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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 33 - 33
1 Dec 2021
Logoluso N Balato G Pellegrini AV De Vecchi E Romanò CL Drago L Lenzi M Ascione T
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Aim

Despite the availability of numerous tests, the diagnosis of periprosthetic infection (PJI) continues to be complex. Although several studies have suggested that coagulation-related markers, such as D-dimer and fibrinogen, may be promising tools in the diagnosis of prosthetic infections, their role is still controversial. The aim of this study is to evaluate the diagnostic accuracy of serum D-dimer and fibrinogen in patients with painful total knee replacement.

Method

83 patients with painful total knee replacement and suspected peri-prosthetic infection were included. All patients underwent pre-operative blood tests to evaluate inflammation indices (ESR and CRP) and serum D-Dimer and Fibrinogen levels. The diagnostic performance of the tests was assessed using the ICM definition as the gold standard. The diagnostic accuracy of the D-dimer and fibrinogen was measured by assessing sensitivity, specificity and by calculating the area under the ROC curve.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 56 - 56
1 Dec 2017
Romanò CL Romanò D Scarponi S Logoluso N
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Aim

The treatment of osteomyelitis often requires extensive surgical debridement and removal of all infected tissues and foreign bodies. Resulting bone loss can then eventually be managed with antibacterial bone substitutes, that may also serve as a regenerative scaffold. Aim of the present study is to report the clinical results of a continuous series of patients, treated at our centre with an antibacterial bioglass*.

Method

From November 2010 to May 2016, a total of 106 patients, affected by osteomyelitis, were included in this prospective, single centre, observational study. Inclusion criteria were the presence of osteomyelitis with a contained bone defect or segmental defects < 10 mm, with adequate soft tissue coverage. All patients underwent a one-stage procedure, including surgical debridement and bone void filling with the bioactive glass*, with systemic antibiotic therapy and no local antibiotics. Clinical, radiographic and laboratory examinations were performed at 3, 6 and 12 months and yearly thereafter.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 43 - 43
1 Dec 2016
Romanò C Malizos K Blauth M Capuano N Mezzoprete R Logoluso N Drago L
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Aim

Aim of this study is to present the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating*, in patients undergoing internal osteosynthesis for closed fractures.

Method

In this prospective, multi-centre, randomized, controlled, prospective study, a total of 260 patients were randomly assigned, in five European orthopaedic centres, to receive the antibiotic-loaded DAC coating or to a control group, without coating. Pre- and post-operative assessment of laboratory tests, wound healing, clinical scores and x-rays were performed at fixed time intervals.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 33 - 33
1 Dec 2016
Trentinaglia MT Drago L Logoluso N Morelli I Romanò C
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Aim

Implant-related infections, including peri-prosthetic joint infection (PJI) and infected osteosynthesis, are biofilm-related. Intra-operative diagnosis and pathogen identification is currently considered the diagnostic benchmark; however the presence of bacterial biofilm(s) may have a detrimental effect on pathogen detection with traditional microbiological techniques. Sonication and chemical biofilm debonding have been proposed to overcome, at least partially, this issue, however little is known about their possible economical impact. Aim of this study was to examine direct and indirect hospital costs connected with the routine use of anti-biofilm microbiological techniques applied to hip and knee PJIs.

Method

In a first part of the study, the “Turn Around Time (TAT)” and direct costs comparison between a system to find bacteria on removed prosthetic implants*, a closed system for intra-operative tissue and implant sampling, transport and anti-biofilm processing, versus sonication has been performed. An additional analysis of the estimated indirect hospital costs, resulting from the diagnostic accuracy of traditional and anti-biofilm microbiological processing has been conducted.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 335 - 335
1 Jul 2011
Romano CL Bonora C Logoluso N Romano D
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Introduction: Surgical site infection is a growing and expensive complication. Surgical site surveillance is performed with the aid of laboratory tests and clinical evaluation; the latter has some limits, including reproducibility and validation of results and, as suggested by many authors, the need of a dedicated well trained staff. At present no imaging instruments are available for routine objective monitoring of “normal” or complicated surgical site healing. Recently, technological improvement made available for clinical use high resolution portable digital telethermocameras at relatively low-costs. No data are available in the literature, concerning the “physiological” thermographic pattern of surgical wounds in orthopaedics. The aim of this study is then to evaluate the physiological telethermographic pattern of surgical site healing after hip and knee prosthetic surgery, to provide a reference value for further analysis.

Methods: The surgical site of 60 consecutive patients undergoing total hip replacement and 40 patients unde-going total knee replacements were examined at fixed intervals from the day before surgery to six weeks after intervention, using a portable telethermographic camera (AVIO TVS-200EX). Results were compared with contralateral side and with laboratory data.

Results: A physiological “telethermographic pattern” of wound healing was observed and showed to be remarkably reproducible among different patients. A thermographic peak was observed at day 3, with a mean temperature elevation (hottest spot) of 2.3 +− 1.3 ^C after hip replacement and of 2.8 +− 1.5 ^C after total knee replacement. Similar results were obtained when considering the mean surface temperature in a 10 cm rectangle area identified around the surgical wound. Temperature at the surgical site slowly returned to baseline (contralateral side as reference) in a six weeks period.

Discussion and Conclusion: Telethermography through a portable camera appears a reliable, not invasive, not irradiating and easy-to-use tool to monitor surgical site following hip or knee arthroplasty at the patient’s bed. Surgical site show a highly reproducible physiological thermographic pattern, with peak values at day 3 and a constant decrease until normal values at week 6 after surgery. This findings may be used as a reference for further studies, to establish the relevance of abnormal thermographic patterns in connection with surgical site complications.