Aim. Two stage revision is the most commonly used surgical treatment strategy for periprosthetic hip infections (PHI). The aim of our study was to assess the intra- and postoperative complications during and after two stage revision using resection arthroplasty between ex- and reimplantation. Method. In this retrospective cohort study, all patients treated with a two stage revision using resection arthroplasty for PHI were included from 2008 to 2014. During the first stage, the prosthesis was removed resulting in a resection arthroplasty without the use a PMMA spacer. During second stage, (cemented or uncemented) reimplantation of the hip prosthesis was performed. The cohort was stratified into two groups according to the length of prosthesis-free interval (≤10 weeks and >10 weeks). Data on complications during explantation, prosthesis-free interval, reimplantation, and after reimplantation was collected. The overall complication rate between both groups was compared using the chi-squared test. The revision-free and infection-free survival was estimated using Kaplan-Meier survival analysis. Results. Overall, 93 patients with hip PJI treated with two-stage revision performing resection arthroplasty were included, 49 had a prosthesis-free interval of ≤10 weeks, and 44 an interval of >10 weeks. A total of 146 complications was documented in the cohort. Patients were followed-up for a mean duration of 42.7 months, range: 13.1 – 104.6 months. Blood loss during reimplantation [n=25], blood loss during explantation [n=23], persistent infection during prosthesis-free interval [n=16], leg length discrepancy [n=13], and reinfection [n=9] were the most common complications. No complication showed a statistically significant difference between both groups except for wound healing disorder after reimplantation, which was more often reported in the group with > 10 weeks interval (p=0.009). A statistically significant increase of periprosthetic bone fractures (p=0.05), blood loss (p=0.039), and total number of complications (p=0.008) was seen with increasing acetabular bone defects (after Paprosky). Infection-free survival rate at 24 months was 93.9% (95% CI: 87.2 – 100) in the group with ≤10 weeks interval and 85.9% (95% CI: 75.4 – 96.4) with an interval of > 10weeks. Conclusions. After two years of follow-up, the infection-free survival rate using resection arthroplasty during two stage revision for PHI was higher in the group with ≤10 weeks interval compared to the group with >10 weeks interval. The most common complications during and after a two stage revision using resection arthroplasty were blood loss during the two surgeries, persistent infection during the prosthesis-free interval, leg length discrepancy, and reinfection

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).

Infection after total hip arthroplasty is a rare but potentially devastating complication. The most common pathogens responsible for these infections are gram positive bacteria. Infection caused by fungi is uncommon. There are few reports of prosthetic joint infection caused by Candida species, and there has no report of implant preservation.

We experienced the case of a patient with Candida arthritis who underwent total hip arthroplasty for hip arthrosis, and successfully could preserved prosthetic joint.

A 60 year-old woman underwent total hip arthroplasty in September 2014. She had had the past of sepsis by the Candida after surgery of the duodenal cancer. After four weeks in total hip arthroplasty, she made clinic visits. Her chief complaints were low-grade fever of 1 week's duration and discharge from operative scar for THA. The patient underwent arthrocentesis of the left hip. The culture was positive for Candida tropicalis.

Operation of surgical debridement and liner change was performed as soon as possible. After operation, the patient was treated with fluconazole intravenously for 28 days.

She has continued to taken fluconazole by mouth. Reactivation of infection have not been in her left hip.

We reported the case of a patient with Candida arthritis who underwent total hip arthroplasty. Prosthetic joint could have preserved because of early detection for infection. This is the first report of preservating implant after Candida infection in total hip arthroplasty.

Introduction

Periprosthetic infection is a serious complication after total hip arthroplasty (THA). Two stage procedure using antibiotic-impregnated cement spacer is one of the treatments for late chronic infection after THA. We investigated the effects of two stage procedure on the infection control and the recurrence of infection after revision THA.

Purpose

Two-stage revision with the removal of all prosthesis has been considered to be the gold standard for treatment of periprosthetic joint infection. However, removal of well-fixed femoral stem is technically challenging and may cause excessive bone loss. The aim of this study was to compare the results between retention and removal of femoral stem when performing two-stage revision total hip arthroplasty for periprosthetic joint infection.

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.

Aim

To evaluate the efficacy of infection elimination and functional outcomes of the resection hip arthroplasty (RHA) with m. vastus lateralis flap plasty in patients with chronic recurrent periprosthetic joint infection (PJI) one year or later after the surgery.

Debridement, antibiotics and implant retention (DAIR) is an established treatment option for periprosthetic joint infection (PJI). Success rates of more than 90% cure have been reported with proper patient selection. While a meticulous debridement of the joint and an appropriate postoperative antibiotic therapy is important for treatment success, the relevance of changing mobile parts is still a matter of debate. The latter procedure is only possible with an extensive soft tissue release, potentially destabilizing the joint. Though, it is impossible with polyethylene-inlays being no longer available. The aim of this study was to evaluate whether cure of PJI with DAIR is influenced by retaining the mobile parts.

Between 01/2004 and 12/2012, 36 patients with 39 episodes of THA-associated infections were treated with DAIR according to our algorithm (NEJM 2004). All patients met the IDSA criteria for DAIR with a stable implant and either a PJI diagnosed during the first postoperative month or a haematogenous PJI with infectious symptoms of less than three weeks. Patients were treated either with a complete debridement, including an exchange of all mobile parts (n=24), or with a complete debridement and retaining mobile parts (n=15). Postoperatively all patients received standardized antibiotic treatment (NEJM 2004).

The patients’ mean age at the time of infection was 74 (SD 9) years. Average time between onset of symptoms and DAIR were 3.6 (0–28) days; Five patients died before the 2-year-follow-up unrelated to PJI. Mean follow-up of the remaining patients was 45.6 (24–119) months. 20 PJI were early postoperative, 15 haematogenously acquired, and four unclear. The most frequent causative microorganisms were coagulase-negative staphylococci (n=16), S. aureus (n=8), streptococci (n=5) and E. coli (n=2). Ten episodes were polymicrobial, and nine cases culture-negative. The overall success rate of all 39 episodes treated with DAIR was 95% (37/39). Two treatment failures were observed, both after haematogenous S. aureus infection and exchange of mobile parts. One of them refused further surgery and was treated with a suppressive antibiotic therapy. The other one had a one-stage exchange four months after DAIR showing a loose cup intraoperatively.

Patients treated with DAIR strictly according to our treatment algorithm show a favourable result regarding overall success rate. From our data it seems debatable, whether the exchange of all mobile parts is mandatory, or should be individually evaluated in each case.

Background. The identification of novel biomarker which is highly specific and sensitive for periprosthetic joint (PJI) have the potential to improve diagnostic accuracy and ultimately improve patient outcomes. Thus, the aim of this systemic review is to identify and evaluate novel biomarkers for the preoperative diagnostics of PJI. Methods. MEDLINE, EMBASE, PubMed and Cochrane Library databases identified from 1. st. of January 2018 to 30. th. of September. 2022. We used “periprosthetic joint infection” OR “prosthetic joint infection” OR “periprosthetic infection” as the diagnosis of interest and the target index applied AND “marker”. To focus on novel biomarkers already used biomarkers of the established PJI diagnostic criteria of MSIS, ICM and EBJIS were not included in the analysis. These three criteria were considered the reference standard during quality assessment. Results. A total of 19 studies were included. In these, fourteen different novel biomarkers were analyzed. Fifteen studies (79%) had prospective designs and the other four (22%) were retrospective studies. Six studies (33%) included only periprosthetic knee infections and thirteen (67%) included periprosthetic knee and hip infections. Proteins were analyzed in most cases (nine studies), followed by molecules (three studies), exosome (two studies) as well as DNA (two studies), interleukin (one study) and lysosome (one study). One novel and promising marker that had been frequently analyzed is calprotectin. Conclusion. No marker demonstrated higher sensitivity and specificity than already known parameters used for standardized treatment based on established PJI definitions. Further studies are needed to elucidate the benefit and usefulness of implementing new biomarkers in diagnostic PJI settings

Aim. Aim of this monocentric, prospective study was to evaluate the safety, efficacy, clinical and radiographical results at 24-month follow-up (N = 6 patients) undergoing hip revision surgery with severe acetabular bone defects (Paprosky 2C-3A-3B) using a combination of a novel phase-pure betatricalciumphosphate - collagen 3D matrix with allograft bone chips. Method. Prospective follow-up of 6 consecutive patients, who underwent revision surgery of the acetabular component in presence of massive bone defects between April 2018 and July 2019. Indications for revision included mechanical loosening in 4 cases and history of hip infection in 2 cases. Acetabular deficiencies were evaluated radiographically and CT and classified according to the Paprosky classification. Initial diagnosis of the patients included osteoarthritis (N = 4), a traumatic fracture and a congenital hip dislocation. 5 patients underwent first revision surgery, 1 patient underwent a second revision surgery. Results. All patients were followed-up radiographically with a mean of 25,8 months. No complications were observed direct postoperatively. HHS improved significantly from 23.9 preoperatively to 81.5 at the last follow-up. 5 patients achieved a defined good result, and one patient achieved a fair result. No periprosthetic joint infection, no dislocations, no deep vein thrombosis, no vessel damage, and no complaint about limbs length discrepancy could be observed. Postoperative dysmetria was found to be + 0.2cm (0cm/+1.0cm) compared to the preoperative dysmetria of − 2.4 cm (+0.3cm/−5.7cm). Conclusions. Although used in severe acetabular bone defects, the novel phase-pure betatricalciumphosphate - collagen 3D matrixshowed complete resorption and replacement by newly formed bone, leading to a full implant integration at 24 months follow-up and thus represents a promising method with excellent bone regeneration capacities for complex cases, where synthetic bone grafting material is used in addition to autografts

Aim. We aimed to assess the incidence and the outcome of Gram-negative prosthetic-joint infections (PJI) in 3 international tertiary hospital. Method. We included patients with Gram-negative PJI at Humanitas Clinical and Research Hospital (Milan, Italy), Centre Hospitalier Universitaire Vaudois (Lausanne, Switzerland) and Hospital Parc de Salut Mar (Barcelona, Spain) between 2014 and 2018 in a retrospective cohort. We described the treatment's success rate according to Gram-negative species and type of surgical procedure. Results. In the present cohort we have 780 PJI out of which 71 (9.1%) were caused by Gram-negative bacteria (polymicrobial infection 30%, Escherichia coli 25%, Pseudomonas aeruginosa 20%, Proteus spp. 4%, Klebsiella spp. 3%, Morganella morganii 3%, Enterobacter 3%, others 12%). Gram-negative PJI were more common in females (60%) than males (40%). Sixty percent had a hip infection, 40% a knee infection, the median age was 74 years and the median ASA score was 3. It was a chronic infection in 60% of the cases and an acute one in 40%. Two-step exchange was performed in 55%, débridement and retention (DAIR) in 30%, one-step exchange in 11% and implant removal without replacement in 4% of the patients. The overall treatment success rate was 89%. The success rate was better for two-step exchange (95%) compared to DAIR (81%) and one-step exchange (87%) (p=0.068). The median antibiotic duration was 68 days and ciprofloxacin was used in 70% of the cured patients versus in 88% of the failures (p=0.388). Infections caused by Escherichia coli were associated with a lower success rate (83%) especially compared to Pseudomonas aeruginosa (93%) and polymicrobial infections (90%) (p=0.358). Finally, the success rate was better in knee PJI compared to hip PJI (97% versus 83%, p=0.121) and in females compared to males (93% versus 82%, p=0.121). Conclusions. The treatment's success of Gram-negative PJI is comparable to reported rates for all bacteria. However, our results suggest that surgical management with two-step exchange might be useful in selected patients’ groups such as those with Escherichia coli PJI. Moreover, ciprofloxacin use seems not to improve cure rate

Aim. This study aims to describe our department experience with single stage revision (SSR) for chronic prosthetic-joint infection (PJI) after total hip arthroplasty (THA) between 2005 and 2014 and to analyze success rates and morbidity results of patients submitted to SSR for infected THA according to pathogen. Method. We retrospectively reviewed our 10 years of results (2005–2014) of patients submitted to SSR of the hip combined with IV and oral antibiotic therapy for treatment of chronic PJI (at least 4 weeks of symptoms), with a minimum follow-up of four years (n=26). Patients were characterized for demographic data, comorbidities, identified germ and antibiotic therapy applied (empiric and/or targeted). Outcomes analyzed were re-intervention rate (infection-related or aseptic), success rate (clinical and laboratory assessment), length of stay, morbidity and mortality outcomes. Results. In this period, 26 single-stage revisions for chronic PJI of the hip were performed. Patients average age was 72 years (range 44–82). Ten patients were women. The average time of follow up was 69 months (range 4 to 12 years). The most commonly isolated bacteria were coagulase-negative Staphylococci (30%), methicillin-resistant Staphylococcus aureus (MRSA) (18%) and methicillin-sensitive Staphylococcus aureus (15%). It wasn't possible to identify the germ in 19% of the patients and other 23% were polymicrobial. Targeted antibiotic therapy was administered to 73% of patients and the most used targeted antibiotics were Vancomycin (53%), Linezolid (32%) and Rifampicin (21%). Mean length of stay was 25 days. In the follow-up period, 9 patients (35%) required a re-intervention for infection relapse. Two patients (8%) needed surgery because of persistent instability. During the follow-up period, the infection-free survival was 65% (33% for MRSA; 82% for coagulase-negative Staphylococci) and the surgery-free survival was 62%. Six patients (23%) died during the follow-up, all due to other medical conditions not related to hip infection. Conclusions. Our experience suggests that SSR is associated with good outcomes and low re-intervention rate, except in the case of infection due to MRSA. In this last group, the results were significantly poorer, what leads to suggest that a two-stage revision may be a better option. The potential advantages of a SSR include good rates of infection eradication, a decrease in surgical morbidity and mortality as well as a decrease in healthcare and global economic costs. As such, a one-stage aggressive surgical attitude in addition to targeted antibiotherapy seems to be a suitable solution in selected patients

There is an apparent need for easily accessible research data on Periprosthetic hip joint infections (PJI)(1). Administrative discharge registers could be a valuable single-sources for this purpose, and studies originating from such registers have been published(2–4). However, the quality of routinely collected data for administrative purposes may be questionable for use in epidemiological research. The aim of this study was to estimate the positive predictive value of the International Classification of Disease 10th revision (ICD-10) periprosthetic hip joint infection diagnose code T84.5. The study was performed as a cross-sectional study on data extracted from the Danish National Patient Register. Patients with a registration of performed surgical treatment for hip PJI were identified via the ICD-10 code T84.5 (Infection and inflammatory reaction due to internal joint prosthesis) in association with hip-joint associated surgical procedure codes. Medical records of the identified patients (n=283) were verified for the existence of a periprosthetic hip joint infection. Positive predictive values with 95% confidence intervals (95% CI) were calculated. A T84.5 diagnosis code irrespective of the associated surgical procedure code had a positive predictive value of 85 % (95% CI: 80–89). Stratified to T84.5 in combination with an infection-specific surgical procedure code the positive predictive value increased to 86% (95% CI: 80–91), and in combination with a noninfection-specific surgical procedure code decreased to 82% (95% CI: 72–89). This study is the first to evaluate the only discharge diagnose code of prosthesis-related infection in an administrative discharge register. It is apparent, that codes in administrative discharge registers are prone to misclassification on an administrative level, either by wrongful coding by the physician or administrative personal in the registration process. Misclassification must be expected and taken into consideration when using single-source administrative discharge registers for epidemiological research on periprosthetic hip joint infection. We believe that the periprosthetic hip joint infection diagnose code can be of use in single-source register based studies, but preferably should be used in combination with alternate data sources to ensure higher validity(5). This study is funded in part by the Lundbeck foundation Centre for Fast-track Hip and Knee Surgery, Denmark

Aim. There is a constant increase of total joint arthroplasties to improve the quality of life of an aging population. Prosthetic-joint infections are rare, with an incidence of 1–2%, but they represent serious complications in terms of morbidity and mortality. Different therapeutic options exist, but their management is still poorly standardized because of the lack of data from randomized trials. The aim of this retrospective study is to assess the infection eradication success rate, over the last ten years, using different patient adapted treatment options. Method. Patients having a prosthetic-joint infection at Lausanne University Hospital (Switzerland) between 2006 and 2016 were included. The success rate depending on age, type of prosthesis, type of infection and type of surgical procedure was analyzed. Results. 444 patients (61% hips, 37% knees) were identified with a median age of 70 years. The success rate was 93% for two-stage exchange, 78% for one-stage exchange and 75% for debridement with retention of the prosthesis. The failure rate was higher for knee prosthetic-joint infections (27%) than hip infections (13%). Furthermore, chronic and in elderly prosthetic-joint infections seemed to have a worse prognosis. Conclusions. The infection eradication depends on age, type of prosthesis, type of infection and type of surgical procedure, with three times less failure in two-stage exchange surgery

The number of cemented femoral stems implanted in the United States continues to slowly decrease over time. Approximately 10% of all femoral components implanted today are cemented, and the majority are in patients undergoing hip arthroplasty for femoral neck fractures. The European experience is quite different. In the UK, cemented femoral stems account for approximately 50% of all implants, while in the Swedish registry, cemented stems still account for the majority of implanted femoral components. Recent data demonstrating some limitations of uncemented fixation in the elderly for primary THA, may suggest that a cemented femoral component may be an attractive alternative in such a group. Two general philosophies exist with regards to the cemented femoral stem: Taper slip and Composite Beam. There are flagship implants representing both philosophies and select designs have shown excellent results past 30 years. A good femoral component design and cementing technique, however, is crucial for long-term clinical success. The author's personal preference is that of a “taper slip” design. The cemented Exeter stem has shown excellent results past 30 years with rare cases of loosening. The characteristic behavior of such a stem is to allow slight subsidence of the stem within the cement mantle through the process of cement creep. One or two millimeters of subsidence in the long-term have been observed with no detrimental clinical consequences. There have been ample results in the literature showing the excellent results at mid- and long-term in all patient groups. The author's current indication for a cemented stem include the elderly with no clear and definitive cutoff for age, most likely in females, THA for femoral neck fracture, small femoral canals such as those patients with DDH, and occasionally in patients with history of previous hip infection. Modern and impeccable cement technique is paramount for durable cemented fixation. It is important to remember that the goal is interdigitation of the cement with cancellous bone, so preparing the femur should not remove cancellous bone. Modern technique includes distal plugging of the femoral canal, pulsatile lavage, drying of the femoral canal with epinephrine or hydrogen peroxide, retrograde fill of the femoral canal with cement with appropriate suction and pressurization of the femoral cement into the canal prior to implantation of the femoral component. The dreaded “cement implantation syndrome” leading to sudden death can be avoided by appropriate fluid resuscitation prior to implanting the femoral component. This is an extremely rare occurrence today with reported mortality for the Exeter stem of 1 in 10,000. A cemented femoral component has been shown to be clinically successful at long term. Unfortunately, the art of cementing a femoral component has been lost and is rarely performed in the US. The number of cemented stems, unfortunately, may continue to go down as it is uncommonly taught in residency and fellowship, however, it might find a resurgence as the limits of uncemented fixation in the elderly are encountered. National joint registers support the use of cemented femoral components, and actually demonstrate higher survivorship at short term when compared to all other uncemented femoral components. A cemented femoral component should be in the hip surgeons armamentarium when treating patients undergoing primary and revision THA

There has been an evolution in revision hip arthroplasty towards cementless reconstruction. Whilst cemented arthroplasty works well in the primary setting, the difficulty with achieving cement fixation in femoral revisions has led to a move towards removal of cement, where it was present, and the use of ingrowth components. These have included proximally loading or, more commonly, distally fixed stems. We have been through various iterations of these, notably with extensively porous coated cobalt chrome stems and recently with taper-fluted titanium stems. As a result of this, cemented stems have become much less popular in the revision setting. Allied to concerns about fixation and longevity of cemented fixation revision, there were also worries in relation to bone cement implantation syndrome when large cement loads were pressurised into the femoral canal at the time of stem cementation. This was particularly the case with longer stems. Technical measures are available to reduce that risk but the fear is nevertheless there. In spite of this direction of travel and these concerns, there is, however, still a role for cemented stems in revision hip arthroplasty. This role is indeed expanding. First and foremost, the use of cement allows for local antibiotic delivery using a variety of drugs both instilled in the cement at the time of manufacture or added by the surgeon when the cement is mixed. This has advantages when dealing with periprosthetic infection. Thus, cement can be used both as interval spacers but also for definitive fixation when dealing with periprosthetic hip infection. The reconstitution of bone stock is always attractive, particularly in younger patients or those with stove pipe canals. This is achieved well using impaction grafting with cement and is another extremely good use of cement. In the very elderly or those in whom proximal femoral resection is needed at the time of revision surgery, distal fixation with cement provides a good solution for immediate weight bearing and does not have the high a risk of fracture seen with large cementless stems. Cement is also useful in cases of proximal femoral deformity or where cement has been used in a primary arthroplasty previously. We have learnt that if the cement is well-fixed then the bond of cement-to-cement is excellent and therefore retention of the cement mantle and recementation into that previous mantle is a great advantage. This avoids the risks of cement removal and allows for much easier fixation. Stems have been designed specifically to allow this cement-in-cement technique. It can be used most readily with polished tapered stems - tap out a stem, gain access at the time of revision surgery and reinsert it. It is, however, now increasingly used when any cemented stems are removed provided that the cement mantle is well fixed. The existing mantle is either wide enough to accommodate the cement-in-cement revision or can be expanded using manual instruments or ultrasonic tools. The cement interface is then dried and a new stem cemented in place. Whilst the direction of travel in revision hip arthroplasty has been towards cementless fixation, particularly with tapered distally fixed designs, the reality is that there is still a role for cement for its properties of immediate fixation, reduced fracture risk, local antibiotic delivery, impaction grafting and cement-in-cement revision

Fully constrained liners are used to treat recurrent dislocations or patients at high risk after total hip replacements. However, they can cause significant morbidities including recurrent dislocations, infections, aseptic loosening and fractures. We examine long term results of 111 patients with tripolar constrained components to assess their redislocation and failure rate. The purpose of this study was to assess survivorship, complications and functional outcomes at a minimum 10 years after the constrained tripolar liners used in our institute. We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1998 and 2008. Eighty-nine were revised due to recurrent dislocations, 11 for pseudotumor with dysfunctional abductors, and 13 for periprosthetic infection with loss of soft tissue stabilizers. All patients had revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 had more than 3 revisions. We extracted demographics, implant data, rate of dislocations and incidence of other complications. Kaplan Meier curves were used to assess dislocation and failure for any reason. WOMAC was used to assess quality of life. At 10 years, the survival free of dislocation was 95.6% (95%CI 90- 98), and at 20 years to 90.6% (95% CI 81- 95.5). Eight patients (7.1%) had dislocations of their constrained liners: 1 patient had simultaneous periprosthetic infection identified at the time of open reduction, and 1 patient sustained stem fracture 3 months prior to the liner dislocation. At 10 years, the survival to any further surgery was 89.4% (95% CI 82–93.8), and at 20 years, this was 82.5 (95% CI 71.9–89.3). Five patients (4.4%) had deep infection: 4 of these had excision arthroplasty due to failure to control infection, while 1 patient was treated successfully with debridement, exchange of mobile components and intravenous antibiotics. Two patients (1.8%) had dissociated rings that required change of liner, ring and head. Two patients (1.8%) had periprosthetic femoral fractures that were treated by revision stems and exchange of constrained liners. The mean WOMAC functional and pain scores were 66.2 and 75.9 of 100, respectively. Constrained tripolar liners in our institute provided favourable results in the long term for recurrent dislocation hip arthroplasty with dysfunctional hip stabilizers. Infection in these patients can prove to be difficult to treat due to their poor soft tissue conditions from repeated surgeries. Comparing long terms results from other types of constrained liners is essential to evaluate these salvage liners

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. Our aim was to evaluate cementless one-stage revision in chronic periprosthetic hip joint infection. Method and patients. The study was performed as a multicentre, proof-of-concept, observational study with prospective data collection. Inclusion of patients with a chronic periprosthetic hip joint infection (PJI) were followed by protocolled surgical treatment (cementless one-stage revision - the CORIHA protocol) at one of 8 participating departments of orthopaedic surgery between 2009 – 2014, and the patients enrolled in a 2-year follow-up program. A PJI were diagnosed based on adopted criteria from McPherson and Zimmerli. At the time of initiation of the study in 2009, the collaborating departments performed approximately one-fourth of all nationwide primary HJR and more than one-third of all revisions. In total 56 PJI patients with a median age of 72 years and a median pre-operative ASA score of 2 met the established eligibility criteria and accepted to participate; 31 (55%) were males. The cohort had a mean follow-up time of 4.0 years, with all patients followed for minimum 2 years. The primary outcome were relapse described as re-revision due to infection (regardless of considered as a relapse or new infection). This was evaluated by competing risk analysis (competing risks: aseptic revisions and death). Secondary, all-cause mortality was evaluated by survival analysis. The study was approved by the local Committees on Biomedical Research Ethics. Results. Five patients were revised due to relapse of infection. The cumulative incidence of re-revision due to infection was 8.9% (95% Confidence Interval 3.2–18.1). Seven patients had died in the follow-up period. None of these were believed to have been re-infected. The 1 and 5 year survival incidence was 96 (95% Confidence Interval 86–99) and 89 (95% Confidence Interval 75–95). Several complications were registered in the follow-up period: Three patients sustained periprosthetic fractures. Five patients had closed reduction due to dislocation - none have been open revised. Five patients sustained acute renal failure without long-term complications. One patient suffered an acute non-stemi myocardial infarction 8 days post-operatively, but with no major sequelae. One patient had soft-tissue revision of the wound following the CORIHA surgery, but is believed free of infection; One patient has severe irritation by the cables left from the extended osteotomy, but no further surgery is planned. Conclusions. We found that cementless one-stage revision in chronic hip PJI is a valuable treatment. This method has gained nationwide acceptance as first-line treatment strategy following this study