Malnutrition is an important consideration during the perioperative period and albumin is the most common laboratory surrogate for nutritional status. The purpose of this study is to identify if preoperative serum albumin measurements are predictive of infection following arthroscopic procedures. Patients undergoing knee, shoulder or hip arthroscopy between 2006–2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with an arthroscopic current procedural terminology code and a preoperative serum albumin measurement were included. Patients with a history of prior infection, including a non-clean wound class, pre-existing wound infection or systemic sepsis were excluded. Independent t-tests where used to compare albumin values in patients with and without the occurrence of a postoperative infection. Pre-operative albumin levels were subsequently evaluated as predictors of infection with logistic regression models. There were 31,906 patients who met the inclusion criteria. The average age was 55.7 years (standard deviation (SD) 14.62) and average BMI was 31.7 (SD 7.21). The most prevalent comorbidities were hypertension (49.2%), diabetes (18.4%) and smoking history (16.9%). The average preoperative albumin was 4.18 (SD 0.42). There were 45 cases of superficial infection (0.14%), 10 cases of wound dehiscence (0.03%), 17 cases of deep infection (0.05%), 27 cases of septic arthritis or other organ space infection (0.08%) and 95 cases of any infection (0.30%). The preoperative albumin levels for patients who developed septic arthritis (mean difference (MD) 0.20, 95% CI, 0.038, 0.35, P = 0.015) or any infection (MD 0.14, 95% CI 0.05, 0.22, P = 0.002) were significantly lower than the normal population. Additionally, disseminated cancer, Hispanic race, inpatient status and smoking history were significant independent risk factors for infection, while female sex and increasing albumin were protective towards developing any infection. Rates of all infections were found to increase exponentially with decreasing albumin. The relative risk of infection with an albumin of 2 was 3.46 (95% CI, 2.74–4.38) when compared to a normal albumin of 4. For each albumin increase of 0.69, the odds of developing any infection decreases by a factor of 0.52. This study suggests that preoperative serum albumin is an independent predictor of septic arthritis and all infection following elective arthroscopic procedures. Although the effect of albumin on infection is modest, malnutrition may represent a modifiable risk factor with regard to preventing infection following arthroscopy

Surgical site infections (SSIs) after spinal fusion surgery increase healthcare costs, morbidity and mortality. Routine measures of obesity fail to consider site specific fat distribution. We aimed to assess the association between the spine adipose index and deep surgical site infection and determine a threshold value for spine adipose index that can assist in preoperative risk stratification in patients undergoing posterior instrumented lumbar fusion (PILF). A multicentre retrospective case-control study was completed. We reviewed patients who underwent PILF from January 1, 2010 to December 31, 2018. All patients developing a deep primary incisional or organ-space SSI within 90 days of surgery as per US Centre for Disease Control and Prevention criteria were identified. We gathered potential pre-operative and intra-operative deep infection risk factors for each patient. Spine adipose index was measured on pre-operative mid-sagittal cuts of T2 weighted MRI scans. Each measurement was repeated twice by three authors in a blinded fashion, with each series of measurement separated by a period of at least six weeks. Forty-two patients were included in final analysis, with twenty-one cases and twenty-one matched controls. The spine adipose index was significantly greater in patients developing deep SSI (p =0.029), and this relationship was maintained after adjusting for confounders (p=0.046). Risk of developing deep SSI following PILF surgery was increased 2.0-fold when the spine adipose index was ≥0.51. The spine adipose index had excellent (ICC >0.9; p <0.001) inter- and intra-observer reliabilities. The spine adipose index is a novel radiographic measure and an independent risk factor for developing deep SSI, with 0.51 being the ideal threshold value for pre-operative risk stratification in patients undergoing PILF surgery

Aim. Prosthetic joint replacement is more commonly done in the elderly group of patients due to an increase pathology related to joint degeneration that comes with age. In this age group is also more frequent having underling condition that may predispose to a prosthetic joint infection. Also, the pharmacological intervention in those patients may play an important role as a risk factor for infection after joint replacement surgery. The use of oral anticoagulants seems to be particularly increased in elderly patients but there aren't enough data published to support an association between prosthetic joint infection and the use of oral anticoagulants. Identifying risk factors in elderly patients age >75 years old with a special focus on the oral anticoagulation therapy is the aim of the study. Methods. In a retrospective study from 2011 till 2018 all the patients >75 years old with knee and hip replacement surgery have been review looking for acute prosthetic infection and risk factors that may be predispose to it. Patients with previous surgery or any other mechanical complication that needed intervention on the same area have been excluded. Results. A total of 1220 patients have been included (801 knee replacement surgery and 419 hip replacement surgery). The mean age was 79.5 ± 3.44 years and most of the patients were women (72,6%). The infection rate was 2,5%. Several factors have been identified to be associated with acute infection. (Table.1.). The patients receiving oral anticoagulants had an increased risk of infection (OR 3.63 (1.60–7.74), p=0.002). Conclusions. Even all the risk factors associated with risk infection have been described previously, the relevant aspect is the increased risk of prosthetic joint infection in patients receiving oral anticoagulants

The use of cannabis is increasingly medically relevant as it is legalized and gains acceptance more broadly. However, the effects of marijuana use on postoperative outcomes following orthopedic surgery have not been well-characterized. This study seeks to illuminate the relationship between marijuana use and the incidence postoperative complications including: DVT, PE, nonunion, and infection following common orthopedic procedures. This study was conducted using a national orthopaedic claims insurance database. We identified all patients undergoing knee arthroscopy, shoulder arthroscopy, operatively managed long bone fractures (humerus, femur, tibia and/or fibula, and radius and/or ulna), and single-level lumbar fusion. The proportion of patients within each surgery cohort who had a diagnostic code for marijuana dependence was assessed. The rates of DVT, PE, and infection within 90 days were assessed for all patients. The rate of nonunion was assessed for the long bone fracture and lumbar fusion cohorts. Univariate analyses of marijuana dependence on all outcomes were performed, followed by a multivariate logistic regression analysis controlling for known patient comorbidities. We identified 1,113,944 knee arthroscopy, 747,938 shoulder arthroscopy, 88,891 lumbar fusion, and 37,163 long bone fracture patients. Out of the 1,987,936 patients, 24,404 patients had a diagnostic code for marijuana dependence. Within all four surgical subgroups, the marijuana dependence cohort experienced increased rates of infection, PE, and DVT, as well as increased rates of nonunion in the lumbar fusion and long bone fracture populations. In the multivariate analyses controlling for a variety of patient risk factors including tobacco use, marijuana dependence was identified as an independent risk factor for infection within all four surgical subgroups (Knee: OR 1.85, p < 0.001; Shoulder: OR 1.65, p < 0.001; Spine: OR 1.45, p < 0.001; Long bone: OR 1.28, p < 0.001), and for nonunion in the lumbar fusion (OR 1.38, p < 0.001) and long bone fracture (OR 1.31, p < 0.001) subgroups. Our data suggests that marijuana dependence may be associated with increased rates of infection and nonunion following a variety of orthopaedic procedures. During preoperative evaluation, surgeons may consider marijuana use as a potential risk factor for postoperative complications, especially within the context of marijuana legalization. Future research into this relationship is necessary

The rate of arterial injury in trauma patients with pelvic ring fractures has been cited as high as 15%. Addressing this source of hemorrhage is essential in the management of these patients as mortality rates are reported as 50%. Percutaneous techniques to control arterial bleeding, such as embolization and REBOA, are being employed with increasing frequency due to their assumed lower morbidity and invasiveness than open exploration or cross clamping of the aorta. There are promising results with regards to the mortality benefits of angioembolization. However, there are concerns with regards to morbidity associated with embolization of the internal iliac vessels and its branches including surgical wound infection, gluteal muscle necrosis, nerve injury, bowel infarction, and thigh / buttock claudication. The primary aim of this study is to determine whether pelvic arterial embolization is associated with surgical site infection (SSI) in trauma patients undergoing pelvic ring fixation. This observational cohort study was conducted using US trauma registry data from the American College of Surgeons (ACS) National Trauma Database for the year of 2018. Patients over the age of 18 who were transported through emergency health services to an ACS Level 1 or 2 trauma hospital and sustained a pelvic ring fracture treated with surgical fixation were included. Patients who were transferred between facilities, presented to the emergency department with no signs of life, presented with isolated penetrating trauma, and pregnant patients were excluded from the study. The primary study outcome was surgical site infection. Multivariable logistic regression was performed to estimate treatment effects of angioembolization of pelvic vessels on surgical site infection, adjusting for known risk factors for infection. Study analysis included 6562 trauma patients, of which 508 (7.7%) of patients underwent pelvic angioembolization. Overall, 148 (2.2%) of patients had a surgical site infection, with a higher risk (7.1%) in patients undergoing angioembolization (unadjusted odds ratio (OR) 4.0; 95% CI 2.7, 6.0; p < 0 .0001). Controlling for potential confounding, including patient demographics, vitals on hospital arrival, open fracture, ISS, and select patient comorbidities, pelvic angioembolization was still significantly associated with increased odds for surgical site infection (adjusted OR 2.0; 95% CI 1.3, 3.2; p=0.003). This study demonstrates that trauma patients who undergo pelvic angioembolization and operative fixation of pelvic ring injuries have a higher surgical site infection risk. As the use of percutaneous hemorrhage control techniques increase, it is important to remain judicious in patient selection

Aim. The incidence of deep infections after internal fixation of ankle and lower leg fractures is estimated 1 to 2%. Hindfoot arthrodesis by retrograde intramedullary nailing (IMN) is a potential alternative to external fixation for post-infectious ankle destruction. The aim of this study was to evaluate the clinical results, complications and effects of soft tissue management with this treatment modality. Method. This is a single-center retrospective review of routine hospital data from 21 patients (15 men, 6 women, median age 65 [range, 21 to 87] years) undergoing IMN arthrodesis of the hindfoot for post-traumatic infections between January 1st, 2012 and March 15, 2018. We observed four bimalleolar, eight trimalleolar, three pilon fractures, and six distal lower leg fractures. Six and three patients had sustained second- and third degree open fractures, respectively. Early- and late-onset surgical infections were observed in 8 and 13 cases. Four participants had diabetes mellitus, two arterial occlusive disease, and four had both. Six patients were smokers. Results. Intraoperative cultures before implanting the nail revealed staphylococcus aureus in 12, staphylococcus epidermidis in five, and enterococcus faecalis in eight cases. After a median follow-up of 21 months, infection was considered cured in 19 / 21 subjects (90%, 95% confidence interval 70 – 99%). Soft tissue comminution required coverage with a suralis flap in five patients, and with a latissimus dorsi flap in another three. Mesh graft was necessary in 8 / 21 reconstructions. Conclusions. Tibiotalocalcaneal fusion by IMN is an effective salvage procedure for post-traumatic ankle infections. Arthrodesis and definitive wound closure or plastic flap coverage can be performed as single-stage surgery. By resecting the prominent distal fibula, lateral soft tissue defects can be managed more easily. The small sample size prohibited a more detailed analysis of exposure variables, but 8 / 13 patients in this cohort had at least one known risk factor for infection and prolonged healing

Introduction. Superficial pin site infection is a common problem associated with external fixation, which has been extensively reported. However, the incidence and risk factors with regards to deep infection is rarely reported in the literature. In this study, we investigate and explore the incidence and risk factors of deep infection following circular frame surgery. For the purpose of this study, deep infection was defined as: persistent discharge or collection for which surgical intervention was recommended. Materials and Methods. Retrospective review of all patients whom underwent frame surgery between 1. st. of April 2015 to 1. st. April 2019 in our unit with a minimum of 1 year follow up following frame removal. We recorded patient demographics, patient risk factors, trauma or elective procedure, number of days the frame was in situ, location of infection and fracture pattern. Results. 304 patients were identified. 27 patients were excluded as they were lost to follow up or had their primary frame surgery as a treatment for infection. This provided us with 277 patients for analysis. Mean age was 47 years (range 9–89 years), the male to female ratio was 1.5:1 and 80% were trauma frames. 13 patients (4.69%) developed deep infection and all occurred in trauma patients. Of the 13 patients who developed deep infection, 4 had infection before frame removal and 9 occurred after frame removal. 8 deep infections occurred within a year of frame removal, 1 occurred between 1 and 2 years. Within the 13 frame procedures for trauma, 12 were periarticular multifragmentary fractures, 3 of which were open, and the remaining was an open diaphyseal fracture. The periarticular fractures were more likely to develop deep infection than diaphyseal fractures (p–0.033). 12 patients (out of 13) also had concurrent minimally invasive internal fixation with screws in very close proximity of the wires. Conclusions. The rate of deep infection following circular frame surgery appears to be low. Pooled, multicentre data would be required to analyse risk factors however multifragmentary, periarticular fracture and the requirement for additional internal fixation appears to be an associated factor

Aim. Prosthetic joint infection (PJI) is a major complication in THA. Nasal carriage with S. Aureus is a well-defined risk factor for infection in hospitalized patients. Risk for infection is reduced up to 50% by eradication therapy. Since PJI rates are very low and only 25% of the population are carriers, significant differences are hard to show and reports on PJI have been inconclusive. We analysed the effect of S. Aureus eradication therapy in THA. Methods. From 2011, patients receiving THA are screened for S. Aureus carriage and carriers are treated. This group was retrospectively compared with a historical THA group in which no screening and eradication therapy was done. We assumed similar carrier rates in both groups and calculated the risk reduction of eradication therapy for PJI in comparison to the historical carriers without treatment. Fisher's Exact test was used to compare outcome. Results. 2072 patients were screened and 478 patients were positive (23%). The historical control group consisted of 1248 patients, with 288 calculated carriers (23%). 15 PJI (0.72%) occurred vs 14 (1.12%) in the historical group (p=0.16). A 52% reduction in S. Aureus infections was found (0.33% vs 0.64% p=0.15). Infection rates for PJI caused by S. aureus was similar in non-carriers and carriers after eradication therapy (0.3 vs 0.4% p=0.506). The calculated infection rates in carriers in the historical group was reduced from 2.6% to 0.8% (RR 3,25, p=0.07) by eradication therapy and from 1.7% to 0,4% (RR 4,25, p=0.07) for S. Aureus PJI. Conclusions. A clear trend in reduction of PJI was demonstrated as a result of S. aureus screening and eradication therapy, reducing the rate of PJI for carriers to the same level as non-carriers

Drainage from the knee wound after TKA is an obvious concern for the arthroplasty surgeon. One of the inherent problems with a total knee arthroplasty is there is a focus on obtaining maximum range of motion but at the same time the wound needs to heal in a timely fashion. Consistent knee drainage after a TKA is a source of concern. The quantity and quality of drainage needs to be assessed and there are certain questions that need to be answered including: 1) Is there bloody drainage which suggests fascial dehiscence?; 2) Is the patient too active?; 3) Is the drainage in some way related to DVT prophylaxis?; 4) Is the patient obese and could the drainage be secondary to fat necrosis or seroma? and 5) Is the drainage suggestive of an infection? The work-up can include C-reactive protein and sed rate, and possibly a knee aspiration. In general, C-reactive protein >100mg/L within the first six weeks after surgery suggests the presence of an infection. The sed rate is generally not useful in the early post-operative period. In the first six weeks after surgery if the number of white cells in the aspiration is >10,000 this suggests infection especially if there are 80–90% polymorphonuclear cells. Each day of prolonged wound drainage is noted to increase the risk of infection by 29%. Morbid obesity has been shown to be an independent risk factor for infection. Some anticoagulants (i.e. low molecular weight heparin) have been associated with increased wound drainage. In a retrospective review of 11,785 total joint arthroplasties, 2.9% of joints developed wound drainage, and of these patients, 28% required further surgery. It was noted that patients that were malnourished had a 35% failure rate with respect to controlling the drainage and preventing infection versus 5% in patients that were healthy. The International Consensus Conference on Infection concluded that a wound that has been persistently draining for greater than 5–7 days requires surgical intervention. The available literature provides little guidance regarding the specifics of this procedure. In general, if the wound is draining or is red, rest the leg for a day or two. In some instances a bulky Jones dressing can be helpful. If the drainage persists one could consider using a negative pressure dressing (wound vac) but there is little data on efficacy after TKA. If there is persistent drainage or cellulitis, then operative intervention is probably necessary. Evaluation of CRP and a knee joint aspiration can be helpful. The decision to return to the OR should be made within the first 7 days after the surgery. At the time of the procedure one will need to decide to perform either a superficial washout versus a washout and polyethylene exchange

Drainage from the knee wound after TKA is an obvious concern for the arthroplasty surgeon. One of the inherent problems with a total knee arthroplasty is there is a focus on obtaining maximum range of motion but at the same time the wound needs to heal in a timely fashion. Consistent knee drainage after a TKA is a source of concern. The quantity and quality of drainage needs to be assessed and there are certain questions that need to be answered including: 1) Is there bloody drainage which suggests fascial dehiscence?; 2) Is the patient too active?; 3) Is the drainage in some way related to DVT prophylaxis?; 4) Is the patient obese and could the drainage be secondary to fat necrosis or seroma? and 5) Is the drainage suggestive of an infection? The work up can include C-reactive protein and sed rate, and possibly a knee aspiration. In general, C-reactive protein >100 mg/L within the first six weeks after surgery suggests the presence of an infection. The sed rate is generally not useful in the early post-operative period. In the first six weeks after surgery if the number of white cells in the aspiration is >10,000 this suggests infection especially if there are 80–90% polymorphonuclear cells. Each day of prolonged wound drainage is noted to increase the risk of infection by 29%. Morbid obesity has been shown to be an independent risk factor for infection. Some anticoagulants (i.e. low molecular weight heparin) have been associated with increased wound drainage. In a retrospective review of 11,785 total joint arthroplasties, 2.9% of joints developed wound drainage, and of these patients, 28% required further surgery. It was noted that patients that were malnourished had a 35% failure rate with respect to controlling the drainage and preventing infection versus 5% in patients that were healthy. The International Consensus Conference on Infection concluded that a wound that has been persistently draining for greater than 5–7 days requires surgical intervention. The available literature provides little guidance regarding the specifics of this procedure. In general, if the wound is draining or is red, rest the leg for a day or two. In some instances a bulky Jones dressing can be helpful. If there is persistent drainage or cellulitis, then operative intervention is probably necessary. Evaluation of CRP and a knee joint aspiration can be helpful. The decision to return to the OR should be made within the first 7 days after the surgery. At the time of the procedure one will need to decide to perform either a superficial washout versus a washout and polyethylene exchange

Aim. Acute postoperative infection is reported to occur in 0.3–2% after arthroscopic rotator cuff repair. Few reports have addressed this dreaded complication although the costs are high both for the patient and for society. The aim of this prospective study was to describe incidence, treatment and outcome after acute postoperative infections following arthroscopic rotator cuff repair. Method. Patients undergoing arthroscopic rotator cuff repair in our department have been prospectively registered since 2009. 11 out of 1072 patients undergoing surgery developed an acute postoperative infection. The patients were examined with an MRI scan and/or functional scores (Constant Murley (CM) and WORC) at final follow-up. Results. All 11 patients that developed acute postoperative infections were male. Mean age was 54 (41–68) years. Except for male gender, no common underlying predisposing risk factor for infection could be identified. 1/11 patient had diabetes mellitus and 2/11 smoked. Average BMI was 27 (21–36). 1/11 was categorized as ASA 3 and the rest of the patients were ASA 1 and 2. All patients underwent arthroscopic debridement and biopsies were collected 26 (14–50) days after primary surgery. In 10 patients Propionibacterium acnes was cultured, and 6 of these patients also had positive cultures for coagulase negative staphylococci. In the remaining patient only coagulase negative staphylococcus was cultured. 5/11 patients were treated with one arthroscopic debridement, 5/11 had two arthroscopic debridements, whereas 1/11 required arthroscopic debridement four times before the infection was eradicated. Only 2/11 patients had to have their implants removed during the reoperation due to loosening of the suture anchors. All 11 patients were treated with parenteral antibiotics for 7–28 days, followed by oral treatment for 1–5 weeks, and all infections had resolved at final follow-up. Median CM score was 84 and median WORC score was 81% at follow-up median 22(11–28) months. 10 patients had a postoperative MRI scan after median 23 (3–49) months, 8 of them showing a healed cuff repair. Conclusions. Acute postoperative infections after arthroscopic rotator cuff repair can be eradicated with arthroscopic debridement(s) and removal of implants may not be necessary if patency is adequate. Despite the postoperative acute infection our patients presented good functional results and were satisfied at last follow-up

Infection is a complication in hip arthroplasty. It increases mortality and morbidity and is a cause for patient's dissatisfaction. Previous Works report an infection rate between 0,4% e 1,5% in primary hip replacement and between 3,2% in revision hip replacement. The aim of this work was to access the infection rates in one hospital, compare them with the reported rates and investigate possible risk factors for infection. Electronic clinical records were consulted. Patients who underwent total hip arthroplasty (primary or revision) or hemiarthroplasty in one hospital, between the 1st February 2011 and 31st February 2013, were included. Two hundred and sixty one patients (267 surgeries) were included. Demographically, 57,5% were female patients and 42,5% were male patients with an average age of 77,1 years (± 12,3 years). Infection rate for hemiarthroplasty 3,1%, for primary total hip arthroplasty was 1,4% and for revision procedures 4,8%. A statistically significant relation was found between arthroplasty infection and superficial wound infection (p<0,001), wound dehiscence (p<0,001), and surgery performed during summer months (p<0,05). No relation was found with duration of the surgery or the hospital stay or the patient's comorbidities. The infection rate is similar to the rate reported in other clinical centres. Superficial wound complications are a good predictor for arthroplasty infection, so it is important to diagnose and start prompt appropriate management and vigilance. The increase in infection rates in summer months may be related to higher operating room temperature or less routined personal. We concluded, therefore, that infection is a complication in hip arthroplasty being prevention is a key feature when arthroplasty is performed, as well as clinical vigilance for infection signs

Because life expectancy is increasing, the number of primary knee arthroplasties performed is projected to increase 673% by 2030, according to Westrich et al. Also, Toulson et al. in a recent study predict that the incidence of deep infection associated with primary total knee arthroplasty ranges from 1% to 2%. Periprosthetic knee infection is one of the most dramatic and difficult to manage complications following total knee arthroplasty. Therefore, periprosthetic knee infection will continue to be a significant complication and an economic burden in the future. Our objective was to identify the risk factors that may provide greater likelihood of infection and thus select high-risk patients and to take maximum prevention strategies. Case-control study, between infected and non infected patients, undergoing primary total knee arthroplasty between January 2008 and January 2013. The risk factors evaluated were: duration of hospital stay, surgery duration, prophylactic antibiotics and timing for administration, volume of blood transfusion, autologous blood recovery system use, anesthetic technique, ASA classification, Diabetes Mellitus, Obesity (BMI>30), immunosuppression and history of any infection in the month preceding surgery. The presence of infection was defined by the criteria of the Center for Disease Control for Nosocomial Surgical Site Infections1. Statistical analysis IBM SPSS Statistics 20 (Fisher's exact test, Mann-Whitney U test and Student's t-test). Statistical significance for p ≤ 0.05. We evaluated 540 patients with a mean follow-up of 56 months. We identified 21 deep infections (3,8%), and 35 superficial wound infections and found a positive correlation between infection and obesity (p <0.01), immunosuppression (p <0.01), volume of blood transfusion (p=0.02), history of any infection in the month preceding surgery (p <0.01). We found a negative correlation with the use of a autologous blood recovery system (p <0.01). Other factors, commonly referred in the literature, showed no association or did not reach statistical significance. The incidence of periprosthetic knee infection after primary total knee arthroplasty stays high. The presence of obesity, immunosuppression, blood transfusion, history of any infection in the month preceding surgery were identified as significant risk factors for infection to occur. The identification, modification or eviction of the risk factors implied are essential to reduce and prevent infection in arthroplasty

Wound ooze is common following Total Knee Arthroplasty and persistent wound ooze is a risk factor for infection, increased length and cost of hospitalisation. We undertook a prospective study to assess the effect of tourniquet time, periarticular local anaesthesia and surgical approach on wound oozing after TKA. The medial parapatellar approach was used in 59 patients (77%) and subvastus in 18 patients (23%). Periarticular local anaesthesia (0.25% Bupivacaine with 1:1000000 adrenalin) was used in 34 patients (44%). The mean tourniquet time was 83 minutes (range 38 to 125 minutes). We found a significant association between cessation of oozing and periarticular local anaesthesia (P = 0.003), length of the tourniquet time (P = 0.03) and the subvastus approach (P = 0.01). Periarticular local anaesthesia, the subvastus approach and shorter tourniquet time were all associated with less wound oozing after total knee arthroplasty

Arthroplasty is a successfulsurgical procedure which provides returning daily activities by relieving pain, correcting deformity, and regaining the loss of ROM which is caused by many diseases such as degenerative arthritis when conservative and other surgical techniques fail to achieve. Successful outcomes depend on many variables at arthroplasty. Proper indication, careful selection of patient, adequate surgical technique and postoperative rehabilitation plays a major role. Despite successful outcomes achieved at arthroplasty, undesired complications can be frustrating for the patient and the surgeon. These complications can be minimized by careful preoperative planning, meticulous surgical procedure and rigorius postoperative care. Infection is the most frequent and most effective complication on outcomes after arthroplasty. Because of that, risk factors for infection must be researched carefully and minimized preoperatively. Antibiotic prophylaxis is routinely suggested before the surgery. Using routine irrigation as well as the standard surgical technique is effective for decreasing postoperative infection rates. Antibiotic impregenated cement is used especially at revision arthroplasties and should be used at primary surgery at high risk groups. In this study we evaluated 19 patients which admitted to Gulhane Military Academy of Medicine, Department of Orthopedics and Traumatology betwen 2007 and 2012. 5 patients had total hip arthroplasty (26.32%), 11 patients had total knee arthroplasty (57.89%) and 3 patients had hip hemiarthroplasty after femoral neck fractures. 14 of the patiens were female (73.68%) and 5 were (26,32%). Mean age was 69.74 (53–83). Primary surgery was held at our institution at 14 of the patients and 5 patients were referred from other instutitions because of their complaints.6 of the knees were right-sided and 5 of them was left-sided. 3 of the totap hips were left-sided and 2 of them was right-sided. 1 of the hip hemiarthroplasties were left-sided and 2 of them was right-sided. 42.11%of the patients were treated medically and 47.37%were treated with two staged surgery. 42.11%of the surgically treated group were healed completely and 5.26%of the patients passed away due to other comorbidities. Wound debridement was applied 10.53%of the patients which were admitted at early phase and resection arthroplasty was applied 5.26%of these patients because of the lack of response to medical and surgical debridement. With these results, patients with infected prosthesis can present with many different symptoms and infection risk must always be considered. It must be remembered that the onset time of infection is very important during diagnosis and treatment. Follow ups and treatment protocols must be standardized by clinics as algorithms. During the treatment the surgeon must be in close contact with infectious diseases and microbiology departments. Especially by new developing techniques during the recent years, spesific agents of the infection can be determined and spesific antibiotics can be used for the treatment

Aims

Orthopaedic infection is a potentially serious complication of elective and emergency trauma and orthopaedic procedures, with a high associated burden of morbidity and cost. Optimization of vitamin D levels has been postulated to be beneficial in the prevention of orthopaedic infection. This study explores the role of vitamin D in orthopaedic infection through a systematic review of available evidence.

The total hip arthroplasty (THA) is an effective operation for the restoration of the hip function. The number of operations is steadily climbing and is going to reach new heights in the future. The most devastating complication is the deep infection of the joint and has to be treated with a total revision of the prostheses. The risk factors for an infection play a very important role in the preoperative assessment of the patient and for the antibiotic treatment. There are many different opinions on which risk factors are associated with the development of a deep infection in the literature. Our goal was to analyze and find the risk factors, which matter most in the clinical treatment of patients. We searched the database “PubMed” and “Embase” with the keywords: „(((hip AND infection)) AND (arthroplasty OR replacement)”. With the help of check lists and limits we extracted the most viable studies for our research. Risk factors associated with a deep infection included the BMI (Body mass index), male gender, prolonged duration of surgery, diabetes mellitus type 2, the ASA (American society of anesthesiologists) score, the Charlson score and the NNIS (National Nosocomial Infections Surveillance System) risk index score. Female gender, age and the diagnosis of rheumatoid arthritis were not associated with deep infections. Patients with risk factors should be assessed preoperatively and receive an appropriate prophylactic antibiotic treatment, to reduce the risk of a deep infection. With the reduction of their weight and adjustment of the diabetes, patients can reduce the risk for infection by their own. Total hip replacement is still a safe and effective operation and thus should not be withheld from patients

Aims

The new COVID-19 variant was reported by the authorities of the UK to the World Health Organization (WHO) on 14 December 2020. We aim to describe the clinical characteristics and nosocomial infection rates in major trauma and orthopaedic patients comparing the first and second wave of COVID-19 infection.

Infection and re-fracture are well-described complications following open paediatric forearm fractures. The purpose of this paper is to determine if patient, injury, and treatment characteristics can be used to predict the occurrence of these complications following the surgical management of paediatric open forearm fractures. This is an IRB-approved retrospective review at a single-institution paediatric level 1 trauma centrefrom 2007–2013 of all open forearm fractures. Medical records were reviewed to determine the type of open fracture, time to administration of initial antibiotics, time from injury to surgery, type of fixation, length of immobilisation, and complications. Radiographs were studied to document fracture characteristics. 262 patients with an average age of 9.7 years were reviewed. There were 219 Gustillo-Anderson Type 1 open fractures, 39 Type 2 fractures, and 4 Type 3 fractures. There were 9 infections (3.4%) and 6 re-fractures (2.3%). Twenty-eight (10.7%) patients returned to the operating room for additional treatment; 21 of which were for removal of implants. Contaminated wounds, as documented within the medical record, had a greater chance of infection (21% vs 2.2%, p=0.002). No difference in infection rate was seen with regard to timing of antibiotics (p=0.87), timing to formal debridement (p=0.20), Type 1 versus Type 2 or 3 open fractures (3.4% vs 5.0%, p=0.64), 24 hours vs. 48 hours of post-operative IV antibiotics (5.2% vs 3.5%, p=0.53), or when comparing diaphyseal, distal, and Monteggia fracture patterns (3.6 vs 2.9% vs 5.9%, p=0.81). There was no difference in infection rate when comparing buried or exposed intramedullary implants (3.5% vs 4.2%, p>0.99). Rate of re-fracture was not increased based on type of open wound (p>0.99) or fracture type (0.4973), although 5 of the 6 re-fractures were in diaphyseal injuries. In this series of open paediatric both bone forearm fractures, initial wound contamination was a significant risk factor for subsequent infection. The rate of infection did not vary with timing of antibiotics or surgery, type of open fracture, or length of post-operative antibiotics. A trend to higher re-fracture rates in diaphyseal injuries was noted. Surgeons should consider planned repeat irrigation and debridement for open forearm fractures with obviously contaminated wounds to reduce the subsequent infection risk

BACKGROUND. Periprosthetic infection is the most challenging complication following total knee arthroplasty (TKA). Poor oral hygiene has been assumed as an important risk factor for TKA infection. We aimed to investigate whether the improvement of oral hygiene through dental scaling could reduce the risk of TKA infection. METHODS. A nested case control study was conducted and enrollees in the National Health Insurance Research Database (NHIRD) aged above 40 years who had received total knee arthroplasty (TKA) between 1999–2002 were included as the TKA cohort. The cases were patients who underwent resection arthroplasty for infected TKA, and each case was matched by 4 controls from the TKA cohort by gender, using incidence density sampling method. The frequency of dental scaling before the index date was analyzed and compared between the case and the control groups. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. RESULTS. The percentages of patients who ever received dental scaling before the end of follow-up were higher in the control group than that in the TKA infection group. As compared with patients never received dental scaling, there was a trend that patients who received dental scaling once within 2 years, may have 9% lower risk in TKA infection (adjusted odds ratio, 0.91; 95% confidence interval, 0.76–1.08). Moreover, the risk of TKA infection can be reduced significantly in patients who had dental scaling at least once per year, with an odds ratio of 0.71 (95% confidence interval, 0.53–0.95). CONCLUSIONS. Improvement of oral hygiene by more frequent and regular dental scaling (at least once per year) may reduce the risk of TKA infection. TKA Patients should be advised to check their oral hygiene regularly