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Background: The detection of causative pathogens plays a crucial role in the diagnosis and targeted treatment of periprosthetic joint infections (PJI). While there have been improvements in analytic methods in the past, pre-analytical procedures have not yet been sufficiently investigated. The objective of this study was to compare the culture yield of four different pre-analytical procedures. Methods: Patients with perioperative diagnosis of PJI were included in a single center cross-sectional study (2021–2022). Tissue samples (n = 20) of each patient were randomly and equally distributed to each of the four study arms. Tissue samples were either send to the laboratory without culture medium (group A) or were transported in thioglycolate medium immediately after sampling at three different temperatures (room temperature, 4 °C, 37° for 24 h; group B-D). Culture media were investigated for growth on days 1, 3, 7, 12, 14. All organisms, the number of positive samples and the time to positivity were recorded and compared between the study arms. Single positive cultures were considered as contamination. Results: In total, 71 patients were included. The proportions of culture negative samples (10–15%) and polymicrobial infections (51–54%) were comparable between the four arms. Seven patients (10%) were culture-negative in group A, but showed growth in thioglycolate media (group B-D). Furthermore, 13% of patients showed growth in all groups, but additional organisms were cultured in thioglycolate. There was growth beyond day 7 of culturing only in thioglycolate, but not in group A. A storage temperature of 4 °C showed a longer time to positivity compared to the other groups (p < 0.001). Conclusions: Pre-analytical storage of tissue samples in thioglycolate broth did not improve the culture yield and did not detect additional cases of infection compared to the standard (pre-analytical storage in sterile containers). However, including a thioglycolate medium to the sampling algorithm reduced the rate of culture-negative infections and helped to identify additional organisms. [ABSTRACT FROM AUTHOR]

Background: 3D printing has a wide range of applications and has brought significant change to many medical fields. However, ensuring quality assurance (QA) is essential for patient safety and requires a QA program that encompasses the entire production process. This process begins with imaging and continues on with segmentation, which is the conversion of Digital Imaging and Communications in Medicine (DICOM) data into virtual 3D-models. Since segmentation is highly influenced by manual intervention the influence of the users background on segmentation accuracy should be thoroughly investigated. Methods: Seventeen computed tomography (CT) scans of the pelvis with physiological bony structures were identified, anonymized, exported as DICOM data sets, and pelvic bones were segmented by four observers with different backgrounds. Landmarks were measured on DICOM images and in the segmentations. Intraclass correlation coefficients (ICCs) were calculated to assess inter-observer agreement, and the trueness of the segmentation results was analyzed by comparing the DICOM landmark measurements with the measurements of the segmentation results. The correlation between segmentation trueness and segmentation time was analyzed. Results: The lower limits of the 95% confidence intervals of the ICCs for the seven landmarks analyzed ranged from 0.511 to 0.986. The distance between the iliac crests showed the highest agreement between observers, while the distance between the ischial tuberosities showed the lowest. The distance between the upper edge of the symphysis and the promontory showed the lowest deviation between DICOM measurements and segmentation measurements (mean deviations < 1 mm), while the intertuberous distance showed the highest deviation (mean deviations 14.5—18.2 mm). Conclusions: Investigators with diverse backgrounds in segmentation and varying experience with slice images achieved pelvic bone segmentations with landmark measurements of mostly high agreement in a setup with high realism. In contrast, high variability was observed in the segmentation of the coccyx. In general, interobserver agreement was high, but due to measurement inaccuracies, landmark-based approaches cannot conclusively show that segmentation accuracy is within a clinically tolerable range of 2 mm for the pelvis. If the segmentation is performed by a very inexperienced user, the result should be reviewed critically by the clinician in charge. [ABSTRACT FROM AUTHOR]

Background: The elbow is a common site for overuse injuries in golfers. Tendinopathies, such as medial and lateral epicondylitis, are frequently diagnosed in amateur and professional golfers. The aim of our study was to determine the effect of an ergonomic golf grip on forearm muscle activity during the five phases of the golf swing. Methods: Thirty right-handed golfers with a mean age of 32 years (range, 18–70 years) and a mean handicap of 15 (range, 0–43) performed 10 golf swings with a standard and ergonomic golf grip respectively. The mean and maximum muscle activity of the Musculus (M.) extensor carpi radialis brevis (ECRB), M. flexor carpi ulnaris (FCU), M. pronator teres (PT) and M. biceps brachii (BB) of the lead and trail arms were assessed during the five phases of the golf swing using surface electromyography (EMG). Subgroup analyses were performed regarding sex, playing ability (handicap < 10 vs. ≥10), weekly playing time (≤ 5 h, 5–20 h, > 20 h) and preexisting elbow pain during golfing (VAS < 2 vs. VAS ≥ 2). Significance was set at p < 0.05. Results: An ergonomic golf grip resulted in a reduction in muscle activity in at least one but up to three consecutive phases of the golf swing for the ECRB, FCU and PT of the lead arm and for the PT of the trail arm. Amateurs, a playing time < 20 h per week and golfers without preexisting elbow pain were factors that were associated with greater reductions in muscle activity. Conclusion: Forearm muscle activity can be decreased using an ergonomic golf grip, indicating the possible role of an ergonomic golf grip as a preventive measure against overuse syndromes such as medial and lateral epicondylitis. Trial registration number: This study was retrospectively registered at the German Clinical Trials Register DRKS-ID: DRKS00033732 (01/03/2024). [ABSTRACT FROM AUTHOR]

Increasing antibiotic resistance has been reported as an issue in the treatment of periprosthetic joint infection (PJI). A repeat two-stage revision for recurrent PJI is at high risk of reinfection. However, it is unclear if the microorganism profile plays a role with potentially more resistant or polymicrobial infections. This is a retrospective, single-center analysis of two-stage revisions performed between 2011 and 2017. We identified 46 patients who underwent a repeat resection arthroplasty for recurrent PJI of the same joint after a previous two-stage revision of the same joint at the same department. All microbiological findings were analyzed focusing on microbiological spectrum and resistance testing as well as the potential impact on reinfection-free survival. The most common organism found at the time of recurrent PJI were coagulase-negative Staphylococci (39%) followed by Gram-negative organisms (28%). The risk of polymicrobial infections, difficult-to-treat resistant organisms, and Gram-negative infections increased significantly. Among staphylococcal infections, there was a high percentage of methicillin-resistant species and resistance to oral antibiotics. Patients with Gram-negative organisms had a reduced infection-free survivorship, while resistant organisms were not associated with decreased survival. Patients who undergo a repeat two-stage revision for recurrent PJI have more polymicrobial and resistant organisms, although the impact on survivorship is unclear. [ABSTRACT FROM AUTHOR]

Purpose: Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay‐off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player‐, match‐ and injury‐related parameters. Methods: All shoulder dislocations within the highest three German football leagues (1.–3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player‐, injury‐ and match‐related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05. Results: A total of 90 first‐time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23–28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty‐four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12–43) following conservative and 103 days (IQR: 85–135) following surgical treatment (p < 0.001). Twenty‐two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2–22) and 7 months (IQR: 3–23) following surgical treatment (n.s.). Conclusion: The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]