Background: The presence of bacteria forming biofilms or prior antimicrobial use has been shown to reduce the sensitivity of the standard technique (PT cultures) in patients with infection of orthopedic implants. Culturing fluid resulting from sonication (FRS) of prosthesis could improve the microbiologic diagnosis.

Objective: To analyze the diagnostic validity of culturing FRS of different orthopedic implants and PT culture

Methods: Between Jan 2007 and Apr 2008, patients undergoing knee or hip prosthesis removal, and those with ostheosyntesis or spinal instrumentation removal, were prospectively included (44 hip prosthesis, 63 knee prosthesis, 91 osteosynthesis and 14 spinal instrumentations). 5 PT specimens were collected for culture. Removed implants were sonicated during 5 min. (40Hz). Both, PT and FRS, were inoculated in aerobic agar (Chocolate Polyvitex), anaerobic agar (Schaedler + 5% blood) and in thioglycolat, for 7 days. Positive culture cut-off was defined as growing of > 5 CFU. Clinical diagnosis of prosthetic-joint infection was made as commonly accepted. Previous antimicrobial therapy was assessed. Diagnostic validity was calculated for both culturing methods. Sensitivity of methods was compared by Chi-square test (SPSS 15.0).

Results: 212 cases were included. Diagnostic of infection was made in 17 hip prosthesis (THA), 20 knee prosthesis (TKA), 24 osteosynthesis (OS) and 6 spinal fusions (SI).

Tissue culture was positive in 9 THA, 11 TKA 18 OS and 4 SI. Sonication culture was positive in 14 THA, 18TKA, 23 Os and 6 SI.

Tissue culture: Sensibility: THA53%, TKA 55%, OS 75% and SI 66%. Specificity: THA 96%, TKA 100%, OS 96%, SI 100%

Sonications: Sensibility: THA 82%, TKA 90%, OS 95% and SI 100%. Specificity: THA 96%, TKA 100%, OS 92%, SI 100%

Statistical differences favoring sonication were found in sensitivity in knee arthroplasty and osteosynthesis implants. 6 patients received antibiotics for > 7 days before implant was removed. Sonication culture was positive in 4 of them whereas only one standard culture yielded positive.

Conclusions: FRS cultures are more sensitive than PT cultures. Sensitivity of the method depends on which device is evaluated. Sonication also improves sensitivity of culture after preoperative antimicrobial therapy.

Objective: Descriptive retrospective analysis of hip peri-prosthetic fractures treated surgically from 2000 to 2005 analysing risk factors and Results:

Material and Methods: 31 patients with a mean age of 77 years (56–94) were operated of a periprosthetic fracture which happened 73 months (0–300) after the index arthroplasty

Fractures were classified following the Vancouver system: 1 patient presented a type Al(3%), 4 a B1(13%), 23 suffered a B2(74%), 1 a B3(3%) and 2 patients presented a type C(6%)

The risk factors described in the literature were evaluated, as well as the different types of treatment with their clinical and radiological results.

Risk factors:

Personal: 21(68%) patients were women

Clinical results:

There were 0(0%) infections and 0(0%) exitus but 7(23%) patients suffered postoperative medical complications

Radiological results:

The mean time for fracture union was 6 months (3–18). At the end of follow-up 1(4%) patient presented non-union

Conclusions:

Patients with periprosthetic fractures present a high number of previous local risk factors

Introduction and purpose: Fractures of the tibial plateau account for 1% of the total. Among them, 55–70% involve the lateral plateau with differences in separation and subsidence. Minimally invasive osteosynthesis under arthroscopic control increases the indications in these cases. Our purpose is to assess the long-term clinical and radiological outcomes.

Materials and methods: We carried out a retrospective analysis of the medium-term results of closed fractures of the tibial plateau treated with arthroscopic reduction and percutaneous fixation with cannulated screws. A series of 32 patients with displaced fractures of the tibial plateau underwent surgery between 1993 and 2004. We used the AO classification. We analysed the clinical, functional and radiological results.

Results: The mean follow-up was 6 years. We treated 12 type 41B1, 7 type 41B21, 5 type 41B22, 7 type 41B31 and 1 type 41B12. All the fractures were consolidated and 79.1% had anatomical reduction. External meniscal injuries that could be sutured were present In 11 cases (34.3%). Joint balance was complete in 24 knees. According to the Lysholm scale 23 had an excellent outcome and 9 good. One case presented infection of the surgical wound, which was resolved by surgical debridement and antibiotic therapy.

Conclusions: The results suggest that this is a good method for treating selected fractures of the tibial plateau.

Introduction and purpose: The functional result of the functional repair of the rotator cuff is multifactorial. The purpose of this study was to assess the influence of supraspinatus and infraspinatus fatty degeneration prior to surgery on the functional result of open rotator cuff repair surgeries.

Materials and methods: The study comprised 32 patients (19 females and 13 males) operated on for a rotator cuff tear by means of open surgery. Mean age: 58.16. The right arm was involved in 20 cases, whereas the left one was involved in the remaining 12. The acromion was type II in 28 cases and type III in 4. In all cases a previous MRi was available. The analysis of fatty degeneration was made on the basis of Goutallier’s criteria. The assessment of the functional result was made according to Constant’s score. Minimum follow-up: 1 year.

Results: Mean Constant score: preop 51.41 (range: 30–69); postop (at the end of follow-up) 83 (range: 77–100). Fatty degeneration of the supraspinatus was deg. I in 32.25% of cases and deg. II in 45.16%. As regards the infraespinatus, 38,7% of cases had no fatty degeneration and 41.93% had deg. I. No significant differences were found regarding the post Constant score between patients with deg. 0-I supraspinatus fatty degeneration and patients with 0-I infraspinatus fatty degeneration (p 0.604) or between patients with deg. II-III-IV supraspinatus fatty degeneration and those with deg. 0-I infraspinatus fatty degeneration (p.654).

Conclusions: (1) Surgical repairs of rotator cuff tears lead to a satisfactory final functional result. (2) Considering the size of our sample, there do not seem to exist significant differences with respect to functional result between patients with supraspinatus (degrees 0–4) and patients with infraspinatus fatty degeneration (limited to deg. 0–1).