Publications by authors named "Olivier Cornu"

54 Publications

Influence of outpatient total knee arthroplasty compared to inpatient surgery on medical and economic outcomes.

Acta Orthop Belg 2021 Mar;87(1):103-109

Firstly, this study compared the rate of readmission after a total knee arthroplasty between selected out- patients (no hospitalization, directly sent home after surgery) and inpatients (3 days hospitalization) at 6 weeks. Secondly, it examined the mobility and the complications in the two groups after the same period of time. The rate of readmission, complications and knee mobility of 32 outpatients (M-age : 61 years ± 10 ; 10 females), were compared against those of 32 birth- matched inpatients (M-age : 64 years ± 8.6 ; 10 females). No patient was re-admitted in either group. Post- surgical complications included one hematoma resorbed at 6 weeks in the outpatient group and three joint effusions in the inpatient group. There were no instances of deep venous thrombosis, failure of primary fixation, infection, or wound dehiscence. Knee mobility was identical between the two groups. This is the first study to compare inpatient and outpatient total knee arthroplasty in a Belgian setting. Our study suggests that day-care total knee arthroplasty in selected patients is possible without increasing the rate of re-admission and complications, and without affecting the mobility at 6 weeks. However, the Belgian financial incentives do not seem to currently promote this surgical approach. These results should be confirmed with a larger sample to define the adequate length of stay after a total knee arthroplasty.
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March 2021

Treatment of open tibia fractures in Sub-Saharan African countries : a systematic review.

Acta Orthop Belg 2021 Mar;87(1):85-92

Open tibia fracture (OTF) treatment is well documented in developed countries. Yet, this fracture pattern remains challenging because it is associated with an increased risk of infection and delayed union, particularly in case of Gustilo III B and C open fractures. Since access to healthcare is limited in Sub- Saharan African countries, this paper explores the results of OTF management in this setting. A systematic review of the literature was conducted using current databases such as MEDLINE, Cochrane, EMBASE, PubMed, ScienceDirect, Scopus, and Google Scholar in order to identify prospective studies with cohorts of patients treated for OTF. Studies were included based on predefined inclusion and exclusion criteria. The quality of studies was analyzed by the Coleman Methodology Score (CMS). Eight papers met the inclusion criteria and had an average CMS of 70 (range 54-73). The most common treatment was non-operative management of the fracture with cast immobilization (67%). Gustilo Type II and III fractures were associated with a higher risk of complications. The infection rate was 30%. Malunion, chronic osteomyelitis and nonunion were observed in 14.5%, 12.3%, and 7% of the cases, respectively. More complications were observed with non-operative treatment (cast immobilization) than with surgical fixation. Although the surgical environment does not allow for internal fixation, poor results of non-operative management of open fractures should lead to the introduction of trainings on the proper use of external fixators. It is also advisable to support the development of locally produced external devices that utilize local source materials, which would make external fixation available at a reasonable cost.
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March 2021

Debridement, antibiotics, irrigation and retention in prosthetic joint infection : predictive tools of failure.

Acta Orthop Belg 2020 Dec;86(4):636-643

Debridement, antibiotic, irrigation and retention of the implant (DAIR) is an attractive treatment for periprosthetic joint infection (PJI). The purpose of this study is to determine predictive factors of failure. We reviewed all DAIR procedures for hip PJI performed between 2002-2017 (n=69). Data recorded included all factors correlated with treatment failure. KLIC score, McPherson adapted score were analyzed. Infection eradication for early PJI (< 4 weeks) was achieved in 68% of patients and was correlated with treatment success (p=0.01). KLIC score (p=0.036), McPherson adapted score (p=0.01), CRP (p=0.025) and late PJI (p=0.031) were significantly predictive of failure treatment. We have established an equation in order to predict failure treatment that has to be validated. DAIR is an effective treatment for early PJI. KLIC score and McPherson adapted score are two ways to predict outcome of a DAIR procedure and should help making the decision in PJI treatment.
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December 2020

A Comparison of Genicular Nerve Blockade With Corticosteroids Using Either Classical Anatomical Targets vs Revised Targets for Pain and Function in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.

Pain Med 2021 05;22(5):1116-1126

Neuro-Musculo-Skeletal pole (NMSK) - Experimental and clinical research institute (IREC), Université catholique de Louvain (UCLouvain), Brussels, Belgium.

Objective: Compare the effectiveness of genicular nerve blockade (GNB) using classical anatomical targets (CT) versus revised targets (RT) in patients suffering from chronic knee osteoarthritis pain.

Design: Double-blinded randomized controlled trial.

Setting: Pain medicine center of a teaching hospital.

Methods: We randomly assigned 55 patients with chronic knee osteoarthritis pain to receive a GNB (using a fluid mixture of 2 mL: lidocaine 1% + 20 mg triamcinolone) with either classical targets (CT-group, n = 28) or revised targets (RT-group, n = 27). Numeric rating pain scale (NRS), Oxford knee score (OKS), Western Ontario and McMaster Universities osteoarthritis index score (WOMAC), Quantitative analgesic questionnaire (QAQ) and global perceived effects were assessed at baseline, and at 1-hour, 24-hours, 1, 4, and 12 weeks post-intervention.

Results: The RT-group showed greater reduction in NRS mean score at 1-hour post-intervention (2.4 ± 2.1 vs 0.4 ± 0.9, 95% confidence interval (CI) [.0-.8] vs [1.6-3.2], P < .001). The proportion of patients achieving more than 50% knee pain reduction was higher in the RT-group at each follow up interval, yet these differences were statistically significant only at 1-hour post intervention (82.1% [95% CI = 63.1-93.9] vs 100% [95% CI = 97.2-100] P = .02). Both protocols resulted in significant pain reduction and joint function improvement up to 12 weeks post-intervention.

Conclusions: The revised technique allowed more pain relief as well as greater proportion of successful responders at 1-hour post intervention. The large volume injected during therapeutic GNB could have compensated the lack of precision of the classical anatomical targets, mitigating differences in outcomes between both techniques.
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http://dx.doi.org/10.1093/pm/pnab014DOI Listing
May 2021

Frequency and risk factors of complications after surgical treatment of ankle fractures : a retrospective study of 433 patients.

Acta Orthop Belg 2020 Sep;86(3):563-574

Ankle fractures are frequently treated using surgical interventions, and are associated with a high rate of postoperative complications. We wonder if complications can be anticipated and correlated to patient demographics, lifestyle, fracture or surgery related factors. We retrospectively reviewed all medical reports of patients who underwent ankle fracture surgery between 2013 and 2017. We focused our risks factors analysis on 5 common complications : poor wound healing, surgical site infection, malunion, nonunion and chronic pain. Multivariate logistic regression was performed to analyze significant risk factors for these complications. We identified 433 patients. Complications were present in 26% of the cases. The most frequent complication was poor wound healing (10%) associated with deep surgical site infection in 6%. Malunion was found in 7% and nonunion in 3%. Seven percent of patients suffered from chronic pain. More severe fractures happened to be a risk factor for poor wound healing (p = 0,032) and malunion (p < 0,001). Open fractures had respectively 6 to 9 times more mal- (p = 0,012) and nonunion (p = 0,018). Overweight patients with alcohol abuse were doubling their chances of cutaneous (p = 0,030) and infectious (p = 0,040) complications, and tripling their risks of ankle fracture nonunion (p = 0,003). Female and patients operated at night (p = 0,045) seemed to be more at risk to develop chronic pain (p = 0,028). Complications of ankle fracture treatment are frequent and their risks increases with more complex and open fractures. This study brings new evidence concerning the combined effect of overweight and alcohol abuse on poor wound healing, surgical site infection and non-union.
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September 2020

Study of the Synergistic Effect of an Enzyme Cocktail and Antibiotics against Biofilms in a Prosthetic Joint Infection Model.

Antimicrob Agents Chemother 2021 03 18;65(4). Epub 2021 Mar 18.

Université catholique de Louvain, Louvain Drug Research Institute, Pharmacologie cellulaire et moléculaire, Brussels, Belgium

Prosthetic joint infections (PJI) are frequent complications of arthroplasties. Their treatment is made complex by the rapid formation of bacterial biofilms, limiting the effectiveness of antibiotic therapy. In this study, we explore the effect of a tri-enzymatic cocktail (TEC) consisting of an endo-1,4-β-d-glucanase, a β-1,6-hexosaminidase, and an RNA/DNA nonspecific endonuclease combined with antibiotics of different classes against biofilms of , , and grown on Ti-6Al-4V substrates. Biofilms were grown in Trypticase soy broth (TSB) with 10 g/liter glucose and 20 g/liter NaCl (TGN). Mature biofilms were assigned to a control group or treated with the TEC for 30 min and then either analyzed or reincubated for 24 h in TGN or TGN with antibiotics. The cytotoxicity of the TEC was assayed against MG-63 osteoblasts, primary murine fibroblasts, and J-774 macrophages using the lactate dehydrogenase (LDH) release test. The TEC dispersed 80.3 to 95.2% of the biofilms' biomass after 30 min. The reincubation of the treated biofilms with antibiotics resulted in a synergistic reduction of the total culturable bacterial count (CFU) compared to that of biofilms treated with antibiotics alone in the three tested species (additional reduction from 2 to more than 3 log CFU). No toxicity of the TEC was observed against the tested cell lines after 24 h of incubation. The combination of pretreatment with TEC followed by 24 h of incubation with antibiotics had a synergistic effect against biofilms of , , and Further studies should assess the potential of the TEC as an adjuvant therapy in models of PJI.
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http://dx.doi.org/10.1128/AAC.01699-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097427PMC
March 2021

Can infection be predicted after intramedullary nailing of tibial shaft fractures?

Acta Orthop Belg 2020 Jun;86(2):313-319

Despite the progress in tibial fracture care, some patients contract infection following intramedullary nailing. We analyzed which risk factors could predict infection in 171 tibial fractures. The independent variables included age, gender, body mass index, and comorbidities, along with external factors of fracture pattern, nailing settings, and treatment processing time. A multiple logistic regression was used to identify infection risk factors. The risk of infection significantly increased according to the open grading, the fractures' classification, time until antibiotic administration, and time until nailing. Gustilo type I fractures presented a higher rate of infection than expected, explained by a longer delay before surgery. The probabilistic equation allows infection prediction with high sensitivity and specificity. In total, we showed that no antibiotics' prescription in emergency service and a transverse fracture pattern were predictors of infection. An infection risk score can be computed, aiding surgeons in decision making. Outcomes could improve keeping these observations in mind. Level of evidence: Retrospective cohort study. Level iii.
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June 2020

Delayed total hip arthroplasty infection with Mycobacterium Tuberculosis complex.

Acta Orthop Belg 2020 Jun;86(2):249-252

Total Hip Arthroplasty (THA) joint infection is an uncommon (0,3-1,7%) (20) but devastating complication after THA. While mostly caused by Gram-positive bacteria, with staphylococci and streptococci accounting for up to 76% of cases (21), orthopaedic surgeons are sometimes faced with atypical germs such as fungi or mycobacteria. We present a case of THA joint infection caused by Mycobacterium tuberculosis (MT) in a patient without a previous history of MT infection. A literature review was performed, and the treatment is discussed.
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June 2020

Traumatic injuries of the distal tibiofibular syndesmosis.

Orthop Traumatol Surg Res 2021 02 14;107(1S):102778. Epub 2020 Dec 14.

Service de chirurgie orthopédique et traumatologie, cliniques universitaires Saint-Luc UCL, université catholique de Louvain, Brussels, Belgium.

The distal tibiofibular syndesmosis (DTFS) is frequently injured during ankle trauma. The sequelae can be significant, including chronic instability, early osteoarthritis and residual pain. The aim of this study is to summarize the current state knowledge about these injuries by answering four questions. They frequently occur in the context of an ankle sprain (20-40% of cases) or during various types of ankle fractures (20-100% of cases). They cannot be ruled out based solely on fracture type and must be investigated when a fibular or posterior malleolar fracture is present. Clinical examination and imaging are essential but do not provide a definitive diagnosis. Ultrasonography, CT scan and MRI have high sensitivity, but their static nature does not allow a treatment strategy to be defined. Dynamic radiographs must be taken, either with load or during a procedure. If instability is detected, stabilization is the general rule. In fracture cases, reduction is achieved by restoring the length and rotation of the distal fibular fragment, preferably during an open procedure. In sprain cases, reduction is not a problem unless there is ligament interposition. Tibiofibular fixation is done 1.5 to 3cm from the talocrural joint, while ensuring the reduction is perfect. The main complication-non-healing of the syndesmosis-is attributed to poor initial reduction. This or functional discomfort during weight bearing will require removal of the fixation hardware. In most cases, this allows functional recovery and correction of the inadequate reduction. Persistence of instability will require ligament reconstruction or fusion of the syndesmosis. Chronic instability can lead to ankle osteoarthritis. LEVEL OF EVIDENCE: V, expert opinion.
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http://dx.doi.org/10.1016/j.otsr.2020.102778DOI Listing
February 2021

Lower limb kinematics improvement after genicular nerve blockade in patients with knee osteoarthritis: a milestone study using inertial sensors.

BMC Musculoskelet Disord 2020 Dec 7;21(1):822. Epub 2020 Dec 7.

Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Secteur des Sciences de la Santé, Avenue Mounier 53, B-1200, Brussels, Belgium.

Background: Genicular nerve blockade is a possible treatment for patients with knee osteoarthritis. Pain relief and improvement in functioning is expected. This procedure could be of major interest for patients in low-income countries where total knee arthroplasty is not available for the population. This study aims at assessing the immediate benefits on pain, gait, and stairs kinematics after a genicular nerve blockade in patients suffering from knee osteoarthritis in Cameroun.

Methods: A prospective study was carried out on 26 subjects in Cameroun. A genicular nerve blockade was performed on 14 women with painful knee osteoarthritis grade 2-4. Lower limb joint angles were recorded with inertial sensors before and 1 h after injection. Patient-reported outcomes of pain and perceived difficulty were collected, as well as 10 m and 6 min walking tests. A reliability analysis of inertial sensors was performed on a sample of 12 healthy subjects by calculating the intraclass correlation coefficient and the standard error of measurement.

Results: Pain and perceived difficulty decreased significantly (p < 0.001). Cadence increased significantly in stairs climbing (upstairs: + 7.7 steps/min; downstairs: + 7.6 steps/min). There was an improvement for hip sagittal range of motion during gait (+ 9.3°) and pelvis transverse range of motion in walking upstairs (- 3.3°). Angular speed range of the knee in the sagittal plane and of the hip in the frontal plane increased significantly in stairs descent (+ 53.7°/s, + 94.5°/s).

Conclusions: This study quantified improvement of gait and stair climbing immediately after a genicular nerve blockade in patients suffering from knee OA in Cameroon. This is the first study objectifying this effect, through wearable sensors.

Trial Registration: Pan African Clinical Trial Registry, PACTR202004822698484 . Registered 28 March 2020 - Retrospectively registered.
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http://dx.doi.org/10.1186/s12891-020-03836-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722305PMC
December 2020

Validation of a new protocol for ultrasound-guided genicular nerve radiofrequency ablation with accurate anatomical targets: cadaveric study.

Reg Anesth Pain Med 2021 03 3;46(3):210-216. Epub 2020 Dec 3.

Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite Catholique de Louvain, Brussels, Belgium.

Introduction: Ultrasound (US)-guided radiofrequency ablation (RFA) of genicular nerves (GNs) is increasingly performed to manage chronic knee pain. The anatomical foundations supporting the choice of original targets for US-guided GN-RFA have been thoroughly improved by recent anatomical studies. Therefore, this study aimed to provide a new protocol with revised anatomical targets for US-guided GN-RFA and to assess their accuracy in a cadaveric model.

Materials And Methods: Fourteen fresh-frozen cadaveric knees were used. After a pilot study with 4 knees, five consistent nerves were targeted in the other 10 knees with revised anatomical landmarks: superior medial genicular nerve (SMGN), superior lateral genicular nerve (SLGN), inferior medial genicular nerve (IMGN), recurrent fibular nerve (RFN) and the infrapatellar branch of the saphenous nerve (IPBSN). For each nerve, the lumen of radiofrequency (RF) cannula was prefilled with non-diffusible black paint, and then the cannula was inserted at the target site under US guidance. After US verification of correct placement, the stylet was introduced in the cannula to create a limited black mark on the tissues at the top of the active tip. Anatomical dissection was performed to assess for accuracy.

Results: The proportion of nerves directly found in contact with the black mark was 7/10, 8/10, 10/10 and 9/10 for the SMGN, SLGN, IMGN and RFN, respectively. The proportions of nerve captured by the theoretical largest monopolar RF lesions were 100% for the SMGN, IMGN and RFN, and IPBSN and 95% for SLGN. The mean distances from the center of the black mark to the targeted nerve were 2.1±2.2 mm, 1.0±1.4 mm, 0.75±1.1 mm and 2.4±4.5 mm for the SMGN, SLGN, IMGN and RFN, respectively.

Conclusion: US-guided GN-RFA with revised anatomical targets resulted in accurate capture of the five targeted nerves. This protocol provides precise sensory denervation of a larger panel of nerves, targeting those whose constancy regarding anatomical location has been clearly demonstrated. It is expected to improve the clinical outcomes.
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http://dx.doi.org/10.1136/rapm-2020-101936DOI Listing
March 2021

Synergistic Effects of Pulsed Lavage and Antimicrobial Therapy Against Biofilms in an Model.

Front Med (Lausanne) 2020 17;7:527. Epub 2020 Sep 17.

Laboratoire de Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium.

Prosthetic joint infections (PJI) are difficult to treat complications of joint arthroplasty. Debridement with implant retention is a common treatment strategy and frequently involves the use of pulsed lavage (PL). However, PL effects on biofilms and antibiotic activity have been scarcely studied . We report the effects of PL, vancomycin or flucloxacillin used independently or in combination against biofilms. Biofilms of 3 methicillin-susceptible (MSSA) and of 3 methicillin-resistant (MRSA) were grown on Ti6Al4V coupons in TGN (TSB + 1%glucose + 2%NaCl). After 24 h, PL was applied to half of the samples (50 mL saline from 5 cm). Samples were either reincubated for 24 h in TGN or TGN + flucloxacillin or vancomycin. Analyses included CFUs counts, biomass assays or fluorescence microscopy. PL transiently reduced bacterial counts by 3-4 Log CFU/coupon, but bacterial regrowth to baseline levels was seen after 24 h. At 20 mg/L, flucloxacillin reduced both the CFU counts (3 Log CFU/coupon) and biomass (-70%) in one MSSA only, while vancomycin had no effects against MRSA. PL combined with a 24 h reincubation with vancomycin or flucloxacillin at 20 mg/L was synergistic (-5 to 6.5 Log CFU/coupon; 81-100% biomass reduction). Fluorescence microscopy confirmed that PL removed most of the biofilm and that subsequent antibiotic treatment partially killed bacteria. While PL only transiently reduces the bacterial load and antibiotics at clinically relevant concentrations show no or limited activity on biofilms, their combination is synergistic against MRSA and MSSA biofilms. These results highlight the need for thorough PL before antibiotic administration in PJI.
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http://dx.doi.org/10.3389/fmed.2020.00527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527469PMC
September 2020

Anatomical study of the descending genicular artery and implications for image-guided interventions for knee pain.

Clin Anat 2021 May 21;34(4):634-643. Epub 2020 Sep 21.

Neuro-Musculo-Skeletal Department (NMSK)-IREC, UCLouvain, Brussels, Belgium.

Introduction: The descending genicular artery (DGA) has recently been mentioned as accompanying some nerves in the medial aspect of the knee joint. This could be clinically relevant as the arteries could serve as landmarks for accurate nerve capture during ultrasound-guided nerve blockade or ablation. The aim of this cadaveric study was to investigate the anatomical distribution of the DGA, assess the nerves running alongside its branches, and discuss the implications for regional anesthesia and knee pain interventions.

Methods: We dissected the femoral artery (FA) all along its course to identify the origin of the DGA, from which we carefully dissected all branches, in 27 fresh-frozen human specimens. Simultaneously, we systematically dissected the nerves supplying the medial aspect of the knee from proximally to distally and identified those running alongside the branches of the DGA. The surrounding anatomical landmarks were identified and measurements were recorded.

Results: The DGA was found in all specimens, arising from the FA 130.5 ± 17.5 mm (mean ± SD) proximally to the knee joint line. Seven distribution patterns of the DGA were observed. We found three consistent branches from the DGA running alongside their corresponding nerves at the level of the medial aspect of the knee: the artery of the superior-medial genicular nerve, the artery of the infrapatellar branch of the saphenous nerve, and the saphenous branch of the DGA.

Conclusion: The consistent arteries and surrounding landmarks found in this study could help to improve the capture of the targeted nerves during ultrasound-guided interventions.
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http://dx.doi.org/10.1002/ca.23680DOI Listing
May 2021

Biomechanical study of a low-cost external fixator for diaphyseal fractures of long bones.

J Orthop Surg Res 2020 Jul 6;15(1):247. Epub 2020 Jul 6.

Experimental and Clinical Research Institute (IREC), Neuro-Musculo-Skeletal Pole (NMSK), Université Catholique de Louvain, Tour Pasteur +4 - 53 Avenue Emmanuel Mounier, 1200, Brussels, Belgium.

Background: External fixation improves open fracture management in emerging countries. However, sophisticated models are often expensive and unavailable. We assessed the biomechanical properties of a low-cost external fixation system in comparison with the Hoffmann® 3 system, as a reference.

Methods: Transversal, oblique, and comminuted fractures were created in the diaphysis of tibia sawbones. Six external fixators were tested in three modes of loading-axial compression, medio-lateral (ML) bending, and torsion-in order to determine construction stiffness. The fixator construct implies two uniplanar (UUEF1, UUEF2) depending the pin-rods fixation system and two biplanar (UBEF1, UBEF2) designs based on different bar to bar connections. The designed low-cost fixators were compared to a Hoffmann® 3 fixator single rod (H3-SR) and double rod (H3-DR). Twenty-seven constructs were stabilized with UUEF1, UUEF2, and H3-SR (nine constructs each). Nine constructs were stabilized with UBEF1, UBEF2, and H3-DR (three constructs each).

Results: UUEF2 was significantly stiffer than H3-SR (p < 0.001) in axial compression for oblique fractures and UUEF1 was significantly stiffer than H3-SR (p = 0.009) in ML bending for transversal fractures. Both UUEFs were significantly stiffer than H3-SR in axial compression and torsion (p < 0.05), and inferior to H3-SR in ML bending, for comminuted fractures. In the same fracture pattern, UBEFs were significantly stiffer than H3-DR (p = 0.001) in axial compression and torsion, while only UBEF1 was significantly stiffer than H3-DR in ML bending (p = 0.013).

Conclusions: The results demonstrated that the stiffness of the UUEF and UBEF device compares to the reference fixator and may be helpful in maintaining fracture reduction. Fatigue testing and clinical assessment must be conducted to ensure that the objective of bone healing is achievable with such low-cost devices.
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http://dx.doi.org/10.1186/s13018-020-01777-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339426PMC
July 2020

Current versus revised anatomical targets for genicular nerve blockade and radiofrequency ablation: evidence from a cadaveric model.

Reg Anesth Pain Med 2020 08 18;45(8):603-609. Epub 2020 Jun 18.

Neuro-Musculo-Skeletal Department, Experimental and Clinical Research Institute, Universite catholique de Louvain, Brussels, Belgium.

Introduction: Recent studies have proposed revised anatomical targets to improve accuracy of genicular nerve (GN) radiofrequency ablation (RFA). This study aims to compare the accuracy of classical and revised techniques for fluoroscopic-guided GN-RFA in cadaveric models.

Materials And Methods: Fourteen knees from seven fresh frozen human cadavers were included in this study. For each cadaver, RF cannulas were placed to capture the GN according to the current targets in one knee, and the revised targets in the other knee, randomly. The stylet was removed from the cannula, plunged into non-diffusible black paint, and reintroduced entirely in the cannula, to create a limited black spot on the tissues at the top of the active tip. Anatomical dissection was performed, and the accuracy of both techniques was compared.

Results: The mean distance from the top of the active tip to the nerve was significantly lower with revised than current targets for the superior-medial GN (0.7 mm vs 17.8 mm, p=0.01) and the descending branch of the superior-lateral GN (3.7 mm vs 24.4 mm, p=0.02). In both superior-medial GN and superior-lateral GN, the accuracy rate was higher with revised than current targets: 100% vs 0% and 64% vs 35%, respectively. In addition, the accuracy of revised targets for the recurrent fibular nerve and the infrapatellar branch of saphenous nerve was 100%.

Conclusion: This study demonstrates that the revised targets are more accurate than the current targets for GN-RFA.
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http://dx.doi.org/10.1136/rapm-2020-101370DOI Listing
August 2020

Alpha Defensin: A Diagnostic Accuracy Depending on the Infection Definition Used.

J Arthroplasty 2020 05 18;35(5):1355-1360. Epub 2019 Dec 18.

Department of Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium; Neuro Musculo Skeletal Lab (NMSK), Institut de Recherche Expérimentale et Clinique, Secteur des Sciences de la Santé, UCL, Brussels, Belgium.

Background: The purpose of this study was to evaluate the alpha defensin qualitative detection (ADLF) sensitivity and specificity as compared with 3 standard classifications in the diagnostic management of chronic prosthetic joint infections.

Materials And Methods: A multicenter cohort of 136 patients with a painful arthroplasty was classified into either infected or noninfected according to the Musculoskeletal Infection Society (MSIS) score, Infectious Diseases Society of America (IDSA) score, European Bone and Joint Infection Society (EBJIS) score. The sensitivity and specificity of the ADLF test were calculated for each score. Spearman's correlations between all scores were then analyzed, and multiple logistic regression was applied to identify independent variables strongly connected to the prosthetic joint infection probability.

Results: The EBJIS score was positive in 68 patients, IDSA score in 50 patients, MSIS score in 41 patients, and ADLF in 40 patients. The ADLF sensitivity was 87.8% compared with MSIS, 70% compared with IDSA, and 55.8% compared with EBJIS. The ADLF specificity was in the range of 94%-97%. A good correlation was observed between synovial fluid cultures and ADLF (r = 0.73). Low to excellent correlations were recorded between ADLF and the EBJIS (r = 0.58), IDSA (r = 0.68), and MSIS (r = 0.84) scores. The synovial fluid's white blood cell count was proven to be the biological test that most influenced the probability of a positive culture (P value: .005).

Discussion: The ADLF sensitivity was variable, whereas its specificity was excellent. The EBJIS score results significantly differed from those obtained via cultures, which possibly explains the ADLF low sensitivity compared with that of the EBJIS score.
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http://dx.doi.org/10.1016/j.arth.2019.12.010DOI Listing
May 2020

Anatomical evidence supporting the revision of classical landmarks for genicular nerve ablation.

Reg Anesth Pain Med 2020 08 5;45(8):672-673. Epub 2019 Dec 5.

Neuro-Musculo-Skeletal Pole, Experimental and Clinical Research Institute, Université Catholique de Louvain, Brussels, Belgium.

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http://dx.doi.org/10.1136/rapm-2019-101103DOI Listing
August 2020

Preoperative sensory knee denervation and postoperative pain after total knee arthroplasty.

Reg Anesth Pain Med 2019 Sep 16. Epub 2019 Sep 16.

Department of Orthopedics and Trauma, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

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http://dx.doi.org/10.1136/rapm-2019-100834DOI Listing
September 2019

Low haemoglobin at admission is associated with mortality after hip fractures in elderly patients.

Bone Joint J 2019 Sep;101-B(9):1122-1128

Department of Intensive Care, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.

Aims: Low haemoglobin (Hb) at admission has been identified as a risk factor for mortality for elderly patients with hip fractures in some studies. However, this remains controversial. This study aims to analyze the association between Hb level at admission and mortality in elderly patients with hip fracture undergoing surgery.

Patients And Methods: All consecutive patients (prospective database) admitted with hip fracture operated in a tertiary hospital between 2012 and 2016 were analyzed. We collected patient characteristics, time to surgery, duration and type of surgery, comorbidities, Hb at admission, nadir of Hb after surgery, the use and amount of red blood cells (RBCs) transfusion products, postoperative complications, and death. The main outcome measures were mortality at 30 days, 90 days, 180 days, and one year after surgery.

Results: We included 829 patients; the mean age was 81 years (sd 11). Mortality at 30 days, 90 days, 180 days, and one year was 5.7%, 12.3%, 18.1%, and 23.5%, respectively. The highest mortality was observed in patients aged over 80 years (162/557, 29%) and in male patients (85/267, 32%). Survival at 90 days, 180 days, and one year after surgery was significantly lower in patients with a Hb level below 120 g/l at admission. In multivariate analysis, Hb level below 120 g/l at admission was found to be an independent factor associated with mortality (adjusted hazard ratio (aHR) 1.68 (95% confidence interval (CI) 1.22 to 2.31); p = 0.001), along with age (aHR 1.06 (95% CI 1.04 to 1.06); p < 0.001), male sex (aHR 2.19 (95% CI 1.61 to 2.96); p < 0.001), and need for RBC transfusions (aHR 1.10 (95% CI 1.02 to 1.19); p = 0.01).

Conclusion: Our results suggest that low Hb at admission along with age and RBC transfusions is significantly associated with short- and long-term mortality after hip fracture surgery, independently of comorbidity confounders. Further studies should be performed to understand how preoperative Hb could be taken into account in perioperative management. Cite this article: 2019;101-B:1122-1128.
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http://dx.doi.org/10.1302/0301-620X.101B9.BJJ-2019-0526.R1DOI Listing
September 2019

Accuracy of fluoroscopic-guided genicular nerve blockade: a need for revisiting anatomical landmarks.

Reg Anesth Pain Med 2019 Aug 26. Epub 2019 Aug 26.

Neuro-Musculo-Skeletal Department (NMSK), Experimental and Clinical Research Institute, Université catholique de Louvain, Brussels, Belgium.

Background And Objectives: Genicular nerve blockade (GNB) and radiofrequency ablation (RFA) have recently emerged as treatment options for patients with chronic knee pain. However, an increasing number of anatomical studies and systematic reviews concluded that the anatomical basis for needle placement was unclear, incomplete and somewhat inaccurate. This study was designed to assess the accuracy of updated anatomical landmarks for fluoroscopy-guided blockade of the consistent genicular nerves in a cadaveric model.

Methods: Based on a comprehensive review of recent anatomical studies and prior dissection of 21 fresh cadaver knees, we defined bony landmarks with high likelihood of successful ablation of the five consistent genicular nerves (GN). We tested the accuracy of GNBs using the above-stated anatomical landmarks in 10 intact fresh cadaveric knees. Needle placement was guided by fluoroscopy and 0.5 mL of 0.1% methylene blue was injected at the site of each nerve. The knees were subsequently dissected to assess the accuracy of the injections. If the nerve was dyed with blue ink, the placement was considered accurate.

Results: The accuracy of our injections was 100% for the superior medial genicular nerve, inferior medial GN, infrapatellar branch of saphenous nerve and recurrent fibular nerve. The superior lateral GN was dyed in 90% of specimens.

Conclusion: This study provides physicians with precise anatomical landmarks for the five consistent GN for fluoroscopic-guided GNB. Our revised technique, which targets more nerves with increased accuracy, could potentially lead to improved therapeutic benefits on chronic knee pain.
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http://dx.doi.org/10.1136/rapm-2019-100451DOI Listing
August 2019

Distribution of sensory nerves supplying the knee joint capsule and implications for genicular blockade and radiofrequency ablation: an anatomical study.

Surg Radiol Anat 2019 Dec 23;41(12):1461-1471. Epub 2019 Jul 23.

Neuro-Musculo-Skeletal Pole (NMSK), Experimental and Clinical Research Institute (IREC), Université Catholique de Louvain (UCLouvain), Tour Pasteur, Avenue Mounier 53, 1200, Brussels, Belgium.

Background: Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose.

Methods: We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained.

Results: The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose.

Conclusion: The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.
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http://dx.doi.org/10.1007/s00276-019-02291-yDOI Listing
December 2019

Clinical characteristics and outcomes of patients receiving outpatient parenteral antibiotic therapy in a Belgian setting: a single-center pilot study.

Acta Clin Belg 2020 Aug 25;75(4):275-283. Epub 2019 Apr 25.

Department of Internal medicine and infectious diseases, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain , Brussels, Belgium.

Background: Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting.

Methods: The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017.

Results: We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients' level of satisfaction was high (99.5%).

Conclusions: In this pilot study, OPAT is found to be efficacious in saving hospitalization's days, with a low rate of readmissions and complications and a high patients' level of satisfaction. We therefore conclude that OPAT is feasible and safe.

Background: Outpatient parenteral antibiotic therapy (OPAT) was not used in Belgium before 2013, except for patients with cystic fibrosis. Thus, we have performed a pilot study to evaluate clinical characteristics and outcomes of patient receiving OPAT in a Belgian setting.

Methods: The study was a prospective observational single-center study of patients receiving OPAT between 1 September 2013 and 31 December, 2017.

Results: We included 218 OPATs. The median age was 58 years and 71% were men. At the end of the treatment, 92% of the patients on OPAT were cured. Risk factors for treatment failure were obesity, diabetes and diabetic foot infections, longer duration of hospitalization before OPAT, and duration of OPAT >16 days. An average of 24 days of hospitalization per patient discharge was saved, which amounted to 5205 days saved during the project. During the OPAT and 30 days thereafter, 71 (32.6%) of patients were readmitted, but only 26 (12%) readmissions were directly related to OPAT. Risk factors for readmissions were diabetes and diabetic foot infections, endovascular infections, longer duration of hospitalization before OPAT, duration of OPAT >30 days, and history of hospitalizations in the year before OPAT. There were 2.3 intravenous catheter-related events per 1000 days of catheter use. Patients' level of satisfaction was high (99.5%).

Conclusions: In our study, OPAT is found to be efficacious in saving hospitalization's days, with a low rate of readmissions and complications and a high patients' level of satisfaction. We therefore conclude that OPAT is feasible and safe.
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http://dx.doi.org/10.1080/17843286.2019.1608396DOI Listing
August 2020

Predictors of mechanical complications after intramedullary nailing of tibial fractures.

Orthop Traumatol Surg Res 2019 05 4;105(3):523-527. Epub 2019 Apr 4.

Service de chirurgie orthopédique et de traumatologie de l'appareil locomoteur, université catholique de Louvain, Bruxelles, Belgium; Institut de recherche expérimentale et clinique (IREC), neuro-musculo-skeletal lab (NMSK), université catholique de Louvain, Bruxelles, Belgium.

Introduction: Intramedullary (IM) nailing is the gold standard treatment for tibial shaft fractures, but can be associated with various mechanical complications, including delayed union.

Hypothesis: We believe that complications do not occur randomly, but in certain conditions that contribute to their development. Risk factors likely to predict delayed union can be identified to support prevention.

Materials And Methods: A cohort of 171 fractures treated by IM nailing between 2005 and 2015 was reviewed retrospectively. Independent variables included intrinsic, patient-related factors and extrinsic factors such as those related to the fracture or surgery. A multiple logistic regression model was used to determine which factors can predict each type of complication.

Results: Delayed union occurred in 22.8% of patients. Smoking and high-energy trauma were risk factors. Hardware breakage was significantly reduced (p<0.05) when the nail diameter was greater than 10mm. A nail diameter/reamer diameter ratio outside the recommended limits (0.80-0.99) was more likely to be associated with screw failure. Diabetes is a risk factor for hardware migration, which itself is associated with other complications.

Discussion: Nonunion is the most common complication after IM nailing of tibial shaft fractures. Smoking cessation after a fracture is necessary in our opinion, even if the literature is ambivalent on this aspect and stopping to smoke once the fracture occurs may not be sufficient to prevent a poor outcome. Use of a nail diameter/reamer diameter between 0.80 and 0.99 favors union and prevents hardware breakage. Hardware migration in a diabetic patient may be a warning sign of other types of complications.

Level Of Evidence: Retrospective cohort study. Level IV.
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http://dx.doi.org/10.1016/j.otsr.2019.01.015DOI Listing
May 2019

Prediction of postoperative mortality in elderly patient with hip fractures: a single-centre, retrospective cohort study.

BMC Anesthesiol 2018 12 3;18(1):183. Epub 2018 Dec 3.

Department of Anesthesiology and Peri-operative Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.

Background: Elderly patients are at high risk for postoperative complications and increased mortality after hip fracture (HF) surgery due to frailty and co-morbidities. The prediction of postoperative outcome could be used for clinical decision making. A reliable score to predict postoperative mortality after HF surgery in this sub-population remains unavailable.

Methods: A single-centre retrospective cohort study was performed in 782 patients who were operated on for HF. Receiver Operating Characteristic (ROC)-curves were used to analyse the performance of gender, age, neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) at admission (D) as prognostic factors, alone or combined with the PreOperative Score to predict PostOperative Mortality (POSPOM) in univariate and multivariate linear regression models.

Results: No correlation between gender, age, NLR D or CRP D and postoperative, intra-hospital mortality was found. The Area Under the ROC-curve (AUC) for age, male gender, NLR and CRP were 0.61 [95% confidence interval (CI) = 0.45-0.61], 0.56 [95% CI = 0.42-0.56], 0.47 [95% CI = 0.29-0.47] and 0.49 [95% CI = 0.31-0.49] respectively. Combination with the POSPOM score did not increase its discriminative capacity as neither age (AUC = 0.69, 95% CI = 0.54-0.69), gender (AUC = 0.72, 95% CI = 0.58-0.72), NLR D (AUC = 0.71, 95% CI = 0.56-0.71), nor the CRP D (AUC = 0.71, 95% CI = 0.58-0.71) improved the POSPOM performance.

Conclusions: Neither age, gender, NLR D nor CRP D are suitable parameters to predict postoperative, intra-hospital mortality in elderly patients undergoing surgery for HF.
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http://dx.doi.org/10.1186/s12871-018-0646-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278082PMC
December 2018

The effect of storage delay and storage temperature on orthopaedic surgical samples contaminated by Staphylococcus Epidermidis.

PLoS One 2018 19;13(3):e0192048. Epub 2018 Mar 19.

Department of Orthopedic Surgery, Cliniques Universitaires Saint Luc, Brussels, Belgium.

Background: Prosthetic Joint Infection (PJI) is a rare but devastating complications with high morbitity and mortality. The identification of the causal microorganism remains crucial and determines therapeutic strategies and success. Microbiology cultures remain the common method to diagnose PJI. Unfortunately, 14% of intra-articular punctures remain negative after culture. The microorganisms are best detected by inoculation of microbiology samples in blood culture bottles (Bactec), or after sonication of the implant and polymerase chain reaction (PCR). The identification of the causal microorganism remains crucial and determines therapeutic success.

Objectives: This study was conducted to assess the effect of culture lead time and sample storage temperature on the detection of the pathogen.

Methods: We obtained bone fragments from femoral heads during primary arthroplasty. Bone fragments were contaminated with a strain of Staphylococcus epidermidis. Four set-ups with different combinations of storage delay and storage temperature were tested.

Results: Our study shows the need to cultivate as soon as possible and optimally within 2h after the completion of sampling. Temporary storage in a refrigerator at 4°C also appears to have a positive influence on bacterial viability. At present, these conclusions concern only the Staphylococcus Epidermidis. Others studies are requested to generalize this conclusion to other bacteria.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0192048PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858844PMC
July 2018

Intersegmental kinematics coordination in unilateral peripheral and central origin: Effect on gait mechanism?

Gait Posture 2018 05 7;62:124-131. Epub 2018 Mar 7.

Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 53, B-1200 Brussels, Belgium.

Background: The gait mechanism requires an efficient intersegmental coordination in order to ensure the displacement of the body while simultaneously maintaining the postural stability. However, intersegmental coordination may be disrupted by neurological or orthopaedic involvement, this increasing the metabolic cost associated with excessive or prolonged muscle co-contraction.

Research Question: Our aim was to evaluate and to understand how hip OA affects lower limbs coordination during gait by using the kinematic segmental covariation law method and predict the energy expenditure.

Methods: In order to evaluate the influence of unilateral alteration of the lower limbs on the gait mechanism, three groups namely 63 hip osteoarthritis patients, 65 chronic hemiparetic stroke patients and 72 healthy subjects performed an instrumented gait analysis. The subjects had to walk barefoot for at least 3 min at a self-selected speed on a force measuring motor-driven treadmill. The biomechanical variables (kinematic, kinetic and energetical cost) were simultaneously recorded.

Results: The comparison between the three groups was tested using a repeated measure ANOVA. All biomechanical parameters show significant differences between the 3 groups highlighting the gait alteration for the patients groups. However, the energetic cost remains normal in the hip osteoarthritis group despite of the alteration of the other variables. A multivariate analysis allowed to identify the independent variables affecting more specifically their gait mechanisms.

Significance: This study showed the importance of quantitative functional evaluation in order to better understand the impact of hip osteoarthritis on the gait mechanism. The biomechanical analysis provides objective evidence of the altered gait mechanism and more particularly of the intersegmental coordination in these patients. This gait analysis is therefore an interesting tool in the functional evaluation of the patient to better guide the diagnosis.
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http://dx.doi.org/10.1016/j.gaitpost.2018.03.014DOI Listing
May 2018

Use of the neutrophil-to-lymphocyte ratio as a component of a score to predict postoperative mortality after surgery for hip fracture in elderly subjects.

BMC Res Notes 2016 May 26;9:284. Epub 2016 May 26.

Department of Internal and Perioperative Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.

Background: Hip fracture precedes death in 12-37 % of elderly people. Identification of high risk patients may contribute to target those in whom optimal management, resource allocation and trials efficiency are needed. The aim of this study is to evaluate a predictive score of mortality after hip fracture in older persons on the basis of the objective prognostic factors easily available: age, sex and neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP).

Patients And Methods: After the ethical committee approval, we analyzed our prospective database including 286 consecutive older patients (>64 years) with hip fracture. A score [range 0-4] was constructed, based on a previous analysis, combining age (1 point per decade above 74 years), sex (1 point for male gender) and NLR at postoperative day +5 (1 point if > 5). A receiver-operating curve (ROC) analysis was performed. Similar analyses were performed with CRP (1 point if > 7.65 mg/dL).

Results: In the 286 patients (male 31 %), the median age was 84 (65-102) years, and the mean NLR values were 6.47 ± 6.07. At 1 year, 82/286 patients died (28.7 %). In the 235 patients with complete data, significant differences in term of mortality risk are observed (P < 0.001). Performance analysis shows an AUC of 0.72[95 % CI 0.65-0.79]. CRP performed less than NLR (AUC for CRP alone: 0.53[95 % CI 0.45-0.61], P = 0.42, with a sensitivity of 58.5 % and a specificity of 57.1 % for a cut-off value of 7.65 mg/dL; and for NLR alone: 0.59 [95 % CI 0.51-0.66]; P = 0.02, with a sensitivity of 55 % and a specificity of 65 % for a cut-off value of 4.9).

Conclusion: A discrete 0-4 scoring systems based on age, sex and the NLR was shown to be predictive of mortality in elderly patients during the first postoperative year following surgery for hip fracture repair.
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http://dx.doi.org/10.1186/s13104-016-2089-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881064PMC
May 2016

Selective Methicillin-Resistant Staphylococcus Aureus (MRSA) screening of a high risk population does not adequately detect MRSA carriers within a country with low MRSA prevalence.

Acta Orthop Belg 2015 Dec;81(4):620-8

Background: Methicillin-Resistant Staphylococcus Aureus (MRSA) has been widely recognized as a serious problem in hospital settings. The purpose of this study is to evaluate the predictive value of MRSA colonization factors in the detection of MRSA carriers in an orthopedic ward.

Methods And Materials: A systematic MRSA detection strategy was set up to assess the predictive value of MRSA colonization factors among 554 patients undergoing elective knee arthroplasty.

Results: In total 116 patients were found positive for Staphylococcus Aureus; among those 110/116 patients were found positive for Methicillin-Sensitive Staphylococcus Aureus (MSSA) and 6/116 for MRSA. Only one patient out of six presented two risk factors according to MRSA risk factors. In this study, no correlation was found between the remaining conventional risk factors, according to Belgian guidelines, defined to target high-risk populations and to identify MRSA carriers.

Conclusions: Established criteria for selective MRSA screening do not allow detecting MRSA carriers. The objective of detecting MRSA carriers is not correctly met by the actual applied criteria (Belgian consensus) for a selective screening policy. Future studies should aim at identifying the right risk factors, depending of the country's prevalence of MRSA, to improve the ability to predict the risk of MRSA carriage at hospital admission.
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December 2015