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Background: Open debridement remains the gold standard for the clinical treatment of post-traumatic elbow stiffness. However, postoperative complications, such as re-contraction and heterotopic ossification of the elbow joint, are highly prevalent. Hinged external fixation appears to offer the potential for greater improvement of joint function and reduction of complications. The purpose of this article is to provide the latest evidence on the effectiveness and safety of hinged external fixation combined with open debridement for the treatment of post-traumatic elbow stiffness. Methods: We searched for randomized controlled trials (RCTs) from the China National Knowledge Infrastructure, MEDLINE, PubMed, Web of Science, EMBASE, and Cochrane Library databases until December 31, 2022. STATA 15.1 software was used to analyze all the data for this article. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3. Results: Finally, we selected 8 high-quality RCTs for our meta-analysis, which included 555 patients. The meta-analysis demonstrated that hinged external fixation combined with open debridement for post-traumatic elbow stiffness (treatment group) showed a significant increase in elbow flexion and extension mobility (WMD = 5.16, 95% CI 4.39–5.49, Z = 13.02, P = 0.000), Mayo elbow function scores (WMD = 5.25, 95% CI 4.33–6.17, Z = 11.15, P = 0.000), and Mayo excellent rate (RR = 1.25, 95% CI 1.14–1.37, Z = 4.87, P = 0.000). Additionally, there was a significant decrease in the complication rate (RR = 1.11, 95% CI 1.02–1.20, Z = 2.54, P = 0.011) compared to open debridement alone (control group). Furthermore, the results of the publication bias test showed no significant bias. Conclusions: With the assistance of hinged external fixation, open debridement for post-traumatic elbow stiffness can lead to increased elbow mobility and a reduced complication rate. However, due to the small sample size, a multicenter randomized controlled trial with a larger sample size is still necessary to further confirm the effectiveness and safety of hinged external fixation combined with open debridement for post-traumatic elbow stiffness. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to explore the effect of vitamin B complex supplementation following periodontal flap surgery on clinical and microbiological parameters. Materials and Methods: A randomized controlled trial on 10 patients with periodontitis in split-mouth design was undertaken to find the effect of vitamin B complex supplementation with open flap debridement on periodontal wound healing. Multiplex polymerase chain reaction (PCR) for Tannerella forsythus and Porphyromonas gingivalis was done using subgingival plaque samples at 0 and 90th day. Results: The results showed a significant reduction (P < 0.01) of clinical (plaque index, gingival index, gingival bleeding index, probing pocket depth, and relative attachment level) and microbial profile in both treatment groups, whereas on intergroup analysis, more reduction in all clinical parameters were observed in the test group, but statistically, the results were insignificant.

Background: The purpose of this study is to explore the effect of vitamin B complex supplementation following periodontal flap surgery on clinical and microbiological parameters. Materials and Methods: A randomized controlled trial on 10 patients with periodontitis in split-mouth design was undertaken to find the effect of vitamin B complex supplementation with open flap debridement on periodontal wound healing. Multiplex polymerase chain reaction (PCR) for Tannerella forsythus and Porphyromonas gingivalis was done using subgingival plaque samples at 0 and 90th day. Results: The results showed a significant reduction (P < 0.01) of clinical (plaque index, gingival index, gingival bleeding index, probing pocket depth, and relative attachment level) and microbial profile in both treatment groups, whereas on intergroup analysis, more reduction in all clinical parameters were observed in the test group, but statistically, the results were insignificant. [ABSTRACT FROM AUTHOR]

Introduction: In acute periprosthetic knee infections, debridement and implant retention (DAIR) is the preferred treatment prior to one- and two-stage revisions. The aim of this study is to compare the outcomes of arthroscopic and open debridement of infected primary total knee arthroplasties (TKA). Material and methods: We analyzed clinical, laboratory, and antibiotic treatment data, collected in patients with periprosthetic knee infection treated with DAIR at a Swiss Level 1 orthopedic and trauma center over a 10-year period between January 2005 and May 2015. Inclusion criteria were primary total knee arthroplasty and early postoperative or acute hematogenous periprosthetic joint infection (PJI). The primary endpoint was the need for further revision surgery due to persistent infection. The secondary endpoint was the prosthesis salvage in further infection surgeries. Results: Forty-two patients with 44 acute or hematogenous periprosthetic knee infections were included. We recorded 20 recurrent infections (45%) in our study population: 10 (77%) out of 13 in the arthroscopic DAIR group and 10 (32%) out of 31 in the open DAIR group. Two-stage revision, meaning complete removal of the TKA, insertion of a spacer and replantation at a second stage, had to be performed in three patients treated initially arthroscopically (23%) and in six patients treated initially with an open surgical procedure (21%). Conclusions: Open debridement for acute periprosthetic knee infection shows clear benefits in terms of infection eradication and prosthesis salvage compared to arthroscopic DAIR. [ABSTRACT FROM AUTHOR]

Abstract Background Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Methods Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2 years follow-up. Results A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2 years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p

Introduction Knee septic arthritis rapidly damages the knee joint. Gächter described a classification of joint infections based on arthroscopic findings: an arthroscopic staging of the common disease has prognostic and therapeutic consequences. The aim of this systematic review was to analyze the application of the Gächter classification system to knee septic arthritis, evaluating prognostic and therapeutic implications of this classification. Materials and Methods A comprehensive electronic search of the literature was performed. The following search terms were used: (Arthroscopy* OR Arthrotom* OR Aspiration) AND Knee AND Septic AND Arthritis. The study reported the Gächter classification in septic knee arthritis and the eradication rate according to the type. The primary endpoint is the eradication rate of septic knee arthritis according to the Gächter sort. Secondary endpoints are surgical procedures according to Gächter classification and the rate of re-operations. Results Seven studies were included. The overall eradication rate of knee septic arthritis ranged from 90% to 100%: 95%-100% Gächter I; 97%-100% Gächter II; 67%-100% Gächter III; 50%-100% Gächter IV. Surgical treatments for knee septic arthritis included arthroscopic irrigation alone, articular irrigation, and debridement in knee arthroscopy or knee arthrotomy according to Gächter stage. However, 28% required re-operations for persistent infection: secondary procedures included further irrigation and debridement with the arthroscopic or arthrotomic approach. Conclusion Gächter classification showed a crucial prognostic role in predicting the outcome of surgical treatment of septic knee arthritis. Regardless of the procedure performed, a prompt operation and an accurate debridement of the synovial membrane are the most critical factors for eradicating infection and good clinical outcomes. Level of Evidence Level II, prognostic study. [ABSTRACT FROM AUTHOR]

Background: Mucoid degeneration of the anterior cruciate ligament (ACL) has been shown to cause restricted terminal range of motion and rest pain. If present in a patient undergoing unicompartmental knee arthroplasty, it can deteriorate the final outcome. This study aims to compare functional and clinical outcomes of debulking the mucoid ACL in patients undergoing mobile-bearing unicompartmental knee arthroplasty (UKA). Methods: Patients with mucoid ACL undergoing mobile-bearing UKA at five different centres by five different arthroplasty surgeons were included. They were segregated into two groups matched for all demographic and pre-operative values: group A did not undergo debulking; group B underwent open debulking by a 15-number blade prior to UKA. Patient-related outcome measures, rest pain, clinical outcomes, and subjective patient satisfaction were recorded and compared at 2 years follow-up. Results: A total of 442 patients (226 patients underwent debulking, 216 patients did not undergo debulking) were included. Both groups showed overall improvement after surgery, however, patients who underwent debulking performed better at 2 years follow-up in terms of Knee Society functional score, International Knee Documentation Committee scores, range of motion, rest pain and overall patient satisfaction (p < 0.05) as compared with their counterparts. Conclusions: Debulking of mucoid ACL in patients undergoing unicompartmental knee arthroplasty significantly reduces the rest pain and improves the final range of motion of the knee joint, subsequently improving the overall functional and clinical outcome of the patient and resulting in greater patient satisfaction. [ABSTRACT FROM AUTHOR]

IntroductionThe mesh-based repair of abdominal wall hernias is a commonly employed approach as it is easy to implement and associated with low rates of hernia recurrence. However, the occurrence of hernia mesh infections following such repair can be extremely serious, and no clinical consensus regarding the optimal treatment of such infections has been established. This study was thus developed to review the management of hernia mesh infection cases treated at our center, summarizing the demographic and clinical characteristics of affected patients and summarizing our associated therapeutic experiences.MethodsData pertaining to 64 cases of hernia mesh infections treated at our center were retrospectively reviewed. Data were obtained from patient medical records, including general situation, hernia type, prior hernia repair approaches, type of mesh, and postoperative condition. Other reviewed outcomes include bacteriological and imaging findings, as well as treatment outcomes. In cases where conservative management was not successful, the approach to mesh removal (laparoscopic vs. open) was made based on the primary surgical approach and the type of material used for the repair.ResultsIn total, 42 patients underwent primary open inguinal hernioplasty (including plug repair, preperitoneal mesh repair, and Lichtenstein repair), while 11 patients underwent laparoscopic repair (9 transabdominal preperitoneal, TAPP and 2 totally extraperitoneal,TEP), and 11 patients with incisional hernias underwent the intraperitoneal onlay mesh (IPOM) procedure. Six patients exhibited mesh erosion of the internal organs. Of these patients, 38 underwent mesh removal via open debridement, while 9 underwent laparoscopic exploration and open debridement, and 1 underwent laparoscopic mesh removal. No patients exhibited serious postoperative sequelae, serious complications, or mortality after the treatment of mesh infections.One patient experienced postoperative infection recurrence following partial mesh removal, with the appearance of a small fistula. Hernias recurred in 2 patients following mesh removal, and 1 patient underwent repair via laparoscopic IPOM.ConclusionsWhile conservative treatment can cure early mesh infections, there is nonetheless a risk that these infections will recur. In view of the variety of surgical intervention of abdominal wall hernias at present,treatment of mesh infection should be individualized. Our findings suggest that hernias repaired via the placement of mesh in the preperitoneal space can more readily contribute to internal organ erosion and late-onset infections, with open debridement often being unable to completely remove the mesh without causing collateral damage. Laparoscopic exploration is an effective and minimally invasive approach to detecting internal organ involvement and removing the infected hernia mesh from affected patients.

Background: Open debridement (OD) of the extensor carpi radialis brevis tendon, both with and without repair to the lateral epicondyle, are effective treatments for recalcitrant lateral epicondylitis. However, few comparative studies exist within the literature. Purpose: To (1) compare the 5-year reoperation rates of patients who underwent OD alone versus OD with tendon repair (ODR) and (2) identify the 90-day adverse event rates, total same-day reimbursement amounts, and national usage trends for these 2 procedures from 2010 to 2019. Study Design: Cohort study; Level of evidence, 3. Methods: The PearlDiver MUExtr database was reviewed for patients diagnosed with lateral epicondylitis who underwent OD alone and ODR or reattachment between January 2010 and December 2019. These patients were stratified into 2 cohorts: the OD cohort and ODR cohort. The 5-year reoperation rates were assessed and compared, and the incidence of 90-day postoperative complications and risk factors were identified. The number of ODs and ODRs performed each year and the mean same-day reimbursement amounts (in US$) for both procedures were assessed. Results: Overall, 41,932 lateral epicondylitis patients who underwent debridement were identified, with 17,139 OD patients and 24,793 ODR patients. There were no significant changes in the proportion of OD versus ODR procedures performed during the study period (P =.18). A significantly higher incidence of hematoma was seen after OD compared with ODR (0.19% vs 0.12%; P =.04), but ODR had a significantly lower 5-year reoperation rate than OD (2.8% vs 3.9%; P =.006), with an absolute risk reduction of 1.1% and a number needed to treat of 91. Finally, ODR ($1683.17 ± $12.15) had a higher mean same-day reimbursement than OD ($1479.05 ± $15.78) (P =.001). Conclusion: Both OD and ODR had low complication rates. The 5-year reoperation rates were low for both procedures, but they were significantly higher for OD. Over the 10-year study period, there were no significant changes in the relative percentages of OD versus ODR performed. ODR had a significantly higher mean same-day reimbursement. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether there are significant differences in 30-day perioperative complications between arthroscopic and open débridement (irrigation and débridement [I&D]) for septic arthritis (SA) of the shoulder using the American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing arthroscopic or open I&D of the native shoulder from 2006-2016 were identified in the National Surgical Quality Improvement Program database. Those with a diagnosis of SA were included in the study. Patients with a concurrent diagnosis of osteomyelitis around shoulder (n = 25) or polyarthritis (n = 2) were excluded from the study. Patient demographics, comorbidities, and complications were compared between the groups. Poisson regression, which controlled for age and American Society of Anesthesiologists (ASA) score, was used to calculate the relative risks with 95% confidence intervals for minor adverse events, serious adverse events, total adverse events, and unplanned reoperations between the 2 treatment groups, with significance set at P <.0125 after Bonferroni correction. Overall, 147 and 57 patients underwent arthroscopic and open I&D, respectively, for SA of the shoulder. Patients in the open I&D group were more likely to be smokers (P =.0213), whereas patients in the arthroscopy group had higher ASA scores (P =.0008). After controlling for age and ASA score, we found no significant differences in the risk of minor adverse events (P =.0995), serious adverse events (P =.2241), total adverse events (P =.1871), or unplanned reoperations (P =.3855). Arthroscopic débridement appears to be a safe alternative to open débridement for SA of the native shoulder. The incidence and risk of 30-day perioperative complications are similar after arthroscopic and open I&D for SA of the shoulder. [ABSTRACT FROM AUTHOR]

There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P <.05). When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement. [ABSTRACT FROM AUTHOR]

Introduction: The mesh-based repair of abdominal wall hernias is a commonly employed approach as it is easy to implement and associated with low rates of hernia recurrence. However, the occurrence of hernia mesh infections following such repair can be extremely serious, and no clinical consensus regarding the optimal treatment of such infections has been established. This study was thus developed to review the management of hernia mesh infection cases treated at our center, summarizing the demographic and clinical characteristics of affected patients and summarizing our associated therapeutic experiences., Methods: Data pertaining to 64 cases of hernia mesh infections treated at our center were retrospectively reviewed. Data were obtained from patient medical records, including general situation, hernia type, prior hernia repair approaches, type of mesh, and postoperative condition. Other reviewed outcomes include bacteriological and imaging findings, as well as treatment outcomes. In cases where conservative management was not successful, the approach to mesh removal (laparoscopic vs. open) was made based on the primary surgical approach and the type of material used for the repair., Results: In total, 42 patients underwent primary open inguinal hernioplasty (including plug repair, preperitoneal mesh repair, and Lichtenstein repair), while 11 patients underwent laparoscopic repair (9 transabdominal preperitoneal, TAPP and 2 totally extraperitoneal,TEP), and 11 patients with incisional hernias underwent the intraperitoneal onlay mesh (IPOM) procedure. Six patients exhibited mesh erosion of the internal organs. Of these patients, 38 underwent mesh removal via open debridement, while 9 underwent laparoscopic exploration and open debridement, and 1 underwent laparoscopic mesh removal. No patients exhibited serious postoperative sequelae, serious complications, or mortality after the treatment of mesh infections.One patient experienced postoperative infection recurrence following partial mesh removal, with the appearance of a small fistula. Hernias recurred in 2 patients following mesh removal, and 1 patient underwent repair via laparoscopic IPOM., Conclusions: While conservative treatment can cure early mesh infections, there is nonetheless a risk that these infections will recur. In view of the variety of surgical intervention of abdominal wall hernias at present,treatment of mesh infection should be individualized. Our findings suggest that hernias repaired via the placement of mesh in the preperitoneal space can more readily contribute to internal organ erosion and late-onset infections, with open debridement often being unable to completely remove the mesh without causing collateral damage. Laparoscopic exploration is an effective and minimally invasive approach to detecting internal organ involvement and removing the infected hernia mesh from affected patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 He, Wang, Fan and Zhao.)

Primary osteoarthritis (OA) of the elbow can cause disabling symptoms of pain, locking, stiffness, and a limitation in the range of motion. There is no consensus regarding the role of open and arthroscopic debridement in the treatment of symptomatic primary elbow OA. The aim of this study is to systematically review the outcome of surgical debridement. A preoperative/postoperative comparison will be made between the two surgical procedures.All studies reporting on debridement as treatment for primary elbow OA with a minimum of one-year follow-up were included. Outcome parameters were functional results, complications, and performance scores.Data were extracted from 21 articles. The arthroscopic group consisted of 286 elbows with a weighted mean follow-up of 40 ± 17 months (range, 16-75). The open group consisted of 300 elbows with a weighted mean follow-up of 55 ± 20 months (range, 19-85). Both procedures showed improvement in Mayo Elbow Performance Score (MEPS), range of motion (ROM) flexion-extension, and ROM pronation-supination. Only in ROM flexion was a statistically significant difference in improvement seen between the groups in favour of the open group. The arthroscopic group showed improvement in pain visual analogue scale (VAS) scores. Nothing could be stated about pain VAS scores in the open group due to a lack of data. In the arthroscopic group 18 complications (6%) were described, in the open group 29 complications (12%).Surgical debridement is an effective treatment for the disabling symptoms of primary elbow OA with an acceptable complication rate. Cite this article: EFORT Open Rev 2020;5:874-882. DOI: 10.1302/2058-5241.5.190095., Competing Interests: ICMJE Conflict of interest statement: AJS reports employment by St Maartenskliniek, The Netherlands. The other authors declare no conflict of interest relevant to this work., (© 2020 The author(s).)

Aims: The treatment of septic arthritis of the shoulder is challenging. The infection frequently recurs and the clinical outcome can be very poor. We aimed to review the outcomes following the use of continuous negative pressure after open debridement with a large diameter drain in patients with septic arthritis of the shoulder., Patients and Methods: A total of 68 consecutive patients with septic arthritis of the shoulder underwent arthrotomy, irrigation and debridement. A small diameter suction drain was placed in the glenohumeral joint and a large diameter drain was placed in the subacromial space with continuous negative pressure of 15 cm H2O. All patients received a standardised protocol of antibiotics for a mean of 5.1 weeks (two to 11.1)., Results: Negative pressure was maintained for a mean of 24 days (14 to 32). A total of 67 patients (98.5%) were cured without further treatment being required. At a mean follow-up of 14 months (three to 72), the mean forward flexion was 123° (80° to 140°) and the mean external rotation was 28°(10° to 40°) in those with a rotator cuff tear, and 125° (85° to 145°) and 35° (15° to 45°) in those without a rotator cuff tear., Conclusion: Continuous negative pressure, following open arthrotomy, irrigation and debridement, was effective in treating septic arthritis of the shoulder. The rate of recurrence was significantly lower than with conventional treatment involving arthroscopic or open debridement reported in the literature. Functional outcomes, even in patients with rotator cuff tears, were excellent., Take Home Message: Continuous negative pressure is effective in treating septic arthritis of the shoulder. Cite this article: Bone Joint J 2016;98-B:660-5., (©2016 The British Editorial Society of Bone & Joint Surgery.)