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Despite ongoing efforts to enhance diagnostic and treatment processes, the success rate for eradicating infections, particularly prosthetic joint infections (PJIs), currently stands at around 50%. For acute infections occurring shortly after arthroplasty, guidelines recommend a treatment known as DAIR (debridement, antibiotics, and implant retention). This approach is suggested for infections within 30 days post-arthroplasty or with less than 3 weeks of symptoms, provided that there is a stable implant and adequate soft-tissue mass. Several authors have suggested extending the use of DAIR beyond the initial 3-week period in specific cases. This extension practice seems increasingly feasible due to the rapid diagnostic capabilities offered by BioFire®. This technology allows for quick pathogen identification, aiding in the exclusion of cases that do not fit the criteria for the DAIR/DAPRI (debridement, antibiotic pearls and retention of the implant) protocol based on pathogen identification. The aim of this review is to re-examine the current literature on acute infections and present our proposed "prosthesis-saving" protocol, which integrates the BioFire® molecular diagnostic system. Continued research and assessment of the efficacy and safety of these protocols, especially regarding extended treatment timelines, are crucial for advancing the management of acute infections and enhancing outcomes for PJI patients. [ABSTRACT FROM AUTHOR]

The accuracy of preoperative synovial fluid microbe detection in periprosthetic joint infection (PJI) is widely reported. However, the reliability of this diagnostic modality amongst the different joints is not yet described. We aimed to compare the concordance rate between preoperative synovial fluid and intraoperative tissue cultures in shoulder, knee and hip PJIs. A total of 150 patients who met the 2018 International Consensus Meeting criteria for shoulder, hip and knee PJI were retrospectively reviewed. This cohort was divided into three groups based on the involved joint (should, hip or knee), with 50 patients in each group. Cultures were collected and held for culture for 14 days. The overall concordance rate was 56.7%. Concordance rates between preoperative and intraoperative cultures were 60%, 56% and 54% for the knee, shoulder and hip joints, respectively. The analysis of high- or low-virulence and difficult- or not-difficult-to-treat germs did not reveal any significant differences between preoperative and intraoperative cultures in any of the groups. However, even considering the higher concordance in knee PJI, the overall discordance between preoperative and intraoperative cultures should prompt surgeons not to rely solely on preoperative synovial fluid culture data in determining appropriate treatment and antibiotics. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic joint infection (PJI), the most common cause of revision after TKA and THA, is a devastating complication for patients that is difficult to diagnose and treat. An increase in the number of patients with multiple joint arthroplasties in the same extremity will result in an increased risk of ipsilateral PJI. However, there is no definition of risk factors, micro-organism patterns, and safe distance between knee and hip implants for this patient group. Questions/purposes: (1) In patients with hip and knee arthroplasties on the same side who experience a PJI of one implant, are there factors associated with the development of subsequent PJI of the other implant? (2) In this patient group, how often is the same organism responsible for both PJIs? (3) Is a shorter distance from an infected prosthetic joint to an ipsilateral prosthetic joint associated with greater odds of subsequent infection of the second joint? Methods: We designed a retrospective study of a longitudinally maintained institutional database that identified all one-stage and two-stage procedures performed for chronic PJI of the hip and knee at our tertiary referral arthroplasty center between January 2010 and December 2018 (n = 2352). Of these patients, 6.8% (161 of 2352) had an ipsilateral hip or knee implant in situ at the time of receiving surgical treatment for a PJI of the hip or knee. The following criteria led to the exclusion of 39% (63 of 161) of these patients: 4.3% (seven of 161) for incomplete documentation, 30% (48 of 161) for unavailability of full-leg radiographs, and 5% (eight of 161) for synchronous infection. With regard to the latter, per internal protocol, all artificial joints were aspirated before septic surgery, allowing us to differentiate between synchronous and metachronous infection. The remaining 98 patients were included in the final analysis. Twenty patients experienced ipsilateral metachronous PJI during the study period (Group 1) and 78 patients did not experience a same-side PJI (Group 2). We analyzed the microbiological characteristics of bacteria during the first PJI and ipsilateral metachronous PJI. Calibrated, full-length plain radiographs were evaluated. Receiver operating characteristic curves were analyzed to determine the optimal cutoff for the stem-to-stem and empty native bone distance. The mean time between the initial PJI and ipsilateral metachronous PJI was 8 ± 14 months. Patients were followed for a minimum of 24 months for any complications. Results: The risk of ipsilateral metachronous PJI in the other joint secondary to a joint implant in which PJI develops can increase up to 20% in the first 2 years after the procedure. There was no difference between the two groups in age, sex, initial joint replacement (knee or hip), and BMI. However, patients in the ipsilateral metachronous PJI group were shorter and had a lower weight (1.6 ± 0.1 m and 76 ± 16 kg). An analysis of the microbiological characteristics of bacteria at the time of the initial PJI showed no differences in the proportions of difficult-to-treat, high virulence, and polymicrobial infections between the two groups (20% [20 of 98] versus 80% [78 of 98]). Our findings showed that the ipsilateral metachronous PJI group had a shorter stem-to-stem distance, shorter empty native bone distance, and a higher risk of cement restrictor failure (p < 0.01) than the 78 patients who did not experience ipsilateral metachronous PJI during the study period. An analysis of the receiver operating characteristic curve showed a cutoff of 7 cm for the empty native bone distance (p < 0.01), with a sensitivity of 72% and a specificity of 75%. Conclusion: The risk of ipsilateral metachronous PJI in patients with multiple joint arthroplasties is associated with shorter stature and stem-to-stem distance. Appropriate position of the cement restrictor and native bone distance are important in reducing the risk of ipsilateral metachronous PJI in these patients. Future studies might evaluate the risk of ipsilateral metachronous PJI owing to bone adjacency. Level of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Unicompartmental knee arthroplasty (UKA) accounts for 10% of knee arthroplasty procedures in Europe. Fixed bearing UKA designs have shown favorable survivorship in registries when compared with mobile bearings. This study analyses long-term follow-up of patients with a medial fixed bearing metal backed tibial UKA and reports 15 years survivorship and clinical outcomes. Methods: Data were collected prospectively for 148 medial unicompartmental fixed bearing metal backed UKAs implanted in 148 patients in two high volumes knee arthroplasty centers between January 2005 and December 2007. The indication was osteoarthritis in all but 2 patients. Patients' reported outcome scores were documented at last follow up. The mean patient age at time of surgery was 65 years. Results: At final follow up, outcome and survivorship data were collected for 124 medial fixed bearing UKAs. Thirteen patients underwent revision; average time to revision was 77 months (SD 35.31). The Kaplan–Meier analysis demonstrated a survivorship of 97.65% at 69 months and of 89,52%. at 120 months and 173 months of follow-up. When revisions for infection were excluded, the survivorship of the implant was 90.3% at the last of follow up. The mean OKS was 43.02 (SD 5.1) at the last follow-up, and the mean FJS was 77.6 (SD 6.9). Conclusion: This Medial fixed bearing metal backed UKA demonstrates promising long-term survivorship and patient outcomes. It appears to be a suitable and reasonably lasting option for the treatment of medial compartment OA. [ABSTRACT FROM AUTHOR]

The development of augmented reality (AR) and its application in total joint arthroplasty aims at improving the accuracy and precision in implant components' positioning, hopefully leading to increased outcomes and survivorship. However, this field is far from being thoroughly explored. We therefore performed a systematic review of the literature in order to examine the application, the results, and the different AR systems available in TJA. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles on the application of augmented reality in total joint arthroplasty using various combinations of keywords since the inception of the database to 31 March 2022. Accuracy was intended as the mean error from the targeted positioning angle and compared as mean values and standard deviations. In all, 14 articles met the inclusion criteria. Among them, four studies reported on the application of AR in total knee arthroplasty, six studies on total hip arthroplasty, three studies reported on reverse shoulder arthroplasty, and one study on total elbow arthroplasty. Nine of the included studies were preclinical (sawbones or cadaveric), while five of them reported results of AR's clinical application. The main common feature was the high accuracy and precision when implant positioning was compared with preoperative targeted angles with errors ≤2 mm and/or ≤2°. Despite the promising results in terms of increased accuracy and precision, this technology is far from being widely adopted in daily clinical practice. However, the recent exponential growth in machine learning techniques and technologies may eventually lead to the resolution of the ongoing limitations including depth perception and their high complexity, favorably encouraging the widespread usage of AR systems. [ABSTRACT FROM AUTHOR]

Introduction: In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock.From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded.Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A.Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure.Materials and methods: In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock.From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded.Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A.Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure.Results: In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock.From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded.Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A.Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure.Conclusions: In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock.From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded.Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A.Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure. [ABSTRACT FROM AUTHOR]