Knee arthrodesis is a potencial salvage procedure for limb preservation in patients with multiple failures of Total Knee Arthroplasty (TKA) with massive bone loss and extensor mechanism deficiency. The purpose of the study is to evaluate the outcome of bridging knee arthrodesis using a modular and non cemented intramedullary nail in patients with septic failure Total Knee Arthroplasty. Between 2005 and 2013 (9 years), 15 patients (13 female and 2 male) with mean age 71.1 years (range 41 to 85) were treated at our Institution with septic two- stage knee arthrodesis using a modular and non- cemented intramedullary nail after multiple failures of septic Total Knee Arthroplasty. Mean follow- up was 70.1 months (24 to 108 months) with a minimum follow- up of 24 months. We evaluated the erradication of infection clinically and with normalization of laboratory parameters (ESR and CRP), limb length discrepancies and complications (periimplant fractures, amputation rates, wound healing disturbances) and the subjective evaluation of the patients after knee arthrodesis. We reported 11 cases of resolution of the infection (73.3 %), with good tolerance of the implant and a mean limb length discrepancies of 15 mm. Of these, 8 patients had been monitored over 5 years without recurrence of the infection. The mean number of previous operations was 4.9 (range 2 to 9). Two patients (13.3 %) required multiples surgical debridements for uncontrolled sepsis and finally underwent knee amputation. Coagulase- negative Staphylococci (SCN) were the most commom pathogen (53.3 %) followed by polimicrobian infections (26.7 %). One patient continues suppressive antibiotic treatment and 1 patient was treated with a one- stage custom- made arthrodesis nail exchange. Bridging knee arthrodesis using a modular and non- cemented intramedullary nail is a salvage procedure with acceptable results in terms of erradication of infection after septic faliure Total Knee Arthroplasty with restoration of limb length discrepancy. Despite these satisfactory results it is not without serious complications such as knee amputation

The aim of this work is to present a clinical case of wrist arthroplasty failure due to chronic infection and try to discuss and draw a therapeutic approach (algorithm) for similar cases taking in consideration the degree of osteolysis, the presence of detachment and inherent instability and the condition of the soft tissues.

The authors report a case of an individual, male, 58 years old, manual worker, that appears with pain and inflammatory signs on right wrist arthroplasty, with fistulous track. The revison procedure was performed in 2 stages: the first stage revision consisted on removal the implant, debridement and interposition of cement spacer with antibiotics and immobilization, the second stage revision a radio-metacarpal arthrodesis with plate and interposition of autologous graft harvested.

The improvement of the implants in recent years have contributed to the increasing use of arthroplasty as a treatment option with good results. Although it presents itself with an attractive option in terms of future functional capabilities, arthroplasty remains with some risks and have a higher rate of complications in the medium and long term than fusion, so the selection of patients should be careful. The main problem of wrist arthroplasty revision is due to bone stock loose to promote fusion and the shortening after implant removal.

At 1,5 years follow-up, we denote a higher patient satisfaction, without pain, radiological fusion and 28 points in DASH score

The success of wrist arthroplasty depends on careful patient selection, careful preoperative planning, rigorous technique and an appropriate program of functional rehabilitation. The wrist arthrodesis can always be seen as an ultimate salvation procedure in the treatment of failure of wrist arthroplasty, either a mechanical or infectious failure.

Aim. The cut-off values for synovial fluid leukocyte count and neutrophils differential (%PMN) for differentiating aseptic from septic failure in total knee arthroplasties were already defined in the past. Our goal was to determine the cut-off values for synovial fluid leukocyte count and %PMN in failed total hip arthroplasties (THA). Method. Patients undergoing revision THA were prospectively included. In perioperative assessment phase, synovial fluid leukocyte count and %PMN were determined. During the surgery, at least 4 intraoperative samples for microbiological and one for histopathological analysis were obtained. Infection was defined as presence of sinus tract, inflammation in histopathological samples, and ≥2 tissue and/or synovial fluid samples growing the same microorganism. Exclusion criteria were systemic inflammatory diseases, revision surgery performed less than 3 months from index surgery and insufficient tissue sampling. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance and Youden's J statistic was computed to identify optimal cut-off values. Results. During the study period (between June 2006 and June 2011) 227 revision THAs were performed by the senior author. 31 patients were excluded. 196 patients (mean age, 69 years; 68% females) with THA failure were included. Aseptic failure was diagnosed in 150 patients (76,5%) and THA infection was diagnosed in 46 patients (23,5%). Synovial fluid leukocyte counts were significantly higher in the infected group (median, 5.50×10. 6. leukocytes/ml range, 0.05 to 143.9×10. 6. leukocytes/mL) than in the aseptic group (median, 0.23×10. 6. cells/ml; range, 0 to 21.3×10. 6. leukocytes/ml, P<0,0001). The %PMN was also significantly higher in the infected group (median, 83%; range, 6% to 97%) than in the aseptic group (median, 27,5%; range, 0% to 94%, P<0,0001). A synovial fluid leukocyte count of > 1.54×10. 6. leukocytes/ml, had a sensitivity of 63%, specificity of 95%, positive and negative predictive values of 78% and 89%, respectively. A synovial fluid %PMN of > 64%, had a sensitivity of 65%, specificity of 93%, positive and negative predictive values of 73% and 90%, respectively. Conclusion. The synovial fluid leukocyte count of > 1.54×10. 6. leukocytes/ml and %PMN of > 64% are useful and reliable tests for excluding THA infection, having a negative predictive value of around 90%. This tests and calculated cut-off values are highly recommended in the diagnostic process of failed THAs

We retrospectively reviewed 161 revision THAs with diaphyseal fitting, mid- modular femoral components performed by ten surgeons at two academic medical centers. The average follow-up was 6.1 years. At final follow-up, 4 patients required re-revision for failure of the femoral component; 3 (2%) for aseptic loosening and 1 for mechanical failure of stem in setting of periprosthetic fracture. There were a total of 24 (14.9%) revisions for any reason, with the most common reason being septic failure (10 of 24). To our knowledge, this is the largest reported series of mid-term survivorship and complications of revision THA with mid-modular femoral components. Our results show that these stems have a low rate of aseptic loosening, subsidence, and mechanical failure

Aim. Femoral or tibial massive bone defects (AORI F2B-F3 / T2B-T3) are common in septic total knee replacement. Different surgical techniques are described in literature. In our study we show clinical and radiological results associated with the use of tantalum metaphyseal cones in the management of cavitary bone defects in two-stage complex knee revision. Method. Since 2010 we have implanted 70 tantalum metaphyseal cones associated with constrained or semiconstrained knee prostheses in 47 patients. The indication for revision was periprosthetic knee infection (43 cases, 91.5%) or septic knee arthritis (4 patients, 8.5%) with massive bone defect. All cases underwent a two-stage procedure. Patients were screened for main demographic and surgical data. Clinical and radiological analysis was performed in the preoperative and at 3,6 months, 1 years and each year thereafter in the postoperative. The mean follow-up was 31.1 months ± 18.8. No dropout was observed. Results. Objective and subjective functional scores (KSS, OKS) showed a statistically significant improvement from the preoperative to last follow-up (p <0.001). All cones but one (98.6%) showed radiological osteointegration. We did not find any cone-related intraoperative or postoperative mechanical complication with a 100% survival rate when we consider aseptic loosening as cause of revision. Six non progressive radiolucencies were observed. Two septic failures (4.3%) with implant and cone removal were reported. Conclusions. The ideal treatment for cavitary bone defects in two-stage TKA septic revision is still unclear. The use of metaphyseal tantalum cones showed excellent clinical and radiographic results with a low rate of related complications. The main finding of our study is the cone-related infection rate (2.9%) in this particular series of patients. This data is comparable or better than other previous report about this topic with unhomogeneous cohort of patients

Aim. Periprosthetic joint infections are a devastating complication after modular endoprosthetic reconstruction following resection of a musculoskeletal tumour. Due to long operating times, soft tissue dissection and immunosuppression, the infection rate after limb salvage is high and ranges between 8% and 15%. The aim of this retrospective single centre study was to assess the reinfection and re-reinfection rate after septic complications of megaprostheses. Method. In this retrospective study, 627 patients with a primary replacement of a musculoskeletal tumour of the lower limb and reconstruction by a megaprosthesis were recorded from 1983 – 2016. 83 out of 621 patients available for follow-up experienced an infection (13.4%). Two patients were treated with debridement and removal of the mobile parts, 61 patients with a one-stage revision, 16 patients with a two-stage revision, and 4 patients with an amputation. The mean follow up was 133 months (range: 2 – 423 months). Results. The reinfection rates after debridement, one-stage revision, two-stage revision, and amputation were 100% (CI 95%: 20 −100%), 49% (CI 95%: 36 – 62%), 38% (CI 95%: 6 – 76%), and 0%, respectively. A reinfection occurred after a mean of 38,7 months (range: 0 to 201 months). The most commonly isolated microorganisms were coagulase negative Staphylococci, followed by Staphylococcus aureus. A re-reinfection occurred in 100% after debridement, in 44% (CI 95%: 22 – 69%) after one-stage revision, in 55% (CI 95%: 31 – 91%) after two-stage revision, and 0% after amputation. Regarding two-stage revision, there was a statistically significant difference in infection rates between patients treated with complete removal of the megaprosthesis and patients with at least one retained component (Fisher's exact test, p = 0.027). Conclusions. Septic failures after megaprosthesis reconstruction of a musculoskeletal tumour of the lower limb are difficult to treat and show high reinfection and re-reinfection rates. A two-stage revision with removal of all components showed the best results among limb salvage procedures for periprosthetic megaprosthesis infection

Among the most critical factors to reducing the risk of infection include the use of pre-incisional antibiotics, appropriate skin preparation with clippers (as opposed to a razor for hair removal) and the use of an alcohol-based skin preparation. Host factors are also likewise critically important including obesity, diabetes, inflammatory arthritis, renal insufficiency, skin disorders and patients who are otherwise immune-compromised. If modifiable risk factors are identified, it would seem reasonable to delay elective surgery until these can be optimised. One other factor to consider is the nutritional status of the patient. In a study of 501 consecutive revisions, we found that serological markers suggestive of malnutrition (albumin, transferrin or total lymphocyte count) were extremely common. Specifically, 53% of patients who presented for treatment of a chronic infection had at least one marker for malnutrition, compared to 33% in the group of patients undergoing revision for an aseptic reason. Malnutrition was found to be an independent risk factor for septic failure (p < 0.001 and OR 2.1). Interestingly, malnutrition was most common among patients of normal weight but was also common among obese patients (so-called “paradoxical” malnutrition). What was more disturbing, however, was that of those patients undergoing an aseptic revision, serum markers of malnutrition were associated with a 6× risk of acute post-operative infection complicating the patient's aseptic revision. We have confirmed this association using the NSQIP database where hypoalbuminemia was associated with a higher risk of infection, pneumonia and readmission. At our center, we also have studied the use of dilute betadine at the end of the case, prior to wound closure, in an attempt to decrease the load of bacteria in the wound. In a retrospective review the prevalence of acute post-operative infection was reduced from just under 1% (18/1862) to 0.15% (1 of 688; p = 0.04). It is critical that the betadine utilised be STERILE and the dilution we use is 0.35% made by diluting 17.5cc of 10% povidone-iodine paint in 500cc of normal saline

Aim. The aim of the study was to assess the accuracy of the alpha defensin lateral flow test for diagnosis of periprosthetic joint infection (PJI) using an optimized diagnostic algorithm and three classification systems. In addition, we compared the performance with synovial fluid leukocyte count, the most sensitive preoperative test. Method. In this prospective multicenter study we included all consecutive patients with painful prosthetic hip and knee joints undergoing diagnostic joint aspiration. Alpha defensin lateral flow test was used according to manufacturer instructions. The following diagnostic criteria were used to confirm infection: Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA) and Swiss orthopedics and Swiss Society of Infectious Diseases (SOSSID). In the latter, PJI was confirmed when at least one of following criteria applied: macroscopic purulence, sinus tract, positive cytology of joint aspirate (>2000 leukocytes/μl or >70% granulocytes), histological proof of acute inflammation in periprosthetic tissue, positive culture (from aspirate, tissue or sonication fluid). Infection was classified as chronic, if symptom duration was more than 3 weeks or if infection manifested after more than 1 month after surgery. The sensitivity and specificity of the alpha defensin lateral flow test and leukocyte count in synovial fluid were calculated and compared using McNemar Chi-square test. Results. Of 151 included patients evaluated for painful prosthetic joints (103 involved knees, 48 hips), the median patient age was 69 years (range, 41–94 years) and 75 patients were female. Systematically evaluating the included patients according to the different diagnostic criteria, MSIS and IDSA revealed both 33 patients with PJI (22%), whereas SOSSID disclosed 47 septic failures (31%), among them 36 chronic infections (77%). Sensitivity of the test was 79% when applying MSIS criteria, 70% with IDSA criteria and 57% with SOSSID criteria. Specificity ranged from 96% (IDSA) to 98% (MSIS) and 99% (SOSSID). Applying the most stringent definition criteria (SOSSID), leukocyte count showed significantly higher sensitivity than the alpha defensin lateral flow test (91% vs. 57%, p<0.001), especially in chronic infections (88% vs. 48%, p<0.001.) In acute infections, both tests detected all infection cases. Processing turnaround time was shorter in Alpha defensin lateral flow test than automated leukocyte count (10 min vs. 2–4 hours). Conclusions. Semi-quantitative alpha defensin test was rapid and highly specific for diagnosing PJI (> 95%). However, sensitivity was limited, especially when applying definition criteria including also low grade infections (SOSSID criteria). Therefore, the alpha defensin lateral flow test does not allow a reliable exclusion of PJI, especially not in chronic infections but may be used as confirmatory test

Minimizing the risk of periprosthetic joint infection (PJI) is of interest to all surgeons performing hip and knee arthroplasty. Among the most critical factors to reducing the risk of infection include the use of pre-incisional antibiotics, appropriate skin preparation with clippers (as opposed to a razor for hair removal) and the use of an alcohol-based skin preparation. Host factors are also likewise critically important including obesity, diabetes, inflammatory arthritis, renal insufficiency, skin disorders and patients who are otherwise immune-compromised. If modifiable risk factors are identified, it would seem reasonable to delay elective surgery until these can be optimised. One other factor to consider is the nutritional status of the patient. In a study of 501 consecutive revisions, we found that serological markers suggestive of malnutrition (albumin, transferrin or total lymphocyte count) were extremely common in the revision population. Specifically, among patients who presented for treatment of a chronic infection, 53% (67 of 126) had at least one marker for malnutrition. The prevalence of serological markers of malnutrition was lower (33%) in the group of patients undergoing revision for an aseptic reason suggesting that malnutrition was a risk factor for septic failure (p < 0.001 and OR 2.1). Interestingly, malnutrition was most common among patients of normal weight but was also common among obese patients (so-called “paradoxical” malnutrition). What was more disturbing, however, that of those patients undergoing an aseptic revision, serum markers of malnutrition were associated with a 6x risk of acute postoperative infection complicating the patient's aseptic revision. At our center, we also have studied the use of dilute betadine at the end of the case, prior to wound closure, in an attempt to decrease the load of bacteria in the wound. In a retrospective review the prevalence of acute postoperative infection was reduced from just under 1% (18/1862) to 0.15% (1 of 688; p = 0.04). It is critical that the betadine utilised be STERILE and the dilution we use is 0.35% made by diluting 17.5cc of 10% povidone-iodine paint in 500cc of normal saline. Although this is a retrospective review, it does suggest a benefit and we have not seen any problems associated with its use

Dislocation is a particular problem after total hip replacement in femoral neck fractures and elderly especially female patients. The increased rate of dislocation in this population is probably due to significant ligamentous laxity in these patients and poor coordination and proprioception. Another population of patients with increased propensity for dislocation is the revision hip replacement patient. Current dislocation rates in these patients can approach 10% with conventional implant systems. The Dual Mobility total hip system is composed of a cobalt chrome acetabular shell with a grit blasted, beaded and/or hydroxyapatite coating to improve bone ingrowth. The polyethylene liner is highly cross-linked polyethylene and fits congruently into the cobalt chrome shell and acts like a large femoral head (usually >40mm). The femoral head attached to the trunnion is usually 28mm or 32mm. The femoral head snaps into the polyethylene liner to acts as a second protection against dislocation. Indications for the Dual Mobility socket are in the high risk for dislocation patient and particularly in elderly female patients. One hundred fifty-six patients with an average age of 79 have been performed to date with a maximum follow up to 4.2 years. To date there have been no mechanical or septic failures and no dislocations. Pain relief has been no different than conventional hip replacement and range of motion is unchanged as well. There have been reported cases of intraprosthetic dislocation but these have not occurred to date

Minimizing the risk of periprosthetic joint infection (PJI) is of interest to all surgeons performing hip and knee arthroplasty. Among the most critical factors to reducing the risk of infection include the use of pre-incisional antibiotics, appropriate skin preparation with clippers (as opposed to a razor for hair removal) and the use of an alcohol-based skin preparation. Host factors are also likewise critically important including obesity, diabetes, inflammatory arthritis, renal insufficiency, skin disorders and patients who are otherwise immune-compromised. If modifiable risk factors are identified, it would seem reasonable to delay elective surgery until these can be optimised. One other factor to consider is the nutritional status of the patient. In a study of 501 consecutive revisions, we found that serological markers suggestive of malnutrition (albumin, transferrin or total lymphocyte count) were extremely common in the revision population. Specifically, among patients who presented for treatment of a chronic infection, 53% (67 of 126) had at least one marker for malnutrition. The prevalence of serological markers of malnutrition was lower (33%) in the group of patients undergoing revision for an aseptic reason suggesting that malnutrition was a risk factor for septic failure (p < 0.001 and OR 2.1). Interestingly, malnutrition was most common among patients of normal weight but was also common among obese patients (so-called “paradoxical” malnutrition). What was more disturbing, however, that of those patients undergoing an aseptic revision, serum markers of malnutrition were associated with a 6× risk of acute post-operative infection complicating the patient's aseptic revision. At our center, we also have studied the use of dilute betadine at the end of the case, prior to wound closure, in an attempt to decrease the load of bacteria in the wound. In a retrospective review the prevalence of acute post-operative infection was reduced from just under 1% (18/1862) to 0.15% (1 of 688; p = 0.04). It is critical that the betadine utilised be STERILE and the dilution we use is 0.35% made by diluting 17.5 cc of 10% povidone-iodine paint in 500 cc of normal saline. Although this is a retrospective review, it does suggest a benefit and we have not seen any problems associated with its use

The presentations to be discussed by the panel are: 1.) No Increased Risk of Knee Arthroplasty Failure in Metal Hypersensitive Patients: A Matched Cohort Study; 2.) Knee Arthrodesis is Most Likely to Control Infection and Preserve Function Following Failed 2 Stage Procedure for Treatment of Infected TKA: A Decision Tree Analysis; 3.) Does Malnutrition Correlate with Septic Failure of Hip and Knee Arthroplasties?; 4.) Diagnosing Periprosthetic Joint Infection: The Era of the Biomarker Has Arrived; 5.) Are Patient Reported Allergies a Risk Factor for Poor Outcomes in Total Hip and Knee Arthroplasty?; 6.) Revising an HTO or UKA to TKA: Is it more like a Primary TKA or a Revision TKA?; 7.) At 5 Years Highly-Porous-Metal Tibial Components Were Durable and Reliable: A Randomised Clinical Trial of 389 Patients; 8.) Current Data Does Not Support Routine Use of Patient-Specific Instrumentation in Total Knee Arthroplasty; 9.) Barbed vs. Standard Sutures for Closure in Total Knee Arthroplasty: A Multicenter Prospective Randomised Trial; 10.) Particles from Vitamin-E-diffused HXL UHMWPE Induce Less Osteolysis Compared to Virgin HXL UHMWPE in a Murine Calvarial Bone Model; 11.) Construct Rigidity: Keystone for Reconstructing Pelvic Discontinuity; 12.) Do You Have to Remove a Corroded Femoral Stem?; 13.) Direct Anterior Versus Mini-Posterior Total Hip Arthroplasty with the Same Advanced Pain Management and Rapid Rehabilitation Protocol: Some Surprises in Early Outcome; 14.) Adverse Clinical Outcomes in a Primary Modular Neck/Stem System

Objectives. The appropriate treatment for chronically infected TKR is controversial. One-stage exchange is believed to be possible only in selected cases, but the respective indications and contra-indications and the criteria of selection are not fully validated. We wanted to test the relevance of the commonly used selection criteria by comparing two groups of patients: the control group operated on with a routine one-stage exchange without selection criteria, and the study group operated on by one stage exchange on selected patients only. We hypothesized that selected one-stage exchange gives fewer failures than routine one-stage exchange procedure. Methods. We performed a retrospective study of 108 cases selected in a database of 600 patients with an infected total knee arthroplasty. The database resulted from a French multicenter trial of specialized surgeons in reference institutions, including all consecutive cases operated on between 2000 and 2010. There were 64 women and 44 men with a mean age of 69 years. All patients were followed-up for a minimal period of two years or when septic failure occurred. The patients were divided into two groups: patients operated on in a center using a routine one-stage exchange policy, and patients operated on in a center using a selected one-stage exchange policy. Patients were matched in the two groups according to body mass index and the aspect of the wound at the initial examination (one scar, several scars, presence of a fistula). The results were expressed as: free of infection, relapse or persistence of the index infection, occurrence of a new infection. The repartition was compared in the two groups by a Chi² test at a 0.05 level of significance. The cumulative survivorship was plotted with infection recurrence for any reason as the end point. Results. The two groups were comparable for age, gender, previous procedures, microorganisms and other risk factors. One stage exchange was successfully completed in all cases. 77% of the patients were considered infection free at the last examination. There was no difference in the failure rate between the two groups. No prognostic factor could be validated. Among the 23% failure cases; 8% were considered as failures by relapse or persistence of the index infection, and 15% by occurrence of a new infection: there was no difference of this repartition between the two groups. The 5-year survival rate was 68%, and no difference was observed between the two groups. No prognostic factor could be validated. Among the 23% failure cases; 8% were considered as failures by relapse or persistence of the index infection, and 15% by occurrence of a new infection: there was no difference of this repartition between the two groups. Conclusion. The use of the generally validated selection factors to decrease the failure rate after one stage exchange for chronically infected total knee replacement was not effective. Routine one stage exchange may be used for any clinical case without increasing the failure rate

The Osteoprotegerin/RANK/RANKL system has been implicated in the biological cascade of events initiated by particulate wear debris and bacterial infection resulting in periprosthetic bone loss around loosened total hip arthroplasties (THA). Individual responses to such stimuli may be dictated by genetic variation and we have studied the effect of single nucleotide polymorphisms (SNPs) within these genes. We performed a case control study of the Osteoprotegerin, RANK and RANKL genes for possible association with deep sepsis or aseptic loosening. All patients included in the study were Caucasian and had had a cemented Charnley THA and polyethylene acetabular cup. Cases consisted of 91 patients with early aseptic loosening and 71 patients with microbiological evidence at surgery of deep infection. Controls consisted of 150 THAs that were clinically asymptomatic for over 10 years and demonstrated no radiographic features of aseptic loosening. DNA samples from all individuals were genotyped using Taqman allelic discrimination. The A allele (p<0.001) and homozygous genotype A/A (p<0.001) for the OPG-163 SNP were highly associated with aseptic failure. Additionally, the RANK-575 (C/T SNP) T allele (p=0.004) and T/T genotype (p=0.008) frequencies were associated with aseptic failure. No statistically significant relationship was found between aseptic loosening and the OPG- 245 or OPG-1181 SNPs. When the septic group was compared to controls, the frequency of the A allele (p<0.001) and homozygous genotype A/A (p<0.001) for the OPG-163 SNP were statistically significant. No statistically significant relationship was found between septic failure and the OPG- 245, OPG-1181 or RANK-575 SNPs. Aseptic loosening and possibly deep infection of THA may be under genetic influence to candidate susceptibility genes. SNP markers may serve as predictors of implant survival and aid pharmacogenomic prevention of THA failure

Introduction:. Deep infection after total joint arthroplasty is a devastating complication with reported incidence of 1–3% with projection to increase to 6.8% by 2030. The direct costs of revision surgery due to septic failure are estimated at over $55,000 per case. Antibiotic-Loaded Bone Cement (ALBC) has been proposed as a preventive measure to decrease post-operative infection rates. Its efficacy has been compared with plain bone cement (PBC) in multiple studies. There has been no study to our knowledge examining its efficacy in “high risk” patients. The purpose of this study is to compare infection rates in three cohorts of patients: (1) all patients receiving only PBC, (2) all patients receiving only ALBC, and (3) only “high risk” patients receiving ALBC. Methods:. A standard cement protocol was instituted at our hospital for primary total knee arthroplasties (pTKA). From January 2000 to 2005 all pTKAs were performed with PBC. From February 2005 to May 2010, all pTKAs were performed with ALBC. From June 2010 to March 2012, all patients received regular bone cement unless they had previous diagnoses of rheumatoid arthritis, obesity, and/or diabetes mellitus. Our institutional joint registry was queried and the three cohorts' individual charts were retrospectively reviewed. Infection rates amongst cohorts were compared at 30 days, 6 months, and 1 year from index surgery date utilizing two sided proportion tests. Results:. A total of 3,292 consecutive primary TKAs with full follow up were included. Overall infection rate at one year for the entire study was 0.76%. There were 1,025 patients who received PBC, 1486 ALBC, and 781 in the risk stratified cohort. The 30-day infection rates for cohorts 1, 2, 3 were .0.29%, 0.20%, and 0.13% respectively. The 6-month infection rates for cohorts 1, 2, 3 were 0.39%, 0.54% and 0.38% respectively. The 1-year infection rate for cohorts 1, 2, 3 were 0.78%, 0.61%, and 0.64% respectively. The differences in infection rates between each cohort at all three time intervals were not statistically significant. Conclusions:. Antibiotic loaded bone cement does not significantly decrease infection rates for primary total knee arthroplasty. Even risk stratified usage of ALBC for “high risk” patients may be unnecessary and add undue costs to both the patient and hospital, without any appreciable benefit

Introduction. Especially in young patients, total hip implants with proven long-term follow-up data should be used. Despite this, almost all patients under 30 years old will face a revision of their hip prosthesis during their life time because of their life expectancy. Therefore, all the used implants should be revisable with reliable outcome. Although, several studies have evaluated the outcome of different THA implants in patients under 30, only few report the long term follow-up of 10 years or more. None of them present the outcome of the revised total hips. Methods. We retrospectively reviewed prospectively collected data of 48 consecutive patients (69 hips), all received a cemented implant and in case of acetabular bone stock deficiency (29 hips), a reconstruction with bone impaction grafting (BIG) was performed. Mean age at surgery was 24.6 years (range, 16.0–29.0 years). Two patients were lost to follow-up. As far as we know, no revisions are performed in these two patients and their data are included in the study up to their last radiographic control. All failed hips were revised with again cemented implants and, if needed, bone impaction grafting. For the primary THA Kaplan-Meier survival curves at 10- and 15-year endpoint revision for any reason and revision for aseptic loosening were calculated. Separate survival rates at 10- and 15- year were calculated for the BIG group versus the non-BIG group. The outcome of the revised hips was studied and reported with re-revision as the endpoint. Results. Mean follow-up of all 69 hips was 11.5 years (range 2–23.4 years). During follow-up 13 revisions were performed. No stem revisions occurred, except in 3 septic failures. The 10- and 15-year survival rates with endpoint revision for any reason were 86% (95%-CI: 74–92%) and 75% (95%-CI:59-86%), the same endpoints revision for aseptic loosening were 90% (95%-CI: 79–96%) and 82% (95%-CI: 65–92%), respectively. The 10- and 15-year survival rates with endpoint revision for any reason in the BIG group were 93% (95%-CI: 74–98%) and 83% (95%-CI:49-95%), whereas for the non-BIG group the rates were 81% (95%-CI: 69–91%) and 71% (95%-CI:50-84%). None of the 13 revisions needed a re-revision within 10 years after re-implantation, although one cup failed after 13 years. Conclusion. This study shows that cemented primary total hip implants in patients under 30 years have acceptable outcomes at 10 and 15 years after surgery. Remarkably, the outcomes of the bone impaction grafting technique are superior to non BIG hips, the BIG-group shows a higher survival percentage as the non-BIG group. However, the most interesting part of the study is that the revised hips, all again re-cemented and, if needed, reconstructed with bone impaction grafting were performing well with no re-revisions within 10 years after surgery

INTRODUCTION. Recently the evolution of prosthesis technology allows the surgeon to replace entire limbs. These special prostheses or megaprostheses were born for the treatment of severe oncological bone loss. Recently, however, the indications and applications of these devices are expanding to other orthopaedic and trauma situations. Since some years we are implanting megaprostheses in non-oncological conditions such as septic post-traumatic failures represented by complex non-unions and critical size bone defects. The purpose of this study is to retrospectively evaluate the clinical outcome of this treatment and register all the complications and infection recurrence. MATERIAL AND METHOD. Between January 2008 and January 2016 we have treated 55 patients with septic post-traumatic bone defects In 48/55 cases we perform a 2 steps procedure: 1° step: resection, debridment, devices removal and antibiotic spacer implantation; 2° step: spacer removal and megaprosthesis implantation. In 7/55 patients in whom all the femur was infected, we performed a one step procedure by the complete removal of the femur and a megaprosthesis (Total Femur) implantation. RESULTS. We obtained good results from a clinical, laboratory and radiological point of view with restoration of the function of the affected limb. Only in 5/55 cases the infection recurred. All the Total Femur megaprosthesis implanted in a one step procedure healed without recurrence of infection. CONCLUSION. Megaprosthesis in severe septic bone loss can be considered, in extreme cases appropriately selected, as an available solution for the orthopedic surgeon. The two steps procedure gives the best results with safety and lower infection recurrence creating a membrane (Chamber Induction Technique) that can protect the prosthesis in a safe environment. We can perform a one step procedure only when all the infected segment is entirely removed. This type of complex surgery must be performed in specialized centers where knowledge and technologies are present