infection

Management

Incidence

 

Knee > Hip

- superficial position

- limited cover of well vascularised muscle 

- watershed area of skin blood supply anterior to the skin incision 

- much increased in fully constrained prosthesis 

 

Ideal < 1%

 

Risk Factors

 

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM

Prevention

Preoperative

 

Identify high risk groups

- immunocompromised

- diabetes

- RA

- malnutrition

 

Urine screen

- check for and treat UTi

 

Groin, nose, axilla swabs

- for MRSA

- if positive, treat

- need 3 consecutive free swabs

 

3 x chlorhexidine preoperative showers in 8 hours

 

Admit day of surgery

- check skin for lesions

Complications

Undercorrection /  loss of correction 

 

Most important factor in good results and duration of results

- must correct to 8o of valgus

- mechanical axis must pass through lateral joint line

 

HTO Insufficient Correction

 

Causes

- inadequate initial correction

Complications

Intraoperative glenoid fracture

 

Avoid by

- careful reaming and drilling osteoporotic bone

 

Management

1.  Rotate metaglene

- use locking screws to stabilise glenoid

2.  PA screws

- cannulated 4.0 mm screws

- inserted percutaneously from posterior

 

Haematomas

 

Great deal of dead space is created

- always use a drain