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Superficial wound complications have been consistently implicated in the development of prosthetic joint infection. This cohort study aimed to determine perioperative risk factors associated with superficial wound complications. The study was performed over an 18-month period ( January 2011 to June 2012) and included 964 patients undergoing prosthetic hip or knee replacement surgery. The factors associated with superficial wound complication differed according to arthroplasty site. In the combined cohort the following factors were associated with superficial wound complications: the use of 0.5% chlorhexidine in 70% alcohol for surgical skin preparation compared with 1% iodine in 70% alcohol (odds ratio ( OR) 4.75; 95% confidence interval ( CI) 1.42, 15.92; p = 0.012); increasing age ( OR, 1.13; 95% CI, 1.06,1.19; p 0.18); increasing body mass index ( BMI) ( OR, 1.08; 95% CI, 1.05,1.12; p < 0.001); rheumatoid arthritis ( OR, 2.56; 95% CI, 1.17, 5.58; p 0.018); and increasing blood transfusions ( OR, 1.26; 95% CI, 1.06,1.49; p 0.008). In the hip arthroplasty cohort, the use of 0.5% chlorhexidine in 70% alcohol for surgical skin preparation ( OR, 13.35; 95% CI, 2.11, 84.29; p 0.006), increasing BMI ( OR, 1.13; 95% CI, 1.06, 1.19; p < 0.001) and increasing blood transfusions ( OR, 1.26; 95% CI, 1.06, 1.49; p 0.008) were associated with superficial wound complications. In the knee arthroplasty cohort rheumatoid arthritis ( OR, 2.75; 95% CI, 1.03, 7.33; p 0.043) and increasing tourniquet time ( OR, 1.01; 95% CI, 1.00, 1.02; p = 0.029) were independent predictors of superficial wound complications. Further research is warranted to assess the impact of modification of these factors on the subsequent development of wound complications and prosthetic joint infection. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect Abstract Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p <0.001), more additional surgery (3.3 vs. 0.07; p <0.001) and longer total bed days (31.6 vs. 7.9 days; p <0.001). In addition they had more inpatient, outpatient and emergency department visits (p <0.001, respectively). For patients with prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69 414 (±29 869) compared with $22 085 (±8147) (p <0.001). The demand for arthroplasty continues to grow and with that, the number of prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. [ABSTRACT FROM AUTHOR]

Information is required about treatment outcomes of Gram-negative prosthetic joint infections treated with prosthesis retention and surgical debridement, especially where biofilm- active antibiotics such as fluoroquinolones are used. The outcome of 17 consecutive patients with an early Gram-negative prosthetic joint infection who had been treated with prosthesis retention and surgical debridement was analysed. Enterobacteriaceae were isolated in 16 patients and infections were mixed with other organisms in 13 (76%) patients. The median joint age was 17 days and the median duration of symptoms before debridement was 7 days. All patients initially received intravenous b-lactam antibiotic therapy and 14 patients were then treated with oral ciprofloxacin. Treatment failure occurred in two patients over a median period of follow-up of 28 months. In only one patient was a relapsed Gram-negative infection responsible for the failure and this patient had not been treated with ciprofloxacin. The 2-year survival rate free of treatment failure was 94% (95% CI, 63–99%). Prosthesis retention with surgical debridement, in combination with antibiotic regimens including ciprofloxacin, was effective and should be considered for patients with early Gram-negative prosthetic joint infection. [ABSTRACT FROM AUTHOR]

Background Sex and body mass may influence knee biomechanics associated with poor total knee arthroplasty (TKA) outcomes for knee osteoarthritis (OA). This study aimed to determine if gait differed between men and women, and overweight and class I obese patients with severe knee OA awaiting TKA. Methods 34 patients with severe knee OA (average age 70.0 (SD 7.2) years, body mass index 30.3 (4.1 kg/m 2 )) were recruited from a TKA waiting list. Three-dimensional gait analysis was performed at self-selected walking speed. Comparisons were made between men and women, and overweight (body mass index (BMI) 25.0–29.9 kg/m 2 ) and class I obese (BMI 30.0–34.9 kg/m 2 ) participants. Biomechanical outcomes included absolute and body size-adjusted peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment, as well as peak knee flexion and varus-valgus angles, peak varus-valgus thrust, and peak vertical ground reaction force (GRF). Findings Men had a higher absolute peak KAM, KAM impulse and peak GRF compared to women, and this sex-difference in frontal plane moments remained after adjusting for body size. However, when additionally adjusting for static knee alignment, differences disappeared. Knee biomechanics were similar between obesity groups after adjusting for the greater body weight of those with class I obesity. Interpretation Men had greater KAM and KAM impulse even after adjustment for body size; however adjustment for their more varus knees removed this difference. Obesity group did not influence knee joint kinematics or moments. This suggests sex- and obesity-differences in these variables may not be associated with TKA outcomes. [ABSTRACT FROM AUTHOR]

Background Varus-valgus thrust is a biomechanical characteristic linked to knee osteoarthritis disease progression. This study aimed to determine: i) direction of thrust in individuals awaiting total knee arthroplasty versus controls, ii) whether thrust and related parameters differed between groups, iii) differences between osteoarthritis patients awaiting surgery with varus and valgus thrust. Methods 44 patients scheduled for surgery and 40 asymptomatic participants were recruited. Primary outcome measures: varus-valgus thrust excursion and absolute thrust magnitude, quantified by 3D gait analysis. Findings Few differences were found between the osteoarthritis group and controls. The osteoarthritis group as a whole had a more varus knee angle during early- (p < 0.0001) and mid-stance (p = 0.010) versus controls. The varus thrust osteoarthritis subgroup had a more varus knee angle in overall (p = 0.012), early- (p < 0.001), and mid- (p < 0.001) stance, and a higher peak knee adduction moment (p = 0.019) and impulse (p = 0.001) when compared to varus thrust controls. No differences were found between the valgus thrust osteoarthritis and control groups. The varus thrust osteoarthritis group had a greater varus peak knee angle in overall (p < 0.001), early- (p < 0.001), and mid- (p < 0.001) stance, higher peak knee adduction moment (p < 0.001) and impulse (p = 0.001), more varus static alignment (p = 0.014), and lower quadriceps strength (p = 0.035) than the valgus thrust osteoarthritis group. Interpretation Those with severe osteoarthritis and a varus thrust have poorer biomechanics, more varus static knee alignment, and lower quadriceps strength compared to those with osteoarthritis with a valgus thrust. Further work is needed to determine if these findings impact total knee arthroplasty outcome. [ABSTRACT FROM AUTHOR]