Culture negative prosthetic joint infections (PJI) still remain an issue even the advantages in PJI diagnosis. This is the reason why some orthopedic surgeons fear to use preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis in intraoperative cultures

An enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI accounted in a University Hospital. Patients were prospectively randomized in two groups.

The control group received the classical preoperative antibiotic prophylaxis. The study group did not receive prophylaxis prior to surgery

There were 14 patients in each group. They correspond to 13 infections of total hip arthroplasty (THA), 12 infections of total knee arthroplasty (TKA) and 3 reverse shoulder prosthesis (RSA) infections. There were 10 patients in the study group and 10 patients in the control group with at least one positive microbiological criterion. There were 8 patients in each group with culture negative PJI (p>0.05)

Preoperative antibiotic prophylaxis does not affect intraoperative cultures in suspected or confirmed PJI. Therefore it is essential to deliver antibiotic prophylaxis in any patient in which prosthesis is to be implanted in order to protect the prosthesis from infection

Successfully treatment of acute shoulder arthroplasty infections strongly depends on the timing of treatment. The objective of this study is to determine the normalization curve of C-reactive protein (CRP) after shoulder arthroplasty

Prospective study including 63 patients undergoing shoulder arthroplasty (46 reverse shoulder arthroplasty (RSA) and 17 total shoulder (TSA)). Mean age 74.1 years old. 25 cuff deficient shoulders, 14 acute fractures, 19 primary gleno-humeral arthritis and 5 fracture sequel were included. Blood samples to determine CRP were obtained before surgery the day of surgery, 24 and 48 hours after surgery and then 6, 8 and 14 days after surgery (data of blood samples was determined based on a previous limited study). Co-morbidities that could interfere CRP were also recorded

Normal value of CRP before surgery (mean 1.28) slightly increases 24 hours after surgery (mean 3.92), reach maximum value at 48 hours after surgery (mean 6.91) and then slowly decreases to normalize at 14 days (6th day mean 3.80, 8th day 2.33 and 14th day 1.08). Normalization curve is not affected by age, diagnosis or type of arthroplasty

CRP after shoulder arthroplasty reaches maximum value at 48h and then slowly decreases to become normal at 14 days. Any deviation from this normalization curve may help in diagnosis and early treatment of acute shoulder arthroplasty infections

Introduction: Gait analysis studies of patients following ankle arthrodesis have demonstrated a functional gait, largely due to tarsal hypermobility compensating for lost tibio-talar motion. We present a prospective radiographic study comparing the pre and post-operative range of motion of the foot following ankle arthrodesis. In this study, we introduce a radiographic technique using reliable anatomic landmarks to measure sagittal range of motion of the foot after ankle arthrodesis.

Materials and Methods: Between 2002 and 2007, we performed 154 arthrodesis procedures of the ankle. Patients were suitable for inclusion in this study if an isolated arthrodesis of the ankle was performed for post traumatic arthritis with a minimum of 1 year follow-up without any additional hindfoot operations. Preoperative and post-operative passive plantar flexion and dorsiflexion radiographs were obtained in a standardized fashion. Anatomic landmarks were then used to measure and compare tibio-talar, mid-tarsal, and subtalar movement.

Results: There were 48 patients who met the inclusion criteria for this study. Preoperatively, the mean measured motion was as follows: total sagittal motion 35o, tibio-talar motion18o, mid-tarsal (transverse tarsal + naviculo cuneiform + tarsometatarsal joints) motion 12o (34% of pre-op sagittal arc), subtalar motion 5.5o (15% of pre-op sagittal arc), and mid-tarsal + subtalar motion 17.5o (49% of pre-operative sagittal motion). These changed post operatively to a mean motion as follows: total sagittal motion 18.5o, (52% of preoperative sagittal motion), mid-tarsal motion 10o (28% of pre-op sagittal arc), subtalar motion 10.5o (27% of pre-op sagittal arc), and mid-tarsal + subtalar motion 20.5o (54% of pre-operative sagittal motion).

Discussion: This study presents an accurate and reproducible means of measuring the sagittal plane range of motion of the hindfoot and ankle, and documents the presence of increased motion in the subtalar and talonavicular joints after ankle arthrodesis.

Ankle arthrodesis is a common operation with published fusion rates ranging from 62–100%. The literature documents the difficulties of obtaining arthrodesis in certain patients for example with neuroarthropathy, but the risk of non union related to deformity, bone quality, bone defects and systemic disease has not previously been reported.

Between 2002 and 2006 we performed an ankle arthrodesis in 154 patients, and analyzed these patients retrospectively to delineate categories of risk factors for achieving arthrodesis. From this analysis we devised a preoperative radiographic scoring system to grade complexity of pre-operative ankle arthrodesis. The scoring system is based upon 5 categories; size and plane of deformity, presence and size of bone defects, presence and area of avascular necrosis, site of previous fracture in post-traumatic arthritis and predisposing condition causing the arthritis. Each category has potential scores of 1–5, apart from the latter which is scored up to 6, with higher scores being more severe. The grade of complexity is derived from a cumulative score from all 5 categories.

Statistical analysis revealed good intra and inter- observer correlation. Multivariate regression analysis demonstrated that this scoring system correlates with the techniques used for arthrodesis as well as outcome. This study demonstrated that if the method of arthrodesis is altered according to the relative risk of non –union then there is no significant difference in outcome between patients of high and low risk for non-union

We present a new scoring system for severity of pre-operative condition in ankle arthrodesis patients and introduce an algorithm for surgical correction based upon this pre-operative scoring system. The surgical techniques for the arthrodesis are presented, ranging from simple screw fixation to more complex bone grafting techniques, bone stimulation and alternative methods of fixation.