The utilization of sonicate fluid cultures (SFC) has been shown to increase the detection rate of periprosthetic joint infection (PJI) in comparison to the use of conventional microbiological methods, because sonication enables a sampling of the causative bacteria directly from the surface of the endoprosthetic components. The hypothesis of this study is that not only will the detection rate of PJI be improved, but also the detection rate of polymicrobial infection in patients with total knee arthroplasty (TKA) revision surgery. 74 patients which underwent TKA revision surgery received a synovial aspiration, intraoperative tissue cultures, histological sampling of the periprosthetic membrane, and sonication of the explanted endoprosthesis. A PJI was defined according to the following criteria: presence of intraarticular pus or a sinus tract, positive isolation of causative bacteria in ≥2 microbiological samples or a histological membrane indicative of infection (type II or III periprosthetic membrane).Introduction
Material and methods
Bone-marrow oedema can occur both in isolation and in association with necrosis of bone, but it has not been shown whether each respond to the same methods of treatment. We treated 16 patients with isolated oedema and 17, in which it was associated with necrosis of the proximal femur, with the prostacyclin derivative iloprost, which has been shown to be effective in the idiopathic form. The Harris hip score, the range of movement, the extent of the oedema as measured by MRI, pain on a visual analogue scale and patient satisfaction were recorded before and subsequent to treatment. In both groups, we were able to show a significant improvement (p <
0.001) in these observations during the period of follow-up indicating that iloprost will produce clinical improvement in both circumstances.
