Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of SSI.According to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 hours.AIM To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of SSI.METHODS Using retrospective data review from the National Trauma Data Bank,Trauma Quality Improvement Project(TQIP)of 2019.TQIP database is own by the ACS and it is the largest database for trauma quality program in the world.Propensity matching analysis was performed for the study.RESULTS There were 390 pediatric patients with open long bone fractures who were incl-uded in the study.After completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 hours.We found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the patients.CONCLUSION Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

Enzymatic debridement shall not modify the global strategy for mass burn events

We read with interest the letter by Surowiecka et al.[1]about early burn wound excision in mass casualty events.We couldn’t agree more with their statement about the benefit of early burn wound excision.Still,we doubt whether applying this strategy to every patient during a mass burn event could be realistic.Of note,while there is an undisputed consensus that early burn wound excision is the gold standard of burn care,what‘early’actually means is still debated.Depending on the authors,the corresponding time limit typically varies from 24 h to a few days[2,3].

Single-stage anterior debridement and reconstruction with tantalum mesh cage for complicated infectious spondylitis

AIM To evaluate the clinical and radiographic results of patients with complicated infectious spondylitis treated with single-stage anterior debridement and reconstruction using tantalum mesh cage(TaMC) followed by immediate instrumentation.METHODS Single-stage radical debridement and subsequent reconstruction with TaMC instead of autograft or allograft were performed to treat 20 patients with spinal deformity or instability due to complicated infectious spondylitis. Clinical outcomes were assessed by careful physical examination and regular serological tests to determine the infection control. In addition, the visual analog score(VAS), neurologic status, length of vertebral body reconstruction, and the correction of sagittal Cobb angle on radiography were recorded and compared before and after surgery. The conditions of the patients were evaluated based on the modified Brodsky's criteria.RESULTS The average VAS score significantly decreased after the surgery(from 7.4 ± 0.8 to 3.3 ± 0.8, P < 0.001). The average Cobb angle correction was 14.9 degrees. The neurologic status was significantly improved after the surgery(P = 0.003). One patient experienced refractory infection and underwent additional debridement. Eighteen patients achieved good outcome based on the modified Brodsky's criteria and significant improvement after the surgery(P < 0.001). No implant breakage orTaMC dislodgement was found during at least 24 mo of follow-up.CONCLUSION Single-stage anterior debridement and reconstruction with TaMC followed by immediate instrumentation could be an alternative method to manage the patients with spinal deformity or instability due to complicated infectious spondylitis.

Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis

BACKGROUND The incidence of lumbar tuberculosis is high worldwide,and effective treatment is a continuing problem.AIM To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.METHODS The C-reactive protein(CRP)level,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)score,oswestry disability index(ODI)and American Spinal Injury Association(ASIA)grade were recorded and analysed pre-and postoperatively.RESULTS The CRP level and ESR returned to normal,and the VAS score and ODI were decreased at 3 mo postoperatively,with significant differences compared with the preoperative values(P<0.01).Neurological dysfunction was relieved,and the ASIA grade increased,with no adverse events.CONCLUSION The multitrack,multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III

BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

Modified ulcer debridement in the treatment of the superficial fungal infection of the cornea

AIM： To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS： A total of 209 patients（209 eyes） with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS： The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes（93.3%）, with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty（PK）（1 eye）, anterior lamellar keratoplasty（LK）（7 eyes）, conjunctival flap covering（4 eyes） or amniotic membrane transplantation（2 eyes）. The best corrected visual acuity（BCVA） was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon（P=0.036） and ever using steroid（P=0.025）.CONCLUSION： Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.

Adjunctive platelet-rich plasma and hyaluronic acid injection after arthroscopic debridement in Kellgren-Lawrence grade 3 and 4 knee osteoarthritis

BACKGROUND Osteoarthritis(OA)is the most common cause of pain and disability,predominantly affecting the knee.The current management of knee OA falls short of completely stopping disease progression,particularly in Kellgren-Lawrence(KL)grade 3 and 4 knee OA.As such,joint replacement is often recommended,although only 15%-33%of candidates accept it.Alternative therapeutic options are still needed to prevent the progression of joint damage and delay the need for knee arthroplasty.AIM To investigate the effect of adjunctive platelet rich plasma(PRP)and hyaluronic acid(HA)after arthroscopic debridement in KL grade 3 and 4 knee OA.METHODS This retrospective cohort study used the Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)score and WOMAC sub-scores(pain,stiffness,and function)to assess 21 patients,grouped according to medical record data of treatment received:Arthroscopic debridement(n=7);arthroscopic debridement with PRP(n=7);or arthroscopic debridement with HA(n=7).WOMAC scores and sub-scores at baseline and at 3 mo and 5 mo posttreatment were recorded.The three-group data were statistically analyzed using the tests of paired t,one-way analysis of variance,and post hoc least significant difference.RESULTS All three treatment groups showed significant improvements in WOMAC score and sub-scores from before treatment to 3 mo and 5 mo after treatment.However,the arthroscopic debridement with PRP treatment group,in particular,showed a significantly lower WOMAC pain score than the group who received arthroscopic debridement alone at 5 mo after the procedure(P=0.03).CONCLUSION Compared to arthroscopic debridement alone,adjunctive PRP after arthroscopic debridement significantly lessened the patients’pain symptom.

Combined debridement in chronic wounds:A literature review

Wounds debridement is important for healing of chronic wounds. Combined debridement is a new technique to deal with the complex chronic wounds. This review introduces several topical methods of combined debridement according to the various color classifications. Methods include combined sharp and hydrogel debridement, combined ultrasonic and enzymatic debridement, ultrasonic debridement combined with surgical debridement and vacuum aspiration on debridement, and other types of debridement. This article also explores why each combined debridement mentioned above can achieve a good effect.

Use of a selective enzymatic debridement agent(Nexobrid■)for wound management:Learning curve

AIM To evaluate the efficacy of Nexobrid~? in the initial management of burns and lessons learned with the procedure.METHODS From January 27^(th) 2015 until January 25^(th) 2016, 25 patients aged between 18-94 years old with deep partial and full thickness burns were treated with Nexobrid~? covering 1%-30% of their total body surface area(TBSA). The debridement was applied in the first 96 h post-injury following the protocol suggested for Nexobrid~?. In patients with burns of more than 15% TBSA a second application of Nexobrid~? was performed. After the removal of the product-4 h post application and after a 2 h period of wet dressing-we used several products to cover the wound like Suprathel~?, Biobrane~?, Mepitel~? with wet dressing, silver sulphadiazine 1% cream, and in some cases even autografts. We treated patients with inhalation injury as well. All the procedures were done under deep sedation, regional blocks in extremities or general anaesthesia in the intensive care unit room or in the operating theatre.RESULTS After these first 25 cases, we have observed that patients with partial thickness burns treated with Nexobrid~?, experienced great benefits in the reduction of the need for autografting compared with the standard of care. This isbecause after selective enzymatic debriding of the burn scar we can distinguish different wound beds, which can coexist in the same patient, and we also managed to associate each one to its ability to epithelize. In major burns, besides the improvement in wound healing, we observed an important improvement in their general state. This may be because SIRS significantly improved through a bloodless debridement of necrotic tissue, decreasing the requirements of vasoactive drugs and fluid resuscitation. Circumferential burns also benefited from enzymatic debridement, observing a decrease in the number of compartment syndromes and the need for escharotomies. At present, we have not observed a positive effect in the evolution and outcome of major burns with inhalation injury.CONCLUSION The introduction of Nexobrid~? shows significant improvement in burn treatment. Cumulative experiences are necessary to adapt its application in all Burns Centres.

Mid-term follow-up of one-stage posterior debridement, intertransverse process bone grafting and screw-rod system fixation for Brucella spondylitis of the lumbar spine

Objective:To investigate the short-term and medium-term efficacy of one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation in the treatment of Brucella spondylitis of the lumbar spine.Method:156 cases of Brucella spondylitis of lumbar spine were selected and divided into experimental group(n=80)and combined group(n=76)according to different surgical methods.The experimental group was treated with one-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation.The combined group was treated with one-stage anterior debridement and intertransverse process bone grafting combined with posterior internal fixation.The operative indexes and clinical effects were compared between the two groups.Result:The operation time,intraoperative bleeding volume and time of landing after operation in the experimental group were less than those in the combined group,with statistical significance(P<0.05).VAS score,ODI index,Cobb angle and Frankel grade of nervous function in the two groups were significantly improved after 3 months and 36 months of treatment(P<0.05),but there was no significant difference between the two groups at the same time(P>0.05).There was no significant difference in the excellent and good rate between the two groups after 3 and 36 months of treatment(P>0.05).There was no recurrence of the lesion in both groups.The intertransverse process bone graft healed and the screw-rod system was well fixed.Conclusion:One-stage posterior debridement,intertransverse process bone grafting and screw-rod system fixation for treatment of Brucella spondylitis of lumbar spine are effective,with short operation time and less trauma,which are worthy of clinical promotion.

Routine laboratory parameters in patients with necrotizing pancreatitis by the time of operative pancreatic debridement:Food for thought

BACKGROUND Timing of invasive intervention such as operative pancreatic debridement(OPD)in patients with acute necrotizing pancreatitis(ANP)is linked to the degree of encapsulation in necrotic collections and controlled inflammation.Additional markers of these processes might assist decision-making on the timing of surgical intervention.In our opinion,it is logical to search for such markers among routine laboratory parameters traditionally used in ANP patients,considering simplicity and cost-efficacy of routine laboratory methodologies.AIM To evaluate laboratory variables in ANP patients in the preoperative period for the purpose of their use in the timing of surgery.METHODS A retrospective analysis of routine laboratory parameters in 53 ANP patients undergoing OPD between 2017 and 2020 was performed.Dynamic changes of routine hematological and biochemical indices were examined in the preoperative period.Patients were divided into survivors and non-survivors.Survivors were divided into subgroups with short and long post-surgery length of stay(LOS)in hospital.Correlation analysis was used to evaluate association of laboratory variables with LOS.Logistic regression was used to assess risk factors for patient mortality.RESULTS Seven patients(15%)with severe acute pancreatitis(SAP)and 46 patients(85%)with moderately SAP(MSAP)were included in the study.Median age of participants was 43.2 years;33(62.3%)were male.Pancreatitis etiology included biliary(15%),alcohol(80%),and idiopathic/other(5%).Median time from diagnosis to OPD was≥4 wk.Median postoperative LOS was at the average of 53 d.Mortality was 19%.Progressive increase of platelet count in preoperative period was associated with shortened LOS.Increased aspartate aminotransferase and direct bilirubin(DB)levels the day before the OPD along with weak progressive decrease of DB in preoperative period were reliable predictors for ANP patient mortality.CONCLUSION Multifactorial analysis of dynamic changes of routine laboratory variables can be useful for a person-tailored timing of surgical intervention in ANP patients.

Comment on amniotic membrane covering promotes healing of cornea epithelium and improves visual acuity after debridement for fungal keratitis

【正】Dear Editor,We congratulate Zeng et al[1]for their study entitled"Amniotic membrane covering promotes healing of cornea epithelium and improves visual acuity after debridement for fungal keratitis".The authors endeavored to present an alternative method for ophthalmologists in the treatment of a challenging case.We would like to express our reservations and ask for the attitudes of the authors about

Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection

AIM:To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis(SAP).METHODS:A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization.An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d.The sinus tract of the drainage catheter was expanded gradually with a skin expander,and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d.Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract.RESULTS:Among the 42 patients,the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts.No death and complication occurred during the procedure.CONCLUSION:Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to SAP.

Preparation and Mechanical Properties of a Novel Textile Pad for Wound Debridement

Various types of wound debridement approaches are currently available in clinical practice such as autolytie, enzymatic. biodebridement, mechanical, and surgical debridemenl techniques. A critical look at these various options can explain their potential but also their limitations. In this study, a novel textile pad, which is composed of polyester filaments on the fleecy side and a bioeompatible coating on the opposite side, was made to provide a safe, inexpensive, easier and especially more efficient debridement process that can be used in all healthcare settings by all healthcare practitioners. Eighteen kinds of samples were prepared with different pile density, ground yarn count and coating amount. Dimensional morphology, stitch density, mass per unit area and mechanical properties were investigated to study the intrinsic relationship of structure and properties of textile pad for wound debridement. Results showed that tensile strength and suturing strength at piped site increased obviously with the increment of ground yarn count, while the amount of coating could also have a slight impact on these two properties. However, compressive load was mainly affected by pile density, with no obvious relation to ground yarn count and coating amount.

Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention?

To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention.A literature search was performed through Pub Med until September 2013.Search terms were"DAIR(debridement,antibiotics,irrigation,and retention)"alone and in combination with"hip"as well as"hip infection+prosthesis retention".A total of 11 studies reporting on 292 cases could be identified.Five different treatment modalities have been described with varying success rates(debridement-21%infection eradication rate;debridement+lavage-75%infection eradication rate;debridement,lavage,with change of modular prosthesis components-70.4%infection eradication rate;debridement,lavage,change of modular prosthesis components+vacuum-assisted closure-92.8%infection eradication rate;acetabular cup removal+spacer head onto retained stem-89.6%infection eradication rate).With regard to the postoperative antibiotic therapy,no general consensus could be drawn from the available data.Debridement,antibiotic therapy,irrigation,and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections.The current literature does not allow for generalization of conclusions with regard to thebest treatment modality.A large,multi-center study is required for identification of the optimal treatment of these infections.

Early debridement and delayed primary vascularized cover in forearm electrical burns: A prospective study

AIM To look into the management options of early debridement of the wound, followed by vascularized cover to bring in fresh blood supply to remaining tissue in electrical burns. METHODS A total of 16 consecutive patients sustaining full thickness forearm burns over a period of one year were included in the study group. Debridement was undertaken within 48 h in 13 patients. Three patients were taken for debridement after 48 h. Debridement was repeated within 2-4 d after daily wound assessment and need for further debridement. RESULTS On an average two debridements(range 1-4) was required in our patients for the wound to be ready for definitive cover. Interval between each debridement ranged from 2-18 d. Fourteen patients were provided vascularized cover after final debridement(6 free flaps, 8 pedicled flaps). Functional assessment of gross hand function done at 6 wk, 2 mo, 3 mo and 6 mo follow-up. CONCLUSION High-tension electrical burns lead to significant morbi-dity. These injuries are best managed by early decompression followed by multiple serial debridements. The ideal timing of free flap coverage needs further investigation.

Arthroscopic Debridement with Lavage and Arthroscopic Lavage Only as the Treatment of Symptomatic Osteoarthritic Knee

In this prospective follow up study we evaluated and compared the effect of arthroscopic lavage with and without debridement as a treatment of moderately osteoarthritic knees in middle aged and elderly population. The study group comprised of 500 patients (250 patients for each type of treatment, mean age 58 years). The patients were followed six months, three years and six years postoperatively. Following both treatments there was a clear deterioration in function of the knee function over the time, as measured starting at six months follow up until six years postoperatively (p < 0.001). This deterioration was more prominent in patients after treatment by the arthroscopic lavage only. We show that for the patients with high functional demand and expectations for long term rehabilitation and improvement both arthroscopic treatments are not satisfactory in more of 60% of cases.

Comparison of the Outcome of Treatment of Chronic Osteomyelitis by Surgical Debridement with and without Local Antibiotic Delivery System: Experience from a Nigerian Teaching Hospital

Background: Chronic osteomyelitis is still common in the developing world and presents a continuing therapeutic challenge. Antibiotics cannot penetrate the dense fibrotic scar tissue that surrounds infected and avascular bone which perpetuates the infection. Surgical debridement/sequestrectomy is the cornerstone to treatment and aims to create a viable, vascularized base which promotes healing. Surgical debridement necessarily creates a dead space which must be dealt with to prevent re-infection. Local antibiotic delivery systems serve the dual purpose of obliterating dead space and creating a sterile local environment with high bactericidal concentrations. Aim: To determine the outcomes in patients with chronic osteomyelitis who received debridement/sequestrectomy alone, and those who received the procedure combined with a local antibiotic delivery system in the University of Calabar Teaching Hospital. Patients and Methods: A prospective descriptive analysis of patients managed surgically for chronic osteomyelitis from July 2007 to December, 2012. Patients’ biodata, aetiology, organisms, treatment options and outcomes were analysed. Results: Forty-four patients presented with the condition and accepted surgery. Male:Female ratio was 2.1:1, and mean age was 27.27 ± 17.48 years. The tibia was the most commonly affected bone (45.5%), Staphylococcus aureus was the commonest organism (56.8% of sinus cultures;73% of marrow/sequestral cultures) and previous acute haematogenous osteomyelitis was the commonest mechanism. The use of a local antibiotic delivery system improved cure rates from 57.7% to 77.8%). Conclusion: Multiple surgical interventions increase the socioeconomic costs of treating this condition and have a direct impact on the economies of individuals especially in the developing world. Surgical interventions should aim at achieving maximum impact with minimum repetition of the processes. Adequate surgical debridement combined with a local antibiotic delivery system offer improved chances of obtaining cure in this therapeutically challenging disease.

Arthroscopic Debridement and Synovium Resection for Inflammatory Hip Arthritis

Objective To evaluate the efficacy of arthroscopic surgery in inflammatory hip arthritis.Methods A retrospective clinical study was conducted inspecting 40 hips in 36 patients of inflammatory arthritis.There were 17 cases of ankylosing spondylitis,11 cases of rheumatoid arthritis,and 8 cases of psoriatic arthritis.The joints were irrigated and the inflamed tissues were debrided with anthroscopy.The patients were followed up with Harris hip score,Oxford hip score,Visual Analog Scale(VAS),and magnetic resonance imaging(MRI).Statistical analysis was performed using Student t test.Results All of the 36 cases were followed up for 46-103 months,averaging 67.2±8.4 months.Harris and Oxford scores increased from 66.9±12.1 and 69.4±16.4 before operation to 78.4±19.3 and 80.2±18.8 after operation,respectively(P<0.05).VAS score decreased from pre-operative 8.5±2.5 to post-operative 7.2±2.5(P<0.05).All the patients showed improved joint range of motion.MRI revealed alleviation of hip synovitis.The results were classified as excellent in 8 patients,good in 17 patients,fair in 8 patient,and poor in 3 according to Harris hip score.Twenty-seven patients were satisfied with the operative outcomes as they regained normal daily activities.Conclusions Arthroscopy-assisted joint debridement and synovium resection is an effective procedure for hip lesion in inflammatory arthritis.The inflammatory lesion might be thereby controlled and the symptoms be relieved.

Endoscopic ultrasonography drainage and debridement of an infected subcapsular hepatic hematoma:A case report

BACKGROUND Endoscopic ultrasonography(EUS)has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure.EUS is now used as an alternative technique to percutaneous and surgical drainage.Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage,there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.CASE SUMMARY We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma(SHH)of the left lobe following percutaneous biliary drainage.After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery,we conducted a EUS drainage and debridement of the SHH.Using a lumen apposing metal stent(LAMS)by a transgastric approach,we were able to gain endoscopic access to the SHH.With our experience in the debridement of walled off pancreatic necrosis using this technique,we were confident it was the right approach.After four debridement sessions,the computed tomography scan showed a clear regression of the SHH.CONCLUSION To our knowledge,this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.