Aim

Septic arthritis of the hip is a rare entity among the adult population, but with a potential severe repercussion. The most accepted treatment is the hip debridement, even though a notorious proportion of the cases need further hip replacement owing to the cartilage destruction. The aim of this study is to analyse all our cases of septic arthritis of the hip treated with a 2-stage strategy using an antibiotic-loaded cement spacer.

Patient safety is a major concern worldwide, but particularly high rates of adverse events are reported in the surgery setting. Orthopaedic and Traumatology is the speciality most frequently involved in claims in Catalonia. The objective of the study is to perform a descriptive study of the claims regarding infection in Orthopaedic and Traumatology in Catalonia.

We performed a retrospective study of the claims regarding infection in Orthopaedic and Traumatology from the prospective claims database of the Service of Professional Liability of The Catalonian Council of Official Colleges of Physicians. The time frame of data collection was from 2003 to 2013. We analyzed both the clinical and legal characteristics of the cases.

During the 10-year period, 638 registered claims were related to the practice of Orthopaedic and Traumatology, and 74 (11,6%) were due to infection. The most frequent surgical procedure involved were arthroplasty (knee, hip or shoulder) (14, 18,9%), traumatic wounds and cellulitis (12, 16,2%), spine procedures (10, 13,5%) and arthroscopy (7, 9,4%). The most frequent anatomical site involved were foot and ankle (17, 22,9%), spine (15, 20,3%), knee (14, 18,9%), wrist and hand (11, 14,8%). The 68,92% of claims was solved by the courts and 29,73% by an “out-of-court” procedure. The average compensation in cases considered to have professional liability was 145.045€.

Orthopaedic and Traumatology seem to be a specialty with a high risk for claims, and infection is one of the most important causes. The study of the claims can lead to improvements in prophylaxis, diagnosis and treatment of infection in Orthopaedic and Traumatology.

Early prosthetic joint infections (PJI) are managed with debridement, implant retention and antibiotics (DAIR). Our aim was to evaluate risk factors for failure after stopping antibiotic treatment.

From 1999 to 2013 early PJIs managed with DAIR were prospectively collected and retrospectively reviewed. The main variables potentially associated with outcome were gathered and the minimum follow-up was 2 years. Primary endpoint was implant removal or the need of reintroducing antibiotic treatment due to failure.

A total of 143 patients met the inclusion criteria. The failure rate after a median (IQR) duration of oral antibiotic treatment of 69 (45–95) days was 11.8%. In 92 cases PJI was due to gram-positive (GP) microorganisms, in 21 due to gram-negatives (GN) and 30 had a polymicrobial infection. In GP infections, combination of rifampin with linezolid, cotrimoxazole or clindamycin was associated with a higher failure rate (27.8%, P=0.026) in comparison to patients receiving a combination of rifampin with levofloxacin, ciprofloxacin or amoxicillin (8.3%) or monotherapy with linezolid or cotrimoxazole (0%) (Figure 1). Among patients with a GN infection, the use of fluoroquinolones was associated with a lower failure rate (7.1% vs 37.5%, P=0.044). Duration of antibiotic treatment was not associated with failure.

The only factor associated with failure was the oral antibiotic selection, but not the duration of treatment. Linezolid, cotrimoxazole and clindamycin but not levofloxacin serum concentrations are reduced by rifampin; a fact that could explain our findings. Further studies monitoring serum concentration could help to improve the efficacy of these antibiotics when combining with rifampin.