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Background: PJIs following total hip and knee arthroplasty represent severe complications with broad implications, and with significant disability, morbidity, and mortality. To be able to provide correct and effective management of these cases, an accurate diagnosis is needed. Classically, acute PJIs are characterized by a preponderance of virulent microorganisms, and chronic PJIs are characterized by a preponderance of less-virulent pathogens like coagulase-negative staphylococci or Cutibacterium species. This paper aims to analyze if there are any changes in the causative microorganisms isolated in the last years, as well as to provide a subanalysis of the types of PJIs. Methods: In this single-center study, we prospectively included all retrospectively consecutive collected data from patients aged over 18 years that were hospitalized from 2016 through 2022, and patients that underwent a joint arthroplasty revision surgery. A standardized diagnostic protocol was used in all cases, and the 2021 EBJIS definition criteria for PJIs was used. Results: 114 patients were included in our analysis; of them, 67 were diagnosed with PJIs, 12 were acute/acute hematogenous, and 55 were chronic PJIs. 49 strains of gram-positive aerobic or microaerophilic cocci and 35 gram-negative aerobic bacilli were isolated. Overall, Staphylococcus aureus was the most common isolated pathogen, followed by coagulase-negative staphylococci (CoNS). All cases of acute/acute hematogenous PJIs were caused by gram-positive aerobic or microaerophilic cocci pathogens. Both Staphylococcus epidermidis and methicillin-resistant S. aureus were involved in 91.66% of the acute/acute hematogenous PJIs cases. 21.8% of the chronic PJIs cases were caused by pathogens belonging to the Enterobacterales group of bacteria, followed by the gram-negative nonfermenting bacilli group of bacteria, which were involved in 18.4% of the cases. 12 chronic cases were polymicrobial. Conclusion: Based on our findings, empiric broad-spectrum antibiotic therapy in acute PJIs could be focused on the bacteria belonging to the gram-positive aerobic or microaerophilic cocci, but the results should be analyzed carefully, and the local resistance of the pathogens should be taken into consideration.

Background: The COVID-19 pandemic has challenged the treatment of Clostridioides Difficile (CD)-infected patients given the increasing number of co-infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this context, fecal microbiota transplantation (FMT) shows promise in modulating the immune system’s function and alleviating the burdens associated with this condition. Methods: To achieve this goal, we performed a comparative, retrospective, single-center study on 86 patients (admitted between January 2020 and March 2022). We based our approach on specific inclusion criteria: 1. The study group included 46 co-infected patients (COVID-19 and CD) receiving antibiotics and FMT; 2. In the control group, 40 co-infected patients received antibiotics only. Our results showed no significant group differences in terms of gender, age, risk factors such as cardiovascular and neurological diseases, type 2 diabetes, and obesity (p > 0.05), or in pre-treatment inflammatory status, evaluated by white blood cell (WBC) count and C-reactive protein (CRP) levels. We report a significant decrease in inflammatory syndrome (CRP, WBC) in coinfected patients receiving FMT in addition to antibiotics (p < 0.05), with a lower relapse rate and mitigation of cramping and abdominal pain (91.3%). In addition, a higher level of fibrinogen, persistent moderate abdominal pain (82.5%), and a significantly higher CD infection relapse rate (42.5%) were recorded in co-infected patients treated only with antibiotics (p < 0.05). Conclusion: Our study provides new data to support the multiple benefits of FMT in the case of COVID-19 and CD co-infection by improving patients’ quality of life and inflammatory syndrome.

Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure often used to eliminate the effects of knee osteoarthritis, a disease that is becoming more widespread worldwide. Optimizing the geometric planning of this operation is a very important preparatory step for the success of the intervention and rapid postoperative recovery. This optimization is performed in two main directions. The first direction evaluates the intraoperative behavior of the tibia during the osteotomy by optimizing four geometric parameters that characterize geometric planning. The second direction aims at a postoperative evaluation of the flat tibia-osteosynthesis assembly taking into account the optimal position on the medial–lateral articular line through which the corrected mechanical axis of the tongue passes and implicitly offloads the transfer from the medial area to the side of the knee. The research methods used are exclusively computer-assisted such as: computer-aided design (hereinafter CAD) for geometric modeling of the tibia taking into account the real bone structure, the finite element method (hereinafter FEM) for performing numerical analyses and design of the experiment (hereinafter DOE) for the design of the research. The results obtained are eloquent and clearly presented and can be important elements for orthopedic doctors at the geometric planning stage of the OWHTO.

This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view.

This paper provides an analysis from a biomechanical perspective of the medial opening wedge high tibial osteotomy surgery, a medical procedure commonly used in treating knee osteoarthritis. The aim of this research is to improve the analysed surgical strategy by establishing optimal values for several very important parameters for the geometric planning of this type of surgical intervention. The research methods used are numerical and experimental. We used finite element, a numerical method used to study the intraoperative behavior of the CORA area for different positions of the initiation point of the cut of the osteotomy plane and for different correction angles. We also used an experimental method in order to determine the maximum force which causes the occurrence of cracks or microcracks in the CORA area. This helped us to determine the stresses, the maximum forces, and the force-displacement variations in the hinge area, elements that allowed us to identify the optimal geometric parameters for planning the surgery.

Background: Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are common heart muscle disorders that are caused by pathogenic variants in sarcomere protein genes. In this study, we describe a variant in the MHY7 gene, segregating in a family having three different phenotypes of cardiomyopathies. MYH7 encodes for the myosin heavy-chain β (MHC-β) isoform involved in cardiac muscle contractility. Method and results: We present the case of a family with four members diagnosed with HCM and four members with DCM. The proband is a 42-year-old man diagnosed with HCM. He has an extended family of eight siblings; two of them are diagnosed with HCM and are implantable cardioverter–defibrillator (ICD) carriers. One of the siblings died at the age of 23 after suffering a sudden cardiac arrest and DCM of unknown etiology which was diagnosed at autopsy. Another brother was diagnosed with DCM during a routine echocardiographic exam. Genetic testing was performed for the proband and two of his siblings and a niece of the proband, who suffered a cardiac arrest at the age of nine, all being MYH7 mutation positive. For all four of them, cardiac imaging was performed with different findings. They are ICD carriers as well. Conclusions: Our results reveal three variants in phenotypes of cardiomyopathies in a family with MYH7 mutation associated with high SCD risk and ICD needed for primary and secondary prevention.

Breakage of tibial interlocking nails is a rare complication and is associated with tibial nonunion. The distal part of a broken tibial nail is difficult to extract and can be a real challenge. Preoperative planning is important, as the retrieval techniques of broken implants are not routine operations. There are various techniques and instruments described by different authors with none being uniformly successful. Therefore, surgeons should know as many methods as possible to choose the most suitable one. Minimally invasive retrieval techniques should be favored because of their reduced morbidity, while fenestration extraction methods should be used as the second intention. Cannulated intramedullary nails are more prone to benefitting from minimally invasive retrieval techniques than solid ones. This paper reviews and describes the present techniques used to extract the distal part of broken tibial nails, to serve as a quick guide for surgeons who need it.

Meniscal lesions often occur in association with anterior cruciate ligament (ACL) tears at the moment of the injury or, secondarily, as a consequence of knee instability. Both ACL and meniscus lesions are associated with a higher risk of osteoarthritis. Adequate treatment of these lesions reduces the rate of degenerative changes in the affected knee. Meniscal tears should be addressed concomitantly with ACL reconstruction and the treatment must be oriented towards preserving the meniscal tissue anytime this is possible. Several options for approaching a meniscus tear are available. The meniscal suture should always be considered, and, if possible, meniscectomy should be the last choice. “Masterly neglect” is a valuable option in selected cases.