Porous tantalum is a highly osteoinductive biomaterial, initially introduced in orthopedics in 1997, with a subsequent rapid evolution of orthopedic applications. The use of porous tantalum for the acetabular component in primary total hip arthroplasty (THA) has demonstrated excellent short-term and mid-term results. However, long term data are scarce. The purpose of this prospective study is to report the long-term clinical and radiological outcome following use of an uncemented porous tantalum acetabular component in primary THA with a minimum follow-up of 17.5 years, in a previously studied cohort of patients.

We prospectively followed 128 consecutive primary THAs in 140 patients, between November 1997 and June 1999. A press-fit porous tantalum monoblock acetabular component was used in all cases. The presence of initial gaps in the polar region, as sign of incomplete seating of the monoblock cup, was assessed on the immediate postoperative radiographs. All patients were followed clinically and radiographically at 6, 12, and 24 weeks and 12 months and then at 2, 5, 8, 10, and 19 years, for a mean of 18.1 years (range 17.5 – 19 years). Periacetabular dome gap filling, acetabular cup migration and polyethylene wear were assessed by the EBRA digital measurement system, until 2 years postoperatively.

Mean age of patients at the time of operation was 60.4 years old (range 24 – 72). Harris hip score, Oxford Hip Score and range of motion (ROM) were dramatically improved in all cases (p < 0.001). In the initial postoperative radiographs, periacetabular dome gaps were observed in the 15% of cases, and were progressively filled within 6 months. In 2 years postoperatively, the mean component migration, as shown in EBRA study, was 0.67 mm. At last follow-up, all cups were radiographically stable with no evidence of migration, gross polyethylene wear, progressive radiolucencies, osteolytic lesions or acetabular fractures. The survivorship with re-operation for any reason as end point was 92.8%, whereas the survivorship for aseptic loosening as an end point was 100%. Upon visual inspection, two removed acetabular components due to recurrent dislocation and infection, respectively, showed extensive bone osseointegration.

In our primary THA series, the porous tantalum monoblock cup demonstrated excellent clinical and radiographic outcomes with no failures because of aseptic loosening at a mean follow-up of 18.1 years. Porous tantalum acetabular components showed excellent initial stability, produced less wear debris and revealed a great potential for bone ingrowth. Due to its unique osteoinductive properties and elliptical shape, porous tantalum monoblock cups have demonstrated superior short and long-term survivorship compared to other press fit prostheses in the market.

Periprosthetic knee infection is a serious complication of total knee replacement, connected to the formation of microbial biofilm on the surface of the implant. The most common bacteria causing periprosthetic infections are: Staphylococcus aureus, coagulase negative staphylococci and Gram negative bacteria. The purpose of this study is to present a rare case of periprosthetic knee infection caused by Ralstonia pickettii, which ultimately resulted in knee arthrodesis.

A 70 years old patient was referred to our clinic because of persistent pain, swelling and fistula in his left knee, 18 months after total knee arthroplasty. The patient had received oral ciprofloxacin and rifampicin during the last three months. The cultures of the fistula and knee aspiration were negative. A 2-stages revision of the total knee arthroplasty was decided. The patient underwent surgical removal of the prosthesis, cement and suspicious tissues and a spacer was placed. Samples from periprosthetic tissues were sent for conventional culture and all metal components were sonicated.

Intraoperative periprosthetic tissue cultures were negative. The culture of the sonicated fluid was positive for Ralstonia pickettii, a finding which was confirmed by the method of 16s rDNA. Ralstonia pickettii is a gram negative bacterium, capable of forming biofilm on metal surfaces. Postoperatively, the patient received intravenous antibiotic therapy with ciprofloxacin and cefepime, for 6 weeks, according to the results of the antibiogram. Due to fistula relapse after two surgical debridements, large bone defects and degeneration of the patellar tendon, knee arthodesis was performed.

In literature, there is only one reference of periprosthetic knee infection because of Ralstonia pickettii. Although quite rare, the periprosthetic knee infection caused by Ralstonia pickettii can be extremely durable with disastrous results for the knee joint.

In spite of its incidence decreasing to 1% nowadays, prosthesis-related infections remain a research, diagnostic, therapeutic and cost-related problem. Early diagnosis, selection of an appropriate surgical strategy, accurate identification of the responsible microorganisms and construction of an appropriate antibiotic regimen are essential elements of any management strategy. Our study aim was firstly to compare the diagnostic accuracy of conventional periprosthetic tissue culture and culture of fluid derived from vortexing and bath sonication of the explanted hardware and secondly to investigate the role of possible metabolic factors affecting the sensitivity of the sonication method.

We investigated 70 patients undergoing revision hip or knee arthroplasty because of loosening of the prostheses, at our institution, between October 2011 and November 2013. Patients’ medical history and demographic characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of prosthetic-joint infection.

Infectious Diseases Society of America (IDSA) Guidelines were used for the definition of prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip prostheses and 22 knee prostheses). The sensitivity of sonication fluid culture was 81.25% and the sensitivity of conventional tissue cultures was 56.25% (p-value = 0.043). The sensitivity of the sonication method was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis (p-values < 0.05).

The sonication method represents a reliable test for the diagnosis of prosthetic – joint infections with a greater sensitivity than the conventional periprosthetic tissue cultures, especially in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of primary osteoarthritis.

Purpose: To determine the effectiveness of a postoperative autologous blood reinfusion system, as an alternative to homologous, banked blood transfusions in total hip arthroplasty.

Material and Methods: We have carried out a prospective randomized, controlled study on 60 patients having unilateral total hip replacement. In all these patients the same surgical team applied the same surgical technique (hybrid THA) and they follow the same rehabilitation program. All the patients received intraoperatively one or two units of homologous banked blood transfusion (average 1.7 units/patient) according to the volume of blood collected in the suction device and to the anaesthesiologist’s estimation. In 30 of these patients (group A) a reinfusion system of unwashed blood salvaged was applied and they supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received also additional blood transfusions when required. The admission of banked blood transfusions determined by haemoglobin value (< 9mg/dL) and/or clinical signs (blood pressure, pulses, etc). The value of haemoglobin, haematocrite and platelets recorded preoperatively and the 1st, 5th and 15th day after operation.

Results: 13 patients of group A required postoperatively 13 units of homologous blood (0.43 units/patient) (total amount for group A 64 banked blood units or 2.14 units/patient). 21 patients of group B required additional 28 banked blood units postoperatively (totally 79 units for group B or 2.63 units/patient). In the study group the total homologous blood requirements reduced by 20%, while the postoperative blood requirements reduced by 54% and the number of patients required additional blood transfusion reduced by 38%. There was no significant difference in the postoperative haematocrite and haemoglobin values between the two groups. None of the patients developed any adverse reactions after reinfusion.

Conclusions: The use of an autologous blood reinfusion system reduces effectively the postoperative demands of homologous banked blood transfusion in total hip arthroplasty.

Purpose: The purpose of our study, is to determine the role of erythropoetin administration, as an alternative to homologous banked blood transfusions in total hip arthroplasty.

Material and Methods: We have carried out a prospective randomized, controlled study on 60 patients having unilateral total hip replacement. In all the above patients, the same surgical team applied the same surgical technique (hybrid THA) and they followed the same rehabilitation program. We examined 2 groups of patients. In group A, all the patients received intraoperatively one unit of homologous blood transfusion (average 1 unit/patient), according to the volume of blood collected in the suction device and to the anaesthesiologist’s estimation. We also administered 40,000 units of erythropoetin subcutaneously one day before the operation followed by 40,000 units (sc) every 3 days in a total scheme of 4 doses. A control group of 30 patients (group B), in whom standard suction drains were used, received intraoperatively one or two units of homologous blood transfusion (average 1,7 units/patient), and also additional blood transfusions when required. The admission of banked blood transfusion was determined by the Haemoglobin value (< 9mg/dl) and/or clinical signs (blood pressure, pulse etc.). The values of Haemoglobin, Haematocrit and Platelets were recorded preoperatively and the 1st, 5th, and 15th day postoperatively.

Results: 5 patients of group A required postoperatively 7 units of homologous blood (0,23 unit/patient) (total amount for group A 37 banked blood units 1,12 units/patient). 21 patients of group B required additional 28 banked blood units postoperatively (totally 79 banked blood units, or 2,63 units/patient). In the group A (study group), the total homologous blood requirements were reduced by 53%, the postoperative blood requirements were reduced by 75% and the number of patients that required additional blood transfusion was reduced by 67%. There was no significant difference noticed in the postoperative values of Haematocrit and Haemoglobin.

Conclusions: The use of erythropoetin reduces effectively the postoperative demands of homologous banked blood transfusion in total hip arthroplasty.

Purpose: The purpose of our study is to estimate the effectiveness of Parecoxib in the post surgical analgesia in the fractures of the hip joint in comparison with the usage of the combination of Diclofenac ant Pethidine

Material and methods: We have carried out a prospective randomized clinical study, during the period January 2003-July 2004, on 90 patients were operated with fractures of the hip joint. We examined two similar groups of patients concerning the age, the type of fracture and the type of anaesthesia. In group A, consisting of 35 patients, we provided 40 mg of Parecoxib i.v., as postsurgical analgesia, twice a day and in Group B, of 55 patients, we provided the combination of Diclofenac 75mg i.m. twice a day and Pethidine i.m. in case of persisting pain.

The intensity of pain was estimated by the Pain Intensity Scale ( PIS ).

Results: In Group A the PIS was 2.5 ± 0.8, and none of the patients needed supplementary analgesic. In Group B the PIS was 3.2 ± 0.8 and 21 (38.3%) patients needed supplementary analgesics (Pethidine).

In the use of Parecoxib no side effects were noticed (decrease BP, vomiting etc).

Conclusion: Parecoxib is more effective in the post surgical analgesia than Diclofenac and Pethidine in the fractures of the hip joint. It is easier to administer (i.v) and is also seems to be safe (no side effects were noticed). Therefore, we suggest that it should be the drug of choice in the post surgical analgesia of the fractures of the hip joint.