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Introduction: In today's world, high-cost procedures are being examined, and alternative procedures are being developed. In this context, one frequently examined procedure is total knee replacement. Purpose: This study aims to examine the three different closure techniques used in total knee replacement. Methods: This study is a prospective randomized controlled study. Two hundred participants who underwent total knee replacement surgery, were included in the study. Participants were randomly divided into three groups. Arthrotomy was performed using a medial parapatellar approach with a midline incision. Standard femoral and tibial cuts were followed by the implantation of a Smith and Nephew genesis II implant for all participants. Complications, joint range of motion, pain scores, certain movement degrees, and functional scores were investigated. Results: Pre-op and post-op range of motion, knee society score, oxford knee score, certain movement degree values have shown no significant difference. Visual analogue scale values were different significantly between the groups. There is a statistical difference between the range of motion, knee society score, oxford knee score, certain movement degree and visual analogue scale values in repeated measurements. The most common complication was a hematoma. This was observed most frequently in the continuous vicryl suture group. The closure time in the Barbed group was significantly lower than in the other groups. Discussion: Treatment for total knee replacement is a heavy economic burden. Health systems and hospitals are under pressure. The results obtained in our study show that there is no superiority of one closure technique over the other. [ABSTRACT FROM AUTHOR]

Aims: Previous studies have reported concern regarding high reoperation rates when septic arthritis of the native shoulder is treated arthroscopically, compared to open arthrotomy. We aimed to compare re-operation rate between the two strategies. Patients and methods: The review was registered prospectively at PROSPERO, (CRD42021226518). We searched common databases and references lists (8 February 2021). The inclusion criteria included interventional or observational studies of adult patients with a confirmed diagnosis of native shoulder joint septic arthritis and had either arthroscopy or arthrotomy. The exclusion criteria included patients with periprosthetic or post-surgical infections, patients who had atypical infections, and studies that did not report re-operation rate. Cochrane Collaboration's tool for assessing risk of bias (ROBINS-I) was used. Results: Nine studies (retrospective cohort studies) were included that involved 5,643 patients (5,645 shoulders). Mean age ranged from 55.6 to 75.5 years, and follow-up time ranged from 1–41 months. Mean duration of symptoms prior to presentation ranged from 8.3–23.3 days. Metanalysis observed a higher re-operation rate for reinfection at any time point following initial arthroscopy in comparison to arthrotomy, odds ratio 2.61 (95% confidence interval 1.04, 6.56). There was marked heterogeneity (I2 = 78.8%) among studies including surgical techniques and missing data. Conclusion: This metanalysis observed a higher reoperation rate in arthroscopy in comparison to arthrotomy for the treatment of native shoulder septic arthritis in adults. The quality of the included evidence is low and the heterogeneity among included studies is marked. Higher quality evidence is still needed that address limitations of previous studies. [ABSTRACT FROM AUTHOR]

Purpose: Septic arthritis of the native hip joint (SANH) is an uncommon surgical and medical emergency with few reports. The aim of this study was to determine predictors of return to theatre (RTT), complications and mortality. Methods: Patients with SANH were identified from January 2009 to June 2022; 50 patients and three subgroups were identified: Pyogenic (surgical washout without systemic inflammatory disease), Systemic (surgical washout with SIDs) and patients managed non-surgically. Patterns of these groups were assessed with a principal component analysis. The cumulative incidences for death, any complication and RTT for repeat washout were calculated. The predictive variables associated with outcomes were selected with univariable models and then incorporated in multivariable CoxPH regressions. Results: The 1-year cumulative incidence was 14% for mortality and 48.5% for any complication. Amongst patients managed surgically, 1-year risk of RTT was 46% in Pyogenic subgroup and 21% in Systemic subgroup. Systemic subgroup had lower complications and RTT and higher rate of sterile aspirate, compared to Pyogenic. Charlson comorbidity index (CCI) (HR = 1.41, P value = 0.03), preoperative albumin (HR = 0.81, P value = 0.009) and preoperative haemoglobin (HR = 0.95, P value = 0.02) were significantly associated with 1-year mortality. Time between symptom onset and admission > 7 days (HR = 3.15, P value = 0.042), preoperative Hb (HR = 1.05, P value = 0.016), socioeconomic deprivation (HR = 1.18, P value = 0.04) and Systemic subgroup (HR = 0.25, P value = 0.04) were significantly associated with RTT. Conclusion: Mortality was well predicted by the usual parameters including CCI, albumin, but also low haemoglobin. Patients presenting in a delayed fashion were more likely to have multiple lavages. [ABSTRACT FROM AUTHOR]

Background: Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2–7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments—arthrocentesis, arthrotomy, and arthroscopy—provides better results in children and when to use them. Methods: Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage's findings. Results: A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique. Conclusions: We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it. [ABSTRACT FROM AUTHOR]

Purpose: To review two cohorts of children treated by two different protocols (repeated needle aspiration-lavage vs. arthrotomy) for surgical treatment of septic arthritis of the hip (SAH). Methods: In order to compare between the two methods, the following parameters were checked: (a) Scar cosmesis was assessed by the Patient and Observer Scar Assessment Scale (POSAS). We considered satisfactory results (no scar discomfort) when POSAS was within 10% of the ideal score; (b) 24-h post-operative pain was evaluated by visual analog scale (VAS); (c) Complication rates of incomplete drainage (re-arthrotomy/therapy modification from aspiration-lavage to arthrotomy). The results were evaluated by the Student t-test or by the chi-square test. Results: Seventy-nine children (aged 2–14 years) admitted during 2009–2018 and available for at least two years of follow-up were enrolled. The POSAS score (range 12–120 points) at the latest follow-up was higher in the arthrotomy group compared with the aspiration-lavage group (18.10 ± 6.22 versus 12.27 ± 1.40, p < 0.001); 77.4% of patients treated by arthrotomy had no scar discomfort. The 24-h post-intervention VAS (range 1–10) was 5.06 ± 1.29 after arthrotomy and 4.03 ± 1.13 after aspiration-lavage, p < 0.04. Complications were three times more frequent in the aspiration-lavage group (8.8% in the arthrotomy group and 26.7% in the aspiration-lavage group, p = 0.045). Conclusions: We conclude that the lower complication rate observed in the arthrotomy group outweighs by far scar cosmesis and post-operative pain advantages in the aspiration-lavage group. Arthrotomy as a drainage method is safer than aspiration-lavage. [ABSTRACT FROM AUTHOR]

The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide. [ABSTRACT FROM AUTHOR]

Background and purpose: Septic arthritis is a serious orthopedic surgery and delayed management causes irreparable damages. The knee is the most common site involved in septic arthritis. The purpose of this study was to determine mortality rate, adverse joint outcome and prognostic factors in adult patients diagnosed with septic arthritis of the knee who had undergone debridement surgery. Materials and methods: This retrospective cohort study was carried out using the medical records of all adult patients admitted to Sari Imam Khomeini Hospital and Sari BuAliSina Hospital between 2009 and 2019 who were treated with either arthrotomy or arthroscopic irrigation for acute septic arthritis of the knee. Patients with prosthetic joints were excluded. The rate of mortality was determined. Clinical findings, laboratory evidence, knee radiographs, and the Knee injury and Osteoarthritis Outcome Scores (KOOS) were compared through statistical analysis to identify possible prognostic factors. Radiographic severity was classified based on the Kellgren-Lawrence grading. Results: We included 31 patients and there were 41.9% female patients (mean age= 51.1±20.56). The most common underlying diseases were hypertension (29%) and diabetes mellitus (25.8%). Staphylococcus aureus was identified in 16.1% of synovial fluid cultures. The mortality rate was 22.6%. Factors influencing mortality included older age (P=0.003), diabetes mellitus (P=0.031), fever (P=0.038), length of hospital stay (P=0.019), high C-reactive protein levels (P=0.002), low creatinine clearance (P=0.003), and type of pathogenic microorganisms (P=0.028). Age was the only factor significantly associated with higher radiographic severity (P=0.014). Conclusion: Septic arthritis is an infectious orthopedic emergency that is associated with a high mortality rate even after joint surgery and debridement. Therefore, proper management and updating information about this disease and its treatment methods are necessary. [ABSTRACT FROM AUTHOR]

Purpose: Septic arthritis is an orthopaedic emergency with high morbidity and mortality. The aim of this study is to determine the risk factors associated with secondary surgery for septic arthritis of the native knee joint. Methods: This is a retrospective study reviewing all patients who underwent surgery for septic arthritis of the knee from 2012 to 2019 in a single institution. A total of 117 patients were recruited. Patients were divided into 2 groups: Group I (79/117, 67.5%) underwent one surgery and Group II (38/117, 32.5%) underwent more than one surgery. Results: Patients with a raised initial total white (TW) cell count of > 20 × 109/L had a significantly higher risk of secondary surgery. (Adjusted hazard ratio 2.42, p < 0.05) A decline of CRP level of less than 20% within 24 h from initial operation was also a risk for secondary surgery. (Adjusted hazard ratio 0.34, p < 0.01) Patients in group II also had significantly higher post-operative median TW cell count and neutrophil count. There was no significant difference in the offending microbe, surgical approach, and duration of operation from initial presentation between the groups. Conclusions: Patients with septic arthritis of the native knee joint who present with raised initial total white cell count of > 20 × 109/L and decline of CRP level of less than 20% within 24 h from initial operation are at higher risk of secondary operation. In these patients, more aggressive treatment strategies and appropriate counselling on the risks of repeated surgery are recommended. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Introduction: The hip is one of the most commonly affected joints in paediatric septic arthritis. Drainage can be performed using arthrocentesis (articular needle aspiration), arthroscopy or arthrotomy. The objective of this systematic review was to identify the most effective drainage technique for septic hip arthritis in the paediatric population. Materials and methods: The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the paediatric hip. Outcome parameters were additional drainage procedures, clinical outcomes and radiological sequelae. The quality of each of the included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) score. Results: Out of 2428 articles, 19 studies with a total of 406 hip joints were included in the systematic review. Additional arthroscopy or arthrotomy was performed in 15% of the hips treated with arthrocentesis, in 14% after arthroscopy and in 3% after arthrotomy. Inferior clinical outcomes and more radiological sequelae were seen in patients treated with an arthrotomy. A meta-analysis could not be performed due to the diversity and low quality of the studies (MINORS median 4 [range 2–15]). Conclusions: This systematic review gives a comprehensive overview of the available literature on treatment for septic hip arthritis in children. Arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. However, arthrotomy might be associated with inferior outcomes in the longer term. The included studies are diverse and the scientific quality is generally low. [ABSTRACT FROM AUTHOR]

• MRI can be useful in preoperative planning of tibial plateau fractures with a high incidence of associated soft tissue injuries diagnosed. • Arthroscopy and arthrotomy can accurately diagnose and permit treatment of associated soft tissue lesions at the time of tibial plateau fracture fixation. • Surgeons who use these diagnostic methods often find concomitant injuries, and most elect to surgically treat the soft tissues. • Good to excellent results have been achieved with arthroscopy and arthrotomy techniques but the literature fails to support clear superiority. • The authors cannot recommend routine MRI, arthroscopy or arthrotomy use in the management of tibial plateau fractures. Currently there is no consensus on the need for investigating knee ligamentous and meniscal injuries in a patient with a tibial plateau fracture. Consequently, many soft tissue injuries are likely undiagnosed and therefore untreated. The impact this has on long term knee outcomes is not well defined. We aimed to identify the impacts of various diagnostic methods on the management of meniscal injuries associated with tibial plateau fractures and evaluate the clinical outcomes. We performed a systematic review using Pubmed, Medline, Embase, CINAHL and Cochrane following Cochrane guidelines. We included studies that operatively managed tibial plateau fractures and soft tissue injuries, which were diagnosed with either preoperative MRI, intra-operative arthroscopy or arthrotomy. 18 articles with 884 people, with a mean age of 46.4 years were included. Soft tissue injuries were detected on MRI (32-73%) and arthroscopy (12-70%), of which the most common were lateral meniscal injuries (7-64% of tibial plateau fractures). When identified by arthroscopy and arthrotomy, these injuries were almost always treated, either by repair or debridement. The clinical outcomes of these patients were poorly reported, with a heterogenous use of patient reported outcome measures, and follow up time points. There were no randomised trials or control groups for comparative analysis, however operative treatment yielded good to excellent outcomes. There is a high incidence of concomitant soft tissue injuries with tibial plateau fractures, particularly lateral meniscal injuries. There are 2 main approaches to meniscal injuries: surgeons who don't investigate, don't treat, whilst surgeons who do investigate often do surgically treat. Although studies that treated these injuries achieved good to excellent results, the currently available evidence doesn't confirm treatment superiority. As there is plausibility for better outcomes, randomised studies are needed to further investigate this clinical question. [ABSTRACT FROM AUTHOR]

A 7‐year‐old female ostrich (Struthio camelus) presented with lameness, left intertarsal joint swelling and a healing wound on the caudomedial aspect of the joint. Synovial culture revealed Corynebacterium species and radiographs were consistent with progressive septic arthritis. Multiple treatments were attempted including through‐and‐through joint lavage, intra‐articular antibiotics, caudomedial arthrotomy, and regional limb perfusion in conjunction with systemic antibiotics and analgesia. Euthanasia was ultimately performed due to prolonged recumbency and poor prognosis. This report describes novel therapies and a surgical approach utilized for treatment of intertarsal septic arthritis in an ostrich and exemplifies the poor prognosis described in other species presenting with non‐responsive septic arthritis of critical joints. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of arthrotomy, when compared with arthroscopy, in the treatment of adults with septic arthritis of any joint. Methods: MEDLINE, EMBASE, and Scopus were searched to identify studies comparing arthrotomy and arthroscopy as therapeutic approaches in patients with septic arthritis of any joint. The main outcome was the re-infection rate. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index. Results: Twenty studies with 10,249 patients treated by arthrotomy or arthroscopy were evaluated. We observed a significant lower risk of re-infection (odds ratio [OR], 1.35 [95% CI, 1.16–1.58]; p = 0.0002) and complications (OR, 1.32 [95% CI, 1.12–1.55]; p = 0.001) rate as well as less hospital stay (mean difference [MD], 0.57 days [95% CI, 0.10–1.05]; p = 0.02) favouring arthroscopic intervention. The subanalysis indicated that patients with knee (OR, 1.50 [95% CI, 1.17–1.92]; p = 0.001) and shoulder (OR, 1.24 [95% CI, 1.00–1.53]; p = 0.04) septic arthritis intervened by arthrotomy had a higher risk of re-infection. A lower number of hospitalization days (MD, 0.89 days [95% CI, 0.31–1.47]; p = 0.003) and a lower risk for complications (OR, 1.26 [95% CI, 1.04–1.52]; p = 0.02) were observed in patients treated with arthroscopy after septic knee arthritis. Conclusions: Available evidence suggests that patients with septic arthritis of the knee and shoulder treated by arthroscopy have less risk of re-infection than those treated by arthrotomy. The quality of the body of evidence is still insufficient to reach reliable conclusions. PROSPERO trial registration number: CRD42020176044. Date registration: April 28, 2020. [ABSTRACT FROM AUTHOR]

Background: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. Purpose: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. Results: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively (P <.001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively (P <.001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P =.008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = −0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = –0.05, P =.80). Conclusion: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT. [ABSTRACT FROM AUTHOR]

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO). Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. [ABSTRACT FROM AUTHOR]

Summary: Osteomyelitis and/or bone sequestra are commonly reported in equids following traumatic wounds. This report describes the clinical management and outcome following an arthrotomy of the temporomandibular joint of a 1‐year‐old Quarter Horse gelding with septic osteomyelitis and arthritis. Computed tomography was used for further assessment of the lesions within the temporomandibular joint and helped guide surgical planning. [ABSTRACT FROM AUTHOR]

Adipose tissue is a rich source of stem cells, which are reported to represent 2% of the stromal vascular fraction (SVF). The infrapatellar fat pad (IFP) is a unique source of tissue, from which human adipose-derived stem cells (hADSCs) have been shown to harbour high chondrogenic potential. This review aims to calculate, based on the literature, the culture time needed before an average knee articular cartilage defect can be treated using stem cells obtained from arthroscopically or openly harvested IFP. Firstly, a systematic literature review was performed to search for studies that included the number of stem cells isolated from the IFP. Subsequent analysis was conducted to identify the amount of IFP tissue harvestable, stem cell count and the overall yield based on the harvesting method. We then determined the minimum time required before treating an average-sized knee articular cartilage defect with IFP-derived hADSCs by using our newly devised equation. The amount of fat tissue, the SVF cell count and the stem cell yield are all lower in arthroscopically harvested IFP tissue compared to that collected using arthrotomy. As an extrapolation, we show that an average knee defect can be treated in 20 or 17 days using arthroscopically or openly harvested IFP-derived hADSCs, respectively. In summary, the systematic review conducted in this study reveals that there is a higher amount of fat tissue, SVF cell count and overall yield (cells/volume or cells/gram) associated with open (arthrotomy) compared to arthroscopic IFP harvest. In addition to these review findings, we demonstrate that our novel framework can give an indication about the culture time needed to scale up IFP-derived stem cells for the treatment of articular cartilage defects based on harvesting method. [ABSTRACT FROM AUTHOR]

Introduction: Meniscal cysts are rare in Stoller grade II horizontal lesions. Several techniques are described in the literature for their management, without any real gold standard. The objective of this work was to report a series of meniscal sutures associated with cyst resection by arthrotomy. The hypothesis was that the results were satisfactory and comparable with the data in the literature regardless of the technique reported without morbidity added by arthrotomy.Materials and Methods: This was a monocentric retrospective study on 13 patients, aged 33 on average with a grade II meniscus lesion associated with a cyst (9 lateral and 4 medial menisci). Pre-operative data available was the VAS (5.7/10) and the Lysholm score (61/100). Primary endpoints were as follows: pain (visual analogue scale), global satisfaction, Lysholm functional score, and return to sports and professional activities at a minimum of two years. Secondary endpoints were complications, possible recurrence, and/or surgical revision. Recurrences, complications, and surgical recovery were gathered.Results: Patients were evaluated with an average follow-up of 32 months. All patients were satisfied or very satisfied. The VAS significantly improved (0.2/10, p < 0.05) as well as the Lysholm score (97/100, p < 0.05). All patients returned to their professional activity: 11 within two months, one within six weeks, and one in the first post-operative week (this patient being a student). Only one patient did not resume pre-operative sport level due to a femoropatellar syndrome, not linked to the meniscal surgery performed. However, only 11 patients resumed their previous sport level (84.6%). No recurrence or surgical revision occurred.Discussion: The results are good and similar to the literature, confirming the working hypothesis. These results are equivalent to partial meniscectomies and arthroscopic sutures associated with a procedure on the cyst by arthroscopy or arthrotomy. The literature is in favour of a procedure on the cyst.Conclusion: The results confirm the effectiveness of a direct approach suture of non-transfixing meniscal lesions associated with a cyst resection with a good functional recovery, without additional morbidity. The hypothesis was confirmed. [ABSTRACT FROM AUTHOR]

Background: Acute native septic arthritis is a joint-threatening emergency. To date, however, no gold-standard treatment nor joint-specific treatment algorithms exist. We aimed to evaluate the etiologies, bacterial spectrum, treatments, and surgical outcomes of septic arthritis of the shoulder and knee. Methods: Seventy-one patients with septic arthritis of either the knee (n = 42) or the shoulder (n = 29) were followed over a mean period of 40 months (26-65). Data were collected according to the performed surgical procedure and pathway as well as the cause of infection, bacterial spectrum, and the Gächter classification. The prospective clinical examination included the Knee Society Score (KSS) or Constant Score (CS; shoulder group), pre- and post-operative pain, and return to previous activity. Results: Septic arthritis was caused primarily by post-interventional or post-traumatic conditions in the knee group and by hematogenous infection in the shoulder group. Staphylococcus aureus and S. epidermidis were most common, whereas Propionibacerium. were seen only in shoulder infections. Remission rates were 95% in the knee versus 90% in the shoulder group, whereas the mortality rate in the shoulder group was 10% (no one died in the knee group). While most knee infections could be managed with an arthroscopic approach, all shoulder infections necessitated an open approach. The mean KSS was 87.3 (49-100); the mean CS was 66.6 (37-95). Fifty percent of patients in the shoulder group versus 71% in the knee group reached their previous level of activity. Conclusion: The knee group exhibited post-interventional etiology, in line with high-virulence microbes and a high success rate with arthroscopic restoration. Septic shoulder arthritis showed hematogenous scattering, low-virulent microbes, and multiple interventions with a final open approach was always required. In contrast to the knee, in septic arthritis of the shoulder, a significant reduction in function has to be expected. [ABSTRACT FROM AUTHOR]

Empyema of the wrist is a rare but serious condition in hand surgery. The diagnostics are challenging due to higher incidences of the differential diagnoses and relies heavily on the anamnesis and clinical findings. For the treatment, in addition to classical arthrotomy, an arthroscopic approach is also justified in mild cases, always in combination with antibiotic treatment. The long-term results essentially depend on the stage of the inflammation and the delay before initiating treatment, so that a timely diagnosis is paramount. [ABSTRACT FROM AUTHOR]

Purpose: Septic arthritis of the knee is an orthopaedic emergency that is associated with marked morbidity and can potentially be life threatening. Surgical debridement can be performed either arthroscopically or via an arthrotomy. The aim of this study was to compare the 30-day complications and adverse outcomes between the two procedures.Methods: Patients with a diagnosis of septic arthritis of the knee between 2011 and 2015 were identified using the ACS-NSQIP database. The study population included 695 patients, who had knee septic arthritis and underwent either an arthroscopic irrigation or debridement (I&D) (n = 464) or open irrigation and debridement (n = 231). Preoperative data included demographics, independent functional status, and comorbidities. Outcomes of interest included wound complications, infectious complications, cardiovascular events, hospital readmissions, and reoperations, or any of the previous adverse events.Results: Both cohorts were similar in most baseline characteristics. Bleeding requiring transfusion was significantly lower in the arthroscopic (n = 13; 3.6%) compared to the open procedure (n = 31; 13.4%; p = 0.0001). Home discharge was significantly higher in the arthroscopic irrigation and debridement group (n = 310; 67.5%) compared to the open group (n = 126; 55%; p = 0.0013). The overall incidence of adverse events was lower in the arthroscopic group (n = 158; 34%) compared to the open group (n = 112; 49%; p = 0.0002). There was no difference in rates of infectious complications, thromboembolic events, hospital readmission, reoperation, or mortality between the groups. Open irrigation and debridement was associated with higher risk of bleeding requiring transfusion (OR = 3.79; 95% CI: 2.02-7.13; p = 0.0001), higher risk of incidence of adverse events (OR = 1.46; 95% CI: 1.02-2.08; p = 0.039), and lower home discharge (OR = 3.79; 95% CI: 2.02-7.13; p = 0.0001) within 30 days after the procedure.Conclusion: Arthroscopic irrigation and debridement demonstrated favourable short-term outcomes. Patients who underwent arthroscopic irrigation and debridement had lower rates of blood transfusions, lower rates of adverse events, and higher home discharge rates compared to open irrigation and debridement. This study is the largest analysis comparing arthroscopic vs. open irrigation and debridement in a national database sample. These findings conclude that arthroscopic debridement can be an alternative first-line option in managing septic arthritis.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Prevotella is a common gram-negative anaerobic rod that is frequently associated with female genitourinary tract infections, pelvic inflammatory disease, aspiration pneumonia, lung abscess and pleural empyema. Osteomyelitis in association with septic arthritis is rare with only a handful of cases reported worldwide. In this case study, we report a patient who presented with a clinical picture of septic arthritis complicated by the presence of a sinus tract at the site of a previous arthroscopic surgery. Initial sinus pus cultures demonstrated Streptococcus agalactiae, which were confirmed with intra-operative joint fluid cultures. After a brief period of clinical improvement following arthrotomy, a sudden clinical deterioration prompted re-cultures demonstrating heavy growth of Provetella bivia. Repeat MRI demonstrated new signs of osseous involvement. The patient was managed with a redo arthrotomy, extensive debridement of osteomyelitic tissue, washout and an extended antibiotic therapy regimen. This association is first of its kind in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Purpose: Snapping annular ligament is an uncommon cause of lateral elbow pain. The purpose of this case series was to evaluate the clinical presentation and surgical outcomes for snapping annular ligament.Methods: Included were 23 patients with snapping annular ligament who received surgical treatment between 2007 and 2016. There were two treatment groups with either resection (arthroscopic or open procedure, n = 15) or open annular ligament reconstruction (n = 8). Patients were assessed with the Mayo Elbow Performance Index and the Oxford Elbow Score. Preoperative and postoperative scores were compared with a paired t test.Results: Pain was located laterally in nine patients (39.1%), anteriorly in three patients (13.0%), anterolaterally in two patients (8.7%), and diffusely in nine patients (39.1%). In total, 16 patients (69.6%) experienced a snapping sensation and ten patients (43.5%) locking of the elbow. According to the patients' reported outcomes, their symptoms improved significantly after both procedures.Conclusions: This is the largest case series in the literature on snapping annular ligament, an uncommon cause of lateral elbow pain. Good treatment results are expected with resection of the interpositioned part of the annular ligament or annular ligament reconstruction.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Radioulnar incongruence can occur due to asynchronous growth between the radius and ulna, leading to shortening of the ulna in relation to the radius or of the radius in relation to the ulna. Surgical treatment is indicated according to the animal's age, degree of instability and pre-existing osteoarthritis. Corrective osteotomies aim to reestablish joint congruence and delay the progression of joint disease. The objective of the work was to report a case of bi-oblique dynamic proximal ulnar osteotomy (BODPUO) for the treatment of medial compartment disease, caused by radioulnar incongruence (RUI) associated with fragmentation of the medial coronoid process of the ulna (FMCPU). A female dog, Golden Retriever, 4 months old, was treated, with a history of lameness of the right thoracic limb (RTL) and carpus varus with external rotation of the limb. On orthopedic examination, presented pain with compression of the medial compartment during flexion and extension of the elbow. Radiographic evaluation indicated radioulnar incongruence and lateral deviation of the radial head in relation to the medial humeral condyle. Computed tomography confirmed the diagnosis showing FMCPU and RUI with a step of 1.6 mm. The patient underwent exploratory arthrotomy and BODPUO to level the radius and ulna. Currently, the patient is 14 days post-operative and has RTL lameness. Clinical improvement in animals undergoing BODPUO occurs on average 6 months after surgical treatment, however, bone consolidation occurs after 16 weeks in most cases. To date, the therapy used has shown favorable evolution and within the expectations described in the literature. [ABSTRACT FROM AUTHOR]

Arthrotomy associated with continuous irrigation; appear to be a good approach in the treatment of Gunshot fractures. We report the cases of two patients of young ages injured in similar conditions, on tread by first arthrotomy with irrigation, simple evolution and the second by arthrotomy with second-line irrigation after a septic complication (hemathrosis infected) in the aftermath of debridement of the banks with irrigation. [ABSTRACT FROM AUTHOR]

Arthrotomy associated with continuous irrigation; appear to be a good approach in the treatment of Gunshot fractures. We report the cases of two patients of young ages injured in similar conditions, on tread by first arthrotomy with irrigation, simple evolution and the second by arthrotomy with second-line irrigation after a septic complication (hemathrosis infected) in the aftermath of debridement of the banks with irrigation. [ABSTRACT FROM AUTHOR]

Purpose: The medial parapatellar arthrotomy (MPPA) is a commonly utilized surgical approach; however, the placement of the arthrotomy and its influence on intraoperative patellar tracking has not been evaluated.Methods: Six knees from three fresh frozen cadavers with transthoracic amputations were operated on. All underwent standard posterior stabilized total knee arthroplasty using a medial parapatellar approach placed at the border of the vastus medialis oblique (VMO)-quadriceps junction. Patellae were resurfaced in the standard fashion. All patellae tracked normally with the first arthrotomy placed at the junction of the VMO-quadriceps tendon using the "no touch" technique. Measurement of patellar lift-off from the implant surface of the medial aspect of the trochlea on the femoral component was made at 50°, 75°, and 90° of flexion and a merchant view radiograph taken to evaluate radiographic patellar tilt. To simulate a more lateral placement of the MPPA, a 5-6 mm slice of quadriceps tendon was then removed from the lateral aspect of the tendon from the patellar insertion to the most proximal portion of the arthrotomy. This simulated a 5-6 mm more lateral placement of the parapatellar arthrotomy. The same measurements and radiographs were taken as described previously. Two more times the same size slices was removed from the quadriceps tendon with subsequent measurements and radiographs obtained.Results: The mean patellar lift-off with the first arthrotomy was 0 ± 0 mm for 50°, 75°, and 90° of flexion. The mean lift with the second arthrotomy was 2 ± 2, 3 ± 3, and 4 ± 3 mm respectively. The third arthrotomy had a mean patellar lift-off of 3 ± 2, 4 ± 3, and 8 ± 2 mm respectively, while the fourth arthrotomy had a mean lift-off of 6 ± 2, 8 ± 2, and 9 ± 4 mm. There was a significant correlation between percentage of quadriceps cut at 1 cm above the superior pole of the patella and patellar lift-off at 50° (R 2 = 0.70; p < 0.0001), 75° (R 2 = 0.68; p < 0.0001), and 90° (R 2 = 0.68; p < 0.0001) of flexion.Conclusion: The location of the MPPA has a significant influence on intraoperative assessment of patellar tracking. An MPPA more lateral in the quadriceps tendon may independently influence the patellar tilt observed intraoperatively and should be taken into consideration when evaluating intraoperative patella tracking. An understanding of the independent influence the MPPA has on patellar tracking may decrease the need for lateral release if the surgeon notes the MPPA was made more than 5-10 mm from the junction of the VMO-quadriceps tendon junction. [ABSTRACT FROM AUTHOR]

Die Gelenkinfektion stellt eine schwerwiegende Komplikation dar und führt bei ausbleibender oder inadäquater Behandlung zur irreversiblen Gelenkzerstörung. Ursächlich für eine Gelenkinfektion sind endogen-hämatogene und exogene Faktoren. In unserem Patientengut sind die Empyeme fast ausschließlich durch iatrogene Maßnahmen (arthroskopische Operationen, Punktionen, intraartikuläre Infektionen) oder als Folge gelenknaher Frakturen und penetrierender Verletzungen verursacht. Bei dem akuten Gelenkempyem handelt es sich um einen unfallchirurgischen Notfall, der sofort operiert werden muss, da aufgrund der pathophysiologischen Vorgänge rasch irreversible Knorpelschäden auftreten. Das akute Empyem ist arthroskopisch zu behandeln. Von einem chronischen Empyem ist auszugehen, wenn klinische Symptome länger als 7 Tage bestehen. Die Behandlung des chronischen Empyems erfolgt durch Arthrotomie, Synovialektomie und Entfernung des einliegenden Fremdmaterials inklusive von Kreuzbandersatz. [ABSTRACT FROM AUTHOR]

This report describes the clinical experience with internal fixation of a sagittal and a medial parasagittal patellar fracture using lag screws. Severely displaced sagittal and medial parasagittal fractures of the patella were diagnosed in 2 horses (a 10-year-old Thoroughbred gelding and a 5-year-old Thoroughbred mare) and were repaired using internal fixation. A direct approach through the fascia latae was used. In both cases, the leg was placed in full extension and the fracture was corrected by a combination of digital manipulation and application of bone reduction forceps. Articular congruency was assured by arthrotomy and digital assessment, and radiographic skyline projection. Then, the leg was placed in flexion and two 5.5 mm cortical screws with washers were inserted in lag fashion, under radiographic guidance (skyline projection). In one case, an additional 6.5 mm cancellous screw was used. Both fractures healed without evidence of degenerative joint disease. However, the first horse's wound dehisced, then healed by second intention uneventfully. The second horse was put in a sling in order to prevent lying down. Both horses were able to be used for their intended purpose. In these clinical cases, sagittal and medial parasagittal patellar fractures were treated successfully by open reduction and internal fixation. Post-operative management in a sling was used successfully in the second case to prevent wound dehiscence. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the efficacy of arthroscopy and arthrotomy in patients with septic monarthritis of the knee.Methods: Seventy consecutive patients who underwent surgery because of a bacterial monarthritis were evaluated. Patients were either treated with arthroscopy or with arthrotomy. Our primary outcome was the early recurrence of infection (>3 months after surgery), which made a second surgical procedure necessary. Furthermore, the influence of potential confounders on treatment outcome was analysed.Results: Of the 70 patients, 41 were treated arthroscopically and 29 with arthrotomy. Eight patients (11.4 %) had to undergo a second surgical procedure because of early re-infection. The rate was significantly higher in patients treated with arthrotomy (n = 6; 20.7 %) compared with those treated by arthroscopy (n = 2) (p = 0.041). Range of motion was significantly better in patients who underwent arthroscopy (p < 0.001). Male sex had negative influence on the treatment success (p = 0.03).Conclusions: Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower re-infection rate and a better functional outcome than those treated with arthrotomy. As arthroscopy is the less invasive method, it should be considered the routine treatment, according to our data.Level Of Evidence: Therapeutic study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: The study was conducted to evaluate clinical and microbiological profile of neonates with septic arthritis and also to assess changing epidemiology in the microbial etiology. Methods: Twenty-nine neonates (1-28 days of life) presenting to the Department of Orthopaedics with acute septic arthritis were included in the study. This was a descriptive study, and the data were collected during the time of hospital admission. History and clinical examination of the neonates were taken, and diagnosis was made based on clinical and laboratory parameters. Emergency arthrotomy was performed to prevent catastrophic sequelae in all the cases given antibiotics as per the culture results. Results: Female children predominated in our study. The children were brought to the OPD with an average of 2.7 days of fever. Thirty-four joints were involved in 29 neonates, out of whom five had more than one joint involvement. Joint effusion or subperiosteal abscess was found in 22 patients by USG. All children had leukocytosis with neutrophilic predominance. Twenty-one of twenty-nine patients had hip-joint involvement followed by knee in seven patients. Gram-negative organisms had grown more commonly, among which Klebsiella pneumonia was grown in nine patients. Conclusion: Prematurity and anemia still appear to be important risk factors for neonatal septic arthritis. As there is changing trend toward gram-negative infections, attention has to be given toward preventing nosocomial and community-acquired infections. This is very important in premature infants who are susceptible for infection when they are kept in resuscitative units in hospitals. [ABSTRACT FROM AUTHOR]

Background: Joint infections represent a severe complication that results in irreversible joint destruction when inadequately treated. The causes of joint infections consist of endogenous, hematological and exogenous factors. The patients in this cohort acquired empyema almost solely through iatrogenic means (e.g. arthroscopic operations, punctures and intra-articular infections) or as a result of fractures close to joints and penetrating injuries. Diagnostics: In order to make a correct diagnosis, a joint puncture with a direct swab test is necessary in addition to laboratory examinations, x-ray and magnetic resonance imaging (MRI). The amount of leucocytes is to be determined (threshold value 25,000/μl) as well as gram staining to identify any bacteria present. Therapy: Acute joint infections are considered to be orthopedic emergencies and immediate surgery is necessary, as irreversible cartilage damage can quickly result due to pathophysiological processes. Acute joint empyema must be treated arthroscopically. Clinical symptoms lasting more than 7 days result in chronic empyema. Chronic empyema should be treated by arthrotomy, synovectomy and the removal of extraneous material including cruciate ligament replacement. Postoperatively, an immediate intensive physiotherapy is necessary, even under the use of pain catheters and transfer to a center specialized in septic surgery is warranted. [ABSTRACT FROM AUTHOR]

Most models of acute post-operative orthopedic pain involve the injection of a clinically irrelevant pro-inflammatory agent. The ideal model should, however, be clinically relevant and allow full functional recovery of enrolled animals after research is completed. This study explored the validity of a model employing arthrotomy and objectively measured limb use. Six purpose-bred Beagles underwent arthrotomies on each stifle with a washout period in between. Using a randomized crossover design, each dog received placebo and an extended-release buprenorphine (ER-Bup) preparation. Static and dynamic ground reaction forces (GRFs) were measured prior to and for 72 h following surgery using a pressure sensitive walkway (PSW). GRFs for each hind limb were compared using difference (delta), and symmetry indices (SI). The effects of surgery and of treatment were analyzed using repeated measures ANCOVA. The results indicated significantly decreased limb use compared to baseline for placebo, and significantly increased limb use in the ER-Bup group over placebo at all times for % bodyweight distribution (%BW distrib ), peak vertical force (PVF) and vertical impulse (VI). There was a significant treatment by time interaction for velocity ( P  = 0.03) and %BW distrib ( P  = 0.01, 0.003). Overall, the data show that reduced limb use was present for at least 72 h following arthrotomy. In addition, the use of the ER-Bup analgesic decreased lameness, confirming the validity of this approach as a model of post-operative pain. Subjective assessments did not detect the pain-inducing effects of arthrotomy or pain-alleviating effects of treatment, and subjective measures of procedural pain in research dogs need to be developed. [ABSTRACT FROM AUTHOR]

A dog was presented with history of limping and partial bearing of weight on the left hind leg since last twenty days. On orthopaedic and neurological examination of both hind legs, no evidence of fracture or neurological problem was noticed. Animal evinced pain on palpating the left stifle joint and positive for the cranial drawer sign test and anterior tibial thrust which was suggestive of cranial cruciate ligament rupture. Surgical correction using modified retinacular imbrication technique (MRIT) was performed for better joint stabilisation. [ABSTRACT FROM AUTHOR]

Background: Joint infections can cause severe complications that result in irreversible joint destruction when treated inadequately. Pathogenesis: Reasons for joint infections consist of endogenous hematological and exogenous factors. Patients acquire empyema almost solely through iatrogenic measures (e.g. arthroscopic operations, punctures and intra-articular infections) or as a result of near joint fractures and penetrating injuries. Diagnosis: To make a correct diagnose, a joint puncture with a direct swab test is necessary in addition to laboratory examinations, x-ray and magnetic resonance imaging (MRI) examinations. The leucocyte count must be determined (threshold value 25,000/μl) as well as a gram stain to microscopically identify possible bacteria present. Therapy: Acute joint infections are considered to be orthopedic emergencies necessitating immediate surgical treatment as irreversible cartilage damage can rapidly result due to the pathophysiological process. Acute joint empyema should be treated arthroscopically. Clinical symptoms lasting more than 7 days emanate in chronic empyema and should be treated by arthrotomy, synovialectomy and removal of extraneous material including a possible cruciate ligament replacement. Postoperatively, an immediate intensive physiotherapy is necessary, even under the use of pain catheters. The transfer to a centre for septic surgery is recommended. [ABSTRACT FROM AUTHOR]

Purpose of study: To evaluate the factors associated with acute hematogenous septic arthritis of the knee in adults and to assess the outcome after open knee arthrotomy. Methods: We performed a prospective evaluation of 26 adult patients with acute nongonococcal septic arthritis of the knee presenting within 7 days. All patients underwent open knee arthrotomy, and final evaluation by means of Knee society score of the affected knee was compared with the contra lateral normal knee. Results: The average duration of symptoms at the time of presentation was 3.9 days. Staphylococcus aureus was the commonest bacteria isolated in 17 (65.4 %) patients. The average duration of follow-up in our study was 18.5 months. In our study, Knee society score decreases as the age of the patient advances ( P < 0.05) and also it was found to be low ( P < 0.05) in the affected knee as compared to contra lateral normal knee. Conclusion: Our study shows that age of the patient at presentation is critical as it shows significant reduction in knee score. This explains that the septic arthritis may contribute to the progression of age-related degeneration of the knee joint. There appears to be no definite contributing factors or conditions associated with acute hematogenous septic arthritis of the knee in adults, although further study may be warranted regarding this matter. [ABSTRACT FROM AUTHOR]

Atraumatic Posterior dislocation of hip is an unusual presentation for septic hip in an infant, reported by only few studies in literature. Septic arthritis in the hip of an infant warrants special emphasis, for diagnosis is often delayed, making the prognosis and later management perhaps different from septic arthritis in other joints. We present a rare presentation of septic hip in an infant and its management by combined and posterior drainage of hip joint with its outcome. [ABSTRACT FROM AUTHOR]

Changes in leukocyte parameters, erythrocyte sedimentation rate (ESR) and interleukin-6 (IL-6) were determined in ten mongrel dogs following knee arthrotomy. About 5 mL of blood was collected from each dog before knee arthrotomy, 2 hours, 24 hours and 3 days after knee arthrotomy for determination of white blood cell counts (WBC), neutrophil counts (NEUT), lymphocyte counts (LYM), neutrophil- lymphocyte ratio (N/L), ESR and IL-6. The data were expressed as mean ± standard deviation and differences compared using analysis of variance (ANOVA) at level of significance P<0.05. The results of this study showed that following knee arthrotomy, WBC, NEUT and ESR were significantly (P<0.05) increased 24 hours after surgery, while there were no significant change in LYM and N/L. Increase in ESR persisted up to three days following arthrotomy. In addition, IL-6 was significantly (P<0.05) increased two hours after knee arthrotomy up to 24 hours after arthrotomy and then decreased significantly by the 3rd day. It was concluded that acute inflammation following knee surgery in dogs induced changes in leukocyte parameters, ESR and IL-6. These changes can be used to monitor prognosis following knee surgery in dogs. [ABSTRACT FROM AUTHOR]

We present the case of a female infant previously vaccinated against Streptococcus pneumoniae who developed a septic arthritis in the right shoulder. An artrothomy was performed. The culture of the synovial fluid was positive for serotype 23F Streptococcus pneumonia. [ABSTRACT FROM AUTHOR]

A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4 weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip. [ABSTRACT FROM AUTHOR]

Purpose: To report on a radiological issue and therapeutic aspects encountered in septic hip dislocations in a developing country. Patients and Methods: Nineteen children among whom 11 boys and 8 girls aged on average 5.3-years old presented 7 recent and 12 late hip dislocations. Those dislocations were distributed into in category 1: dislocations without associated lesion; category 2: dislocations associated with minor lesions; category 3: dislocations associated with major lesion. Ten children who presented an elevated erythrocyte sedimentation rate (ESR) received antibiotics. An arthrotomy was performed in children with a recent dislocation. Traction was performed in all children with an average duration of 5 weeks. The results were considered good, intermediate or bad using two parameters: ESR and reduction of dislocation. Results: 2 category 1 dislocations, 6 category 2 dislocations and 11 category 3 dislocations were noted. As concerns the recent dislocations, there were 2 category 1 dislocations and 5 category 2 dislocations. For late dislocations, 1 category 2 and 11 category 3 dislocations were recorded. There were 8 good results and 11 bad results. The good results concerned 7 recent dislocations and one late dislocation. The bad results concerned exclusively late dislocations. Conclusion: In children with septic hip dislocations, the good results concern almost exclusively recent dislocations but arthrotomy and immobilization must be done early. [ABSTRACT FROM AUTHOR]

Abstract: We compared the distance of patellar subluxation (lateral patellar displacement) during MIS TKA arthrotomy among sequential variations of tourniquet application and soft tissue release in a consecutive series of 40 knees. The distance of patellar subluxation from the Whiteside''s line was measured for every knee under four consecutive conditions; A) the tourniquet inflated with knee in full extension, B) no tourniquet pressure applied, C) the tourniquet inflated with knee in deep flexion, and D) the tourniquet inflated with knee in deep flexion and lateral tibial release (a limited subperiosteal soft tissue dissection including limited patellar fat pad excision and limited capsular release from the upper lateral tibial plateau). There were 28 women and 12 men with the average age of 70 years and the average BMI of 25.5. All knees had preoperative flexion more than 110°. The tourniquet pressure ranged from 280 to 300 mm Hg. The average skin incision length was 9 cm. The average measured distance of condition A, B, C and D were 10, 14.5, 15.8 and 22 mm, respectively with significant difference (p <0.001). The distance of patellar subluxation correlated between conditions A) and C) (r 2, 0.67) and between conditions C) and D) (r 2, 0.72) in the studied group. However, there was no statistical difference of measured distance between group with condition B and C (p =0.40). In conclusion, when MIS TKA is performed using the tourniquet, inflating the tourniquet with knee in deep flexion provided better arthrotomy exposure than the knee in full extension. Combined inflating tourniquet in deep knee flexion and lateral tibial release provided the greatest arthrotomy visualization. [Copyright &y& Elsevier]

Background: The results following open revision surgery following a failed arthroscopic Bankart procedure are not well documented. Purpose: To evaluate the results of patients with a failed arthroscopic Bankart repair treated with a traditional, open Bankart repair. Study Design: Case series; Level of evidence, 4. Methods: Thirty patients (28 male and 2 female) who had a mean age of 24 years (range 15-36) at the time of operation were evaluated. The mean interval from the time of the operation to the final follow-up was 46 months (range 24-55). The rating systems of Rowe and the University of California at Los Angeles (UCLA) were recorded preoperatively and at the time of the final evaluation. Results: After open repair, mean modified Rowe scores improved from 25 preoperatively to 84.2 points. The results were excellent in 2 (6.7%), good in 24 (80%), and fair in 4 (13.3%); there were no poor results. The UCLA shoulder score improved from a mean of 17 points preoperatively to 29 points (P = .001 for all comparisons). Twenty-six patients (87%) did not have an anchor placement inferior to the 4-o'clock position for a right shoulder or the 8-o'clock position for the left shoulder after the index arthroscopic repair. There were no rotator interval closures performed at the index arthroscopic Bankart repair, and 10 patients (33%) required an interval closure at the open revision procedure. Twenty-five patients (83%) immobilized the operated arm in a sling for less than 2 weeks following the index arthroscopic repair. Conclusion: Patients with failed arthroscopic Bankart repairs can be successfully treated with a revision, open Bankart repair. Inadequate postoperative immobilization, large rotator intervals, and improper anchor placement are possible risk factors that may increase the incidence of failure of an arthroscopic Bankart repair. [ABSTRACT FROM AUTHOR]

Background: Recently, osteochondral grafting has become a popular procedure for treating challenging talar dome lesions. However, no guidelines exist for selection of the surgical approach to obtain perpendicular access to the talar dome. Hypothesis: The majority of the talar dome can be accessed for perpendicular resurfacing procedures without need for osteotomy. Study Design: Descriptive laboratory study. Methods: Nine human cadaveric ankles were dissected in a standard fashion to expose the talar dome. Seven approaches were used, including 4 arthrotomies (anteromedial, anterolateral, posteromedial, and posterolateral) and 3 osteotomies (anterolateral [Chaput], distal fibula, and medial malleolar). The area available for perpendicular access to the dome was determined for each approach. Results: On average, 17% (range, 10%-24%) of the medial talar dome and 20% (range, 16%-25%) of the lateral talar dome could not be accessed without osteotomy. On the lateral aspect of the superior talar dome surface, an anterolateral osteotomy adds a mean of 22% to sagittal plane exposure. Malleolar osteotomies, when performed using the method described, provide access to the entire medial and lateral sides; however, there remains a mean residual 15% (range, 11%-38%) of the central talar dome that cannot be accessed in a perpendicular manner with any approach. Conclusion: Most of the talar dome can be accessed perpendicularly for resurfacing without malleolar osteotomy. Osteotomies substantially increase the access and are needed for extensive lesions. Part of the central portion of the talar dome is inaccessible to perpendicular resurfacing techniques with any standard approach. Clinical Relevance: This study generated clear clinical guidelines to help decision making regarding the surgical approach to resurface the talar dome with osteochoridral techniques. The majority of the talar dome can be accessed without osteotomy. [ABSTRACT FROM AUTHOR]

Between 1984 and December 2002, 211 patients underwent a revision anterior cruciate ligament reconstruction using a contralateral patellar tendon autograft. The patients were divided up into 3 groups. The first 2 groups consisted of individuals who had a primary ACL reconstruction from another surgeon, both intraarticular reconstructions (N = 103) and extraarticular reconstructions (N = 51). Patients in the third group (N = 57) underwent a primary ACL reconstruction by the senior author. Subjective questionnaires were received from 165 patients at longer than 2 years after surgery (mean time, 6.67 years). The mean subjective score for patients who had undergone a previous extraarticular procedure by another surgeon before revision ACL surgery was 77.4 points, which, statistically, is significantly lower than the mean of 87.9 for patients who had a previous intraarticular procedure by a different surgeon and 92.7 for patients who had a previous intraarticular procedure done by the senior author. Objective evaluation obtained for 126 patients at a mean of 4.0 years after surgery showed that only 57% of patients who had undergone a previous extraarticular procedure had both normal extension and normal flexion, which, statistically significant, was less than 74% for patients who underwent a previous intraarticular ACL reconstruction by the senior author and 67% for patients who had undergone previous intraarticular procedures by another surgeon (P = 0.0372). Objective stability was not, statistically, different significantly between groups (P = 0.6040). The use of a mini-arthrotomy with contralateral patellar tendon autograft for revision ACL reconstruction allows patients to consistently achieve the goals of restoring stability, range of motion, and function after surgery. [ABSTRACT FROM AUTHOR]

A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5 L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness. [ABSTRACT FROM AUTHOR]

Summary: A 2‐week‐old 75 kg Thoroughbred filly was presented for the investigation of an acute forelimb lameness. Radiographs revealed a fracture of the medial epicondylar physis of the left humerus (Salter–Harris type II fracture). The fragment was removed via arthrotomy under general anaesthesia. Two months post‐operatively, the foal was sound and at 2 years had resumed normal turn out. This case report describes a previously unreported surgical treatment for a fracture of the medial epicondylar physis in a foal. [ABSTRACT FROM AUTHOR]

The article present repot of native joint septic arthritis. Topic include the type of organisms causing these infections may have biased the results in favor of the efficacy of shorter durations of antibiotics; Central Nervous System (CNS) involvement in patients with whipple disease; and tested for the presence of tropheryma whipplei Deoxyribo Nucleic Acid (DNA) by Polymerase Chain Reaction (PCR).

Synovitis of knee due to unaware incident of splinter piercing is rare in adult. It is a case report of 30-year-old female with the painful knee in flexed attitude and had the swelling. History taking did not reveal any positive finding i.e., recent trauma, fever or any such previous episode. After the arthrotomy turbid synovial fluid with inflamed friable synovial thickening were seen. On further inspection there was a foreign body in the suprapateller pouch. It was removed and washed which was ultimately a splinter. Normal inflammatory marker and very mild sign and symptom of infection may provide weightage to this differential diagnosis. Arthrotomy and washing with antibiotic coverage can give the excellent result. [ABSTRACT FROM AUTHOR]

Background Septic arthritis is a joint-threatening and life-threatening infection, with the knee representing the most frequently involved joint. There is no definitive treatment algorithm for the management of this condition, which typically includes surgical debridement to decompress the joint, followed by organism-specific intravenous antibiotics. Methods Search Methods. MEDLINE (1965–2018), SCOPUS (1973–2018), The COCHRANE Library (2006–2017), EMBASE (1974–2018), reference lists, and scientific meetings were searched for relevant studies on the treatment of native knee septic arthritis by three independent reviewers. No language restrictions were used. Selection criteria included all studies reporting on native knee septic arthritis in adults treated with arthroscopy and open arthrotomy with irrigation and debridement. Data Collection and Analysis Studies were identified, subjected to inclusion and exclusion criteria, and reviewed by three independent reviewers. Patient characteristics, interventions, and outcomes were extracted, and the trials were rated for quality based on established criteria. A meta-analysis was conducted for the primary outcome, reoperation occurring after arthroscopic vs. open arthrotomy irrigation and debridement for the treatment of septic arthritis. We used a qualitative analysis for secondary outcomes physical function and hospital length of stay. Results From 624 abstracts, eight trials met inclusion criteria, one randomized controlled trial and seven retrospective cohorts. Quantitative meta-analysis showed arthroscopic irrigation and debridement resulted in fewer reoperations compared with open arthrotomy (RR = 0.76; 95% CI 0.59–0.97, P = 0.03, I 2 = 24%), Figure 1. A qualitative summary of seven included studies assessing physical function showed arthroscopic debridement results in improved functional outcomes and range of motion compared with open arthrotomy. Based on four trials, qualitative summary demonstrated that arthroscopic debridement results in decreased hospital length of stay compared with open arthrotomy. Conclusion Arthroscopic irrigation and debridement is favored over open arthrotomy with regard to lower rates of reoperation, improved functional outcomes, and shorter hospital length of stay. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background: Intra-articular lipomas are rare and very few cases have been reported in the knee. To the best of our knowledge, here we report the largest lipoma to have ever been observed in the knee. It is crucial to avoid the misdiagnose of lipoma arborescens, which is associated with degenerative joint disease. Lipoma is a homogeneous, ovoid, adipose tissue tumor that is contained within a fibrous capsule and not associated with previous disease.Case Presentation: A 48-year-old male, with a soft-tissue tumor on the superomedial aspect of the right knee. Magnetic resonance imaging (MRI) revealed an intra-articular lipoma. The mass was resected by means of a limited arthrotomy.Conclusions: Knee lipoma is an extremely rare disease that must be diagnosed by MRI. Where possible, it should be resolved by arthroscopic resection. [ABSTRACT FROM AUTHOR]