Local antibiotics released through a carrier is a commonly used technique to prevent infection in orthopaedic procedures. An interesting carrier in aseptic bone reconstructive surgery are bone chips impregnated with AB solution. Systemically administered Cefazolin (CFZ) is used for surgical site infection prophylaxis however in vitro study showed that fresh frozen and processed bone chips impregnated with CFZ solution completely release the CFZ within a few hours. On the other hand irradiated freeze-dried bone chips, treated with supercritical CO2 (scCO2) have been shown to be an efficient carrier for the antibiotics vancomycine or tobramycine. With this pilot study we wanted to investigate if CFZ solution impregnation of bone chips treated with scCO2 shows a more favorable release pattern of CFZ. The bone chips were prepared using the standard scCO2 protocol and were impregnated with 100 mg/ml cefazolin at different timepoints during the process: before freeze drying (BC type A), after freeze drying (BC type B) and after gamma-irradiation. 0.5g of the impregnated bone grafts were incubated with 5ml of fetal calf serum (FCS) at 37°C. At 2, 4, 6, 8 and 24h of incubation 200µl of eluate was taken for analysis. After 24h the remaining FCS was removed, bone grafts were washed and new FCS (5ml) was added. Consecutive eluate samples were taken at 48, 72 and 96h of incubation. The concentration of CFZ in the eluates was measured with the validated UPLC-DAD method. Analysis was performed in triplicate.Aim
Method
The surgical management of late PJI was usually done in two stages with the placement of a temporary cement spacer. The development of one-stage surgical care raises questions about the two-stage strategy. The objectives of this study are to identify the complications related to the presence of the cement spacer within a two-stage strategy. The septic recurrence rate is also evaluated after a minimum follow-up of two years. Medical files of 208 patients (101 knees and 107 hips) who underwent a two-stage revision for late PJI prosthesis infection were retrospectively reviewed. Antibiotic loaded articulated homemade cement spacers were used. Second stage was usually planned on average 4 to 6 weeks after the first stage. Patients were allowed to walk without loading. The success rate was defined as the absence of septic recurrence after a minimum follow-up of two years. Descriptive statistics and uni- and multivariate analysis were conducted.Introduction
Material and methods
We wonder what the results of two stage procedures were in terms of morbidity (amputation, dead) and infection recurrence. We also seek to identify risk factors for failure and see if the results of a second two stage surgery were not even worse. We retrospectively reviewed 140 prosthetic joint infection (PJI) treated with a two stage procedure. Patient data has been reviewed to determine which factors would be predictive for failure.Aim
Material and Methods
The management of patients with open leg fracture in Ivory Coast does not meet the standards of developed countries due to socio-economic conditions, accessibility and organization of care. However, is this care problematic? Is it associated with more post-traumatic infection or mechanical complications and are these correlated with the delay for treatment and the method of treatment? This is a single-center prospective study conducted on between January 2018 and May 2018 at Bouaké University Hospital. The observed parameters included factors related to patient, fracture and treatment conditions and were correlated with the rates of complications by multivariate analysis.Introduction
Material and Methods
We performed a retrospective study at a university hospital in Belgium. All cases of high risk adult SAB between January 2014 and June 2017 were reviewed. We collected the clinical characteristics including presence of metastatic foci on 18F-FDG PET/ CT, mortality at 1 year.Aim
Method
Apart from other biomarkers isolated in the synovial fluid, alpha-defensin appears to be a promising diagnostic tool to confirm a periprosthetic joint infection (PJI) in the hip or knee. The purpose of this study was to evaluate the sensitivity and specificity of an alpha defensin lateral flow (ADLF) test compared to usual standard classifications in the diagnostic management of PJI. This investigation was set up as a multicenter prospective cohort study. Synovial fluid was obtained by means of joint aspiration or intra-operative tissue biopsies. A presumptive PJI diagnosis was made according to criteria outlined by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA) and the European Bone and Joint Infection Society (EBJIS). The intention to treat by the surgeon was logged. Sensibility and specificity for the ADLF test was plotted for each aforementioned diagnostic algorithm. Spearman correlations between all scores were analyzed. Multiple logistic regression was used to determine the contribution of independent variables to the probability of PJI.Aim
Method
Our study aimed to analyze 1) the prevalence of peripheral arterial disease (PAD) and infection in diabetic patients with and without Charcot foot (CF), 2) the characteristics of PAD in these 2 groups, 3) the prognosis of patients with CF and PAD and/or infection. We retrospectively reviewed the medical and radiological records of 172 hospitalized patients in our diabetic foot unit between 2010 and 2014. These patients were identified using the ICD-9-CM. The CF group and the diabetic foot (DF) group included 56 and 116 patients, respectively. All statistical analyses were performed using SPSS 25.0.01. A Aim
Method
Irrigation is a major step during debridement surgery in the context of Prosthetic Joint Infections (PJI), but its effects on biofilms are poorly described. The present study aims at evaluating the effect of PW alone or followed by antibiotics on MSSA and MRSA biofilms grown on Ti6Al4V coupons in-vitro. Strains: 1 reference (MSSA: ATCC25923; MRSA: ATCC33591) and 2 clinical MSSA and MRSA isolated from PJI. Biofilm culture: Coupons were incubated for 24h at 37°C with bacteria (starting inoculum ∼6.6Log10CFU/mL in TGN [TSB + 1% glucose + 2% NaCl]), under shaking at 50rpm. Treatment: Half of the coupons were irrigated with 50mL physiological serum from 5cm using a Stryker Interpulse; the coupons were then either analysed (ControlT0 and PWT0) or reincubated for 24h in TGN or TGN containing flucloxacillin (MSSA) or vancomycin (MRSA) at MIC or 20mg/L. Analysis: Coupons were rinsed twice with PBS. Biomass was measured by crystal violet (CV) assay. CFUs were counted after recovering bacteria from coupons using sonication and TSA plating.Aim
Method
DAIR is an attractive treatment for PJI. The purpose of this study is to determine predictive factors of failure. We reviewed all DAIR procedures for hip PJI performed between 2002–2017 (n=69). Data recorded included all factors correlated with treatment failure. KLIC score and an adapted McPherson score (sum of three criteria where the lower score is three for 3 A and the higher is 9 for 3 C) were analyzed.Background
Materials and Methods
The treatment of a chronic prosthetic joint infection (PJI) is a combination of the bacteria's identification, a «carcinological» surgery and an appropriate antibiotherapy. In case of gram positive cocci infection, rifampicin is often used. The aim of this study is to determine which factors are responsible for the development of resistance to rifampicine. All patients had a total hip (THA) or knee (TKA) arthroplasty with a chronic infection. They were treated with a two-time surgery. All of them received a bi-antibiotic treatment. In case of gram positive cocci infection, and according to the susceptibility test, they received rifampicin. The 221 patients were operated from July 1997 to November 2013 in 3 university centers (one Belgian and two French) and were retrospectively analysed. The demographical, clinical and bacterial data as well as the antibiotic treatment were collected. The healing was defined as the absence of recurrence during the 2 years following surgery.Aim
Method
Bacterial identification in musculoskeletal infection is sometimes difficult and treatment strategy difficult facing unknown pathogen agent. We wonder if the delay of incubation and the preservation conditions of the samples between surgical procurement and subculture on plates have an influence. 25 cm³ bone fragments were obtained from femoral heads retrieved during hip arthroplasty and excluded for bone transplant donation. Informed consent was obtained from the donor for research purpose. The study was approved by the Ethic Committee (N°B403201317725). Bone fragments were immersed for 30 minutes under gently agitation (140 RPM) at 35°C in a physiologic solution (negative control) or two solutions with two concentrations of staphylococcus epidermidis (0.5 Mc Farland or 1.5× 108 bacteria and 7.5×102 bacteria). Bone samples were separated and preserved at room temperature or at 4°C until seeded on Petri Plates to observe the influence of preservation conditions. Samples were plated after different delays (T0, T30min, T1H, T2H, T4H, T6H, T8H, T12H, T16H, T24H et T48H) to observe the influence of delay of culture. Experiments were repeated 5 times. When culture was positive, results were expressed with the number of colony.Aim
Method
Patient satisfaction after total hip arthroplasty (THA) has been reported to be significantly better than after total knee arthroplasty (TKA). The same has been observed for the capacity to forget during daily life activities about the operated joint. Recently a new patient reported outcome score, the Forgotten Joint Score (FJS-12) a twelve item questionaire, has been used to evaluate postoperative outcome in joint arthroplasty. A better FJS-12 score was measured in THA than in TKA objectivating the intuitive feeling that the joint was more forgotten in THA than in TKA. A higher preoperative FJS-12 score is the reason for a higher postoperative FJS-12 score in THA compared to TKAIntroduction
Hypothesis
