Objectives. Surgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk orthopaedic procedures. This study aimed to determine the seroprevalence of four BBPs among patients undergoing joint arthroplasty in Shanghai, China. In addition, we evaluated the significance of pre-operative screening by calculating a cost-to-benefit ratio. Methods. A retrospective observational study of pre-operative screening for BBPs, including hepatitis B and C viruses (HBV and HCV), human immunodeficiency virus (HIV) and Treponema pallidum (TP), was conducted for sequential patients in the orthopaedic department of a large urban teaching hospital between 01 January 2009 and 30 May 2016. Medical records were analysed to verify the seroprevalence of these BBPs among the patients stratified by age, gender, local origin, type of surgery, history of previous transfusion and marital status. Results. Of the subjects who underwent arthroplasty surgery in our institution, pre-operative screening tests were available for 96.1% (11 609 patients). The seroprevalence of HBV, HCV, HIV and TP was 5.47%, 0.45%, 0.08% and 3.6%, respectively. A total of 761 seropositive cases (68.4%) were previously undiagnosed. Pre-operative screening for HIV resulted in a low cost to benefit ratio, followed by HCV and HBV. Conclusion. Routine HCV and HIV screening prior to joint arthroplasty is not a cost-effective strategy. Considering the high rate of undiagnosed patients and the shortage of protective options, targeted pre-operative screening for HBV and syphilis should be considered for the protection of healthcare workers in China who have not been vaccinated. Cite this article: Bone Joint Res 2017;6:566–571

Introduction and aim:. With up to 70% of adults with tuberculosis in Sub-Saharan Africa infected with human immunodeficiency virus (HIV), severe spinal tuberculosis presents a different set of clinical and surgical challenges. To overcome the disadvantages of various traditional techniques, particularly in patients who are HIV-positive with opportunistic pulmonary pathology, and to obviate the need to violate the diaphragm in the lower thoracic and upper lumbar spine, a posterior vertebral column resection through a single posterior approach was proposed. The aim of this study is to report on the early results of the single-stage posterior only vertebral column resection. Method:. A total of 12 patients (10 females and 2 males) seen at CMJAH between January 2007 and January 2011 underwent a single-stage posterior only posterior vertebral column resection, and were retrospectively reviewed. The indications for PVCR are essentially the same as those for 360 degrees decompression and fusion. The mean follow-up period was 15.8 months (range 5 to 44 months). Results:. Eleven allografts and 1 autograft were placed centrally and secured. The kyphosis correction averaged 17.83 degrees (range 0 to 45 degrees); with no loss of correction at last follow-up. The mean number of vertebrae removed was 1.325 (0.75 to 2) with the mean instrumented levels of 3.8 (2 to 7). The mean duration of surgery was 266.6 minutes (140 to 415 mins), the mean intra-operative blood loss was 712.5 mls (350–2100 mls). No loosening or breakage of screws occurred. The mean Frankel neurology grading at last follow-up was D (B to E). Conclusion:. Early results of single-stage only PVCR are gratifying, particularly in patients with decreased pulmonary functions who will not withstand to adverse effects of anterior surgery and 2 stage-surgery. It is an effective surgical technique but technically demanding procedure with possible risks of major complications

Considerable efforts have been invested into identifying risk factors for periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). Preoperative identification of risk factors for developing PJI is imperative for medical optimization and targeted prophylaxis. The purpose of this study was to create a preoperative risk calculator for PJI by assessing a patient's individual risks for developing PJI with resistant organisms and S.aureus. A retrospective review of 27117 patients (43253 TJAs) from 1999 to 2014, including 1035 PJIs, was performed. A total of 41 risk factors including demographics, comorbidities (using the Elixhauser and Charlson Index), and the number of previous TJAs, were evaluated. Multivariate analysis was performed; coefficients of the models were scaled to produce useful integer scoring. Predictive model strength was assessed employing area under the curve (AUC) analysis. Among the 41 assessed variables, the following were significant risk factors in descending order of significance: prior surgeries (p<0.0001), drug abuse (p=0.0003), revision surgery (p<0.0001), human immunodeficiency virus (p=0.0004), coagulopathy (p<0.0001), renal disease (p<0.0001), congestive heart-failure (p<0.0001), psychoses (p=0.0024), rheumatological disease (p<0.0001), knee involvement (p<0.0001), diabetes (p<0.0001), anemia (p<0.0001), males (p<0.0001), liver disease (p=0.0093), smoking (p=0.0268), and high BMI (p<0.0001). Furthermore, presence of heart-valve disease (p=0.0409), metastatic disease (p=0.0006), and pulmonary disease (p=0.0042) increased the resistant organism PJIs. Patients with metastatic disease were also more likely to be infected with S. aureus (p=0.0002). AUCs were 0.83 for any PJI, 0.86 for resistant PJI, and 0.84 for S.aureus PJI models. This large-scale single-institutional study has determined various risk factors for PJI. Some factors are modifiable and need to be addressed before elective arthroplasty. It is imperative that surgeons are aware of these risk factors and implement all possible preventative measures, including targeted prophylaxis, in patients with high-risk of PJI. Continued efforts are needed to find novel and effective solutions to minimize the burden PJI

Introduction. The Human immunodeficiency virus (HIV) has changed all aspects of orthopaedic practice in Durban, South Africa. In our Arthroplasty unit, we have noticed a significant increase in HIV positive patients that required total hip arthroplasty (THR). Method. We conducted a retrospective, demographic chart review of all patients below the age of 55years undergoing primary THR in our unit from 2004 to 2011. Results. The results show a steady rise from 22 THR's in 2004, to 51 in 2011. There was a demographic change in patients presenting with avascular necrosis (AVN) as primary diagnosis, with a significant increase of HIV positive patients. The new demographic group that makes up 44% of our current practice are black Africans, particularly females (70% of all black patients). The majority of them (66%) have none of the previous risk factors for AVN (alcohol, smoking and steroids) and out of this group 52% are HIV positive on anti-retroviral medication (ARV's) with an average CD4 count of 516. All HIV positive patients, in this demographic study, were black African females. Discussion. In the past, the typical patient receiving a primary THR for AVN in Durban was a young Asian male. These patients had strong associations with alcohol, smoking and oral steroid use. This demographic group makes up 33% of our current practice. Demonstrated clearly is a change in demographics of patient population and this lead to a number of interesting questions. What caused this sudden increase in HIV related AVN in our unit? To what extend do ARV's contribute to this accelerated progression of AVN and HIV?. This paper focuses our attention on HIV and its affect in modern orthopaedics. The challenge is great, the question remains … how will we respond?. NO DISCLOSURES

A 51-year-old Caucasian woman was admitted to the Rheumatology Department of our hospital due to a 3-week history of diffuse neck, shoulder and upper torso pain, exacerbated by movements. An outpatient trial of non-steroidal anti-inflammatory medications had been unsuccessful. A few days later, the pain was localised above the manubrium, the left clavicle and sternomastoid muscle and fever up to 39.5°C was reported. The patient had no significant past medical history and lived in a suburban area. She did not work and liked to do gardening in her spare time. There was no history of local trauma or any medications. On examination, there was intense redness, tenderness and swelling of the manubrium and the left sternoclavicular joint. Chest CT revealed osteolytic changes of the manubrium and presence of inflammatory tissue surrounding the manubrium and extending posteriorly. The lung parenchyma was unaffected. Brain and abdominal CT were unremarkable. A triple-phase bone scan was indicative of sternal osteomyelitis without other bone involvement. Blood and urine cultures remained negative. The patient was empirically treated with high-dose intravenous vancomycin and ciprofloxacin with no response. Antibody testing to human immunodeficiency virus and hepatitis viruses was negative. An open biopsy was performed 1 week later, revealing persistent inflammatory tissue around the sternum and fluid collection posteriorly. Multiple bone specimens were sent for histological examination and cultures. Histology showed acute and chronic granulomatous inflammation, while both cultures of the bone marrow and the fluid revealed Nocardia nova. No other pathogen was identified. The patient responded to high-dose intravenous trimethoprim-sulfamethoxazole, which was continued on an outpatient basis for 1 year without further sequelae. This is the first reported case of primary sternal osteomyelitis due to Nocardia species. The possibility of nocardiosis needs to be included in the differential diagnosis of sternal osteomyelitis, even for apparently immunocompetent adults

Aim

The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff.

Aims

Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature.

Objectives

Adipose-derived mesenchymal stem cells (ADMSCs) are a promising strategy for orthopaedic applications, particularly in bone repair. Ex vivo expansion of ADMSCs is required to obtain sufficient cell numbers. Xenogenic supplements should be avoided in order to minimise the risk of infections and immunological reactions. Human platelet lysate and human plasma may be an excellent material source for ADMSC expansion. In the present study, use of blood products after their recommended transfusion date to prepare human platelet lysate (HPL) and human plasma (Hplasma) was evaluated for in vitro culture expansion and osteogenesis of ADMSCs.

The February 2014 Trauma Roundup³⁶⁰ looks at: predicting nonunion; compartment Syndrome; octogenarian RTCs; does HIV status affect decision making in open tibial fractures?; flap timing and related complications; proximal humeral fractures under the spotlight; restoration of hip architecture with bipolar hemiarthroplasty in the elderly; and short versus long cephalomedullary nails for the treatment of intertrochanteric hip fractures in patients over 65 years.