Aim. There is controversy regarding the use of Antibiotic-loaded cement (ALBC) as compared to non-antibiotic-loaded cement (NALBC) to reduce the overall infection rate without affecting implant survival or adding additional risks on fixation for primary total knee arthroplasty (TKA). Method. To conduct the analysis, we utilized the Catalan Arthroplasty Registry (RACat) for the TKAs implanted between 2005 and 2017. The primary variable recorded was the use of cement with or without antibiotics. Other recorded variables included were age, sex, diabetes mellitus, obesity, Charlson index and type of hospital. We analyzed the effect of ALBC vs. NALBC in reducing the risk of prosthetic infection at 3, 6, 12, and 24 months as well as prosthetic survival due to mechanical causes at 1, 5, and 10 years. Univariate and multivariable analyses of risk factors were conducted. Thereby, an interactive predictive model that determines the risk of prosthetic infection based on each patient's characteristics was created. Results. A total of 28,287 TKAs from the RACat were analyzed. In that total, there were 19,788 NALBC and 8,499 ALBC. The infection rates for TKAs with NALBC vs. those with ALBC at 3, 6, 12, and 24 months were respectively: 1.69% vs. 1.39% (p=0.132); 1.81% vs. 1.56% (p=0.147); 2.14% vs. 1.73% (p=0.030); 2.51% vs. 1.86% (p=0.001). A statistically significant reduction in periprosthetic infection rate was observed in the ALBC group at 12 and 24 months. No differences were observed between the two groups in terms of prosthetic mechanical survival. Being younger, male and having had previous knee surgery or having a high comorbidity index all led to a higher risk of prosthetic revision due to infection. Conclusions. The use of ALBC as a fixation method for TKA leads to a reduction in the risk of prosthetic infection without altering the mechanical survival of the implant. The creation of a predictive model helps determine the individualized risk of prosthetic infection based on the patient's characteristics

Aim. Despite a preoperative workup with no evidence to suspect a prosthetic joint infection (PJI) before revision surgery, routinely obtained intraoperative cultures still can be unexpectedly positive. The purpose of this study was (1) to assess the incidence of unexpected positive intraoperative cultures in presumed aseptic knee and hip revisions and (2) to determine whether a difference exists between the infection-free implant survival rate of patients with and without unexpected positive intraoperative cultures. Method. We selected patients who underwent a one-stage revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) for different reasons. Three or more separate intraoperative cultures were obtained during each procedure. A negative result was defined as less than two positive cultures with the same microorganism. An unsuspected PJI was defined as having two or more positive cultures with the same microorganism. Patients’ medical records were reviewed to collect demographics, preoperative laboratory results, culture results, and the occurrence of infection during follow-up. Results. A total of 340 and 339 patients with a presumed aseptic knee and hip revision, respectively, were analyzed. The incidence of unsuspected PJIs was 7.9% and 12.1% in the knees and hips, respectively. Of these unsuspected PJIs, the infection-free prosthetic survival rate at 2 year follow-up was 88% (95%CI 59–97) and 92% (95%CI 73–98) in knees and hips, respectively. In the knee group, the infection-free prosthetic survival rate of patients with an unsuspected PJI was significantly lower compared to that of patients with negative intraoperative culture results (88% (95%CI 59–97) versus 97% (95%CI 93–99) with p=0.01). In the hip group, there was no such a difference (92% (95%CI 73–98) versus 93% (95%CI 88–96) with p=0.41). Conclusions. We found incidences of unsuspected PJI and infection-free prosthetic survival rates that are comparable with previous studies. During follow-up after one-stage revision TKA, a higher incidence of infection was observed in patients with an unsuspected PJI. This difference was not observed in the hip revisions

Background. The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection. Methods. We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection. Of 625 patients treated with a total of 655 eligible revisions, ninety-two received chronic oral antibiotics for a minimum of six months and were eligible for inclusion in our study. These patients were compared with a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. Results. The five-year infection-free prosthetic survival rate was 68.5% (95% confidence interval = 59.2% to 79.3%) for the antibiotic-suppression group and 41.1% (95% CI = 34.9% to 48.5%) for the non-suppression group (hazard ratio = 0.63, p = 0.008). Stratification by the type of surgery and the infecting organism showed a higher five-year survival rate for the patients in the suppression group who underwent irrigation and debridement with polyethylene exchange (64.7%) compared with those in the non-suppression group who underwent irrigation and debridement with polyethylene exchange (30.4%, p < 0.0001) and a higher five-year survival rate for the patients in the suppression group who had a Staphylococcus aureus infection (57.4%) compared with those in the non-suppression group who had a Staphylococcus aureus infection (40.1%, p = 0.047). Conclusions. Chronic suppression with oral antibiotics increased the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection. Patients who underwent irrigation and debridement with polyethylene exchange and those who had a Staphylococcus aureus infection had the greatest benefit

Introduction. Periprosthetic joint infection (PJI) represents the costliest complication in Orthopedics. Studies of mixing vancomycin to bone graft at Impaction Bone Grafting (IBG) have shown high local concentration for 3 weeks. Patients and methods. 55 consecutive revisions PJI, age 68 (SD 10.9), (9 one-stage and 46 two-stage) were retrospectively analyzed. All cases were revised using IBG. Most cases had vancomycin mixed in graft or added locally in joint. All had bone cement containing Gentamycin and Vancomycin. Follow up 2–16 years included clinical Merle d'Aubigne-Postel score, radiology and laboratory tests. We analyzed surgical time, bleeding, hospitalization time, infection eradication and prosthetic survival for one- and two-stage revision procedures. One patient was lost to follow up and 6 died (2 one- and 4 2-stage) before 2 years. Values are mean and SD. Analyses done by students t-test. Results. Preoperatively scores for 1- and 2-stage groups were 11.7 (0.79) and 10.2 (1.27) respectively. Follow up scores were 17.5 (0.38) and 15.9 (0.73) respectively. Total intra-operative blood loss (ml) for one- and two-stage procedures were 1638 (780) and 2764 (828) respectively p<0.05. Total surgery time (minutes): 238 (206) and 409 (108) respectively p<0.05. Total hospitalization time (days): 13 (6.2) and 34 (13) p<0.05. Radiology at follow-up showed no signs of PJI, signs of mechanical loosening in one. There were no persistent or new PJI, no revision for mechanical loosening. Two revision for any reason in the 2-stage and one in the 1-stage group. Five reoperations without component exchange for periprosthetic fracture, all in the 2-stage group. Conclusion. No mechanical loosening and no persistent or new PJI are favourable results. Blood loss, hospitalization- and surgery-time were substantially increased for the two-stage group. Muscle atrophy, osteoporotic development and decrease general physical condition are all well-known side effects of two-stage procedure. Revision one-stage hip PJI using IBG avoids increased suffering and resources connected to the two-stage procedure. Literatures have not shown eradication of PJI, to be clearly superior after two- compared to one-stage procedures. Reconstitution of bone defects and the possibility of very high local antibiotic concentration are substantial advantages when using IBG. We recommend a careful one-stage IBG procedure using antibiotic loaded graft for none “difficult to treat” cases

Haemophilia care has steadily improved over the years and especially so during the last decade. The routine use of prophylactic treatment has undoubtedly resulted in a significant improvement in the life-style, quality of life and life expectancy of these patients. However despite our best efforts there is still a group of young adults who have a severe degree of knee joint destruction as a result of repeated articular bleeding episodes during their early years. The knee is the most common joint affected in haemophilia (50%). The repeated articular bleeding episodes during the patients' early years leads to the onset of pain and significant functional disability at a time when they require the best possible quality of life. The major objective of total joint replacement is to reduce the level of pain in the affected joint and, in addition, a significant reduction in the frequency and number of joint bleeds, which improves both function and mobility. The results of 60 primary total knee replacements performed in 42 patients with severe haemophilia between 1983 and 2003 were reviewed retrospectively. Functional results were assessed using the Hospital for Special Surgery (HSS) knee score both pre- and post-operatively. Kaplan-Meier survivorship analysis was used to calculate prosthetic survival. The mean age of patients was 43.35 (range 25-70yrs). The overall prevalence of infection was less than 2%. The HSS clinical score was excellent or good for 95% of the knees. We believe that total joint replacement is a safe and effective procedure in the management of haemophilic joint arthropathy. The latest techniques using continuous infusion and recombinant factor replacement have gone a long way to reducing the complications rate and to achieving results that match those of the general population

In order to assess current opinions on the long-term outcome after primary total hip replacement, we performed a multicentre, cross-sectional survey in 22 centres from 12 European countries. Different patient characteristics were categorised into ‘decreases chances’, ‘does not affect chances’, and ‘increases chances’ of a favourable long-term outcome, by 304 orthopaedic surgeons and 314 referring practitioners. The latter were less likely to associate age older than 80 years and obesity with a favourable outcome than orthopaedic surgeons (p < 0.001 and p = 0.006, respectively) and more likely to associate age younger than 50 years with a favourable outcome (p = 0.006). Comorbidity, rheumatoid arthritis, and poor bone quality were thought to be associated with a decreased chance of a favourable outcome. We found important differences in the opinions regarding long-term outcome after total hip replacement within and between referring practitioners and orthopaedic surgeons. These are likely to affect access to and the provision of total hip replacement.