Browsing by Author "Solomon, C."

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    Mycobacterium fortuitum as infectious agent in a septic total knee replacement : case study and literature review
    (Champagne Media, 2015) Venter, R. G.; Solomon, C.; Baartman, M.
    Infection of prosthetic joints with non-tuberculous mycobacteria (NTM) is rare. The rapidly growing mycobacteria (RGM) are a subgroup of NTM. They are not very virulent organisms, found ubiquitously in the environment, and most infections in humans are due to direct inoculation of the organism into a joint or soft tissue. We describe a 70-year-old patient, who developed an infection with Mycobacterium fortuitum after primary knee arthroplasty, one of only a handful described in the literature. Peri-prosthetic infections with RGM are a challenge because there is a lack of data guiding management, and because the diagnosis is often delayed. Routine cultures of joint effusions or tissue are often discarded before the non-tuberculous mycobacteria have a chance to culture (in our case, 14 days). Principles of treatment include: making a diagnosis from tissue culture, staged revision surgery with aggressive surgical debridement of the joint and high dosages antibiotics (for at least six weeks, treating empirically initially until a sensitivity profile for the organism is available). The second stage of the revision should be delayed by 3-6 months. In our case the removed implant was autoclaved and re-implanted loosely with antibiotic-loaded cement as part of the first-stage revision.
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    Optimising perioperative care for hip and knee arthroplasty in South Africa : a Delphi consensus study
    (BioMed Central, 2018-05-09) Plenge, U.; Nortje, M. B.; Marais, L. C.; Jordaan, J. D.; Parker, R.; Van der Westhuizen, N.; Van der Merwe, J. F.; Marais, J.; September, W. V.; Davies, G. L.; Pretorius, T.; Solomon, C.; Ryan, P.; Torborg, A. M.; Farina, Z.; Smit, R.; Cairns, C.; Shanahan, H.; Sombili, S.; Mazibuko, A.; Hobbs, H. R.; Porrill, O. S.; Timothy, N. E.; Siebritz, R. E.; Van der Westhuizen, C.; Troskie, A. J.; Blake, C. A.; Gray, L. A.; Munting, T. W.; Steinhaus, H. K. S.; Rowe, P.; Van der Walt, J. G.; Isaacs Noordien, R.; Theron, A.; Biccard, B. M.
    Background: A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs. Methods: Applying a Delphi method, 33 stakeholders (13 arthroplasty surgeons, 12 anaesthetists and 8 physiotherapists) from 10 state hospitals representing 4 South African provinces identified and prioritised i) risk factors associated with poor outcomes, ii) perioperative interventions to improve outcomes and iii) patient and clinical outcomes necessary to benchmark practice for patients scheduled for primary elective unilateral total hip and knee arthroplasty. Results: Thirty of the thirty-three stakeholders completed the 3 months Delphi study. The first round yielded i) 36 suggestions to preoperative risk factors, ii) 14 (preoperative), 18 (intraoperative) and 23 (postoperative) suggestions to best practices for perioperative interventions to improve outcomes and iii) 25 suggestions to important postsurgical outcomes. These items were prioritised by the group in the consecutive rounds and consensus was reached for the top ten priorities for each category. Conclusion: The consensus derived risk factors, perioperative interventions and important outcomes will inform the development of a structured, perioperative multidisciplinary enhanced patient care protocol for total hip and knee arthroplasty. It is anticipated that this study will provide the construct necessary for developing pragmatic enhanced care pathways aimed at improving patient outcomes after arthroplasty in LMICs.