The burden of prosthetic joint infection (PJI) in total knee arthroplasty (TKA) has been rising in line with the number of primary operations performed. Current estimates suggest an infection rate of 1–2.4%. Two-stage revision has traditionally been considered the gold standard of treatment; however, some studies suggest comparable results can be achieved with single-stage procedures. The potential advantages include less time in hospital, a single anaesthetic, reduced costs, and greater patient satisfaction. We reviewed data for 72 patients (47 males, 25 females), with a mean age of 71 years (range, 49 to 94), who underwent single-stage revision TKA for confirmed PJI between 2006 and 2016. A standardized debridement protocol was performed with immediate single-stage exchange. All cases were discussed preoperatively at multidisciplinary team (MDT) meetings, which included input from a senior musculoskeletal microbiologist. Patients were not excluded for previous revisions, culture-negative PJI, or the presence of a sinus.Introduction
Methods
Osteolysis has been reported following ACJ reconstruction with a synthetic graft. We present the first study into its prevalence and pattern, and its effect on patient outcome. Patients who underwent treatment of an unstable ACJ injury using the Surgilig/LockDown implant were identified via our database. Patients were invited to attend a dedicated outpatient clinic for clinical examination, radiographic evaluation, and completion of outcome scoring. Patients who were unable to attend were contacted by telephone. 49 patients were identified. We assessed 21 clinically at a mean of 7 years post-procedure (range 3–11 years). All had radiographic evidence of distal clavicle and coracoid osteolysis. We did not observe progression of osteolysis from the final post-operative radiographs. A further 13 were contacted by phone. The mean Oxford Shoulder Score was 43 (range 31–48) and mean DASH score was 8.5 (range 3–71). The average Patient Global Impression of Change score was 6 (range 2–7). Six patients underwent removal of a prominent screw at a mean of 2 years after surgery; the pattern of osteolysis was no different in this group. All patients had comparable abduction, forward flexion and internal rotation to their uninjured shoulder. We did not observe any relationship between patient demographics, position of implant or etiology and the pattern of osteolysis. Osteolysis of the distal clavicle and/or coracoid is always seen following synthetic reconstruction of the ACJ using this implant, but is non-progressive. Range of shoulder movement is largely unaffected and patient outcomes remain high.
