Introduction. Septic arthritis of the hip in the newborn baby can result in severe long term sequelae in the form of dislocation of the hip, loss of movement and growth disturbance with leg length discrepancy. Reconstructive procedures for this difficult problem have not been satisfactory. Patient and methods. This series comprises eight patients with
Purpose. We analyzed a consecutive series of 36 total hip arthroplasties using cementless conical stem with a shortening osteotomy combined with greater trochanter transfer in cases with a high dislocated hip. Material and Methods. The causes of total hip arthroplasty were the sequelae of a
Patients with a history of septic arthritis or tuberculosis (TB) of the hip frequently develop secondary osteoarthritis (OA). These patients present a challenge for having joint replacement because of abnormal bone development, the possibility of re-infection, soft tissue problems and their life-style (more active than patients with old age arthritis). We retrospectively review a decent group of 55 cases where one stage cemented total hip arthroplasty was performed with history of old hip infection by a team of surgeons at Wrightington Hospital, Lancashire, UK from 1970 to 2008. The purpose of this study is to find the survival analysis with revision (for infection) as the end stage. There are 33 females and 22 males aged from 25 to 75 yrs (mean 52 years). 21 patients had proven or probable tuberculous infection, 29 had the past history of old
Background: Childhood
This study was undertaken to assess the feasibility of a new subtrochanteric osteotomy technique for total hip arthroplasty (THA) in cases with a high dislocated hip secondary to the sequelae of a
Introduction and objective: Infection is one of the greatest threats in hip surgery. It is agreed that the implant should be removed. The debate remains open if one or two stage surgery is perferable. This study evaluates the two stage
Due to medical and organizational factors, it occurs in everyday practice that spacers are left in place longer than originally planned during a two-stage prosthesis exchange in the case of prosthetic joint infections. Patients are severely restricted in their mobility and, after initial antibiotic administration, the spacer itself only acts as a foreign body. The aim of this study is to analyze whether the duration of the spacer in situ has an influence on the long-term success of treatment and mortality. We retrospectively studied all 204 two-stage prosthesis replacements of the hip and knee from 2012 to 2016 with a minimum follow-up of two years at an arthroplasty center with 3 main surgeons. The duration of the spacer interval was divided into two groups. Patients replanted within ten weeks (as is standard in multiple algorithms) after systemic antibiotic treatment were assigned to the ‘Regular Spacer Interval (< 70 days)’ group. If the spacer interval was longer, they were assigned to the ‘Long Spacer Interval (≥ 70 days)’ group.Aim
Method
Reasons for bone loss in
Introduction. Antibiotic loaded polymethyle methacrylate spacers are commonly used in the management of septic hip replacements. Aim. The aim of this study was to determine wear patterns on the articulating surfaces of these spacers, as well as to determine the extent of PMMA particulate debris generation. Method. We took tissue specimens around the acetabulae in 12 cases at the time of the second stage procedure for
Traditionally, serum white blood count (WBC), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have been utilized as markers to evaluate septic arthritis (SA). Recently, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been identified as prognostic factors for treatment failure, mortality and morbidity in various clinical settings. To date, these markers have not been utilized for evaluating outcomes after hip and knee SA. Thus, the purpose of this study was to determine the ability of admission NLR and PLR to predict treatment failure and postoperative 90-day mortality in hip and knee SA. A retrospective study was performed using our institutional research patient database to identify 235 patients with native hip and knee septic arthritis from 2000–2018. Patient demographics, comorbidities and social factors (alcohol intake, smoking and intravenous drug use) were obtained, and NLR and PLR were calculated based on complete blood count values (absolute neutrophil, lymphocyte and platelet count) on admission. Treatment failure was defined as any reoperation or readmission within 90 days after surgery. Receiver operating curves were analyzed, and optimal thresholds for NLR and PLR were determined using Youden's test. Univariate and multivariate analyses were performed to determine if these ratios were independent predictors of treatment failure and 90-day mortality after surgery. These ratios were compared to serum WBC, CRP, and ESR.Aim
Method
Since July 1996, we have treated 97 patients who developed sepsis following total knee arthroplasty and 53 who developed sepsis following total hip arthroplasty. We evaluated the rate of retention of prosthesis. In 69 A-host patients, 80 B-host and 1 C-host, we identified 70 cases of Staphylococcus aureus, 76 of Staphylococcus epidermidis, 33 of Pseudomonas, 23 of Escherichia coli and 18 of Enterococcus. Five patients were diabetic. Muscle flaps were used in 51 cases. Of the 131 patients available for follow-up, 94 healed with retention of prosthesis. Five patients had to undergo amputation. We are still treating 36 patients, some of whom have received a temporary prosthesis. Most patients could be salvaged with a two-staged revision. Host status influenced outcome.
Infection of total hip replacement still is considered a devastating complication. One-stage revision, meaning complete removal of the implant and thorough debridement of the site together with the insertion of a new prosthesis during the same operation, is desirable because of improved rehabilitation of the patient and reduced costs. Although this method is known since more than 30 years it is not used widely yet because of several related risks: known methods rely on the use of antibiotic-loaded cement, which often has shown insufficient release of the added antibiotic. The carrier may even act as a bed for colonisation with selected bacteria. Osseous conditions presented during revisions prevent interconnection of the cement with the sclerotic bone. The toxic monomers of PMMA and heating during polymerisation causes necroses which may be origin of repeated loosening and new growth of bacteria. Filling the defects with cement provides unfavourable conditions in case of another revision, which has to be expected at a high percentage. To overcome these disadvantages uncemented techniques seem to be favourable. After removal of the implants debridement is performed as in conventional septic surgery. After thorough cleaning and rinsing, bone voids are filled with bone graft using an impaction technique. We use allograft or xenograft bone that is free from antigenic material but intact structures of bone concerning collagen and mineral content. The bone is impregnated with high loads of antibiotic, using a specific incubation technique. There are two options of antibiotic impregnation: vancomycin (“V”) or tobramycin (“T”), the choice being dependent on the causative pathogen isolated. Combinations are possible in cases of mixed infections. The impregnation procedure guarantees high levels of antibiotics at the grafting site for several weeks during which the antibiotic is released into the surroundings. Systemic drug levels are usually undetectable. At the acetabular site we take care that the ground be sufficiently filled with antibiotic graft. Preferably an uncemented cup of hemispherical design is inserted. At the femoral site we prefer implants with a rectangular diameter. This design enables stable press fit contact with the shaft medially and laterally and leaves enough space for graft impaction at the posterior and anterior aspect of the endoprosthesis. Wounds are drained and closed immediately; rehabilitation is performed as after non-septic surgery. Between 1998 and 2004 thirty-seven patients have been revised because of culture-proven infection of hip endoprosthesis. Causative pathogens were Coag.neg. staph (18x), S.aureus (11x), MRSA (4x), enterococci (9x) and other gram-positive pathogens (3x). In 6 hips gram-negative germs were found additionally. All hips could be followed up with a minimum of 2 years and a maximum of 8 years (mean: 4.1 years). Wound healing was uneventful in all cases. Mean hospital stay was 16 days (10–32 days). Rehabilitation was in the range of uncomplicated primary THR in cases with short history of infection (up to 3 months) and prolonged in relation to duration of infection and amount of preceding surgery. In three hips there was recurrence of the infection, diagnosed between 6 and 12 weeks after surgery. In one of them the well-fixed stem had not been exchanged, in another one a technical error had occurred during impregnation of the bone graft. This one could be successfully re-operated using the same technique with appropriately impregnated bone graft, the other two were converted to a girdlestone situation. All other 32 hips showed no sign of infection until the last follow-up. Bone processed in an adequate way represents an excellent carrier for vancomycin and tobramycin. With antibiotic graft compound eradication of pathogens, grafting of bony defects and re-insertion of an uncemented prosthesis may be accomplished in a single operation, making it an ideal tool in one stage non-cemented revision for infected total hip replacement. However, principles of septic surgery need to be observed. We now recommend removing even well-fixed prostheses and taking care, that we implant at least 50cc of well impregnated bone graft. Since the graft gradually is replaced by healthy own bone, improved conditions may be expected even in the case of another revision.
Between 1996 and 2003 35 patients have been revised because of culture proven infection of a hip endoprostheses. All hips could be followed with a minimum of 3months and a maximum of 6years.
Two-stage revision arthroplasty is the gold standard for treatment of infection after total hip Arthroplasty and end stage septic arthritis of the hip. In the first stage we used a modified technique to insert an inexpensive modular femoral component coated with antibiotic-impregnated polymethylmethacrylate articulating with a polyethylene liner. The construct was used in 8 patients with infected arthroplasty, and 6 patients with septic arthritis of the hip. Two patients were excluded (no second stage). Of the remaining 12 patients, only one patient had persistent infection after the first stage; 11 patients received a successful re-implantation at the second-stage. The technique provide a construct that can be used safely and successfully in the awaiting period between the two stages of revision arthroplasty.
Introduction: Septic total hip arthroplasty is a devastating complication. Most treatment protocols for infection of more than 2 – 3 weeks duration recommend removal of the prosthesis and cement followed by 4 – 6 weeks of IV antibiotics. Results using an antibiotic spacer to allow mobility of the patient and local antibiotic deliverance by elution from the spacer are reported. Methods: Since January of 1994, antibiotic spacers have been used as adjunctive treatment along with IV antibiotics and prosthetic resection in 18
We describe a technique of ‘cross-hip distraction’ to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.
Aims. Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for
Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision necessitate removal of all bone cement from the femur. In our two institutions, we have been using a cement-in-cement technique, leaving the distal femoral cement in selected cases for
Background. The patients with high hip dislocation due to the sequelae of
Aim. The effectiveness of mandatory joint aspiration prior to re-implantation in patients with a cement spacer already in place is unclear. The aim of this study was to evaluate the role of culturing articular fluid obtained by joint aspiration prior to re-implantation in patients who underwent a two stage septic revision. Method. A retrospective observational study was conducted, assessing51 patients that underwent a two stage
Introduction: There is a paucity in the literature regarding the long term outcome of children with
Reconstruction of massive acetabular bone defects in primary and revision THA is challenging for reconstructive joint surgeons. The use of porous metal augments is one of the options. The advantages of porous metal augments are easy to use, modularity and lack of resorption. We investigated the radiological results of porous metal augments used for massive acetabular bone defects in primary and revision THA. Forty-one hips in forty patients had porous metal augments between 2011 and 2016. Thirty of the procedures were revision arthroplasties and 11 were primary procedures (Crowe type III in 5 hips, Crowe type IV in 3,
In patients with primary hip replacement for previous infective arthritis the risk of recurrence of infection is of major concern. In addition, the safe time interval post infective arthritis for primary hip replacement is not known. Clinical & radiological results of consecutive series of 80 primary hip replacements performed for septic / tuberculous arthritis at Wrightington hospital from 1970 to 2008. Data was collected till latest follow up. Re-infection or revision for any reason was considered as primary end point for survivorship. Average age at primary hip replacement was 55.55 years (24 – 75). Mean follow up was 14.47 years (2–41). Twelve patients in
Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated.Aims
Methods
Hip arthroscopy is particularly attractive in
children as it confers advantages over arthrotomy or open surgery,
such as shorter recovery time and earlier return to activity. Developments
in surgical technique and arthroscopic instrumentation have enabled
extension of arthroscopy of the hip to this age group. Potential
challenges in paediatric and adolescent hip arthroscopy include
variability in size, normal developmental change from childhood to
adolescence, and conditions specific to children and adolescents
and their various consequences. Treatable disorders include the
sequelae of traumatic and sports-related hip joint injuries, Legg–Calve–Perthes’
disease and slipped capital femoral epiphysis, and the arthritic
and
Histology is an established tool in diagnosing periprosthetic joint infections (PJIs). Different thresholds, using various infection definitions and histopathological criteria, have been described. This study determined the performance of different thresholds of polymorphonuclear neutrophils (≥ 5 PMN/HPF, ≥ 10 PMN/HPF, ≥ 23 PMN/10 HPF) , when using the European Bone and Joint Infection Society (EBJIS), Infectious Diseases Society of America (IDSA), and the International Consensus Meeting (ICM) 2018 criteria for PJI. A total of 119 patients undergoing revision total hip (rTHA) or knee arthroplasty (rTKA) were included. Permanent histology sections of periprosthetic tissue were evaluated under high power (400× magnification) and neutrophils were counted per HPF. The mean neutrophil count in ten HPFs was calculated (PMN/HPF). Based on receiver operating characteristic (ROC) curve analysis and the z-test, thresholds were compared.Aims
Methods
Aim: To audit the impact of emergency hip ultrasound in the management of suspected hip septic arthritis. Methods and Results: Case series – Review of 13 consecutive patients who presented with acute hip pain, where clinical examination and inflammatory markers, highly suspicious of Septic arthritis. Emergency ultrasound was only available in 9 patients. Only 5 (38%) of these 13 patients had septic arthritis. Septic arthritis group. – Emergency ultrasound unavailable in 2 patents. They proceeded straight to arthrotomy yielding pus. – 3 had a preoperative ultrasound which confirmed the hip joint had an effusion. “Non Septic Arthritis of Hip” (8 patients). – In 2 patients emergency ultrasound unavailable. They underwent emergency arthrotomy with negative findings of pus. – 1 actually had septic arthritis of knee. – 6 patients did have emergency ultrasound which showed no effusion. Emergency arthrotomy was cancelled. – They proceeded to MRI of Hip. MRI revealed pathology close to but not involving the hip:. Pelvic osteomyelitis,. Psoas abscess,. Gluteal abscess secondary to small bowel fistula. Cellulitis of medial thigh. Femoral Epiphysis osteomyelitis. and inflammation of tendon secondary to line insertion. Inflammation of rectus femoris tendon (secondary to central line insertion). Conclusion: Use of ultrasound avoided unnecessary arthrotomy in 6 patients (48%). If ultrasound was available in all cases, then 8 (63%) patients would have avoided an unnecessary arthrotomy. Out of hours urgent hip ultrasound may be difficult to request. However our recent experience leads us to propose that if available ultrasound should be performed in all suspected case of hip septic arthritis prior to surgical drainage. Pathology in the vicinity of the hip can often masquerade convincingly as a
Current guidelines consider analyses of joint aspirates, including leucocyte cell count (LC) and polymorphonuclear percentage (PMN%) as a diagnostic mainstay of periprosthetic joint infection (PJI). It is unclear if these parameters are subject to a certain degree of variability over time. Therefore, the aim of this study was to evaluate the variation of LC and PMN% in patients with aseptic revision total knee arthroplasty (TKA). We conducted a prospective, double-centre study of 40 patients with 40 knee joints. Patients underwent joint aspiration at two different time points with a maximum period of 120 days in between these interventions and without any events such as other joint aspirations or surgeries. The main indications for TKA revision surgery were aseptic implant loosening (n = 24) and joint instability (n = 11).Aims
Methods
Introduction: In severe Legg-Calve-Perthes (LCPD) disease with subluxated femoral head, the acetabulum sometimes takes a bicompartmental appearance. This study analyzed acetabular pathoanatomy using a 3-D CT program. Materials and Methods: A 3-D CT software program that affords the section of 2-D image in any plane was used to analyze the acetabular pathoanatomy, with specific reference to the morphology of the inner surface of the acetabulum. Thirteen children with the bicompartmental acetabulae (12 LCPD and 1 AVN subsequent to
Bone loss, either due to a septic process or to surgical débridements, is frequently associated with bone infections. Bone loss may be present in septic non-unions, osteomyelitis or septic joint prosthesis. In each of these conditions the use of bone or bone substitutes may be indicated. However, the risk of septic recurrence makes the choice of the right implant in these patients particularly difficult. Clinical cases are presented to show the different choices available. Attention is focussed on: (1) when, in the presence of bone loss, a bone graft can be avoided and with which suitable procedures good results can be obtained; (2) when and how autologous bone grafts should be used; (3) when homologous bone grafts or bone substitutes are indicated; (4) how bone grafts should be protected against bacterial adesion and proliferation; and (5) the role of new technologies, such as bone growth factors. In this regard the clinical results are presented of the use of platelet-rich plasma (PRP) added to autologous or homologous bone after bone débridement in six patients treated with two-stage non-cemented revision of
The aim of this study was to identify the incidence of positive
cultures during the second stage of a two-stage revision arthroplasty
and to analyse the association between positive cultures and an
infection-free outcome. This single-centre retrospective review of prospectively collected
data included patients with a periprosthetic joint infection (PJI)
of either the hip or the knee between 2013 and 2015, who were treated
using a standardised diagnostic and therapeutic algorithm with two-stage
exchange. Failure of treatment was assessed according to a definition
determined by a Delphi-based consensus. Logistic regression analysis
was performed to assess the predictors of positive culture and risk
factors for failure. The mean follow-up was 33 months (24 to 48).Aims
Patients and Methods
Between September 2004 and December 2005 we carried out a prospective study of all cases of sepsis of the hip in childhood at a South African regional hospital with a large local population, and which also took referrals from nine rural hospitals. The clinical, radiological, ultrasound and bacteriological features were assessed. All the hips were drained by arthrotomy and the diagnosis was confirmed microbiologically and histologically. Hips with tuberculosis were excluded. The children were reviewed in a dedicated clinic at a mean follow-up of 8.1 months (3 to 18). There were 40 hips with sepsis in 38 patients. Two patients were lost to follow-up. Nine (24%) had multi-focal sepsis. Overall, 13 hips (34%) had a full and uncomplicated clinical and radiological recovery and 25 (66%) had complications. All patients treated by arthrotomy and appropriate antibiotics within five days of the onset of symptoms had an uncomplicated recovery. Initial misdiagnosis was associated with a delay to arthrotomy. However, ‘deprivation’, consultation with a traditional healer, maternal educational attainment and distance to a primary health-care facility were not associated with delay to arthrotomy. The early correct diagnosis of this condition, common in the developing world, remains a significant factor in improving the clinical outcome.
A total of 31 patients, (20 women, 11 men; mean
age 62.5 years old; 23 to 81), who underwent conversion of a Girdlestone
resection-arthroplasty (RA) to a total hip replacement (THR) were
compared with 93 patients, (60 women, 33 men; mean age 63.4 years
old; 20 to 89), who had revision THR surgery for aseptic loosening
in a retrospective matched case-control study. Age, gender and the
extent of the pre-operative bone defect were similar in all patients.
Mean follow-up was 9.3 years (5 to 18). Pre-operative function and range of movement were better in the
control group (p = 0.01 and 0.003, respectively) and pre-operative
leg length discrepancy (LLD) was greater in the RA group (p <
0.001). The post-operative clinical outcome was similar in both
groups except for mean post-operative LLD, which was greater in
the study group (p = 0.003). There was a significant interaction
effect for LLD in the study group (p <
0.001). A two-way analysis
of variance showed that clinical outcome depended on patient age
(patients older than 70 years old had worse pre-operative pain,
p = 0.017) or bone defect (patients with a large acetabular bone
defect had higher LLD, p = 0.006, worse post-operative function
p = 0.009 and range of movement, p = 0.005), irrespective of the
group. Despite major acetabular and femoral bone defects requiring complex
surgical reconstruction techniques, THR after RA shows a clinical
outcome similar to those obtained in aseptic revision surgery for
hips with similar sized bone defects. Cite this article:
Ten patients, who were unsuitable for limb lengthening over an intramedullary nail, underwent lengthening with a submuscular locking plate. Their mean age at operation was 18.5 years (11 to 40). After fixing a locking plate submuscularly on the proximal segment, an external fixator was applied to lengthen the bone after corticotomy. Lengthening was at 1 mm/day and on reaching the target length, three or four screws were placed in the plate in the distal segment and the external fixator was removed. All patients achieved the pre-operative target length at a mean of 4.0 cm (3.2 to 5.5). The mean duration of external fixation was 61.6 days (45 to 113) and the mean external fixation index was 15.1 days/cm (13.2 to 20.5), which was less than one-third of the mean healing index (48 days/cm (41.3 to 55). There were only minor complications. Lengthening with a submuscular locking plate can successfully permit early removal of the fixator with fewer complications and is a useful alternative in children or when nailing is difficult.
In this retrospective study we evaluated the
proficiency of shelf autograft in the restoration of bone stock
as part of primary total hip replacement (THR) for hip dysplasia,
and in the results of revision arthroplasty after failure of the primary
arthroplasty. Of 146 dysplastic hips treated by THR and a shelf
graft, 43 were revised at an average of 156 months, 34 of which
were suitable for this study (seven hips were excluded because of
insufficient bone-stock data and two hips were excluded because
allograft was used in the primary THR). The acetabular bone stock
of the hips was assessed during revision surgery. The mean implant–bone
contact was 58% (50% to 70%) at primary THR and 78% (40% to 100%)
at the time of the revision, which was a significant improvement
(p <
0.001). At primary THR all hips had had a segmental acetabular
defect >
30%, whereas only five (15%) had significant segmental
bone defects requiring structural support at the time of revision.
In 15 hips (44%) no bone graft or metal augments were used during
revision. A total of 30 hips were eligible for the survival study. At a
mean follow-up of 103 months (27 to 228), two aseptic and two septic
failures had occurred. Kaplan-Meier survival analysis of the revision
procedures demonstrated a ten-year survival rate of 93.3% (95% confidence
interval (CI) 78 to 107) with clinical or radiological failure as
the endpoint. The mean Oxford hip score was 38.7 (26 to 46) for
non-revised cases at final follow-up. Our results indicate that the use of shelf autografts during
THR for dysplastic hips restores bone stock, contributing to the
favourable survival of the revision arthroplasty should the primary
procedure fail. Cite this article:
We compared the accuracy of the growth remaining
method of assessing leg-length discrepancy (LLD) with the straight-line
graph method, the multiplier method and their variants. We retrospectively
reviewed the records of 44 patients treated by percutaneous epiphysiodesis
for LLD. All were followed up until maturity. We used the modified Green–Anderson
growth-remaining method (Method 1) to plan the timing of epiphysiodesis.
Then we presumed that the other four methods described below were
used pre-operatively for calculating the timing of epiphysiodesis. We
then assumed that these four methods were used pre-operatively.
Method 2 was the original Green–Anderson growth-remaining method;
Method 3, Paley’s multiplier method using bone age; Method 4, Paley’s
multiplier method using chronological age; and Method 5, Moseley’s
straight-line graph method. We compared ‘Expected LLD at maturity
with surgery’ with ‘Final LLD at maturity with surgery’ for each
method. Statistical analysis revealed that ‘Expected LLD at maturity
with surgery’ was significantly different from ‘Final LLD at maturity
with surgery’. Method 2 was the most accurate. There was a significant
correlation between ‘Expected LLD at maturity with surgery’ and
‘Final LLD at maturity with surgery’, the greatest correlation being
with Method 2. Generally all the methods generated an overcorrected
value. No method generates the precise ‘Expected LLD at maturity
with surgery’. It is essential that an analysis of the pattern of
growth is taken into account when predicting final LLD. As many
additional data as possible are required. Cite this article:
We retrospectively reviewed the records of 16 children treated for spondylodiscitis at our hospital between 2000 and 2007. The mean follow-up was 24 months (12 to 38). There was a mean delay in diagnosis in hospital of 25 days in the ten children aged less than 24 months. At presentation only five of the 16 children presented with localising signs and symptoms. Common presenting symptoms were a refusal to walk or sit in nine children, unexplained fever in six, irritability in five, and limping in four. Plain radiography showed changes in only seven children. The ESR was the most useful investigation when following the clinical course of the disease. Positive blood cultures were obtained in seven children with The early use of MRI in the investigation of children with an atypical picture may avoid unnecessary delay in starting treatment and possibly prevent long-term problems. All except one of our children had made a complete clinical recovery at final follow-up. However, all six children in the >
24-month age group showed radiological evidence of degenerative changes which might cause problems in the future.
In this study of 41 patients, we used proteomic, Western blot and immunohistochemical analyses to show that several reactive oxygen species scavenging enzymes are expressed differentially in patients with primary osteoarthritis and those with non-loosening and aseptic loosening after total hip replacement (THR). The patients were grouped as A (n = 16, primary THR), B (n = 10, fixed THR but requiring revision for polyethylene wear) and C (n = 15, requiring revision due to aseptic loosening) to verify the involvement of the identified targets in aseptic loosening. When compared with Groups A and B, Group C patients exhibited significant up-regulation of transthyretin and superoxide dismutase 3, but down-regulation of glutathione peroxidase 2 in their hip synovial fluids. Also, higher levels of superoxide dismutase 2 and peroxiredoxin 2, but not superoxide dismutase 1, catalase and glutathione perioxidase 1, were consistently detected in the hip capsules of Group C patients. We propose that dysregulated reactive oxygen species-related enzymes may play an important role in the pathogenesis and progression of aseptic loosening after THR.
We performed a systematic review of the optimal management of septic arthritis in children as recommended in the current English literature using MEDLINE, EMBASE, CINAHL, the Cochrane Library and reference lists of retrieved articles without date restrictions up to 31 January 2009. From 2236 citations, 227 relevant full-text articles were screened in detail; 154 papers fulfilled the inclusion criteria, from which conclusions were drawn on the management of infected joints in children. Our review showed that no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively joint infection. The roles of aspiration, arthrotomy and arthroscopy in treatment are not clear cut, and the ideal duration of antibiotic therapy is not yet fully defined. These issues are discussed. Further large-scale, multi-centre studies are needed to delineate the optimal management of paediatric septic arthritis.