steps, has more opportunities for error during preoperative planning, intraoperative registration, and operation. Fourth, soft tissues, including the skin and subcutaneous tissues, are usually not considered during the preoperative planning, which can be a problem for kinematic and stability assessment. Many studies have concluded that ACLR using a CN system is more expensive than conventional surgery, it adds extra time to the surgery and it is not mitigated by better clinical outcomes. This, combined with costs and invasiveness, has limited the use of CN to research-related cases. Future technology should prioritize less invasive intra-operative surgical navigationItem Posterolateral corner knee injuries: a narrative review(2021) Figueroa, Francisco; Figueroa, David; Putnis, Sven; Guiloff, Rodrigo; Caro, Patricio; Espregueira-Mendes, João; Clinica Alemana-Universidad del Desarrollo, Santiago, ChileLimited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis.Item Trends in Total Knee Arthroplasty in a Developing Region: A Survey of Latin American Orthopaedic Surgeons(2020-03) Figueroa, David; Figueroa, Francisco; Calvo, Rafael; Vaisman, Alex; Figueroa, María; Putnis, SvenIntroduction: A number of different total knee arthroplasty techniques are available. There is also a degree of surgeon preference for these, and the variation across orthopaedic surgeons in Latin America is currently unknown. Methods: A survey on members of Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte was performed, with questions based on categories within worldwide national joint registries. In total, 315 Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte members received the survey via e-mail, and the return answers were compared with the latest worldwide national joint registry annual reports. Results: The survey was completed in full by 262 surgeons (83%). It was answered that 19% of surgeons perform less than 10 total knee arthroplasties per year, 54% perform less than 30, and only 9% perform more than 100. Seventy-three percent of surgeons use a posterior stabilized total knee replacement, 18% use a cruciate retaining total knee replacement, and 9% use a medial pivot design. Forty-nine percent of surgeons resurface the patella, 27% never resurface it, and 24% choose to resurface it based on an individual case scenario. Ninety-eight percent of surgeons use cemented fixation in the femur and tibia, with the remaining 2% choosing hybrid fixation and 1% using fully noncemented fixation. Conclusion: This survey among Latin American surgeons has demonstrated important differences in surgical technique and implants choice compared with worldwide national registries.Item Vancomycin Presoaking of Hamstring Autografts in Anterior Cruciate Ligament Reconstruction Is Associated With Higher Magnetic Resonance Imaging Graft Signal Without Influencing Clinical Outcome(2021) Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Nuñez, Marilaura; Serrano, Gonzalo; Barrera, Javier; Putnis, SvenTo present the clinical and imaging results of a series of patients undergoing anterior cruciate ligament reconstruction with vancomycin presoaking of the hamstring autograft compared with patients in the immediate period prior, when no vancomycin was used.Item Vancomycin Presoaking of the Graft Appears to Prevent Infection After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis(2021) Figueroa, Francisco; Figueroa, David; Calvo, Rafael; Vaisman, Alex; Núñez, Marilaura; Putnis, SvenBackground: Vancomycin presoaking of the graft has been shown to decrease infection rates in some case series of anterior cruciate ligament (ACL) reconstruction. Purpose: We sought to substantiate the efficacy of vancomycin presoaked grafts for the prevention of infection after ACL reconstruction. Methods: We performed a systematic review of Medline and OVID to assess the incidence of postoperative infection in studies comparing patients undergoing ACL reconstruction with the use of vancomycin presoaked ACL grafts and a control group of patients undergoing ACL reconstruction without the use of presoaked grafts. The efficacy of vancomycin presoaking was calculated using the Agresti-Coull confidence interval. Relative risk (RR) was calculated for every study and the total sample. Results: The 11 studies that met inclusion criteria comprised 24,298 patients. In patients with vancomycin presoaking of the graft, 1 infection was reported in 8764 cases (0.01% rate). In the studies with control groups that did not have vancomycin presoaked grafts, there were 125 infections in 15,534 ACL reconstructions (0.8% rate). The efficacy of vancomycin presoaking in preventing infection after ACL reconstruction was 99.9% (0.999%–1.000% CI). The overall RR obtained was 0.07 (0.03–0.16 CI). All included studies were retrospective cohort studies (level III). Conclusions: Vancomycin presoaking of the graft has been shown to decrease infection rates after ACL reconstruction in studies of low evidence level. This suggests the need for prospective randomized controlled trials addressing this issue so that recommendations on the routine use of vancomycin presoaking of ACL grafts can be made with confidence.