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Aims: It is well described that patients with bone and joint infections (BJIs) commonly experience significant functional impairment and disability. Published literature is lacking on the impact of BJIs on mental health. Therefore, the aim of this study was to assess health-related quality of life (HRQoL) and the impact on mental health in patients with BJIs. Methods: The AO Trauma Infection Registry is a prospective multinational registry. In total, 229 adult patients with long-bone BJI were enrolled between 1 November 2012 and 31 August 2017 in 18 centres from ten countries. Clinical outcome data, demographic data, and details on infections and treatments were collected. Patient-reported outcomes using the 36-Item Short-Form Health Survey questionnaire (SF-36), Parker Mobility Score, and Katz Index of Independence in Activities of Daily Living were assessed at one, six, and 12 months. The SF-36 mental component subscales were analyzed and correlated with infection characteristics and clinical outcome. Results: The SF-36 physical component summary mean at baseline was 30.9 (95% CI 29.7 to 32.0). At one month, it was unchanged (30.5; 95% CI 29.5 to 31.5; p = 0.447); it had improved statistically significantly at six months (35.5; 95% CI 34.2 to 36.7; p < 0.001) and at 12 months (37.9; 95% CI 36.4 to 39.3; p < 0.001). The SF-36 mental component summary mean at baseline was 42.5 (95% CI 40.8 to 44.2). At one month, it was unchanged (43.1; 95% CI 41.4 to 44.8; p = 0.458); it had improved statistically significantly at six months (47.1; 95% CI 45.4 to 48.7; p < 0.001) and at 12 months (46.7; 95% CI 45.0 to 48.5; p < 0.001). All mental subscales had improved by the end of the study, but mental health status remained compromised in comparison with the average USA population. Conclusion: BJIs considerably impact HRQoL, particularly mental health. Patients suffering from BJIs reported considerable limitations in their daily and social activities due to psychological problems. Impaired mental health may be explained by the chronic nature of BJIs, and therefore the mental wellbeing of these patients should be monitored closely. Cite this article: Bone Jt Open 2024;5(9):721–728.

Abstract Purpose Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) presents significant challenges, especially in elderly and comorbid patients, often necessitating revision surgeries. We report on a series of patients with confirmed PJI of the knee and concomitant soft‐tissue/extensor apparatus defects, treated by using pedicled myocutaneous medial or lateral sural artery perforator (MSAP/LSAP) gastrocnemius flaps. Methods Our retrospective study at the Center for Musculoskeletal Infections, included patients with knee PJI undergoing pedicled myocutaneous MSAP/LSAP gastrocnemius flap reconstruction for combined soft tissue and extensor apparatus defects. The tendinous back of the gastrocnemius muscle was used and, if required, the Achilles tendon for extensor apparatus reconstruction, with the skin island addressing the cutaneous defect. Perioperative complications and postoperative outcomes after 1 year were evaluated, including functional and clinical assessments with the American Knee Society Score (AKSS). Results Eight patients (mean age 73 years; five female) were included, predominantly with Staphylococcus aureus infections. Six patients involved isolated MSAP flaps, two were extended with the Achilles tendon. The median time for wound healing was 9 days. Short‐term follow‐up showed successful reconstruction in seven patients, with minor wound dehiscence in one patient. One patient required flap revision for a perigenicular haemato‐seroma and two patients were diagnosed with new haematogenous PJI infection. Significant improvement in AKSS scores after surgery was observed (functional AKSS: median 33–85; clinical AKSS: median 64–91, p = 0.001). Conclusion Pedicled myocutaneous MSAP/LSAP gastrocnemius flaps offer a safe, reliable and versatile option for reconstructing combined soft tissue and extensor apparatus defects in PJI after TKA. This approach yields excellent functional outcomes with minimal peri‐ and postoperative complications, which is particularly beneficial in elderly and comorbid patients and feasible in settings without microsurgical availability. Level of evidence Level IV.

Background Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee joint mobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps.

Abstract Background The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) – a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification. Methods In this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions. Results Baseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0–31.2) hours with BF-FA-BCIP compared to 45.7 (37.7–51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes. Conclusions Rapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted. Trial registration Clinicaltrials.gov, NCT04156633, registered on November 5, 2019.

Abstract Background To investigate hip implant-related metal artifacts on a 0.55-T system compared with 1.5-T and 3-T systems. Methods Total hip arthroplasty made of three different alloys were evaluated in a water phantom at 0.55, 1.5, and 3 T using routine protocols. Visually assessment (VA) was performed by three readers using a Likert scale from 0 (no artifacts) to 6 (extremely severe artifacts). Quantitative assessment (QA) was performed using the coefficient of variation (CoV) and the fraction of voxels within a threshold of the mean signal intensity compared to an automatically defined region of interest (FVwT). Agreement was evaluated using intra/inter-class correlation coefficient (ICC). Results Interreader agreement of VA was strong-to-moderate (ICC 0.74−0.82). At all field strengths (0.55-T/1.5-T/3-T), artifacts were assigned a lower score for titanium (Ti) alloys (2.44/2.9/2.7) than for stainless steel (Fe-Cr) (4.1/3.9/5.1) and cobalt-chromium (Co-Cr) alloys (4.1/4.1/5.2) (p < 0.001 for both). Artifacts were lower for 0.55-T and 1.5-T than for 3-T systems, for all implants (p ≤ 0.049). A strong VA-to-QA correlation was found (r = 0.81; p < 0.001); CoV was lower for Ti alloys than for Fe-Cr and Co-Cr alloys at all field strengths. The FVwT showed a negative correlation with VA (-0.68 < r < -0.84; p < 0.001). Conclusions Artifact intensity was lowest for Ti alloys at 0.55 T. For other alloys, it was similar at 0.55 T and 1.5 T, higher at 3 T. Despite an inferior gradient system and a larger bore width, the 0.55-T system showed the same artifact intensity of the 1.5-T system.

Background and Objectives: Implantation of a short femoral stem in revision total hip arthroplasty (rTHA) could reduce the perioperative time, soft tissue damage, and preserve the bone stock of the proximal femur. The objective of this study was to describe the clinical and radiographic outcomes after the use of short stems in rTHA with a follow-up of 1 to 5 years. Materials and Methods: This retrospective, single center, and observational study analyzed the data of 31 patients (12 female, 19 male) with a median (interquartile range) age of 68.2 years (61.2–78.4) and BMI of 26.7 kg/m2 (24.6–29.4) who received an uncemented short femoral stem in rTHA between 2015 and 2020. Clinical outcomes were extracted from medical reports and assessed using the modified Harris Hip Score (mHHS), the numerical rating scale (NRS) for pain and satisfaction, and the UCLA Physical Activity Score. Radiographs were analyzed for stem subsidence, fixation, and bone parameters. The Wilcoxon test was used for pre–post rTHA differences (p < 0.05); clinical relevance was interpreted based on effect sizes according to Cohen’s d. Results: All the clinical outcome measures improved significantly (p ≤ 0.001) at follow-up compared to preoperative status, with large effect sizes (Cohen’s d) ranging from 2.8 to 1.7. At the last follow-up, the median (interquartile) mHHS was 80.9 (58.6–93.5). Stem fixation was stable in all cases. Complications included stem subsidence of 3 mm (n = 1) and 10 mm (n = 1), heterotopic ossification Brooker stage III (n = 2), intraoperative femur perforation (n = 1), periprosthetic fracture Vancouver type A (n = 1), and dislocation (n = 2). Conclusions: The good clinical results in our selective study population of patients with mild to moderate bone deficiency, supported by large effect sizes, together with a complication rate within the normal range, support the consideration of short stems as a surgical option after a thorough preoperative analysis.

Background and purpose: A new periprosthetic joint infection (PJI) definition has recently been proposed by the European Bone and Joint Infection Society (EBJIS). The goals of this paper are to evaluate its diagnostic accuracy and compare it with previous definitions and to assess its accuracy in preoperative diagnosis. Patients and methods: We retrospectively evaluated a multicenter cohort of consecutive revision total hip and knee arthroplasties. Cases with minimum required diagnostic workup were classified according to EBJIS, 2018 International Consensus Meeting (ICM 2018), Infectious Diseases Society of America (IDSA), and modified 2013 Musculoskeletal Infection Society (MSIS) definitions. 2 years’ minimum follow-up was required to assess clinical outcome. Results: Of the 472 cases included, PJI was diagnosed in 195 (41%) cases using EBJIS; 188 (40%) cases using IDSA; 172 (36%) using ICM 2018; and 145 (31%) cases using MSIS. EBJIS defined fewer cases as intermediate (5% vs. 9%; p = 0.01) compared with ICM 2018. Specificity was determined by comparing risk of subsequent PJI after revision surgery. Infected cases were associated with higher risk of subsequent PJI in every definition. Cases classified as likely/confirmed infections using EBJIS among those classified as not infected in other definitions showed a significantly higher risk of subsequent PJI compared with concordant non-infected cases using MSIS (RR = 3, 95% CI 1–6), but not using ICM 2018 (RR = 2, CI 1–6) or IDSA (RR = 2, CI 1–5). EBJIS showed the highest agreement between pre-operative and definitive classification (k = 0.9, CI 0.8–0.9) and was better at ruling out PJI with an infection unlikely result (sensitivity 89% [84–93], negative predictive value 90% [85–93]). Conclusion: The newly proposed EBJIS definition emerged as the most sensitive of all major definitions. Cases classified as PJI according to the EBJIS criteria and not by other definitions seem to have increased risk of subsequent PJI compared with concordant non-infected cases. EBJIS classification is accurate in ruling out infection preoperatively.

Deglacial forest expansion in the Northern Hemisphere poses a conundrum: Model results agree with the climate signal but are several millennia ahead of reconstructed forest dynamics. The underlying causes remain unsolved.

Background: This prospective study assesses the use of rapid remote online cytological evaluation for diagnosing endoscopical achieved biopsies. It focuses on its effectiveness in identifying benign and malignant conditions using digital image processing. Methods: The study was conducted between April 2021 and September 2022 and involved analyses of 314 Rapid Remote Online Cytological Evaluations in total (154 imprint cytologies, 143 fine needle aspirations and 17 brush cytologies) performed on 239 patients at the LungenClinic Grosshansdorf. During on-site evaluation via telecytology, the time requirement was recorded and the findings were compared with the cyto-/histological and final diagnoses. Results: By means of rapid remote online evaluation, findings of 86 cytological benign, 190 malignant and 38 unclear diagnoses were recorded (Ø assessment time, 100 s; range, 11–370 s). In 27 of the 37 specimens with unclear diagnoses, the final findings were malignant tumours and only 6 were benign changes. The diagnosis of another 4 of these 37 findings remained unclear. Excluding these 37 specimens, rapid remote online evaluation achieved a sensitivity of 90.5% with a specificity of 98.5% and a correct classification rate of 92.4% with regard to the final diagnosis of all cases. As expected, an increase in the sensitivity rate for the cytological detection of malignant tumours (76.1% vs. 92.5%) was found especially in fine-needle aspirations. Conclusions: Rapid remote online analysis allows the fast quantitative and qualitative evaluation of clinically obtained cytological specimens. With a correct classification rate of more than 93%, sampling deficiencies can be corrected promptly and diagnostic and therapeutic approaches can be derived.