Author : Mohamed Abdo Khalafallah 

Periprosthetic joint infection is a serious complication that can occur following joint replacement surgeries, posing significant challenges to patients and healthcare providers. To mitigate the risk of infection and improve patient outcomes, it is essential to implement comprehensive prevention strategies throughout the perioperative period. This article explores the various methods and protocols available for preventing periprosthetic joint infection, focusing on preoperative, intraoperative, and postoperative management. By understanding and implementing effective infection control measures, healthcare professionals can help reduce the incidence of this debilitating complication and enhance the success of joint replacement procedures. Our goal is to provide the most up-to-date and accurate recommendations based on the latest scientific research findings.  

Before initiating any surgical procedures
 It is crucial to implement key strategies to prevent infections in the operating room. One of the primary strategies is conducting a thorough Risk Assessment and Patient Selection process to ensure that only suitable candidates undergo surgery, thereby reducing the risk of infections. Additionally, practices such as Bacterial Decolonization, Preoperative skin Preparation for both the patient and surgeon, administration of Prophylactic Antibiotics, and the use of Antibiotic-loaded bone cement can further enhance infection prevention measures. By incorporating these strategies into our surgical protocols, we can significantly reduce the likelihood of post-operative infections and promote better patient outcomes. 

In the operating room
There are several management processes that must be carefully considered. These include hair removal, draping, the use of surgical gloves and gowns, anesthesia administration, conservation practices, the duration of the operation, managing operating room traffic, ensuring the availability and proper use of medical equipment and implants, maintaining a sterile operating room environment, and properly closing wounds and applying surgical dressings. It is crucial to meticulously oversee each of these processes to ensure the safety and success of surgical procedures. 

 Educating patients about postoperative care instructions and warning signs of infection is crucial for early detection and intervention. By empowering patients to recognize symptoms such as increased pain, swelling, or fever, healthcare providers can address potential infections promptly and prevent complications. Long-term monitoring and rehabilitation plans are essential components of postoperative care for joint replacement patients. Regular follow-up appointments allow healthcare providers to assess healing progress, monitor for signs of infection, and guide patients through rehabilitation exercises to promote optimal recovery and joint function. 

 By adhering to best practices in preoperative assessment, intraoperative infection control, and postoperative management, healthcare providers can significantly reduce the risk of infection and promote better patient outcomes. Continued research and advancements in infection prevention techniques will further enhance the quality of care provided to patients undergoing joint replacement procedures. By prioritizing infection prevention strategies, healthcare professionals can contribute to the overall success and longevity of joint replacements, ultimately improving the quality of life for individuals with prosthetic joints.  

Author : Mohamed Abdo Khalafallah 

Shoulder injuries, particularly those involving the rotator cuff, can significantly impact an individual’s quality of life and ability to perform daily activities. Two surgical approaches commonly used to address these injuries are Superior Capsular Reconstruction and Partial Repair. By examining each approach’s effectiveness and considerations, readers can better understand which treatment option may be most suitable for managing shoulder injuries. Our goal is to conduct a systematic review and meta-analysis of the existing evidence to compare the clinical and functional outcomes between the two procedures, such as constant shoulder score, disabilities of the arm, shoulder, and hand, acromiohumeral distance, re-operation rate, forward flexion, and VAS score. 

Superior capsular reconstruction involves using a graft to replace the damaged superior capsule, providing stability and support to the shoulder joint. In Partial repair, the surgeon repairs only part of the torn rotator cuff, aiming to restore function and reduce pain. 

In shoulder injuries, the decision between superior capsular reconstruction and partial repair can be challenging. In conclusion, the decision between Superior Capsular Reconstruction and Partial Repair for shoulder injuries is a critical one that should be made in consultation with a healthcare provider. Both techniques offer unique benefits and considerations, and understanding the differences in surgical approaches, outcomes, and rehabilitation protocols is crucial for achieving optimal recovery and long-term shoulder function. Ultimately, the choice of treatment should be tailored to the individual patient’s specific condition and goals, ensuring the best possible outcome for their shoulder injury management. 

Author : Lukas Ernstbrunner

Hypothesis: Is salvage reverse total shoulder arthroplasty (RTSA) a justifiable treatment for failed operative treatment (open reduction-internal fixation [ORIF] or primary and secondary hemiarthroplasty) of proximal humeral fractures in patients younger than 60 years? Methods: Thirty patients (mean age, 52 years; age range, 30-59 years) were reviewed after a mean follow-up period of 11 years (range, 8-18 years). Of the patients, 7 (23%) underwent RTSA for failed ORIF and 23 (77%) for failed hemiarthroplasty. Clinical and radiographic outcomes were assessed longitudinally. Results: At final follow-up, the mean relative Constant score had improved from 25% (±12%) to 58% (±21%, P < .001). Significant improvements were seen in the mean Subjective Shoulder Value (20% to 56%), active elevation (45° to 106°), abduction (42° to 99°), pain scores, and strength (P < .001). Clinical outcomes did not significantly deteriorate over a period of 10 years. Patients with salvage RTSA for failed secondary hemiarthroplasty (n = 8) vs. those for failed ORIF (n = 6) showed significantly inferior active abduction (77° vs. 116°, P = .023). Patients with a healed greater tuberosity (n = 9) showed significantly better external rotation than patients with a resorbed/resected greater tuberosity (n = 13, 21° vs. 3°, P = .025). One or more complications occurred in 18 shoulders (60%), and 6 (20%) resulted in explantation of the RTSA. Conclusions: Salvage RTSA in patients younger than 60 years is associated with a high complication rate. It leads nonetheless to substantial and durable improvement beyond 10 years, provided the complications can be handled with implant retention. Inferior shoulder function is associated with greater tuberosity resorption or resection and inferior overhead elevation with the diagnosis of failed hemiarthroplast

Author : Anshul Sobt

Purpose:
COVID-19 pandemic has created havoc all over the globe and spared no oneregardless of status, gender, location and ethnicity. There were questions raised if traumaand orthopaedic (T&O) procedures actually generated aerosols? The need for a review ofliterature highlighting the nature and impact of aerosol generation within T&O surgery wasnoted.
Methods:
A comprehensive online search was performed for all published articles in theEnglish language, evaluating AGPs in T&O surgery and the relevant personal protectionequipment used.Results: The search strategy populated 43 studies.
Six studies were identified as duplicates.The shortlisted 37 studies were screened and nine studies were included in the review. Anadditional four studies were included from the bibliography review.Conclusion: Most orthopaedic procedures are high-risk aerosol generating procedures(AGPs).
Conventional surgical masks do not offer protection against high-risk AGPs.
In thecurrent era of COVID-19 pandemic, there is a significant risk to the transmission ofinfection to the theatre staff.
For protection against airborne transmission, appropriatemasks should be used.
These need proper fitting and sizing to ensure full protection whenused.

Author : Mohamed A. Imam

Background:
The trial aimed to prospectively compare the functional outcome of patients undergoing arthroscopic rotator cuff repair using Transosseous-Equivalent Double-Row (TEDR) or single-raw (SR) suture anchor techniques at three years postoperatively for both large (over 3cm) and small (under 3cm) tears.
Methods:
Eighty patients with a symptomatic and MRI proven full-thickness RC tear, who had failed conservative management of at least 6 months duration and who had a complete passive range of motion of the affected shoulder were enrolled in the trial.
Patients were randomized to TEDR repair (n=40) or SR repair (n=40).
Subgroup analysis was conducted for tears < 3 cm (TEDR n = 17, SR n=19) and tears > 3 cm (TEDR n=23, SR n=21).
Primary outcomes included the Oxford Shoulder Score (OSS), the University of California, Los Angeles score (UCLA), and the Constant-Murley Outcome Score (CMS).
The secondary outcomes included a 0-100 mm Visual Analogue Scale (VAS) for pain, range of motion (ROM) and EQ-5D.
All patients completed a follow-up period of three years.
Results:
There was a significant difference in the mean OSS postoperative score for tears >3cm (p=0.01) and mean improvement from baseline in the TEDR group (p=0.001).
For tears >3cm, mean postoperative scores were also significantly higher in the TEDR group for UCLA (p=0.015) and CMS (p=0.001).
Post Hoc testing showed that the differences between these groups was statistically significant (p<0.05).
For tears <3cm, a significant postoperative difference in favor of SR repair was seen with mean CMS (p=0.011), and post hoc testing showed that the difference was statistically significant (p=0.015).
No significant difference was seen with mean postoperative OSS or UCLA and post hoc testing did not show a statistically significant difference between groups.
Conclusions:
TEDR repair showed improved functional outcomes for tears greater than 3cm when compared to SR repair.
For tears less than 3cm, no clear benefit was seen with either technique.
Level of evidence Level I; Randomized Controlled Trial; Treatment Study