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Biomedical subjects

G Josefsson

Publications and source records attributed to G Josefsson.

14 recordsLinked to original sources
PubMed1990

Hip arthroplasty infection. Current concepts.

Due to systemic or local antibiotic treatment and other preventive procedures, the incidence of deep hip-prosthetic infections in Scandinavia is less than 1 percent, with the majority hematogenous. Coagulase-negative staphylococci and anaerobes are involved in more than half of the cases. The diagnosis is sometimes difficult; preoperative aspiration often gives misleading results; and granulocyte scanning usually adds valuable information. In deep infection the current strategy is to revise with a two-stage procedure. Revisions should be carried out at specialized centers with bacteriologic competence and sufficient experience with implants.

Bacterial Infections↗
PubMed1990

Prophylaxis with systemic antibiotics versus gentamicin bone cement in total hip arthroplasty. A five-year survey of 1688 hips.

In Sweden in 1976, nine orthopedic departments organized a prospective, randomized, and controlled study in which the prophylactic effect of systemic antibiotics (SA) was compared to gentamicin bone cement (GBC) in 1688 consecutive total hip arthroplasties (THAs). After a follow-up period of one to two years, there was a statistically significant difference in the infection rate between the two groups in favor of the gentamicin cement. After five years or more, the difference was unaltered. Altogether, 16 deep infections had occurred in the SA group (1.9%) and seven (0.8%) in the GBC group. Roentgenographically, aseptic loosening had occurred in 29% and 24% of the hips in the SA and GBC groups, respectively, which suggests that admixture of the antibiotic did not weaken the cement. The results of this five-year review clearly showed the prophylactic value of gentamicin cement against deep infection after THA but did not support the hypothesis that this effect was prolonged over one year.

Adult↗
PubMed1988

Revision operations on infected total hip arthroplasties. Two- to nine-year follow-up study.

One hundred two of 110 infected hip arthroplasties revised with the protection of gentamicin-loaded cement were followed for a minimum of two years. In 77 of 102 hips the infection healed after one revision operation and in five of eight hips after a second revision operation, representing a final healing rate of 80%. No significant difference in healing rate could be demonstrated with regard to individual bacterial species. However, in infections with a mixed flora, the healing rate was only 27% (p less than .01). After an average of six years, 33 of 82 healed hips had signs of roentgenographic loosening, nine of which had been revised. The modified Merle d'Aubigne and Postel score averaged 5.3 for pain, 3.7 for walking ability, and 4.0 for range of motion (ROM) in patients with healed infections.

Adult↗
PubMed1987

Prevention of thromboembolism in total hip replacement. Aspirin versus dihydroergotamine-heparin.

In a prospective and controlled study, we compared the prophylactic effect of high-dose acetylsalicylic acid (ASA) and dihydroergotamine-heparin (DHEH) in 82 patients over 50 years of age undergoing total hip replacement. The patients were screened by pulmonary scan and 125I fibrinogen uptake. Phlebography was done if the 125 I fibrinogen test was positive. According to our criteria, thromboembolism developed in 9 of 40 receiving ASA and in 5 of 42 patients receiving DHEH. The effect of ASA was limited to men; in 16 men on this therapy, none had thromboembolism versus 9 of 24 women. Twenty-two patients showed wound hematomas, but none needed surgical intervention.

Aspirin↗
PubMed1985

Radiographic loosening after revision with gentamicin-containing cement for deep infection in total hip arthroplasties.

Seventy-two infected total hip arthroplasties were revised with cement containing gentamicin and were followed up with regular radiograms for periods of up to six years. The infection healed in 61 cases and persisted in 11. An analysis of the radiographic changes in regard to the signs of loosening showed that about half of the cases with a healed infection had a minimal demarcation between bone and cement. In about one-third of the patients, a radiolucent zone of up to 2 mm in thickness developed during the first one to two years and then seemed to remain stable. In the other cases, a progressive resorption, indicating true loosening, was observed. All the cases with remaining infection (except one patient who died of heart disease) exhibited progressively increasing resorption zones. Progress, however, was possibly slowed by the effects of the gentamicin cement and the systemic antibiotic treatment.

Aged↗
PubMed1983

Prevention and treatment of deep infection following total hip replacement.

Three different methods of prophylaxis in total hip replacement are discussed and evaluated: the systemic use of antibiotics, use of gentamicin-containing bone cement and the ultraclean technique. The lowest incidence of deep infection is achieved with a combination of the clean room and antibiotics either in local or systemic form. The results after revision using gentamicin-impregnated bone cement show that a healing rate of 80% is possible; however, there is a high risk of aseptic loosening during the postoperative course.

Anti-Bacterial Agents↗
PubMed1981

Systemic antibiotics and gentamicin-containing bone cement in the prophylaxis of postoperative infections in total hip arthroplasty.

In a prospective controlled multicenter study, the prophylactic effect of gentamicin-containing bone cement on postoperative infections in total hip arthroplasties was compared with that of systemically given antibiotics; 812 arthroplasties were randomly assigned to an antibiotic and 821 to a gentamicin-cement group. When the patients had been followed for a period of one to two years, 13 deep infections were diagnosed in the antibiotic group and three in the gentamicin-cement group. The difference was statistically significant.

Anti-Bacterial Agents↗
PubMed1980

Function of fifty-seven septic, revised and healed total hip arthroplasties.

An evaluation of hip function was made 2-5 years postoperatively in 57 patients reoperated using gentamicin-containing bone cement because of deep infection after total hip arthroplasty. Forty patients were completely free from pain and 17 had slight intermittent pain. Fifty-one had normal or nearly normal walking ability. Most patients managed dressing and getting in and out of a bath without help. It is concluded that revision in most case offers a satisfactory solution for the patient and gives a better functional result than simple removal of the prosthesis.

Aged↗
PubMed1978

Revision with gentamicin-impregnated cement for deep infections in total hip arthroplasties.

Seventy-seven total hip arthroplasties complicated by deep infection were treated by reoperation and fixation of a new prosthesis with gentamicin-containing cement. The infection was proved in each case by positive bacterial cultures. Systemic antibiotic treatment was continued for six months postoperatively. Sixty hips were considered healed; the patients had no pain and had normal sedimentation rates and roentgenograms. Nine still had pain or an abnormal sedimentation rate and were classified as doubtful with regard to eradication of the infection. Eight were still infected. The patients were followed for six months to three and one-half years after reoperation.

Adult↗
PubMed1977

Rupture of the distal biceps tendon. Report of five cases.

Five cases of rupture of the distal biceps tendon are described. Three were operated on--two in the acute stage and one after 3 months--and the other two were managed conservatively. The literature on this condition is reviewed and alternative forms of treatment are discussed.

Arm Injuries↗
PubMedDate not supplied

Analgesic efficacy and safety comparison of ketorolac tromethamine and Doleron for the alleviation of orthopaedic post-operative pain.

The analgesic efficacy and safety of ketorolac tromethamine (ketorolac), a potent analgesic with anti-inflammatory and antipyretic activities, were evaluated and compared with Doleron, a combination analgesic, in 115 patients with moderate to severe orthopaedic post-operative pain. This was a randomized, double-blind (double-dummy), parallel-group comparison of a single oral dose of one capsule of 10 mg ketorolac with a single oral dose of two Doleron tablets (each tablet contained 150 mg dextropropoxyphene napsylate, 350 mg aspirin and 150 mg phenazone). During the 6 h following treatment, 80% of ketorolac treated patients and 82% of Doleron treated patients experienced adequate pain relief. There were no statistically significant differences in the overall analgesic efficacy between the treatment groups. Three patients (one on ketorolac, two on Doleron) withdrew because of adverse events (vomiting). Nausea (two patients in each treatment group), vertigo (none on ketorolac, three on Doleron) and sore throat (none on ketorolac, two on Doleron) were the only drug-related adverse events reported by more than one person in a treatment group during the trial. A total of 82% of patients given ketorolac and 76% given Doleron experienced no adverse events. A single oral dose of 10 mg ketorolac was shown to be as effective and safe as two Doleron tablets in the treatment of moderate to severe orthopaedic post-operative pain.

Adult↗