Introduction. The burden of peri-prosthetic joint infection (PJI) following hip and knee surgery is increasing. Endoprosthetic replacement (EPR) is an option for management of massive bone loss resulting from infection around failed lower limb implants. Aims. To determine clinical outcome of EPRs for treatment of PJI around the hip and knee joint. Methods. This was a retrospective consecutive case-series of hip and knee EPRs between 2007–2014 in our tertiary unit for the treatment of PJI following complex arthroplasty or fracture fixation. Data recorded included indication for EPR (infected primary/revision arthroplasty, infected non-union/failed osteosynthesis, gross bone loss following native joint infection), number of previous surgeries, and organism identified. Outcome measures included PJI eradication rate (with failure defined as EPR revision, amputation, or being on life-long suppressive antibiotics), complications, implant survival, mortality, and functional outcome (Oxford Hip/Knee Score; OHS/OKS). Results. 58 EPRs (32 knee and 26 hip) were performed with a mean age of 68 years (range: 35–92). The mean number of previous surgeries prior to EPR was 3.4 (range: 1–10). At mean follow-up of 3.5 years, 11 (19%) patients were deceased. EPR was implanted as a two-stage procedure in 76% of cases. Plastic surgical involvement and flap coverage was necessary in 11 cases. Polymicrobial growth was detected in 40% of cases, followed by Coagulase-negative staphylococci (26%). The overall complication rate was 40%. Recurrence of infection post-EPR occurred in 14 patients (24%); 5 were treated with Debridement, Antibiotics and Implant Retention (DAIR), 3 with revision, 1 with above-knee amputation and the remaining 6 remained on long-term suppressive antibiotics. PJI eradication was achieved in 44 (76%) cases (69% knees and 85% hips). Of the remaining 14 cases, 9 remain on long-term antibiotics. The complication rate was similar in knees (41%) and hips (38%). PJI eradication was more successful in hips (85%) compared to knees (69%). To date, 6 EPRs have been revised (10%). The overall 5-year implant survivorship was 83% (95% CI: 68–98%). The mean OHS was 25 (range 7–39.) and the mean OKS was 20 (range 6–43), the best possible score being 48. Conclusions. This mid-term study provides further support for the use of massive endoprostheses in the eradication of PJI in complex, previously multiply revised cases with subsequent limb salvage (in all but one case). We describe PJI eradication rate of 76% with acceptable functional outcomes. This eradication rate is comparable to that following treatment of PJI associated with standard arthroplasty

Periprosthetic infection is a challenging complication of total knee arthroplasty (TKA) which reported incidence varies from 1 to 2% in primary TKA and 3–5% in revision TKA. Persistent infection of TKA may benefit from knee arthrodesis when all reconstruction options have failed. Knee arthrodesis also demonstrated better functional results and pain relief than other salvage procedures such as above-knee amputation. The purpose of this study was to analyze treatment results in patients who underwent knee arthrodesis following infected TKA. Retrospective study with review of the data of all patients treated in our department with knee arthrodesis for chronic infection of knee arthroplasty between 2009 and 2014. Clinical and radiographic data were evaluated as well as several variables: technique used, fusion rate, time to fusion, need for further arthrodesis and complications. Patients with less than 8 months of follow-up were excluded from this study. 46 patients were treated with knee arthrodesis in our department from 2009 to 2014 for chronic infection of total knee arthroplasty. The sample included 26 (57%) women and 20 (43%) men, median age of 70 years. In 45 patients, the technique used was compressive external fixation, while an intramedullary modular nail was used in 1 patient. Mean follow-up of these patients was 35 months (8–57). Primary knee fusion was obtained in 32 (70%) patients with a mean time to fusion of 5,8 months (4–9). 9 (20%) patients needed rearthrodesis and 7 (15%) ultimately achieved fusion. 33 (72%) patients underwent knee arthrodesis in a single surgical procedure, while 13 (28%) firstly removed knee arthroplasty and used a spacer before arthrodesis. Overall complication rate was 35%; 7 (15%) patients experienced persistent infection and 4 (9%) of these undergone above knee amputation. Treatment of septic total knee replacement is a surgical challenge. Compressive external fixation was the method of choice to perform knee arthrodesis following chronic infected TKA. Although complication rate was worrisome, overall fusion rate was satisfactory and this arthrodesis method can be safely performed in one stage

Purpose. Rotationplasty was first described in 1930 by Borggreve for treatment of limb shortening with knee ankylosis after tuberculosis. In 1948, Van Nes described its use for management of congenital defects of the femur and in the 1980s, Kotz and Salzer reported on patients with malignant bone tumors around the knee treated by rotationplasty as an alternative to above-knee amputation. Currently, rotationplasty is one of the options for surgical management of lower extremity bone sarcomas in skeletally immature patients but alternative limb salvage techniques, such as the use of expandable endoprosthesis, are also available. Despite rather satisfactory functional results have been uniformly associated with rotationplasty, concern still exists about the potential psychological impact of the new body imagerelated to the strange appearance of the rotated limb. Results of rotationplasty for sarcomas of the distal femur over a 20-year period were analyzed, focusing on long-term survival, function, quality of life and mental health. Method. Retrospective study of 73 children who had a rotationplasty performed at two institutions between 1984 and 2007 for a bone sarcoma of the distal femur; 42 males and 31 females, mean age at surgery 8.7 yrs (range 3–17). Four patients were converted to transfemoral amputation due to early vascular complication; 25 eventually died of their disease (mean survival 34 months, range 4–127). The 46 remaining survivors were evaluated for updated clinical outcome, MSTS score, gait analysis, SF-36 score, quality of life interview and psychological assessment at mean follow-up of 15 yrs (range 3–23). Results. Overall survival was 64%. All the survivors were disease-free at last follow-up. Four patients required hardware revision for nonunion and subsequently healed. Three patients refused participation in the long-term follow-up study. Mean MSTS score was 79 (range 64–88). SF-36 score was obtained in 35 patients (age > 16); male patients showed a trend toward greater activity and vitality. Compared to age-group norms, rotationplasty scores were lower for physical activity level (p <0.05) and higher for general health perception (p = 0.05) and mental health (p < 0.05). Conclusion. Rotationplasty remains a durable reconstructive option with good long-term function and acceptable psychological impact for children with bone sarcomas of the distal femur

Aims

Safety concerns surrounding osseointegration are a significant barrier to replacing socket prosthesis as the standard of care following limb amputation. While implanted osseointegrated prostheses traditionally occur in two stages, a one-stage approach has emerged. Currently, there is no existing comparison of the outcomes of these different approaches. To address safety concerns, this study sought to determine whether a one-stage osseointegration procedure is associated with fewer adverse events than the two-staged approach.

Aims

Orthopaedic surgeries are complex, frequently performed procedures associated with significant haemorrhage and perioperative blood transfusion. Given refinements in surgical techniques and changes to transfusion practices, we aim to describe contemporary transfusion practices in orthopaedic surgery in order to inform perioperative planning and blood banking requirements.

Aims

The UK government declared a national lockdown on 23 March 2020 to reduce transmission of COVID-19. This study aims to identify the effect of lockdown on the rates, types, mechanisms, and mortality of musculoskeletal trauma across Scotland.

Aims

Chronic osteomyelitis may recur if dead space management, after excision of infected bone, is inadequate. This study describes the results of a strategy for the management of deep bone infection and evaluates a new antibiotic-loaded biocomposite in the eradication of infection from bone defects.

Bactericidal levels of antibiotics are difficult to achieve in infected total joint arthroplasty when intravenous antibiotics or antibiotic-loaded cement spacers are used, but intra-articular (IA) delivery of antibiotics has been effective in several studies. This paper describes a protocol for IA delivery of antibiotics in infected knee arthroplasty, and summarises the results of a pharmacokinetic study and two clinical follow-up studies of especially difficult groups: methicillin-resistant Staphylococcus aureus and failed two-stage revision. In the pharmacokinetic study, the mean synovial vancomycin peak level was 9242 (3956 to 32 150; sd 7608 μg/mL) among the 11 patients studied. Serum trough level ranged from 4.2 to 25.2 μg/mL (mean, 12.3 μg/mL; average of 9.6% of the joint trough value), which exceeded minimal inhibitory concentration. The success rate exceeded 95% in the two clinical groups. IA delivery of antibiotics is shown to be safe and effective, and is now the first option for treatment of infected total joint arthroplasty in our institution.

Cite this article: Bone Joint J 2016;98-B(1 Suppl A):31–6.

This study was undertaken to evaluate the safety and efficacy of retrievable inferior vena cava filters in high-risk orthopaedic patients. A total of 58 patients had a retrievable inferior vena cava filter placed as an adjunct to chemical and mechanical prophylaxis, most commonly for a history of previous deep-vein thrombosis or pulmonary embolism, polytrauma, or expected prolonged immobilisation. In total 56 patients (96.6%) had an uncomplicated post-operative course. Two patients (3.4%) died in the peri-operative period for unrelated reasons.

Of the 56 surviving patients, 50 (89%) were available for follow-up. A total of 32 filters (64%) were removed without complication at a mean of 37.8 days (4 to 238) after placement. There were four filters (8%) which were retained because of thrombosis at the filter site, and four (8%) were retained because of incorporation of the filter into the wall of the inferior vena cava. In ten cases (20%) the retrievable filter was left in place to continue as primary prophylaxis. No patient had post-removal thromboembolic complications.

A retrievable inferior vena cava filter, as an adjunct to chemical and mechanical prophylaxis, was a safe and effective means of reducing the acute risk of pulmonary embolism in this high-risk group of patients. Although most filters were removed without complications, thereby avoiding the long-term complications that have plagued permanent indwelling filters, a relatively high percentage of filters had to be left in situ.

We report our experience using a biodegradable calcium sulphate antibiotic carrier containing tobramycin in the surgical management of patients with chronic osteomyelitis. The patients were reviewed to determine the rate of recurrent infection, the filling of bony defects, and any problems with wound healing. A total of 193 patients (195 cases) with a mean age of 46.1 years (16.1 to 82.0) underwent surgery. According to the Cierny–Mader classification of osteomyelitis there were 12 type I, 1 type II, 144 type III and 38 type IV cases. The mean follow-up was 3.7 years (1.3 to 7.1) with recurrent infection occurring in 18 cases (9.2%) at a mean of 10.3 months post-operatively (1 to 25.0). After further treatment the infection resolved in 191 cases (97.9%). Prolonged wound ooze (longer than two weeks post-operatively) occurred in 30 cases (15.4%) in which there were no recurrent infection. Radiographic assessment at final follow-up showed no filling of the defect with bone in 67 (36.6%), partial filling in 108 (59.0%) and complete filling in eight (4.4%). A fracture occurred in nine (4.6%) of the treated osteomyelitic segments at a mean of 1.9 years (0.4 to 4.9) after operation.

We conclude that Osteoset T is helpful in the management of patients with chronic osteomyelitis, but the filling of the defect in bone is variable. Prolonged wound ooze is usually self-limiting and not associated with recurrent infection.

Cite this article: Bone Joint J 2014; 96-B:829–36

We report the results of six trauma and orthopaedic projects to Kenya in the last three years. The aims are to deliver both a trauma service and teaching within two hospitals; one a district hospital near Mount Kenya in Nanyuki, the other the largest public hospital in Kenya in Mombasa. The Kenya Orthopaedic Project team consists of a wide range of multidisciplinary professionals that allows the experience to be shared across those specialties. A follow-up clinic is held three months after each mission to review the patients. To our knowledge there are no reported outcomes in the literature for similar projects.

A total of 211 operations have been performed and 400 patients seen during the projects. Most cases were fractures of the lower limb; we have been able to follow up 163 patients (77%) who underwent surgical treatment. We reflect on the results so far and discuss potential improvements for future missions.