Traffic in the operating room during joint replacement is a multidisciplinary problemBackground: Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic. Methods:We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer's intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application. Results:The mean number of door openings during primary TJA was 71.1 (range 35-176) with a mean operative time of 111.9 (range 53-220) minutes, for an average of 0.64 (range 0.36-1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings. Conclusion:There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA.Contexte : Les ouvertures de porte perturbent le flux laminaire et accroissent la numération bactérienne au bloc opératoire. Nous avons voulu mesurer l'incidence des ouvertures de porte au bloc opératoire durant les chirurgies pour prothèse articulaire totale (PAT) et déterminer si des correctifs étaient requis ou s'il était possible de réduire la circulation du personnel au bloc opératoire. Méthodes :Nous avons dénombré les ouvertures de porte durant 100 chirurgies électives primaires pour PAT; le personnel du bloc opératoire n'était pas au courant de l'intention de l'observateur. Le temps opératoire a été subdivisé en une période pré-incision, définie par l'intervalle entre l'ouverture des plateaux chirurgicaux et l'incision chirurgicale, et une période post-incision, définie par l'intervalle entre l'incision et l'application du pansement.

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Background: Reverse total shoulder arthroplasty (RTSA) procedures have significantly increased in the last decade as an alternative to the current treatments for cuff-tear arthropathy. Since Grammont's theory in 1987, few data about the in vivo kinetics of the shouldergirdle musculature in patients with RTSA have been available. The goals of this study are to (1) describe the contribution of principal muscles around the shoulder by electromyography and (2) access the range of motion of 5 movements of patients with RTSA compared with normal shoulders. Methods: This is an observational prospective cohort study of 21 patients divided into 11 patients with RTSA and 10 controls. The muscular activity was recorded with bipolar cutaneous electrodes, whereas the range of motion was synchronized and recorded by 8 motion cameras. Five movements (flexion, abduction, neutral external rotation, external rotation in 90 of abduction, and internal rotation in 90 of abduction) were studied. Results: The upper trapezius is the main activator in all directions with early and constant activity (P < .01). The latissimus dorsi demonstrates increased muscular activity in internal rotation (P < .01) as well as the posterior deltoid in external rotation in the RTSA group compared with control (P < .01). Conclusion: RTSA shoulder muscle activation is significantly different than in normal shoulders. The significant contribution of the trapezius in all directions, latissimus dorsi in internal rotation, and posterior deltoid in external rotation has never been described within the same study until today. New rehabilitation protocols targeting those muscles could demonstrate better and more homogeneous results and increase patient satisfaction.