Olof Sköldenberg

Purpose and aims: Our overarching goal is to reduce the risk of the most-dreaded post-operative complication of total hip replacement (THR) – prosthetic joint infection (PJI). This project involves a nationwide, randomized, placebo-controlled, double-blinded clinical drug trial to test the hypothesis that antibiotic-impregnated bone graft (AIBG) reduces the risk for PJI in THR with bone graft.Survey of the field: The administration of local antibiotics as a complement to systemic antibiotic treatment has become popular in complex THR. The advantage over standard systemic treatment is that high local concentrations of antibiotics can be achieved that inhibit perioperative colonization of the implant, thereby avoiding systemic toxicity and development of antibiotic resistance. However, to support the clinical use of AIBG a pivotal trial is needed.Organization, time plan and methods: Within 2 years, we will establish a nationwide study group (orthopedic surgeons, infection specialists, microbiologists and patient representatives) and analyze results from a pilot study to facilitate implementation of the full study. All hospitals using bone graft will be invited to participate.Patients: THR with bone graftIntervention: AIBGControl: SalineOutcome: risk of PJIThe exact dosing of the antibiotics and serum levels (safety assessment) will be determined during Year 1.Importance: To test if AIBG can reduce the risk for PJI in THR and avoiding development of antibiotic resistance.

Rational for conducting the study: The most commonly used treatment of displaced femoral neck fracture in the elderly is hemiarthroplasty which provides a reliable clinical result. Deep periprosthetic joint infection (PJI) is a severe complication associated with an increased morality and often leads to major and repeated reoperations. PJI has been reported to occur in 2-4% of hemiarthroplasties after fracture. The aim of the trial is to investigate whether the risk of PJI is reduced after the use of dual impregnated antibiotic laden bone cement.Study design: Register-based, cluster randomized controlled trial.Population: Number of patients: 7,312. Inclusion criteria: Patients aged ≥60 year, with a displaced femoral neck fracture and eligible for hemiarthroplasty according to local guidelines. Exclusion criteria: Previous inclusion of contralateral hip. Pathological or stress fracture of the femoral neck or fracture adjacent to a previous ipsilateral hip implant.Intervention: Dual-impregnated antibiotic laden bone cement.Control: Single-impregnated antibiotic laden bone cement.Outcome: Primary outcome variable is the incidence of PJI within one year. Secondary outcome variables include the occurrence of re-operations for any reason, mortality,and health care costs. Future benefit and clinical application: A reduction of PJI could decrease the morbidity and mortality of this elderly population and reduce the need for reoperations and antibiotic treatment.

COVID-19 Coronavirus Pandemic has a devastating social and economic impact on humans leaving hundreds of millions of people at risk of extreme poverty. Until April 1st 2021, more than 129 million people have been infected, and nearly 2.9 million deaths have been reported worldwide. In only a year, the coronavirus pandemic has wiped out decades of global development in everything from health to economy and beyond.The COVID-19 pandemic also reveals shortcomings in emergency preparedness around the world. In the case of similar virus outbreaks, there will be an urgent need for a fast and effective method to increase the capacity of hospital isolation rooms and intensive care units to cope with the influx of patients. The present project aims at creating and designing a novel cost-effective, flexible and easy-to-implement solution for upgrading standard patient rooms to simplified isolation rooms (AIIR) for airborne infection. To that end: (I) A local ventilation exhaust will be designed, optimized, and implemented to remove emitted respiratory droplets from the hospitalized patients. Also (II) we will avoid leakage out of the room using an additional ventilation system smartly integrated into the standard patient room. Finally (III) we will combine the first two steps and verify the system (proof-of-concept) in laboratory measurements with industry participation. The solution will be used both for new construction and retrofitting of hospital buildings.