X-ref For other Roundups in this issue that cross-reference with Research see: Knee Roundups 5 and 8; Foot & Ankle Roundup 2; Trauma Roundup 8; Oncology 1.
Prevention of surgical infection
We would draw the attention of all readers to the first ever publication of the WHO guidelines on the prevention of surgical infection. The rather extensive document draws together all of the evidence that currently exists on the best strategies to prevent peri-operative infection and where the best place is to concentrate effort. The author team based in Geneva (Switzerland)1 has aimed to distil all of the evidence in a similar way to that in which national guidance is produced. The most interesting thing for us here at 360 is the emphasis. The guidance emphasises the importance of simple steps, and clearly underlines the evidence to support this approach: “For many years, environmental contamination was considered to be less important than many other factors in contributing to HAI. However, recent evidence shows that a contaminated health care environment plays a significant role in the transmission of microorganisms.”
Crossover analysis in meniscal tear: physiotherapy to surgery
There has been much in the academic press in recent times concerning the potential benefits (or usually, otherwise) of arthroscopic debridement of the knee, particularly in degenerative meniscal tears. The evidence would currently suggest that, at least in the setting of degenerative meniscal tears, arthroscopy has little benefit over physiotherapy. Of course, the caveat to this, and perhaps the saviour of the arthroscopic knee surgeon, is the high crossover rate in all published studies which, when undertaking an intention-to-treat analysis, could be said to skew the results somewhat. The academic team in Boston, Massachusetts (USA)2 have undertaken a re-analysis with an attempt to quantify which patients are more likely to cross over from one to the other, i.e. which patients are …