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The optimal postoperative antibiotic duration has not been determined for aseptic revision total knee arthroplasty (R-TKA) where the risk of periprosthetic joint infection (PJI) is 3%-7.5%. This study compared PJI rates in aseptic R-TKA performed with extended oral antibiotic prophylaxis (EOAP) to published rates.Aseptic R-TKAs consecutively performed between 2013 and 2017 at a tertiary care referral center in the American Midwest were retrospectively reviewed. All patients were administered intravenous antibiotics while hospitalized and discharged on 7-day oral antibiotic prophylaxis. Infection rates and antibiotic-related complications were assessed.Sixty-seven percent of the 176 analysis patients were female, with an average age of 64 years and body mass index of 35 kg/mEOAP after aseptic R-TKA resulted in a PJI rate equivalent to primary TKA, representing a 2- to-4-fold decrease compared with published aseptic R-TKA infection rates. Further study on the benefits and costs of EOAP after aseptic R-TKA is encouraged.

Dislocation after hip replacement is a complication that can have dramatic consequences for the patient. The purpose of this article is to review the different parameters influencing stability and how to reduce this risk. The approach, the diameter of the femoral head, and the use of dual-mobility acetabular cups have led to a drastic reduction in the rate of dislocation, particularly in patients at risk, in cases of imbalance of the spino-pelvic complex, or in cases of revision surgery. The inclusion of patients in dedicated clinical pathways and participation in preoperative education sessions also contribute to the reduction of dislocation risk.La luxation après prothèse de hanche est une complication qui peut avoir des conséquences dramatiques pour le patient. Cet article a pour but de revoir les différents paramètres influençant la stabilité prothétique et pouvant diminuer ce risque. La voie d’abord, le diamètre de la tête fémorale et l’usage de cotyles à double mobilité ont permis une diminution drastique du taux de luxation, en particulier chez les patients à risque, en cas de déséquilibre du complexe spino-pelvien ou en cas de reprise chirurgicale. L’inclusion des patients dans des itinéraires cliniques dédiés et la participation à des séances d’information préopératoire participent également à la réduction du risque de luxation.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation. Depuis 1996, le registre genevois des arthroplasties aux HUG recueille, archive et diffuse des informations pertinentes de haute qualité concernant les arthroplasties primaires de la hanche et du genou ainsi que les procédures de révision réalisées au Service de chirurgie orthopédique et traumatologie de l’appareil moteur. Les patients sont suivis pendant toute leur vie avec la prothèse. Le registre a été essentiel pour mieux comprendre et ensuite améliorer la prise en charge de patients avec arthroplastie de hanche et de genou. Il continuera à remplir sa mission et à assurer une transmission encore plus efficace des connaissances obtenues vers tous les groupes concernés (stakeholders) et à leur implémentation.

Since 1996, the Geneva Arthroplasty Registry at the University Hospitals of Geneva (HUG) has been collecting, archiving and disseminating relevant high-quality information on primary total hip and knee arthroplasties and revision procedures performed at the Division of Orthopaedics and Traumatology. Patients are followed throughout their lifetime with the prosthesis. The registry has been essential to better understand and subsequently improve the care of patients with hip and knee replacements. It will continue to fulfil its mission and to work towards an even more effective transfer of the knowledge obtained to all stakeholders and as well as towards its implementation.Depuis 1996, le registre genevois des arthroplasties aux HUG recueille, archive et diffuse des informations pertinentes de haute qualité concernant les arthroplasties primaires de la hanche et du genou ainsi que les procédures de révision réalisées au Service de chirurgie orthopédique et traumatologie de l’appareil moteur. Les patients sont suivis pendant toute leur vie avec la prothèse. Le registre a été essentiel pour mieux comprendre et ensuite améliorer la prise en charge de patients avec arthroplastie de hanche et de genou. Il continuera à remplir sa mission et à assurer une transmission encore plus efficace des connaissances obtenues vers tous les groupes concernés (stakeholders) et à leur implémentation.

Giant cell tumor is a benign epiphyseo-metaphyseal bone tumor affecting the young patient. It is characterized by an extensive osteolysis, a high potential for recurrence, a risk of malignant transformation and pulmonary metastases. Curettage and cavity filling is the most common treatment, even in the case of a pathological fracture. A wide resection with prosthetic reconstruction must sometimes be considered. Better knowledge of the role of RANK-L in the pathophysiology of these tumors has led to clinical trials involving denosumab. Treatment with denosumab is suggested for inoperable lesions, or for aggressive lesions, in particular of the spine, pelvis, and sacrum before en bloc resection.La tumeur à cellules géantes est une tumeur osseuse bénigne épiphysométaphysaire touchant le sujet jeune. Elle est caractérisée par une ostéolyse parfois extensive, un potentiel de récidive élevé, un risque de transformation maligne et de métastases pulmonaires. Le curetage-comblement est le traitement de choix, y compris en cas de fracture pathologique. Une résection plus large avec reconstruction prothétique doit parfois être envisagée. La meilleure connaissance du rôle de RANK-L dans la physiopathologie de ces tumeurs a conduit à des essais cliniques impliquant le dénosumab. Un traitement par celui-ci est proposé pour les lésions inopérables ou agressives, notamment du rachis, du pelvis et du sacrum, avant une résection en bloc.

Background the aim of this study was to determine if an open tibia fracture is at increased risk to be associated with acute compartment syndrome (ACS), when compared to a closed tibia fracture. Methods a cohort of 711 consecutive adult patients sustaining 725 tibia fractures between January 2005 and December 2009 were included in this retrospective study. The outcome measure was ACS, which was clinically diagnosed. The following variables were assessed: soft tissue condition (closed, open Gustilo type 1 or open Gustilo type 2 and 3); low- vs. high-energy injury; associated contiguous skeletal injury; type of fracture (proximal intra-articular, extra-articular, distal intra-articular). A logistic regression model was used to measure the association between ACS and the variables. Adjustment was performed for age and sex. Statistical significance was defined as p

Hip and knee replacement are among the most successful orthopaedic interventions in terms of satisfaction and they are now proposed to younger patients. Recommendations regarding return to sports are based on expert opinions and on the results of surveys performed among surgeons. Sports activities are classified as recommended, recommended with some level of experience, and discouraged. They take into account the risks associated with sports activities, but are not necessarily in line with the growing expectations of patients. This article addresses the risks related to return to sports, recommended sports, and the rate and appropriate timing of sport resumption. The main predictor remains the motivation of the patient and the pre-operative sporting level.Le remplacement prothétique de la hanche ou du genou donne satisfaction à un grand nombre de patients, permettant aujourd’hui d’étendre les indications à des patients plus jeunes. Les recommandations concernant la reprise du sport reposent sur des avis d’experts et des enquêtes menées auprès de chirurgiens, et classent les activités en activités recommandées, recommandées avec un certain niveau d’expérience et déconseillées. Elles tiennent compte des risques liés à la pratique sportive, mais ne sont pas toujours en phase avec les attentes croissantes des patients. Cet article pose la question des risques associés à la reprise du sport après chirurgie, des sports recommandés ainsi que du taux et du délai de reprise. Le principal facteur prédictif de reprise du sport demeure la motivation du patient et le niveau sportif préopératoire.

Background The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. Methods All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. Results The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (

Direct anterior approach (DAA) with the patient lying supine has facilitated the use of intraoperative fluoroscopy and allows for standardized positioning of the patient. The current study presents a new technique to measure acetabular component anteversion using intraoperative fluoroscopy. The current paper describes a mathematical formula to calculate true acetabular component anteversion based on the acetabular component abduction angle and the c-arm tilt angle (CaT). The CaT is determined by tilting the c-arm until an external pelvic oblique radiograph with the equatorial plane of the acetabular component perpendicular to the fluoroscopy receptor is obtained. CaT is determined by direct reading on the C-arm device. The technique was validated using a radiopaque synbone model comparing the described technique to computed tomography anteversion measurement. The experiment was repeated 25 times. The difference in anteversion between the two measuring techniques was on average 0.2° (range -3.0-3.1). The linear regression coefficients evaluating the agreement between the experimental and control methods were 0.99 (95%CI 0.88-1.10, p

Wear, corrosion and periprosthetic osteolysis are important causes of failure in joint arthroplasty, especially in young patients. Ceramic bearings, developed 40 years ago, are an increasingly popular choice in hip arthroplasty. New manufacturing procedures have increased the strength and reliability of ceramic materials and reduced the risk of complications. In recent decades, ceramics made of pure alumina have continuously improved, resulting in a surgical-grade material that fulfills clinical requirements. Despite the track record of safety and long-term results, third-generation pure alumina ceramics are being replaced in clinical practice by alumina matrix composites, which are composed of alumina and zirconium. In this review, the characteristics of both materials are discussed, and the long-term results with third-generation alumina-on-alumina bearings and the associated complications are compared with those of other available ceramics.Cite this article: EFORT Open Rev 2018;3:7-14. DOI: 10.1302/2058-5241.3.170034

Studies demonstrate that revision rates after primary total knee arthroplasty (TKA) tend to be higher in obese patients. However, the existence of a body mass index (BMI) threshold remains unexplored. We conducted a prospective cohort study of 2442 primary TKAs in 2035 patients (69.1 % women; mean age 72 years; mean follow-up 93 months, range 38–203). We evaluated the influence of BMI in five categories on all-cause revision after TKA using incidence rates (IR), hazard ratios (HR), and Kaplan–Meier survival analysis. Adjustment for baseline imbalances was performed using Cox regression analysis. Over the study period, 71 revisions occurred. Revision rates were 3.2 cases/1000 patient-years for patients of normal weight, 3.4/1000 for overweight patients and 3.0/1000 for patients classified as obese class I. At BMI ≥ 35, a significant increase in revision was noted. Comparing BMI ≥ 35 vs. < 35, there were 6.4 vs. 3.2 /1000. Crude HR was 2.0 [95 % confidence interval (CI) 1.2–3.3, p = 0.009], and the adjusted HR was 2.1 (95 % CI 1.2–3.6, p = 0.008). All-cause revision rates after primary TKA doubled in patients with a BMI of 35 but were similar in those with a BMI

Total hip replacement can provide pain relief and restore function in patients suffering from hip arthritis, including in those under the age of 50. However, shortened implant longevity in this age group has been a concern because the clinical results after revision surgery are inferior to those after primary hip arthroplasty. Technical choices (approach, implants, type of fixation and bearing couple) must be made to maximise longevity based on published data and thoroughly discussed with the patient. Finally, long term results (clinical outcome and implant longevity) associated with this surgery are such that it appears unnecessary to postpone the surgery once the indication is established.L’arthroplastie de hanche est le traitement de choix de la coxarthrose, y compris chez les patients de moins de 50 ans. La longévité raccourcie des implants dans cette classe d’âge est source d’inquiétude car la chirurgie de reprise est associée à des résultats cliniques inférieurs à la chirurgie première. Les choix techniques (voie d’abord, choix des implants, type de fixation et couple de frottement) doivent contribuer à maximiser la durée de vie des implants en étant basés sur des données publiées et faire l’objet d’une discussion approfondie avec le patient. Finalement, les résultats à long terme (gain fonctionnel et longévité) de cette intervention sont tels qu’il n’est pas nécessaire de retarder le geste chirurgical une fois l’indication posée.

Some patient populations and types of orthopaedic surgery could be at particular risk for anaerobic infections. In this retrospective cohort study of operated adult patients with infections from 2004 to 2014, we assessed obligate anaerobes and considered first clinical infection episodes. Anaerobes, isolated from intra-operative samples, were identified in 2.4% of 2740 surgical procedures, of which half (33/65; 51%) were anaerobic monomicrobial infections. Propionibacterium acnes, a penicillin and vancomycin susceptible pathogen, was the predominantly isolated anaerobe. By multivariate analysis, the presence of fracture fixation plates was the variable most strongly associated with anaerobic infection (odds ratio: 2.1, 95% CI: 1.3-3.5). Anaerobes were also associated with spondylodesis and polymicrobial infections. In contrast, it revealed less likely in native bone or prosthetic joint infections and was not related to prior antibiotic use. In conclusion, obligate anaerobes in our case series of orthopaedic infections were rare, and mostly encountered in infections related to trauma with open-fracture fixation devices rather than clean surgical site infection. Anaerobes were often co-pathogens, and cultures most frequently recovered P. acnes. These observations thus do not support changes in current practices such as broader anaerobe coverage for perioperative prophylaxis.

Direct anterior approach (DAA) with the patient lying supine has facilitated the use of intraoperative fluoroscopy and allows for standardized positioning of the patient. The current study presents a new technique to measure acetabular component anteversion using intraoperative fluoroscopy. The current paper describes a mathematical formula to calculate true acetabular component anteversion based on the acetabular component abduction angle and the c-arm tilt angle (CaT). The CaT is determined by tilting the c-arm until an external pelvic oblique radiograph with the equatorial plane of the acetabular component perpendicular to the fluoroscopy receptor is obtained. CaT is determined by direct reading on the C-arm device. The technique was validated using a radiopaque synbone model comparing the described technique to computed tomography anteversion measurement. The experiment was repeated 25 times. The difference in anteversion between the two measuring techniques was on average 0.2° (range -3.0-3.1). The linear regression coefficients evaluating the agreement between the experimental and control methods were 0.99 (95%CI 0.88-1.10, p 0.001) and 0.33 (95%CI -1.53-2.20, p = 0.713) for the slope and intercept, respectively. The current study confirms that the described three-step c-arm acetabular cup measuring technique can reproducibly and reliably assess acetabular component anteversion in the supine position, as compared to CT-imaging. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2307-2312, 2017.

Background and purpose — Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate. Patients and methods — We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories

Foot infections are a frequent and potentially harmful complication of diabetes mellitus. In one skin ulceration out of two, further evolution towards infection occurs and often leads to amputation increasing morbidity and health care costs. Skin disruptions, favored by the sensorimotor neuropathy and vascular disease, constitute the initial factors leading to this complication. To ensure effective care, these cases must be managed by a multidisciplinary team in a specialized center. All caretakers involved with patients suffering from diabetes mellitus must be capable of preventing and recognizing diabetic foot infections, as well as informing the patients about this complication and its management.

The main causes of lower limb amputations are peripheral artery disease (92% of the cases) and trauma (7%). The selection of the amputation level aims at optimizing the chances of healing and the functionality of the involved limb. Foot preserving amputations offer the best functional outcome but the healing process is frequently slow and difficult. After a below-knee amputation, 60% of the patients are capable of ambulating again, whereas only 20% of the patients undergoing an above-knee amputation ambulate autonomously. Complications after amputations are frequent, can occur a long time after surgery and must be managed by a highly specialized team.