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Potpourri
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
October 1999, Supplement 1 • Volume 15 • Number 7
• • • •
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Potpourri Abstracts These are the abstracts of the papers presented at the Second Biennial Meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Washington, DC, May 29June 3, 1999.
191. Short-Term Therapy With Cefonicid as Antibiotic Prophylaxis in Surgical Arthroscopy of the Knee. M. Benazzi A. Savarese G. Zanon B. Bertani
Potpourri
Purpose: This non comparative study (3 centers) evaluated the efficacy and tolerability of Cefonicid (CEF©DIE I. V-I.M. 1 g), a second generation cephalosporin, in pre-surgical antibiotic prophylaxis in surgical arthroscopy of the knee. Method: This study foresaw the enrollment of 884 evaluable, hospitalized, over 18 years old patients of both sexes (male: 636/72%; female: 248/28%), who had to undergo an intervention of surgical arthroscopy of the knee. Cefonicid was administered 1 g. I.V 1 hour before the intervention and 1 g. I. M. 6 hours after the intervention. The enrollment duration, for each center, was of 15 months from the http••••ww2•us•e•se•ierhea•th•c•m/inst/serve?se•••id=aar•15•7babs&action=searchDB&gr•up=P•tpourri
(1 of 4) [12113/2007 12:47:42 PM]
Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online
obtained of the local approval. Severe inclusion and exclusion criteria were adopted. Case report forms were completed at each visit. The clinical evaluation at 3, 10-12 and 20-40 days after intervention, in order to avoid different evaluation, had to be made by the same investigator for each patient. For the entire duration of the study, no concomitant administration of other systemic antibiotics is allowed. In case this happened, the patient was automatically excluded from the evaluation for protocol violation. Particular attention were paid in order to note all risk factors linked to the general clinical conditions of the patient as well as to the procedural conditions relevant to the arthroscopic intervention. Results: The study showed that only 2 patients presented a confirmed infection caused by S. Aureus after Cefonicid injections as antibiotic prophylaxis of the knee (0.2%). During the monitoring period of follow-up 3 patients at day 10-12 presented mild symptom of infection without microbiological confirmation of bacteriological infection (0.33%). Only 12 patients presented adverse experiences possibly related to Cefonicid (1.3%). These results confirmed that Cefonicid is efficacious, tolerable and is able to quickly reach prophylactically significant concentrations in the synovial fluid. Conclusion: Because of the low rate of infections and of adverse experiences, we considered the Cefonicid to have good efficacy and tolerability as antibiotic prophylaxis in the arthroscopic surgery of the knee. The "one-day administration" is very useful in this kind of "one-day surgery" and is not correlated to the compliance of the patient. Significance: The lack of studies performed in Italy, had led us to believe it useful to propose a protocol regarding short term pre-surgical antibiotic prophylaxis suitable for arthroscopic surgery of the knee.
193. Patient Satisfaction With Post Operative Pain Management After Major Orthopedic Surgery. Jonathan L. Schaffer, M.D. Mitchefl J. Ross, M.D. Fran Griffin, R.N. Joyce Levy, R.N., M.S., C.S Potpourri
Objective: Increasing attention has been given to the assessment of patient satisfaction as a way to monitor quality of care in hospital settings. Postoperative patient satisfaction has been thought to be related to level of pain intensity, expectation of outcome, perceived concern by the staff, helpfulness of treatments and absence of complications. Methods: A multidisciplinary team was formed to assess outcome of postoperative pain management within the hospital. A satisfaction questionnaire was developed and administered to 119 patients who had undergone total hip or knee arthroplasty surgery. Most of the patients were diagnosed with degenerative arthritis (63.3%) and reported moderate to severe preoperative pain (80.1%). Results: The 13-item measure was found to be reliable (test-retest r= .86; inter-examiner r= .98), valid (exploratory factor analysis; intercorrelations), and easy to administer. Results showed that most patients were satisfied with their care (91%), postoperative pain intensity (94%) and the way they were treated by the physicians and nurses (98%). Patients with low postoperative pain ratings who http://www2.us.elsevierhealth.com/inst/serve?se...id aar01507babs&action searchDB&group Potpourri (2 of 4) [12/13/2007 12:47:42 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
perceived that the physicians and nurses showed concern with how much pain they were feeling reported greatest satisfaction with their care (p < 0.001). Conclusion and Significance: In general, lower postoperative pain ratings were the best predictors of satisfaction and helpfulness of treatment. Interestingly, preoperative pain status, expected level of postoperative pain, and time waiting for pain medication after a request was made were not significantly correlated with ratings of postoperative pain or satisfaction. These results highlight the important influence of adequate treatment of postoperative pain and perceived concern by the hospital staff on patient satisfaction.
194. Clinical and A r t h r o s c o p i c A c c u r a c y in A n t e r i o r Cruciate L i g a m e n t of the Knee in Athletes. Is Necessary MRI For the Diagnosis?
Benigno Zenteno, M.D. Potpourri
Purpose: To demonstrate that with a complete and systematic physical examination by an experienced orthopedic surgeon, the ruptured anterior cruciate ligament of the knee in athletes can be consistently detected without the aid of sophisticated or expensive diagnostic tests as MRI. Method: From March 1987 to May 1996, a cohort, prospective longitudinal study was done, in 182 athletes. A complete history in addition with a thoroughly examination of the knee was perform. Only X rays were taken before arthroscopic surgery was done by the same Surgeon. Clinical and arthroscopic diagnosis were correlated. Results: One hundred and six patients were diagnosed clinically as a ruptured anterior cruciate ligament (ACL). Nine false negative cases were found, 7 false positive. The study demonstrated a sensitivity of 91%, specificity of 90%, positive predictive value of 93% and negative of 88%. Conclusion: And adequate clinical examination in an injured knee, provides consistently the diagnosis for a rupture of the anterior cruciate ligament of the knee in athletes. It is not necessary MRI for the diagnosis. Significance: The clinical diagnosis for a injury in the knee related to the ACL is reliable, without the aid of sophisticated or expensive additional tests.
195. The Effect of the Degree of A r t i c u l a r Degeneration on the Outcome of A r t h r o s c o p i c D e b r i d e m e n t of the Knee Joint.
Nandkumar Sundaram, F.R.C.S., M. Sc. (Orth.) T. Madhu, M.B.B.S., D.NB. Potpourri Aim: Arthroscopic debridement of the knee joint along with chondroplasty has been advocated as an effective modality for an early management of degenerative arthritis of the knee joint. This study presents a medium term follow up of up to 5 years in patients who had undergone arthroscopic
http://www2.us.elsevierhealth.com/inst/serve?se...id aarO1507babs&action searchDB&group Potpourri (3 of 4) [12/13/2007 12:47:42 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
debridement and chondroplasty. The effectiveness of the procedure is measured in this study by the functional evaluation of the patients. The results were evaluated to find the effect of various parameters on the effective outcome of the procedure. Method: The study is a prospective evaluation of 160 knee joints (136 patients) who had undergone arthroscopic debridement and chondroplasty. Patients in whom a clinical diagnosis of primary degenerative arthritis of the knee joint was made following clinical examination, along with a radiological evaluation, underwent the procedure. The patients were evaluated both preoperatively and postoperatively using the Lysholm II Score. The follow-up period ranged from 23 months to 61 months. The findings on arthroscopy were recorded and evaluated. The scores were graded as Excellent (81100), Good (71-80), Fair (61-70), Poor (60). Results: Out of the 160 knee joints evaluated for an average follow up of 39 months. 109 knees (74%) had excellent/Good results according to the Lysholm score. 51 Knees (26%) had a fair/poor outcome of the debridement. On evaluation of the degree of articular cartilage degeneration, it was revealed that among the 51 knee joints that had a poor outcome 32 knees showed Grade 4 (62.7%), 16 knees showed Grade 3 (31.4%) and 3 Knees (5.9%), showed Grade 2 changes in the articular cartilage. Thus the degree of articular degeneration was found to significantly effect the outcome of arthroscopic debridement of the knee joint. It was also found that other factors like the presence of associated loose bodies, meniscal and ligament injuries, the compartment involved, age, sex did not significantly effect the outcome of the above procedure. Conclusion: This study highlights the fact that arthroscopic debridement and chondroplasty tends to be more effective in patients in whom the articular cartilage has not undergone significant degeneration.
http://www2.us.elsevierhealth.com/inst/serve?se...id aarO1507babs&action searchDB&group Potpourri (4 of 4) [12/13/2007 12:47:42 PM]
October 1999, Supplement 1 • Volume 15 • Number 7
• • • •
Previous article in Issue Next article in Issue Drug links from Mosby's DrugConsult Genetic information from OMIM
<< Back to topic list
Potpourri Abstracts These are the abstracts of the papers presented at the Second Biennial Meeting of The International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Washington, DC, May 29June 3, 1999.
191. Short-Term Therapy With Cefonicid as Antibiotic Prophylaxis in Surgical Arthroscopy of the Knee. M. Benazzi A. Savarese G. Zanon B. Bertani
Potpourri
Purpose: This non comparative study (3 centers) evaluated the efficacy and tolerability of Cefonicid (CEF©DIE I. V-I.M. 1 g), a second generation cephalosporin, in pre-surgical antibiotic prophylaxis in surgical arthroscopy of the knee. Method: This study foresaw the enrollment of 884 evaluable, hospitalized, over 18 years old patients of both sexes (male: 636/72%; female: 248/28%), who had to undergo an intervention of surgical arthroscopy of the knee. Cefonicid was administered 1 g. I.V 1 hour before the intervention and 1 g. I. M. 6 hours after the intervention. The enrollment duration, for each center, was of 15 months from the http••••ww2•us•e•se•ierhea•th•c•m/inst/serve?se•••id=aar•15•7babs&action=searchDB&gr•up=P•tpourri
(1 of 4) [12113/2007 12:47:42 PM]
Arthroscopy: The Journal oi: Arthroscopic & Related Surgery Online
obtained of the local approval. Severe inclusion and exclusion criteria were adopted. Case report forms were completed at each visit. The clinical evaluation at 3, 10-12 and 20-40 days after intervention, in order to avoid different evaluation, had to be made by the same investigator for each patient. For the entire duration of the study, no concomitant administration of other systemic antibiotics is allowed. In case this happened, the patient was automatically excluded from the evaluation for protocol violation. Particular attention were paid in order to note all risk factors linked to the general clinical conditions of the patient as well as to the procedural conditions relevant to the arthroscopic intervention. Results: The study showed that only 2 patients presented a confirmed infection caused by S. Aureus after Cefonicid injections as antibiotic prophylaxis of the knee (0.2%). During the monitoring period of follow-up 3 patients at day 10-12 presented mild symptom of infection without microbiological confirmation of bacteriological infection (0.33%). Only 12 patients presented adverse experiences possibly related to Cefonicid (1.3%). These results confirmed that Cefonicid is efficacious, tolerable and is able to quickly reach prophylactically significant concentrations in the synovial fluid. Conclusion: Because of the low rate of infections and of adverse experiences, we considered the Cefonicid to have good efficacy and tolerability as antibiotic prophylaxis in the arthroscopic surgery of the knee. The "one-day administration" is very useful in this kind of "one-day surgery" and is not correlated to the compliance of the patient. Significance: The lack of studies performed in Italy, had led us to believe it useful to propose a protocol regarding short term pre-surgical antibiotic prophylaxis suitable for arthroscopic surgery of the knee.
193. Patient Satisfaction With Post Operative Pain Management After Major Orthopedic Surgery. Jonathan L. Schaffer, M.D. Mitchefl J. Ross, M.D. Fran Griffin, R.N. Joyce Levy, R.N., M.S., C.S Potpourri
Objective: Increasing attention has been given to the assessment of patient satisfaction as a way to monitor quality of care in hospital settings. Postoperative patient satisfaction has been thought to be related to level of pain intensity, expectation of outcome, perceived concern by the staff, helpfulness of treatments and absence of complications. Methods: A multidisciplinary team was formed to assess outcome of postoperative pain management within the hospital. A satisfaction questionnaire was developed and administered to 119 patients who had undergone total hip or knee arthroplasty surgery. Most of the patients were diagnosed with degenerative arthritis (63.3%) and reported moderate to severe preoperative pain (80.1%). Results: The 13-item measure was found to be reliable (test-retest r= .86; inter-examiner r= .98), valid (exploratory factor analysis; intercorrelations), and easy to administer. Results showed that most patients were satisfied with their care (91%), postoperative pain intensity (94%) and the way they were treated by the physicians and nurses (98%). Patients with low postoperative pain ratings who http://www2.us.elsevierhealth.com/inst/serve?se...id aar01507babs&action searchDB&group Potpourri (2 of 4) [12/13/2007 12:47:42 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
perceived that the physicians and nurses showed concern with how much pain they were feeling reported greatest satisfaction with their care (p < 0.001). Conclusion and Significance: In general, lower postoperative pain ratings were the best predictors of satisfaction and helpfulness of treatment. Interestingly, preoperative pain status, expected level of postoperative pain, and time waiting for pain medication after a request was made were not significantly correlated with ratings of postoperative pain or satisfaction. These results highlight the important influence of adequate treatment of postoperative pain and perceived concern by the hospital staff on patient satisfaction.
194. Clinical and A r t h r o s c o p i c A c c u r a c y in A n t e r i o r Cruciate L i g a m e n t of the Knee in Athletes. Is Necessary MRI For the Diagnosis?
Benigno Zenteno, M.D. Potpourri
Purpose: To demonstrate that with a complete and systematic physical examination by an experienced orthopedic surgeon, the ruptured anterior cruciate ligament of the knee in athletes can be consistently detected without the aid of sophisticated or expensive diagnostic tests as MRI. Method: From March 1987 to May 1996, a cohort, prospective longitudinal study was done, in 182 athletes. A complete history in addition with a thoroughly examination of the knee was perform. Only X rays were taken before arthroscopic surgery was done by the same Surgeon. Clinical and arthroscopic diagnosis were correlated. Results: One hundred and six patients were diagnosed clinically as a ruptured anterior cruciate ligament (ACL). Nine false negative cases were found, 7 false positive. The study demonstrated a sensitivity of 91%, specificity of 90%, positive predictive value of 93% and negative of 88%. Conclusion: And adequate clinical examination in an injured knee, provides consistently the diagnosis for a rupture of the anterior cruciate ligament of the knee in athletes. It is not necessary MRI for the diagnosis. Significance: The clinical diagnosis for a injury in the knee related to the ACL is reliable, without the aid of sophisticated or expensive additional tests.
195. The Effect of the Degree of A r t i c u l a r Degeneration on the Outcome of A r t h r o s c o p i c D e b r i d e m e n t of the Knee Joint.
Nandkumar Sundaram, F.R.C.S., M. Sc. (Orth.) T. Madhu, M.B.B.S., D.NB. Potpourri Aim: Arthroscopic debridement of the knee joint along with chondroplasty has been advocated as an effective modality for an early management of degenerative arthritis of the knee joint. This study presents a medium term follow up of up to 5 years in patients who had undergone arthroscopic
http://www2.us.elsevierhealth.com/inst/serve?se...id aarO1507babs&action searchDB&group Potpourri (3 of 4) [12/13/2007 12:47:42 PM]
Arthroscopy: The Journal of Arthroscopic & Related Surgery Online
debridement and chondroplasty. The effectiveness of the procedure is measured in this study by the functional evaluation of the patients. The results were evaluated to find the effect of various parameters on the effective outcome of the procedure. Method: The study is a prospective evaluation of 160 knee joints (136 patients) who had undergone arthroscopic debridement and chondroplasty. Patients in whom a clinical diagnosis of primary degenerative arthritis of the knee joint was made following clinical examination, along with a radiological evaluation, underwent the procedure. The patients were evaluated both preoperatively and postoperatively using the Lysholm II Score. The follow-up period ranged from 23 months to 61 months. The findings on arthroscopy were recorded and evaluated. The scores were graded as Excellent (81100), Good (71-80), Fair (61-70), Poor (60). Results: Out of the 160 knee joints evaluated for an average follow up of 39 months. 109 knees (74%) had excellent/Good results according to the Lysholm score. 51 Knees (26%) had a fair/poor outcome of the debridement. On evaluation of the degree of articular cartilage degeneration, it was revealed that among the 51 knee joints that had a poor outcome 32 knees showed Grade 4 (62.7%), 16 knees showed Grade 3 (31.4%) and 3 Knees (5.9%), showed Grade 2 changes in the articular cartilage. Thus the degree of articular degeneration was found to significantly effect the outcome of arthroscopic debridement of the knee joint. It was also found that other factors like the presence of associated loose bodies, meniscal and ligament injuries, the compartment involved, age, sex did not significantly effect the outcome of the above procedure. Conclusion: This study highlights the fact that arthroscopic debridement and chondroplasty tends to be more effective in patients in whom the articular cartilage has not undergone significant degeneration.
http://www2.us.elsevierhealth.com/inst/serve?se...id aarO1507babs&action searchDB&group Potpourri (4 of 4) [12/13/2007 12:47:42 PM]