BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications w...BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.展开更多
Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficient...Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.展开更多
A 98-year-old male patient with history of hemiarthroplasty suffered periprosthetic fracture of right femoral shaft and developed acute coronary event in three days after hospitalization.Femoral nerve and lateral femo...A 98-year-old male patient with history of hemiarthroplasty suffered periprosthetic fracture of right femoral shaft and developed acute coronary event in three days after hospitalization.Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia were implemented for the internal fixation surgery.The recovery was uneventful after discharge.In this case report,we discussed the main considerations of anesthesia specifically for this complicated case.展开更多
BACKGROUND The alpha-defensin lateral flow(ADLF)test is a new diagnostic tool for periprosthetic joint infection(PJI).Test accuracy for combined cohorts of hip and knee PJI has been reported to be good.AIM To assess t...BACKGROUND The alpha-defensin lateral flow(ADLF)test is a new diagnostic tool for periprosthetic joint infection(PJI).Test accuracy for combined cohorts of hip and knee PJI has been reported to be good.AIM To assess the accuracy of the ADLF test for hip PJI,and to compare three different diagnostic criteria for PJI.METHODS A cohort of 52 patients was identified,with a painful or poor-functioning total hip-or hemi-arthroplasty,that underwent aspiration and a subsequent ADLF test.PJI was diagnosed with Musculoskeletal Infection Society(MSIS)criteria,and sensitivity,specificity,overall accuracy,positive predictive value and negative predictive value were calculated.Furthermore,test specifics were compared with the European Bone and Joint Infection Society(EBJIS)and 2018 International Consensus Meeting(ICM)criteria for PJI.RESULTS Using MSIS criteria,sensitivity was 100%(CI:54%-100%)and specificity was 89%(CI:76%-96%).Six true positives and 5 false positives were found,including one case of metallosis.Using EBJIS criteria,more PJIs were found(11 vs 6),sensitivity was lower(71%,CI:42%-92%)and specificity was higher(97%,CI:86%-100%),with 4 false negatives and one false positive result.Using 2018 ICM criteria,sensitivity was 91%(62%-100%)and specificity 100%(91%-100%).The results in this cohort are comparable to previous studies.CONCLUSION Overall test accuracy of the ADLF test was good in this cohort,with a sensitivity of 100%and specificity of 89%.Using different PJI definition criteria,sensitivity and specificity changed slightly but overall accuracy remained around 90%.Using the ADLF test in metallosis cases can result in false positive results and should be performed with caution.展开更多
Periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing eff...Periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively(4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one ormore positive culture results. Debridement, antibiotics and implant retention(DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus(aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients.展开更多
Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of c...Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.展开更多
Despite significant improvements over the past several decades in diagnosis,treatment and prevention of periprosthetic joint infection(PJI),it still remains a major challenge following total joint arthroplasty.Given t...Despite significant improvements over the past several decades in diagnosis,treatment and prevention of periprosthetic joint infection(PJI),it still remains a major challenge following total joint arthroplasty.Given the devastating nature and accelerated incidence of PJI,prevention is the most important strategy to deal with this challenging problem and should start from identifying risk factors.Understanding and well-organized optimization of these risk factors in individuals before elective arthroplasty are essential to the ultimate success in reducing the incidence of PJI.Even though some risk factors such as demographic characteristics are seldom changeable,they allow more accurate expectation regarding individual risks of PJI and thus,make proper counseling for shared preoperative decision-making possible.Others that increase the risk of PJI,but are potentially modifiable should be optimized prior to elective arthroplasty.Although remarkable advances have been achieved in past decades,many questions regarding standardized practice to prevent this catastrophic complication remain unanswered.The current study provide a comprehensive knowledge regarding risk factors based on general principles to control surgical siteinfection by the review of current literature and also share own practice at our institution to provide practical and better understandings.展开更多
AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty(TKA).METHODS: A literature search was done to identify studies that fit...AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty(TKA).METHODS: A literature search was done to identify studies that fit the inclusion criteria. The database search yielded 185 results, which were further reduced by the exclusion criteria to 13 papers, totaling 157 patients that met these criteria. Incidence rates of the different types of periprosthetic tibia fractures were determined and their treatments were subsequently analyzed based on the fracture's subclass, with patient outcomes being overall favorable.RESULTS: Of the 144 documented patients, 54(37.5%) had a subclass C fracture, which are frequently seen in revision arthroplasties or when using cement intraoperatively. The fractures of subclasses A and B occur postoperatively. There were 90 subclass A and B fractures with incidences of 18.75% and 43.75% respectively. When broken down by type, 62(55.36%) were type 1, 24(21.4%) were type 2, 24(21.4%) were type 3, and 2(1.8%) were type 4. Furthermore, from the studies that included origin of injury, the types were further classified as having non-traumatic or traumatic origins. Type 1 had 78%(40/51) non-traumatic origin and 22%(11/51) traumatic origin. Fifteen fractures were type 2, but 5 were falls and 1 through a motor vehicle accident, giving a trauma causation of 40%(6/15). Of the 24 type 3 fractures, 12 were falls and 2 vehicular accidents, leading to a trauma causation of 58%(14/24).CONCLUSION: Type 1 fractures were the most common. Subclass A was treated with locking plates, B required a revision TKA, and C was treated intraoperatively or nonoperatively.展开更多
AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients pr...AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.展开更多
AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections(PJI).METHODS This systematic review included full-text studies that...AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections(PJI).METHODS This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio(OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias. RESULTS Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies(14.8%) reviewed PJI of the hip, 3(11.21%) of the knee, and 20(74.1%) reviewed both joints. Nineteen studies(70.4%) were retrospective and 8(29.6%) prospective. Record bias was identified in the majority of studies(66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids(OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50(OR = 18.3, P < 0.001), tobacco use(OR = 12.76, 95%CI: 2.47-66.16, P= 0.017), body mass index below 20(OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes(OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease(OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).CONCLUSION We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.展开更多
The era of metal-on-metal(MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to descri...The era of metal-on-metal(MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977,along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as(1) gross(metallosis, necrosis, cyst formation and pseudotumour);(2) histological(macrophage-dominated, lymphocyte-dominated or mixed);and(3) molecular(expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and materi-al-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris.展开更多
BACKGROUND Candidal periprosthetic joint infection is a rare and difficult to diagnose complication of total knee arthroplasty.The treatment of such complications is inconclusive and may include prosthesis removal,deb...BACKGROUND Candidal periprosthetic joint infection is a rare and difficult to diagnose complication of total knee arthroplasty.The treatment of such complications is inconclusive and may include prosthesis removal,debridement,arthrodesis,and extensive antifungal therapy to control the infection.CASE SUMMARY A 62-year-old male with a history of total knee arthroplasty(TKA)in his left knee presented with ipsilateral knee pain and a sinus discharge 20 mo after TKA.The patient was previously evaluated for left knee pain,swelling,and a transient fever one month postoperatively.Prothesis removal and insertion of a cement spacer were performed in a local hospital six months prior to the current presentation.Medical therapy included rifampicin and amphotericin which were administered for 4 wk following prosthesis removal.A second debridement was performed in our hospital and Candida parapsilosis was detected in the knee joint.Fourteen weeks following the latter debridement,the patient suffered a left intertrochanteric fracture and received closed reduction and internal fixation with proximal femoral nail anterotation.Two weeks after fracture surgery,a knee arthrodesis with autograft was performed using a double-plate fixation.The patient recovered adequately and was subsequently discharged.At the two-year follow-up,the patient has a stable gait with a pain-free,fused knee.CONCLUSION Fungal periprosthetic joint infection following TKA may be successfully and safely treated with prosthesis removal,exhaustive debridement,and arthrodesis after effective antifungal therapy.Ipsilateral intertrochanteric fractures of the affected knee can be safely fixated with internal fixation if the existing infection is clinically excluded and aided by the investigation of serum inflammatory markers.展开更多
We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there w...We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.展开更多
AIM: To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners. METHODS: A Vancouver B1 periprosthetic fracture was simulated i...AIM: To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners. METHODS: A Vancouver B1 periprosthetic fracture was simulated in femur prosthesis constructs using sawbones and cemented regular straight hip stems. Fixation was then performed with either unicortical locked-screw plating using the less invasive stabilization system-plate or with intraprosthetic screw fixation using inserted liners. Two experimental groups were formed using either prostheses made of titanium alloy or prostheses made of cobalt chrome alloy. Fixation stability was compared in an axial load-to-failure model. Drilling was performed using a specially invented prosthesis drill with constantly applied internal cooling.RESULTS: The intraprosthetic fixation model with titanium prostheses was superior to the unicortical lockedscrew fixation in all tested devices. The intraprosthetic fixation model required 10 456 N ± 1892 N for failure and the unicortical locked-screw plating required 7649 N ± 653 N(P < 0.05). There was no significant difference between the second experimental group and the control group.CONCLUSION: Intraprosthetic screw anchorage with special threaded liners enhances the primary stability in treating periprosthetic fractures by internal fixation.展开更多
BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI...BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.展开更多
AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retro...AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years(range: 2.5-9 years). RESULTS: The causative pathogens were isolated from 29 patients(76%), 26 of whom were infected with highly virulent organisms. Sixteen patients(42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity(P < 0.001), a lower preoperative Harris hip score(HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection(P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7(20%), 12(34%), 11(32%)and 5(14%) patients receiving excellent, good, fair and poor ratings, respectively. CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients(i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level Ⅳ.展开更多
BACKGROUND Periprosthetic joint infection(PJI)is a catastrophic complication that can occur following total knee arthroplasty(TKA).Currently,the treatment for PJI mainly includes the use of antibiotics alone,prostheti...BACKGROUND Periprosthetic joint infection(PJI)is a catastrophic complication that can occur following total knee arthroplasty(TKA).Currently,the treatment for PJI mainly includes the use of antibiotics alone,prosthetic debridement lavage,primary revision,secondary revision,joint fusion,amputation,etc.AIM To explore the clinical effect of two-stage revision surgery for the treatment of PJI after TKA.METHODS The clinical data of 27 patients(3 males and 24 females;age range,47–80 years;mean age,66.7±8.0 years;27 knees)with PJI treated with two-stage revision surgery in our hospital between January 1,2010 and December 31,2020 were analyzed retrospectively.The following outcomes were compared for changes between preoperative and last follow-up results:Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores,knee range of motion(ROM),and infection cure rates.RESULTS All 27 patients were followed up(range,13–112 mo).The ESR(14.5±6.3 mm/h)and CRP(0.6±0.4 mg/dL)of the patients at the last follow-up were significantly lower than those at admission;the difference was statistically significant(P<0.001).The postoperative VAS score(1.1±0.7),HSS score(82.3±7.1),and knee ROM(108.0°±19.7°)were significantly improved compared with those before the surgery;the difference was statistically significant(P<0.001).Of the 27 patients,26 were cured of the infection,whereas 1 case had an infection recurrence;the infection control rate was 96.3%.CONCLUSION Two-stage revision surgery can effectively relieve pain,control infection,and retain good joint function in the treatment of PJI after TKA.展开更多
BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the eld...BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.展开更多
BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Alth...BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.展开更多
BACKGROUND The quantitative alpha-defensin enzyme-linked immunosorbent assay(ELISA)demands a prior synovial fluid centrifugation,whereas this processing is not routinely required prior to the alpha-defensin lateral fl...BACKGROUND The quantitative alpha-defensin enzyme-linked immunosorbent assay(ELISA)demands a prior synovial fluid centrifugation,whereas this processing is not routinely required prior to the alpha-defensin lateral flow test.AIM To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection(PJI)diagnosis.METHODS Fifty-three cases were included in this study:22 classified as PJI and 31 classified as aseptic cases,according to Musculoskeletal Infection Society 2013 criteria.Synovial fluid samples were submitted to centrifugation,and the supernatant was evaluated by ELISA and lateral flow tests.The sensitivity(SE),specificity(SP)and accuracy of each method were calculated as well as the agreement between those two methods.RESULTS In all of the 31 samples from aseptic patients,alpha-defensin ELISA and lateral flow tests showed negative results for infection.Regarding the 22 infected patients,the lateral flow test was positive in 19 cases(86.4%)and the ELISA was positive in 21(95.5%).Sensibility,SP and accuracy were,respectively,86.4%(95%CI:65.1%-97.1%),100%(95%CI:88.8%-100%)and 93.2%(95%CI:82.8%-98.3%)for the lateral flow test and 95.5%(95%CI:77.2%-99.9%),100%(95%CI:88.8%-100%)and 98.1%(95%CI:89.9%-100%)for ELISA.An agreement of 96.2%between those methods were observed.No statistical difference was found between them(P=0.48).CONCLUSION Alpha-defensin lateral flow test showed high SE,SP and accuracy after a prior synovial fluid centrifugation,achieving comparable results to ELISA.Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition,a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.展开更多
基金Supported by the General Cultivation Project of Xi'an Health Commission,No.2021ms08.
文摘BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.
文摘Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.
文摘A 98-year-old male patient with history of hemiarthroplasty suffered periprosthetic fracture of right femoral shaft and developed acute coronary event in three days after hospitalization.Femoral nerve and lateral femoral cutaneous nerve blocks combined with general anesthesia were implemented for the internal fixation surgery.The recovery was uneventful after discharge.In this case report,we discussed the main considerations of anesthesia specifically for this complicated case.
文摘BACKGROUND The alpha-defensin lateral flow(ADLF)test is a new diagnostic tool for periprosthetic joint infection(PJI).Test accuracy for combined cohorts of hip and knee PJI has been reported to be good.AIM To assess the accuracy of the ADLF test for hip PJI,and to compare three different diagnostic criteria for PJI.METHODS A cohort of 52 patients was identified,with a painful or poor-functioning total hip-or hemi-arthroplasty,that underwent aspiration and a subsequent ADLF test.PJI was diagnosed with Musculoskeletal Infection Society(MSIS)criteria,and sensitivity,specificity,overall accuracy,positive predictive value and negative predictive value were calculated.Furthermore,test specifics were compared with the European Bone and Joint Infection Society(EBJIS)and 2018 International Consensus Meeting(ICM)criteria for PJI.RESULTS Using MSIS criteria,sensitivity was 100%(CI:54%-100%)and specificity was 89%(CI:76%-96%).Six true positives and 5 false positives were found,including one case of metallosis.Using EBJIS criteria,more PJIs were found(11 vs 6),sensitivity was lower(71%,CI:42%-92%)and specificity was higher(97%,CI:86%-100%),with 4 false negatives and one false positive result.Using 2018 ICM criteria,sensitivity was 91%(62%-100%)and specificity 100%(91%-100%).The results in this cohort are comparable to previous studies.CONCLUSION Overall test accuracy of the ADLF test was good in this cohort,with a sensitivity of 100%and specificity of 89%.Using different PJI definition criteria,sensitivity and specificity changed slightly but overall accuracy remained around 90%.Using the ADLF test in metallosis cases can result in false positive results and should be performed with caution.
文摘Periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively(4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one ormore positive culture results. Debridement, antibiotics and implant retention(DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus(aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients.
文摘Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.
基金Supported by The grant of Research Institute of Medical Science,Catholic University of Daegu(2011)
文摘Despite significant improvements over the past several decades in diagnosis,treatment and prevention of periprosthetic joint infection(PJI),it still remains a major challenge following total joint arthroplasty.Given the devastating nature and accelerated incidence of PJI,prevention is the most important strategy to deal with this challenging problem and should start from identifying risk factors.Understanding and well-organized optimization of these risk factors in individuals before elective arthroplasty are essential to the ultimate success in reducing the incidence of PJI.Even though some risk factors such as demographic characteristics are seldom changeable,they allow more accurate expectation regarding individual risks of PJI and thus,make proper counseling for shared preoperative decision-making possible.Others that increase the risk of PJI,but are potentially modifiable should be optimized prior to elective arthroplasty.Although remarkable advances have been achieved in past decades,many questions regarding standardized practice to prevent this catastrophic complication remain unanswered.The current study provide a comprehensive knowledge regarding risk factors based on general principles to control surgical siteinfection by the review of current literature and also share own practice at our institution to provide practical and better understandings.
文摘AIM: To investigate the known incidences, treatment options, and related outcomes of periprosthetic tibia fractures after total knee arthroplasty(TKA).METHODS: A literature search was done to identify studies that fit the inclusion criteria. The database search yielded 185 results, which were further reduced by the exclusion criteria to 13 papers, totaling 157 patients that met these criteria. Incidence rates of the different types of periprosthetic tibia fractures were determined and their treatments were subsequently analyzed based on the fracture's subclass, with patient outcomes being overall favorable.RESULTS: Of the 144 documented patients, 54(37.5%) had a subclass C fracture, which are frequently seen in revision arthroplasties or when using cement intraoperatively. The fractures of subclasses A and B occur postoperatively. There were 90 subclass A and B fractures with incidences of 18.75% and 43.75% respectively. When broken down by type, 62(55.36%) were type 1, 24(21.4%) were type 2, 24(21.4%) were type 3, and 2(1.8%) were type 4. Furthermore, from the studies that included origin of injury, the types were further classified as having non-traumatic or traumatic origins. Type 1 had 78%(40/51) non-traumatic origin and 22%(11/51) traumatic origin. Fifteen fractures were type 2, but 5 were falls and 1 through a motor vehicle accident, giving a trauma causation of 40%(6/15). Of the 24 type 3 fractures, 12 were falls and 2 vehicular accidents, leading to a trauma causation of 58%(14/24).CONCLUSION: Type 1 fractures were the most common. Subclass A was treated with locking plates, B required a revision TKA, and C was treated intraoperatively or nonoperatively.
基金Supported by The"Deutsche Arthrose-Hilfe e.V.",No.P192-A362-2009-12
文摘AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.
文摘AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections(PJI).METHODS This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio(OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias. RESULTS Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies(14.8%) reviewed PJI of the hip, 3(11.21%) of the knee, and 20(74.1%) reviewed both joints. Nineteen studies(70.4%) were retrospective and 8(29.6%) prospective. Record bias was identified in the majority of studies(66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids(OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50(OR = 18.3, P < 0.001), tobacco use(OR = 12.76, 95%CI: 2.47-66.16, P= 0.017), body mass index below 20(OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes(OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease(OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).CONCLUSION We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.
文摘The era of metal-on-metal(MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977,along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as(1) gross(metallosis, necrosis, cyst formation and pseudotumour);(2) histological(macrophage-dominated, lymphocyte-dominated or mixed);and(3) molecular(expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and materi-al-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris.
基金Supported by Clinical Technology Innovation Cultivation Program of Army Medical University of PLA,No.CX2019JS109Independent Project of State Key Laboratory of Trauma,Burns and Combined Injuries,No.SKLZZ201603Chongqing Appropriate Technology Promotion Project No.2018jstg019。
文摘BACKGROUND Candidal periprosthetic joint infection is a rare and difficult to diagnose complication of total knee arthroplasty.The treatment of such complications is inconclusive and may include prosthesis removal,debridement,arthrodesis,and extensive antifungal therapy to control the infection.CASE SUMMARY A 62-year-old male with a history of total knee arthroplasty(TKA)in his left knee presented with ipsilateral knee pain and a sinus discharge 20 mo after TKA.The patient was previously evaluated for left knee pain,swelling,and a transient fever one month postoperatively.Prothesis removal and insertion of a cement spacer were performed in a local hospital six months prior to the current presentation.Medical therapy included rifampicin and amphotericin which were administered for 4 wk following prosthesis removal.A second debridement was performed in our hospital and Candida parapsilosis was detected in the knee joint.Fourteen weeks following the latter debridement,the patient suffered a left intertrochanteric fracture and received closed reduction and internal fixation with proximal femoral nail anterotation.Two weeks after fracture surgery,a knee arthrodesis with autograft was performed using a double-plate fixation.The patient recovered adequately and was subsequently discharged.At the two-year follow-up,the patient has a stable gait with a pain-free,fused knee.CONCLUSION Fungal periprosthetic joint infection following TKA may be successfully and safely treated with prosthesis removal,exhaustive debridement,and arthrodesis after effective antifungal therapy.Ipsilateral intertrochanteric fractures of the affected knee can be safely fixated with internal fixation if the existing infection is clinically excluded and aided by the investigation of serum inflammatory markers.
文摘We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.
文摘AIM: To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners. METHODS: A Vancouver B1 periprosthetic fracture was simulated in femur prosthesis constructs using sawbones and cemented regular straight hip stems. Fixation was then performed with either unicortical locked-screw plating using the less invasive stabilization system-plate or with intraprosthetic screw fixation using inserted liners. Two experimental groups were formed using either prostheses made of titanium alloy or prostheses made of cobalt chrome alloy. Fixation stability was compared in an axial load-to-failure model. Drilling was performed using a specially invented prosthesis drill with constantly applied internal cooling.RESULTS: The intraprosthetic fixation model with titanium prostheses was superior to the unicortical lockedscrew fixation in all tested devices. The intraprosthetic fixation model required 10 456 N ± 1892 N for failure and the unicortical locked-screw plating required 7649 N ± 653 N(P < 0.05). There was no significant difference between the second experimental group and the control group.CONCLUSION: Intraprosthetic screw anchorage with special threaded liners enhances the primary stability in treating periprosthetic fractures by internal fixation.
文摘BACKGROUND Periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.
文摘AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years(range: 2.5-9 years). RESULTS: The causative pathogens were isolated from 29 patients(76%), 26 of whom were infected with highly virulent organisms. Sixteen patients(42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity(P < 0.001), a lower preoperative Harris hip score(HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection(P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7(20%), 12(34%), 11(32%)and 5(14%) patients receiving excellent, good, fair and poor ratings, respectively. CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients(i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level Ⅳ.
文摘BACKGROUND Periprosthetic joint infection(PJI)is a catastrophic complication that can occur following total knee arthroplasty(TKA).Currently,the treatment for PJI mainly includes the use of antibiotics alone,prosthetic debridement lavage,primary revision,secondary revision,joint fusion,amputation,etc.AIM To explore the clinical effect of two-stage revision surgery for the treatment of PJI after TKA.METHODS The clinical data of 27 patients(3 males and 24 females;age range,47–80 years;mean age,66.7±8.0 years;27 knees)with PJI treated with two-stage revision surgery in our hospital between January 1,2010 and December 31,2020 were analyzed retrospectively.The following outcomes were compared for changes between preoperative and last follow-up results:Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores,knee range of motion(ROM),and infection cure rates.RESULTS All 27 patients were followed up(range,13–112 mo).The ESR(14.5±6.3 mm/h)and CRP(0.6±0.4 mg/dL)of the patients at the last follow-up were significantly lower than those at admission;the difference was statistically significant(P<0.001).The postoperative VAS score(1.1±0.7),HSS score(82.3±7.1),and knee ROM(108.0°±19.7°)were significantly improved compared with those before the surgery;the difference was statistically significant(P<0.001).Of the 27 patients,26 were cured of the infection,whereas 1 case had an infection recurrence;the infection control rate was 96.3%.CONCLUSION Two-stage revision surgery can effectively relieve pain,control infection,and retain good joint function in the treatment of PJI after TKA.
文摘BACKGROUND Periprosthetic supracondylar femoral fractures(PSFs)present a challenge in terms of optimizing fixation in patients with poor bone quality.Surgical treatment and peri-operative management of PSFs in the elderly remain a burden for orthopedic surgeons.Among different treatment options,locking plate(LP)and retrograde intramedullary nail(RIMN)have shown favorable results.However,reduced mobility and protected weight-bearing are often present in the postoperative older population.With a purpose of allowing for early weight-bearing,a modified nail plate combination(NPC)was redesigned for PSF management.CASE SUMMARY In our cases,two elderly osteoporotic female underwent total knee arthroplasty(TKA),and then suffered from low energy trauma onto their knees after falling to the floor.Plain radiographs or computed tomography scans demonstrated oblique or transverse PSFs,both of which occurred at the distal femur above TKA.The modified NPC technique was performed for treatment of PSFs.The patient was made foot flat weight bearing in 1 wk.At 6-mo follow-up,the union was ultimately achieved using modified NPC with satisfactory implant outcomes.CONCLUSION Neither LP nor RIMN alone may provide adequate support to allow for union in circumstances where the patient has severely osteopenic bone.Therefore,developing a modified implant offer an alternative choice for treating PSFs.These two cases revealed that this technique is a viable option for the geriatric osteoporotic PSFs,offering safe,early weight bearing and favorable clinical outcomes.
文摘BACKGROUND Periprosthetic joint infection(PJI)in primary total hip replacement(THR)is one of the most important threats in orthopedic surgery,so one important surgeon’s target is to avoid or early diagnose a PJI.Although the incidence of PJI is very low(0.69%)in our department,with an average follow-up of 595 d,this infection poses a serious threat due to the difficulties of treatment and the lower functional outcomes after healing.AIM To study the incidence of PJI in all operations occurring in the year 2016 in our department to look for predictive signs of potential infection.METHODS We counted 583 THR for 578 patients and observed only 4 cases of infection(0.69%)with a mean follow-up of 596 d(min 30,max 1451).We reviewed all medical records to collect the data:duration and time of the surgery,presence,type and duration of the antibiotic therapy,preoperative diagnosis,blood values before and after surgery,transfusions,presence of preoperative drugs(in particularly anticoagulants and antiaggregant,corticosteroids and immunosuppressants),presence of some comorbidities(high body mass index,blood hypertension,chronic obstructive pulmonary disease,cardiac ischemia,diabetes,rheumatological conditions,previous local infections).RESULTS No preoperative,intraoperative,or postoperative analysis showed a higher incidence of PJI.We did not find any class with evident major odds of PJI.In our study,we did not find any border value to predict PJI and all patients had similar values in both groups(non-PJI and PJI).Only some categories,such as female patients,showed more frequency of PJI,but this difference related to sex was not statistically significant.CONCLUSION We did not find any category with a higher risk of PJI in THR,probably due to the lack of few cases of infection.
基金Supported by Fundação de AmparoàPesquisa do Estado de São Paulo.
文摘BACKGROUND The quantitative alpha-defensin enzyme-linked immunosorbent assay(ELISA)demands a prior synovial fluid centrifugation,whereas this processing is not routinely required prior to the alpha-defensin lateral flow test.AIM To evaluate whether a prior synovial fluid centrifugation could lead the lateral flow performance to achieve comparable results to ELISA during periprosthetic joint infection(PJI)diagnosis.METHODS Fifty-three cases were included in this study:22 classified as PJI and 31 classified as aseptic cases,according to Musculoskeletal Infection Society 2013 criteria.Synovial fluid samples were submitted to centrifugation,and the supernatant was evaluated by ELISA and lateral flow tests.The sensitivity(SE),specificity(SP)and accuracy of each method were calculated as well as the agreement between those two methods.RESULTS In all of the 31 samples from aseptic patients,alpha-defensin ELISA and lateral flow tests showed negative results for infection.Regarding the 22 infected patients,the lateral flow test was positive in 19 cases(86.4%)and the ELISA was positive in 21(95.5%).Sensibility,SP and accuracy were,respectively,86.4%(95%CI:65.1%-97.1%),100%(95%CI:88.8%-100%)and 93.2%(95%CI:82.8%-98.3%)for the lateral flow test and 95.5%(95%CI:77.2%-99.9%),100%(95%CI:88.8%-100%)and 98.1%(95%CI:89.9%-100%)for ELISA.An agreement of 96.2%between those methods were observed.No statistical difference was found between them(P=0.48).CONCLUSION Alpha-defensin lateral flow test showed high SE,SP and accuracy after a prior synovial fluid centrifugation,achieving comparable results to ELISA.Considering the lower complexity of the lateral flow and its equivalent performance obtained in this condition,a prior centrifugation might be added as a valuable step to enhance the PJI diagnosis.
