Aim. Culture-based conventional methods are still the gold standard to identify microorganisms in hip and knee PJIs diagnosis. However, such approach presents some limitations due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range polymerase chain reaction (PCR), are available for diagnostic use in a suspected PJI. However, limited data is available on their sensitivity and specificity. This study aimed to evaluate the performance of a rapid and simple Investigational Use Only (IUO) version of the BioFire® JI multiplex PCR panel when compared to traditional microbiological procedures. Method. Fifty-eight native synovial fluid samples were recovered from 49 patients (female n=26; male =23) who underwent one or multiple septic or aseptic revision arthroplasties of the hip (n=12) and knee (n=46). The JI panel methodology was used either on specimens freshly collected (n=6) or stored at −80°C in our Musculoskeletal Biobank (n=52). The JI panel performance was evaluated by comparison with culture reference methods. Patient's medical records were retrieved from our institutional arthroplasty registry as well as our prospectively maintained PJI infection database. Results. The JI panel identified additional microorganisms in 3/39 (7.7%) positive cases, and a different microorganism in 1/39 (2.6%) sample. Out of 9/58 (15.5%) culture negative samples, two (22%) were positively detected by the JI panel. In total 49/58 (84%) native synovial fluid specimens were positive by culture methods, versus 39/58 (81.2%) with the JI panel. Ten samples are currently under investigation for confirmatory results. Out of 39 positive detections with the JI panel, 35 (89.7%) were concordant with the identified microorganism (n=29 same species; n=6 same genus). The combined information from the JI panel results and clinical records revealed the existence of 6/58 (10.3%) PJIs’ cases which would have required a different antibiotic therapeutic approach. Conclusions. The work presented, provides additional value for the clinical use of the JI panel to the improvement of PJI management in terms of rapid and successful treatment decisions, patient outcome, and healthcare costs. This technique shows high sensitivity to detect PJIs specific microorganisms in both fresh as well frozen native synovial fluid samples, thus emphasizing its use for retrospective studies analysis

Aim. Dalbavancin is a novel second-generation lipoglycopeptide antibiotic with strong activity against many gram-positive bacteria and a prolonged half-life of 6–11 days. This allows a once-a-week intravenous application and therefore an outpatient intravenous therapy. Currently, only little is known about the use of Dalbavancin in Periprosthetic joint infection (PJI). The aim of this retrospective study, was to compare the outcome of hip and knee periprosthetic joint infections (PJI) in patients who received dalbavancin (DAL) with patients which was treated by standard of care antimicrobial agents (SoC). Methods. Between 02/2017 and 02/2020 a total of 89 (42 male/47 female) patients with PJI of the hip 56/89 (62.9%) and knee 33/89 (37.1%) who received at least one dosage of Dalbavancin were included. A 1:1 propensity-score (PS) matching between the DAL-group (n=89) and the SoC-group (n=89) was performed, using defined demographic covariates such as body-mass-index, age, sex, causative pathogens, knee or hip joint and infection after primary or revision surgery, surgical site infections, Charlson-comorbidity index and the types of infection (acute, late acute and chronic). Patient's demographics were analysed by our prospectively maintained institutional arthroplasty registry and PJI database. We analysed the outcome of the included patients evaluate the re-infection and re-revision rate and gave details about surgical management and the type of PJI with a minimum follow-up of one year. Results. Microbiological and clinical successes were achieved in 69 (77.5%) patients of the DAL-group and in 66 (74.2%) patients of the SoC-group. In the DAL-group 13 (14.6%) and in the SoC-group 12 (13.5%) patients had an infection related re-revision. Median follow-up was 706 (369; 1310) days in the DAL-group and 1329 (9; 3,549) days in the SoC-group. Overall, polymicrobial infections were found in 20 procedures (DAL-group: 10; SoC-group: 10) and monomicrobial infections in 154 (DAL-group: 75; SoC-group: 79). Polymicrobial infections were found in 20 patients and monomicrobial infections in 154. The most common microorganisms were Staphylococcus epidermidis n=63 (32.3%), Staphylococcus aureus n=27 (13.8%) and Cutibacterium spp. n=22 (11.3%). There are significantly less Gram-positive microorganisms (p=0.034) after re-revisions in patients with DAL treatment. Conclusions. Dalbavancin has excellent safety and high clinical effectiveness for Gram-positive PJIs

Introduction. Management of Vancouver type B1 and C periprosthetic fractures in elderly patients requires fixation and an aim for early mobilisation but many techniques restrict weightbearing due to re-fracture risk. We present the clinical and radiographic outcomes of our technique of total femoral plating (TFP) to allow early weightbearing whilst reducing risk of re-fracture. Methods. A single-centre retrospective cohort study was performed including twenty-two patients treated with TFP for fracture around either hip or knee replacements between May 2014 and December 2017. Follow-up data was compared at 6, 12 and 24 months. Primary outcomes were functional scores (Oxford Hip or Knee score (OHS/OKS)), Quality of Life (EQ-5D) and satisfaction at final follow-up (Visual Analogue Score (VAS)). Secondary outcomes were radiographic fracture union and complications. Results. Mean OHS and OKS was 50.25, EQ-5D score was >4 for all modalities, VAS was 64.4/100. Radiographs demonstrated bony union in 58% at 3 months and 76% at 6 months. We identified no case of re-fracture however non-union occurred in 4 patients. No other operative complications were identified. Conclusion. These results suggest that TFP may be a safe, viable option for management of periprosthetic fractures around stable implants allowing the benefit of early weightbearing, satisfactory outcomes and low re-fracture risk

Aim. It is unclear if the prevalence of resistance organisms causing (PJI) in total hip/knee arthroplasty is different among North/South American and European countries. Therefore, we sought to compare causative organisms, rates of resistant organisms, and polymicrobial infections in hospitals in North/South America, and Europe. Method. We performed a retrospective study of 654 periprosthetic hip (n=361) and knee (n=293) infections (January 2006-October 2019) identified at two facilities in the United States (US) (n=159), and single institutions located in Argentina (n=99), Uruguay (n=130), United Kingdom (UK) (n=103), Germany (n=59), and Russia (n=104). The analyses were performed for the entire cohort, knees, and hips. Alpha was set at 0.05. Results. Overall, the most frequent organisms identified were Staphylococcus aureus (24.8%) and Staphylococcus epidermidis (21.7%). The incidence of organisms resistant to at least one antibiotic was 58%. In this regard, there was a significant difference between hips (62.3%) and knees (52.6%) (p=0.014). The rates of resistant organisms among countries were significantly different: 37.7% (US), 66.7% (Argentina), 71.5% (Uruguay), 40.8% (UK), 62.7% (Germany), and 77.9% (Russia) (p<0.001). The overall incidence of polymicrobial infections was 9.3% and the rates across nations were: 9.4% in the US, 11.1% (Argentina), 4.6% (Uruguay), 4.9% (UK), 11.9% (Germany), and 16.3% (Russia) (p=0.026). In an exclusive analysis of the hips, the incidence of resistant organisms was 62.3% while polymicrobial infections accounted for 10.5% of all cultures. The rates of resistant organisms in each country were: 42.9% in the US, 59.2% (Argentina), 78.5% (Uruguay), 41.3% (UK), 63.9% (Germany), and 80.0% in Russia (p<0.001). The incidences of polymicrobial infections were: 9.1% in the US, 6.1% (Argentina), 6.5% (Uruguay), 6.5% (UK), 16.7% (Germany), and 21.7% in Russia (p=0.024). Regarding the knees, the incidence of resistant organisms was 52.6% while the frequency of polymicrobial infections was 7.8%. The rates of resistant organisms in each country were: 32.9% in the US, 74% (Argentina), 54.1% (Uruguay), 40.4% (UK), 60.9% (Germany), and 75% in Russia (p<0.001). The frequencies of polymicrobial infections were: 9.8% in the US, 16% (Argentina), 0% (Uruguay), 3.5% (UK), 4.3% (Germany), and 9.1% in Russia (p=0.072). Conclusions. Staphylococcus aureus and epidermidis accounted for almost 50% of all infections. The US and the UK had the lowest incidence of resistant organisms while Germany and Russia had the highest. The UK and Uruguay had the lowest rates of polymicrobial infections. These differences between countries and continents may affect comparative studies that evaluate treatments for PJI

In Canada, hip and knee replacements are each among the top three surgeries performed annually. In 2020, surgeries across the country were cancelled in response to the COVID-19 pandemic. We examined the impact on these joint replacement surgeries throughout the year.

Using the Discharge Abstract Database and National Ambulatory Care Reporting System, we developed a dataset of all 208,041 hip and knee replacements performed in Canada (except from Quebec) between January 1, 2019 to December 31, 2020. We compared patient and surgical characteristics (including sex, age, main diagnosis, and type of surgery (planned/urgent, primary/revision, inpatient/day surgery) in 2020 to 2019.

In 2020, hip and knee replacements volumes decreased by 18.8% compared to 2019. In April and May 2020, hip and knee replacements fell by 69.4% and 93.8%, respectively, compared to the same period in 2019. During those months, 66.5% of hip replacements were performed to treat hip fracture versus 20.2% in April and May 2019, and 64.5% of knee replacements were primaries versus 93.0% in April and May 2019. Patterns by patient age group and sex were similar compared to 2019. These patterns were similar across all provinces. By the summer, planned surgeries resumed across the country and volumes mostly returned to pre-pandemic monthly levels by the end of the year. We also found that there was an increase in the proportion of hip and knee replacements done as day surgery, with 4% in 2020 versus 1% in 2019, and patients undergoing day surgery replacement for osteoarthritis were older, with a median age of 64 for hip patients and 65 for knee patients, versus 63 for both joints the previous year.

As a result of the COVID-19 pandemic, there was a notable drop in 2020 of hip and knee replacements performed in Canada. With the demand for joint replacements continuing to grow, the resulting backlog will have an immediate, significant impact on wait lists and patient quality of life. The shift to a greater proportion of joint replacements performed as day surgeries may have an effect on patient outcomes as well shifts in access to care. It will be important to continue monitor patient outcomes following day surgery and the impact on patients for which day surgery was not an option.

Aim. Little is known about microbiological spectrum and resistance patterns as well as the clinical outcome in patients who undergo a repeat first stage procedure as part of a 2-stage revision arthroplasty for the treatment of periprosthetic hip and knee joint infections. Methods. Between 2011 and 2019, a total of 327 2-stage revision arthroplasties were performed on 312 patients with PJI of the knee and hip at our institution. We performed a retrospective analysis of all patients, who underwent a repeat first stage procedure regarding re-revision rate, host factors, culture negative and positive stages, monomicrobial and polymicrobial infections as well as microbiological spectrum and antimicrobial resistance patterns. Results. Overall, 52/312 (16.7%) patients (27 knee/25 hip) underwent a repeat first stage procedure. There were 35/52 (67.3%) culture positive first, 17/52 (32.7%) culture positive repeat first and 12/52 (23.1%) culture positive second stage procedures. In 13/52 (25%) patients a re-revision surgery was necessary at a median follow-up of 46.8 months (range, 12.2 to 93.3 months). High re-revision rates (10/12 [83.3%]) were found in patients with culture positive second stage and low re-revision rates (3/40 [7.5%]; p<0.01) were found in patients with culture negative second stage. The microbiological spectrum changed in 9/11 (81.8%) patients between culture positive first and repeat first stage, in 3/4 (75%) patients between culture positive repeat first and second stage and in 5/6 (83.3%) between culture positive second stage and subsequent re-revision surgery. Moreover, the antimicrobial resistance pattern changed in 6/9 (66.7%) of persistent microorganisms. Conclusion. Microbiological results during first, repeat first and second stage procedures significantly impacted the re-revision rates and changes in microbiological spectrum and resistance patterns between stages are common. However, if eradication of the microorganism at second stage can be accomplished, low re-revision rates can be achieved, even in patients who require a repeat first stage procedure

Proximal femoral focal deficiency is a congenital disorder of malformation of the proximal femur and/or the acetabulum. Patients present with limb length discrepancy and clinical features along a spectrum of severity. As these patients progress through to skeletal maturity and on to adulthood, altered biomechanical demands lead to progression of arthropathy in any joint within the lower limb. Abnormal anatomy presents a challenge to surgeons and conventional approaches and implants may not necessarily be applicable. We present a case of a 62-year-old lady with unilateral proximal femoral focal deficiency (suspected Aitken Class A) who ambulated with an equinus prosthesis for her entire life. She presented with ipsilateral knee pain and instability due to knee arthritis but could not tolerate a total knee arthroplasty due to poor quadriceps control. A custom osteointegration prosthesis was inserted with a view to converting to the proximal segment to a total hip replacement if required. The patient went on to develop ipsilateral symptomatic hip arthritis but altered acetabular anatomy required a custom tri-flange component (Ossis, Christchurch, New Zealand) and a custom proximal femoral component to link with the existing osseointegration component (Osseointegration Group of Australia, Sydney, Australia) were designed and implanted. The 18 month follow up of the custom hip components showed that the patient had Oxford hip scores that were markedly improved from pre-operatively. Knee joint heights were successfully restored to equal when the patient's prosthesis was attached. The patient describes feeling like “a normal person”, walks unaided for short distances and can ambulate longer distances with crutches. Advances in design and manufacture of implants have empowered surgeons to offer life improving treatments to patients with challenging anatomy. Using a custom acetabular tri-flange and osseointegration components is one possible solution to address symptomatic ipsilateral hip and knee arthropathy in the context of PFFD in adulthood

Purpose. Investigating the effects of femoral stem length on hip and knee muscle strength. Methods. The study included 20 patients having undergone total knee prostheses (TKP) due to coxarthrosis and 10 healthy subjects. Of the 20 patients, 10 underwent conventional TKP and 10 had Thrust Plate Prothesis (TPP). For the assessment of the patients’ muscle strength of operated and non-operated hips (Gl. medius and Gl. Maximus) and knees (Quadriceps Femoris-QF), the Hand-Held Dynamometer (HHD) was used. Results. A significant difference was observed in the muscle strength of Gl. medius in TPP patients and of Gl. maksimus in conventional TKP patients (p <0.05). Compared to the healthy group, only hip muscle strength decreased in TPP patients, but both hip and knee muscle strengths decreased in conventional TKP patients (p <0.05). Conclusion. A decrease in hip and knee muscle strengths was determined in the TPP and conventional THA patients, compared to healthy subjects. Compared to the bone protective prosthetic systems (eg TPP), a significant difference is observed in the QF muscle strength in intramedullary prosthesis applications. This data may be used in planning the treatment of patients with hip arthroplasty

The Oxford hip and knee scores are used to measure the outcome after primary total hip and knee replacement. We propose a new layout for the instrument in which patients are always asked about both limbs. In addition, we have defined an alternative scoring method which accounts for missing data. Over a period of 4.5 years, 4086 (1423 patients) and 5708 (1458 patients) questionnaires were completed for hips and knees, respectively. The hip score had a pre-operative median of 70.8 (interquartile range (IQR) 58.3 to 81.2) decreasing to 20.8 (IQR 10.4 to 35.4) after one year. The knee score had a pre-operative median of 68.8 (IQR 56.2 to 79.2) decreasing to 29.2 (IQR 14.6 to 45.8). There was no further significant change in either score after one year. As a result of the data analysis, we suggest that the score percentiles can be used as a standard for auditing patients before and after operation

Prosthetic joint infection continues to remain a diagnostic challenge for unhappy primary arthroplasty of hip and knees. There is increasing dependence upon alpha-defensin test to make key decisions like whether to revise or not & to decide between one-stage versus two-stage. Aim. This study aims to assess diagnostic accuracy of alpha-defensin test in determining prosthetic hip & knee infection and to provide guidance for appropriate use of this novel but expensive investigation. Methods. Retrospective review of all alpha-defensin investigated patients in an orthopaedic institute between February 2015 & March 2017 was performed. Clinical and radiological outcomes including re-infections, re-operations were analysed and alpha-defensin outcomes were compared with that of other available investigations. Results. Of total 52 tests performed (17 hips & 35 knees), 3 were positive. On comparison with intra-operative culture (gold standard), sensitivity is 100%. All suspected prosthetic hip infections have good clinical outcomes following their decisions being made based upon alpha-defensin test. Among the negative knee test results, 6 patients developed signs of infection in the post-operative period, 4 of which have been revised with washout, poly exchange or full revision. Conclusion. No single clinical investigation can accurately predict prosthetic joint infection in revision for suspected infection. Alpha-defensin test, however, is a useful adjunct to intra-operative surgeon's findings & pre-operative investigations to decide for crucial decisions like whether to revise or not & for deciding between single and two stage

Aim. To assess the influence of route of antibiotic administration on patient-reported outcome measures (PROMS) of individuals treated for hip and knee infections in the OVIVA multi-centre randomised controlled trial. Method. This study was designed to determine whether oral antibiotic therapy is non-inferior to intravenous (IV) therapy when given for the first six weeks of treatment for bone and joint infections. Of the 1054 participants recruited from 26 centres, 462 were treated for periprosthetic or native joint infections of the hip or knee. There were 243 participants in the IV antibiotic cohort and 219 in the oral cohort. Functional outcome was determined at baseline through to one year using the Oxford Hip/Knee Score (OHS/OKS) as joint-specific measures (0 the worse and 48 the best). An adjusted quantile regression model was used to compare functional outcome scores. Results. Of the 214 participants in the hip sub-group, 110 were randomized to IV antibiotics and 104 to oral. Of the 248 participants in the knee cohort, 133 were treated with IV antibiotics and 115 with oral. The OHS/OKS questionnaire response rate was 68%. Baseline median OHS of the hip sub-group was 14 (Interquartile range [IQR]:8–22) for the IV cohort and 12 (IQR:7–22) for the oral cohort. The one-year median OHS was 35 (IQR: 23–44) for the IV cohort and 27 (IQR:16–40) for the oral cohort with no significant difference between cohorts (p=0.181). The baseline median OKS of the knee sub-group, was 14 (IQR:8–23) for the IV cohort and 12 (IQR:8–21) for the oral cohort. The one-year median OKS was 24 (IQR: 15–35) for the IV cohort and 27 (IQR:17–38) for the oral cohort with a statistically significant difference in favour of oral therapy (p=0.036). Conclusions. At one year, there was improvement in functional outcome of patients treated with either IV or oral antibiotics in this RCT. It suggests that joint function generally improved progressively following the start of treatment irrespective of the route of antibiotic therapy. Functional outcome of patients with hip infections was similar irrespective of the route of antibiotic therapy, whereas there was statistically greater improvement in functional outcome of patients with knee infections treated with oral antibiotics. The PROMS findings of this trial support the clinical findings (i.e. infection eradication rates) and suggest that there is no advantage of using prolonged intravenous therapy as compared to oral therapy in the early treatment of infections around the hip and knee joint

Aim. The purpose of this study was to report on outcomes after stabilization of large skeletal defects following radical debridement of hip or knee infections and staged reimplantation using segmental antibiotic mega-spacers. Method. From 1998–2018, 39 patients (18 male, 21 female) were treated for musculoskeletal infections at the hip (14) or knee (25). Patients were treated for infection after a procedure related to oncology (20), arthroplasty (16), or trauma (3). Following debridement, defects were stabilized with antibiotic impregnated PMMA and intramedullary nails. All patients underwent a standardized protocol: 6 weeks of intravenous antibiotics followed by 6 weeks of oral antibiotics guided by intraoperative cultures. After a 6-week holiday of antibiotics, repeat intraoperative cultures and inflammatory markers were analysed for infection resolution. Success was defined by reimplantation without additional infection-related complications or requirement of suppressive antibiotics at latest follow-up. Results. Mean age was 50.5±19.4 years. Mean defect size was 20.4cm. Mean time from surgery until infection was 34.5 months, with 74% of patients presenting with infection greater than one year after their most recent surgery. Mean follow-up was 110±68 months. Most common organisms of infection were Staphylococcus Epidermidis (11) and Staphylococcus Aureus (10). Mean defect size was significantly different among oncology (28±8 cm), trauma (19±5 cm) and arthroplasty (12±6 cm) patients (p<0.0001), though outcomes were comparable. Two patients with antibiotic spacers have not underwent attempted reimplantation – one patient with clinical and laboratory signs of resolved infection; one patient with recent spacer placement. One patient died of oncologic disease shortly after spacer placement. These three patients were excluded from outcomes analysis. Twenty-nine (81%) patients were successfully re-implanted with a segmental endoprosthesis. Eight patients required an additional procedure prior to infection resolution, including additional antibiotic spacer and debridement due to sustained inflammatory markers and clinical signs of infection (5), antibiotic spacer exchange due to mechanical failure (2), and polyethylene exchange 9 months after reimplantation (1). Two patients have remained on chronic suppressive antibiotics, but have retained their limb, prosthesis, and pain-free function. Four (11%) patients ultimately required an amputation for infection control (3 above knee amputations; 1 hip disarticulation). Conclusions. Following radical debridement for infection, staged management of large segmental defects at the hip and knee with antibiotic cement and temporary intramedullary stabilization results in an 81% success-rate of limb salvage with infection control

Aim. The number of periprosthetic joint infections (PJI) is increasing due to ageing population and increasing numbers of arthroplasty procedures and treatment is costly. Aim of the study was to analyze the direct healthcare costs of PJI in Europe for total hip arthroplasties (THA) and total knee arthroplasties (TKA). Method. A systematic review in PubMed with search of direct costs of PJI in European countries was performed. Thereby the term cost* AND (infection OR PJI) AND (prosthesis OR knee OR hip OR “TKA” OR “THA” OR arthroplast*) was combined with each European country to detect relevant publications. Publications with definition of performed procedure and joint localization were included into further analysis. The mean value of direct healthcare cost was calculated for the respective joint and the respective operation performed. Results. Screening revealed 1,274 eligible publications. After review of abstracts and full-texts n=11 manuscripts were included into final analysis (Figure 1). The mean combined direct hospital costs for revision for PJI after TKA and THA was 26,311€. Mean costs for revision procedures for PJI after TKA were 24,617€. Direct costs for TKA-PJI treated with debridement, antibiotics and implant retention (DAIR) were on average 10,121€. For two-stage revisions in knee arthroplasties total average costs were 30,829€. Referring to revision surgery for PJI in THA, the mean hospital costs in Europe were 28,005€. For a DAIR procedure direct healthcare costs of 5,528€ were identified. Two-stage revision cost on average 31,217€. Conclusions. PJIs are associated with significant direct healthcare costs. The financial burden of up to 30,000 € per case underlines the impact of the disease for European health care system. However, the number of detailed reports on PJI costs is limited and the quality of the literature is limited. There is a strong need for more detailed financial data on the costs of PJI treatment. For any tables or figures, please contact the authors directly

Same day home (SDH) discharge in total joint arthroplasty (TJA) has increased in popularity in recent years. The objective of this study was to evaluate the causes and predictors of failed discharges in planned SDH patients.

A consecutive cohort of patients who underwent total knee (TKA) or total hip arthroplasty (THA) that were scheduled for SDH discharge between April 1, 2019 to March 31, 2021 were retrospectively reviewed. Patient demographics, causes of failed discharge, perioperative variables, 30-day readmissions and 6-month reoperation rates were collected. Multivariate regression analysis was undertaken to identify independent predictors of failed discharge.

The cohort consisted of 527 consecutive patients. One hundred and one (19%) patients failed SDH discharge. The leading causes were postoperative hypotension (20%) and patients who were ineligible for the SDH pathway (19%). Two individual surgeons, later operative start time (OR 1.3, 95% CI, 1.15-1.55, p=0.001), ASA class IV (OR 3.4, 95% CI, 1.4-8.2; p=0.006) and undergoing a THA (OR 2.0, 95% CI, 1.2-3.1, p=0.004) were independent predictors of failed SDH discharge. No differences in age, BMI, gender, surgical approach or type of anesthetic were found (p>0.05). The 30-day readmission or 6-month reoperation were similar between groups (p>0.05).

Hypotension and inappropriate patient selection were the leading causes of failed SDH discharge. Significant variability existed between individual surgeons failed discharge rates. Patients undergoing a THA, classified as ASA IV or had a later operative start time were all more likely to fail SDH discharge.

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

Nationally, experimental estimated Indigenous life expectancy was 59 years for Indigenous males (compared with 77 for all males) and 65 years for Indigenous females (compared with 82 years for all females). This is a difference of around 17 years for both males and females (ABS 2004). The Australian Government has embarked on numerous educational and health campaigns addressing the disease processes that lead to such a stark difference in life expectancy. The results of these campaigns are evident, as the population of Indigenous Australians over 60 years of age has risen from 9968 (Census 1986) to 25604 (Census 2008). As a result, we are now beginning to see orthopaedic degenerative disease states such as osteoarthritis. This increase in the number of Iindigenous Australians suffering from osteoarthritis will result in a greater number of hip and knee joint arthroplasty for osteoarthritis. Although the largest populations of Indigenous patients reside in urban areas, notably Sydney (census count 41,800), Brisbane (41,400) and Perth (21,300), the Torres Strait region of Queensland has 83% of the Indigenous population in remote Australia (Census 2008). This is reflected in the number of hip and knee joint arthroplasties performed through the orthopaedic department at the Cairns Base Hospital on indigenous patients, from a total of seven in 2001 to a total of 22 in 2008. Retrospective analysis was conducted of those patients failing to attend their full complement of post-operative follow-up in the first year post total hip and knee joint arthroplasty for the eight year period from 2001 to 2008 at the Cairns Base Hospital. Within this period a total of 99 hip and knee arthroplasties were performed on indigenous patients. Over 30% of indigenous patients failed to attend their full complement of post-operative follow up in the first year post hip and knee joint arthroplasty. Due to the increasing life expectancy of the indigenous population, more are presenting with orthopaedic degenerative disease states that require joint arthroplasty. The higher number of co-morbidities such as type II diabetes mellitus and peripheral vascular disease makes post operative follow up of the indigenous patient essential to avoid complications. The lack of follow up will undoubtedly lead to an inability to appropriately monitor the indigenous patient's recovery and/or decrease in morbidity post total hip and knee joint arthroplasty. Patient centered follow-up must be given greater consideration in relation to the Australian indigenous population such as an increase in outreach services, the provision of orthopaedic follow up by the local health practitioners in the rural and remote setting, maintaining up to date contact details along with affording the indigenous patient greater access to transport so as to improve follow up

Aim. Analysis of microbiological spectrum and resistance patterns as well as the clinical outcome of patients who underwent a Debridement, antibiotics and implant retention (DAIR) procedure in the early phase following failed two-stage exchange arthroplasty of the knee and hip. Method. Of 312 patients treated with two-stage exchange arthroplasty between January 2011 and December 2019, 16 (5.1%) patients (9 knee, 7 hip) underwent a DAIR procedure within 6 months following second stage. We retrospectively analyzed the microbiological results as well as changes in the microbiological spectrum and antibiotic resistance patterns between stages of two-stage exchange arthroplasties and DAIR procedures. Patient's re-revision rates after a minimum follow-up of 12 months following DAIR procedure were evaluated. Moreover, differences between knee and hip and between infected primary total joint replacement (TJRs) and infected revision TJRs as well as patient's host factors and microbiological results regarding the outcome of DAIR were analyzed. Results. In 7/16 (43.8%) patients the first and second stage procedure was culture positive, in 5/16 (31.2%) patients the first and second stage procedure was culture negative and in 4/16 (25%) patients the first stage procedure was culture positive, and the second stage procedure was culture negative. Moreover, 6 (37.5%) out of 16 DAIR procedures showed a positive microbiological result. In 5/7 (71.4%) patients with culture positive second stage procedure a different microorganism compared to first stage procedure was detected. In 6/6 (100%) patients with culture positive DAIR procedure, the isolated microorganisms were not detected during first or second stage procedure. An additional re-revision surgery was necessary in 4/16 (25%) patients after a median time of 31 months (range, 12 to 138 months) at a mean follow up of 63.1 ± 32 months following DAIR procedure. Highest re-revision rates were found in patients with culture positive second stage procedures (3/7 [42.9%]) and patients with culture positive DAIR procedures (2/6 [33.3%]). Conclusions. DAIR procedure seems to be a useful early treatment option following failed two-stage exchange arthroplasty. The re-revision rates were independent of different combinations of culture positive and culture negative first and second stage procedures. The high number of changes in the microbiological spectrum needs to be considered in the treatment of PJI

Aim

Synovial calprotectin point-of-care test (POC) has shown promising clinical value in diagnosing periprosthetic joint infections (PJIs). However, limited data are available in unclear cases. Moreover, cut-off values for calprotectin lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) need to be adapted. The aim of this study was to evaluate the performance of an upgraded and more sensitive version of a synovial calprotectin LFA along with ELISA immunoassay in patients with septic, aseptic, and unclear cases.

Aim

Aim was to compare revision rates when using single versus dual antibiotic loaded cement (ABLC) in hip fracture arthroplasty and aseptic revision hip or knee arthroplasty using data from the Dutch national joint registry (LROI).

Aim. Periprosthetic joint infections (PJI) and surgical site infections (SSI) are one of the most severe complications in joint arthroplasty. Decolonization measures prior to elective orthopedic surgeries have shown to reduce the risk of infection especially in patient identified as carriers of S. aureus. However additional screening measures can be difficult to implement in daily routine. The objective was to study the influence of universal decolonization with polihaxanid on SSI rates. Method. Between January 2017 and December 2018 patients scheduled for hip or knee joint arthroplasty in 5 participating orthopedic centers received polyhexanid containing decolonization set consisting of oral, nasal and wipes. Patients were instructed to perform a 5 day decolonization regimen 4 days prior to surgery. SSIs were recorded according to modified CDC criteria for a surveillance period of 90days after surgery. Results. During the study period, 4437 decolonization sets were distributed to patients. 1869 patients consented to participate in the study and provide detailed feedback on compatibility and compliance. Overall SSI rate was 0.87 per 100 surgeries prior to introduction of the decolonization, while it was 0.97 per 100 surgeries during the period of decolonization and 0.59 per 100 surgeries in those using the decolonization set. SSI rates due to Staphylococcus aureus were 0.32 per 100 surgeries, 0.21 per 100 surgeries and 0.05 per 100 surgeries respectively. In patients receiving an elective hip-joint arthroplasty SSI rate was 0.93 per 100 surgeries prior to introduction, while it was 1.17 per 100 surgeries during the intervention period and 0.96 per 100 surgeries in patients that used the decolonization set. However SSI rates due to Staphylococcus aureus were 0.30 per 100 surgeries, 0.14 per 100 surgeries and 0.10 per 100 surgeries respectively. In patients receiving, an elective knee-joint arthroplasty SSI rate was 0.52 per 100 surgeries prior to introduction, while it was 0.53 per 100 surgeries during the intervention period and 0.12 per 100 surgeries in patients that used the decolonization set. However, SSI rates due to Staphylococcus aureus were 0.20 per 100 surgeries, 0.13 per 100 surgeries and 0.00 per 100 surgeries respectively. In addition to these preliminary results, we will provide and present a further analysis of the study results. Conclusions. Polyhexanid based universal decolonization measures were safely implemented. Universal decolonization with polyhexanid might have a benefit on S. aureus SSI rates in patients with joint arthroplasty, especially in elective knee arthroplasty. Further evaluations are needed