Search

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THA), total knee arthroplasties (TKA) and partial hip arthroplasty (PHA) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26&ndash, 7.57, p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12&ndash, 13.67, p &lt, 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01&ndash, 9.20, p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

Background It is believed that the path of acetabular screws may represent a shuttle between hydroxyapatite (HA) particles and the liner. The aim was to assess the relationship between acetabular screws and revision surgery for aseptic loosening in total hip arthroplasties (THAs). Material and methods A retrospective multicentric study was performed. Patients older than 18 years and patients who underwent THA with both the stem and cup HA-coated were included. The rate of revision-surgery considering only aseptic loosening was calculated. The proportion of cases in which acetabular screws were used was registered, as well as the proportion of cups that showed osteolysis. The statistical relationship between acetabular screws and osteolysis, as well as acetabular screws and revision-surgery for aseptic loosening were assessed. Results There were 749 cases. Mean age 62.1 (45–84) years. Mean follow-up 14.19 (8.9-16.7) years. Revision surgery was performed in 12.8% (96/749) of the cups. 73.95% (71/96) of the revised cups showed aseptic loosening. The overall 15-year survival of the cups considering only aseptic loosening was 84.4%. Acetabular screws were used in 47.5% (356/749) of the cups. Acetabular screws were used in 40.44% (55/136) of the cups that showed osteolysis. The use of acetabular screws was associated with less osteolysis (p = 0.006). Acetabular screws were used in 35.21% (25/71) of the cups that were revised for aseptic loosening. The use of acetabular screws was associated with a lower rate of revision surgery (p = 0.020). Conclusions In THA with the stem and cup HA-coated, the use of acetabular screws is associated with a lower rate of revision surgery.

Objectives Clostridium species are anaerobic bacilli that are rarely reported as etiologic agents of infectious arthritis. Previous cases of arthritis caused by Clostridium ramosum have not been reported. We describe the first 2 cases of C. ramosum arthritis. Methods We reviewed the etiology of arthritis in our hospital during the previous 15 years. Results Both patients had underlying immunocompromising conditions and their infections involved a joint with preexisting disease: patient 1 had rheumatic arthritis and a prosthetic joint; patient 2, chronic renal failure on dialysis and hip osteoarthritis. The infection was hematogenously acquired and the course was indolent but destructive in both the cases. Management included open arthrotomy and resection arthroplasty. The infection had a persisting and relapsing course, and prolonged antibiotic treatment was required. In the literature review, we found 55 previous cases of arthritis caused by Clostridium species between 1966 and 2014; Clostridium perfringens was the most common infecting species; the infection was traumatically acquired in most of the cases. A total of 15 patients have been described with infections caused by C. ramosum ; none had septic arthritis. The majority were elderly or immunocompromised adults. Proper collection, transportation and processing of clinical specimens is essential for diagnosing clostridial infections. More information about the best management of clostridial arthritis are needed. Conclusions We describe the first 2 cases of septic arthritis caused by C. ramosum. They shared several pathogenic and clinical features. The possibility of anaerobic arthritis should always be considered when collecting diagnostic specimens. An increasing number of clostridial arthritis cases are likely to be diagnosed in future years.

It is important to know the spectrum of the microbial aetiology of prosthetic joint infections (PJIs) to guide empiric treatment and establish antimicrobial prophylaxis in joint replacements. There are no available data based on large contemporary patient cohorts. We sought to characterize the causative pathogens of PJIs and to evaluate trends in the microbial aetiology. We hypothesized that the frequency of antimicrobial-resistant organisms in PJIs has increased in the recent years. We performed a cohort study in 19 hospitals in Spain, from 2003 to 2012. For each 2-year period (2003-2004 to 2011-2012), the incidence of microorganisms causing PJIs and multidrug-resistant bacteria was assessed. Temporal trends over the study period were evaluated. We included 2524 consecutive adult patients with a diagnosis of PJI. A microbiological diagnosis was obtained for 2288 cases (90.6%). Staphylococci were the most common cause of infection (1492, 65.2%). However, a statistically significant rising linear trend was observed for the proportion of infections caused by Gram-negative bacilli, mainly due to the increase in the last 2-year period (25% in 2003-2004, 33.3% in 2011-2012; p 0.024 for trend). No particular species contributed disproportionally to this overall increase. The percentage of multidrug-resistant bacteria PJIs increased from 9.3% in 2003-2004 to 15.8% in 2011-2012 (p 0.008), mainly because of the significant rise in multidrug-resistant Gram-negative bacilli (from 5.3% in 2003-2004 to 8.2% in 2011-2012; p 0.032). The observed trends have important implications for the management of PJIs and prophylaxis in joint replacements. N. Benito, (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

We assess 254 consecutive primary total hip replacements (THRs) using a fully hydroxyapatite (HA)-coated stem and socket (Furlong; JRI, London, UK). Minimum follow-up was 10 years. Harris hip score (HHS) increased from 49.8 preoperatively to 86.2 at follow-up. The most remarkable clinical finding was the near absence of thigh pain. After 10 years of follow-up, all stems met stability criteria and none needed revision for aseptic loosening. Three cups (1.2%) were revised for aseptic loosening. Two more cups were revised for recidivant dislocation. Varus placement of the femoral stem was present in 63 hips (24.8%) and valgus in 13 hips (5%). None of these technical defects showed radiologic progression, and there was no measurable correlation between them and the clinical score. Intraoperative femoral fractures occurred in 25 cases (9.8%) with no further influence on implant evolution. These findings strongly support the use of the JRI Furlong system for primary THR because it provides excellent clinical and radiologic results, with 0% and 1.2% cup and stem aseptic loosening, respectively, at 10 years. In addition, its tolerance to technical implantation defects makes it suitable even for less experienced hip surgeons.