The aim of the study was to compare two methods of calculating pelvic incidence (PI) and pelvic tilt (PT), either by using the femoral heads or acetabular domes to determine the bicoxofemoral axis, in patients with unilateral or bilateral primary hip osteoarthritis (OA). PI and PT were measured on standing lateral radiographs of the spine in two groups: 50 patients with unilateral (Group I) and 50 patients with bilateral hip OA (Group II), using the femoral heads or acetabular domes to define the bicoxofemoral axis. Agreement between the methods was determined by intraclass correlation coefficient (ICC) and the standard error of measurement (SEm). The intraobserver reproducibility and interobserver reliability of the two methods were analyzed on 31 radiographs in both groups to calculate ICC and SEm.Aims
Methods
Calprotectin (CLP) is produced in neutrophils and monocytes and released into body fluids as a result of inflammation or infection. The aim of this study was to evaluate the utility of blood and synovial CLP in the diagnosis of chronic periprosthetic joint infection (PJI). Blood and synovial fluid samples were collected prospectively from 195 patients undergoing primary or revision hip and knee arthroplasty. Patients were divided into five groups: 1) primary total hip and knee arthroplasty performed due to idiopathic osteoarthritis (OA; n = 60); 2) revision hip and knee arthroplasty performed due to aseptic failure of the implant (AR-TJR; n = 40); 3) patients with a confirmed diagnosis of chronic PJI awaiting surgery (n = 45); 4) patients who have finished the first stage of the PJI treatment with the use of cemented spacer and were qualified for replantation procedure (SR-TJR; n = 25), and 5) patients with rheumatoid arthritis undergoing primary total hip and knee arthroplasty (RA; n = 25). CLP concentrations were measured quantitatively in the blood and synovial fluid using an immunoturbidimetric assay. Additionally, blood and synovial CRP, blood interleukin-6 (IL-6), and ESR were measured, and a leucocyte esterase (LE) strip test was performed.Aims
Methods
Infection remains a serious complication of total hip replacement (THR). Management options have been developed to improve clearance of infection while maintaining joint function during treatment and improve outcome at reimplantation. The gold standard in management is generally considered to be implant removal and thorough debridement with antibiotic therapy delivered systemically and locally with impregnated spacers. However, some surgeons still prefer to use Girdlestone resection arthroplasty, thus not leaving any foreign body The aim of this study was to compare infection clearance rates, radiographic and functional outcomes after two-stage revision of total hip arthroplasty with (1) gentamicin-loaded bone cement spacer or (2) Girdlestone resection arthroplasty as the first stage of treatment. We retrospectively reviewed data of 48 patients (20 females, 28 males) with implanted spacers and 53 patients (21 females, 32 males) treated with resection arthroplasty at tertiary care university hospital in the years 2008–2012. Minimum follow-up was three years (range, 3–7 years). Treatment choice was at the operating surgeons's discretion. In the spacer group, mean age at the time of first stage was 62 years (range 24–79 years), time from primary replacement 14 months, and the time from the first to the second stage of the revision 7 months. At latest, minimum 3-year follow-up, two were still ambulating with a spacer in situ, and five were re-revised with another spacer before the reimplantation of the THR. In the resection arthroplasty group, mean age at the time of first stage was 64 years (range, 37–87 years), time from primary replacement 13 months, and the time from the first to the second stage of revision − 10 months. At the latest follow-up, four patients were ambulating with resection arthroplasty, one did not clear his infection and one died of unrelated causes. The cure ratio appeared to be the same within both groups (Fisher exact test, p=0.08). Patients with spacers achieved better functional results, used less supports for ambulation and had less leg length discrepancy after the second stage of revision. In the light of those results, we cannot recommend for the use of resection arthroplasty in the treatment of the infected THR.
