Suppressive antimicrobial therapy (SAT) is used worldwide for patients with a prosthetic joint infection (PJI but clear definitions or guidelines regarding the indications, antimicrobial strategy or treatment duration are currently lacking in the literature. The aim of this study was to identify the global differences in the clinical practice of SAT for PJI. An online survey was designed to investigate the current opinion on indication and treatment goals, preferred antimicrobial drugs, dosing and treatment duration and follow-up of patients with PJI on suppression. The survey was distributed using e-mail lists of several international bone and joint infection societies and study groups. Recipients were asked to share the survey with colleagues who were not a member of one of the societies but who were involved in PJI care.Aim
Method
Prosthetic joint infections (PJI) are devastating complications. Our knowledge on hip fractureassociated hemiarthroplasty PJI (HHA-PJI) is limited compared to elective arthroplasty. The goal of this study was to describe the epidemiology, risk factors, management, and outcomes for HHA-PJI. A population-based (465,000) multicentre retrospective analysis of HHAs between 2006-2018 was conducted. PJI was defined by international consensus and treatment success as no return to theatre and survival to 90 days after the initial surgical management of the infection. Univariate, survival and competing risk regression analyses were performed. 1852 HHAs were identified (74% female; age:84±7yrs;90-day-mortality:16.7%). Forty-three (2.3%) patients developed PJI [77±10yrs; 56% female; 90-day-mortality: 20.9%, Hazard-Ratio 1.6 95%CI 1.1-2.3,p=0.023]. The incidence of HHA-PJI was 0.77/100,000/year and 193/100,000/year for HHA. The median time to PJI was 26 (IQR 20-97) days with 53% polymicrobial growth and 41% multi-drug resistant organisms (MDRO). Competing risk regression identified younger age [Sub-Hazard-Ratio(SHR) 0.86, 95%CI 0.8-0.92,p<0.001], chronic kidney disease (SHR 3.41 95%CI 1.36-8.56, p=0.01), body mass index>35 (SHR 6.81, 95%CI 2.25-20.65, p<0.001), urinary tract infection (SHR 1.89, 95%CI 1.02-3.5, p=0.04) and dementia (SHR 9.4, 95%CI 2.89-30.58,p<0.001) as significant risk factors for developing HHA-PJI. When infection treatment was successful (n=15, 38%), median survival was 1632 days (IQR 829-2084), as opposed to 215 days (IQR 20-1245) in those who failed, with a 90-day mortality of 30%(n=12). There was no significant difference in success among debridement, excision arthroplasty or revision arthroplasty. HHA PJI is uncommon but highly lethal. All currently identified predictors are non-modifiable. Due to the common polymicrobial and MDRO infections our standard antibiotic prophylaxis may not be adequate HHA-PJI is a different disease compared to elective PJI with distinct epidemiology, pathogens, risk factors and outcomes, which require targeted research specific to this unique population.
This text has been removed at the authors' request.
The vascular anatomy of the femoral head and neck has been previously reported, with the primary blood supply attributed to the deep branch of the Medial Femoral Circumflex Artery (MFCA). This understanding has led to development of improved techniques for surgical hip dislocation for multiple intra-capsular hip procedures including Hip Resurfacing Arthroplasty (HRA). However, there is a lack of information in the literature on quantitative analysis of the contributions of the Lateral Femoral Circumflex Artery (LFCA) to femoral head and neck. Additionally, there is a lack of detailed descriptions in the literature of the anatomic course of the LFCA from its origin to its terminal branches. Twelve fresh-frozen human pelvic cadaveric specimens were studied (mean age 54.3 years, range 28–69). One hip per specimen was randomly assigned as the experimental hip, with the contralateral used as a control. Bilateral vascular dissection was performed to cannulate the MFCA and LFCA. Specimens were assigned as either LFCA-experimental or MFCA-experimental. All specimens underwent a validated quantitative-MRI protocol: 2mm slice thickness with pre- and post- MRI contrast sequences (Gd-DTPA diluted with saline at 3:1). In the LFCA-experimental group 15ml of MRI contrast solution was injected into the LFCA cannula. In the MFCA-experimental group 15ml of contrast solution was injected into the MFCA cannula. On the control hip contrast solution was injected into both MFCA and LFCA cannulas, 15ml each (30ml total for the control hip). Following MRI, the MFCA and LFCA were injected with polyurethane compound mixed with barium sulfate (barium sulfate only present in either MFCA or LFCA on each hip). Once polymerization had occurred, hips underwent thin-slice CT scan to document the extra- and intra-capsular course of the LFCA and MFCA. Gross dissection was performed to visually assess all intra-capsular branches of both the MFCA and LFCA and assess for extravasation. Quantitative-MRI analysis was performed based on Region of Interest (ROI) assessment. Femoral heads were osteotomized at the level of the largest diameter proximal to the articular margin and perpendicular to the femoral neck, for placement of a 360° scale. Measurements using the 360° scale were recorded. For data processing, we used right-side equivalents and integrated our 360° data into the more commonly used imaginary clock face.Introduction
Materials & Methods
