Compare clinical outcomes following staged revision arthroplasty for periprosthetic joint infection (PJI) secondary to either multidrug resistant (MDR) bacteria or non-MDR (NMDR) bacteria. Retrospective analysis of a prospectively collected bone infection database. Adult patients diagnosed and treated for hip or knee PJI, between January 2011 and December 2014, with minimum one-year follow-up, were included in the study. Patients were divided into two groups: MDR group (defined as resistance to 3 or more classes) and N-MDR group (defined as acquired resistance to two classes of antibiotic or less). The Charlson Comorbidity Index was used to stratify patients into low, medium and high risk. The diagnosis of PJI, and any recurrence following treatment, was made in accordance with the Musculoskeletal Infection Society criteria. Failure was defined as recurrence of infection necessitating implant removal, excision arthroplasty, arthrodesis or amputation.Aim
Method
Periprosthetic joint infections (PJI) are rare and require complex multi-disciplinary management. Successful single and two-stage revision procedures have been described. We describe the clinical features of this rare diagnosis from a single institution. Patients were identified retrospectively from a prospectively collected institutional infection database. Clinical notes were evaluated for demographic, comorbid and clinical outcomes. The diagnosis of PJI, and any recurrence following treatment, was made in accordance with the Musculoskeletal Infection Society criteria. Failure was defined as recurrence of infection necessitating implant removal, excision arthroplasty or amputation.Aim
Method
We would like to present this service evaluation of Taylor Spatial Frame use within a busy limb reconstruction unit. We present a cohort of 60 patients representing a year of work from January 2011 to January 2012 with a breakdown of coding data. Included are details of operative episodes, length of stay, outpatient follow up including software programming episodes, strut changes and general frame care from our specialist nurses. We have produced a comparison of cost to HRG coding tarifs with an audit of coding errors and cost implications of these corrections. Also included is a breakdown of comparison data from patients undergoing frame assisted deformity correction and internal fixation, Computer Hexapod Assisted Orthopaedic Surgery. Exact and careful coding of these procedures is required considering their relatively high cost.
Orthopaedic cobalt chromium particles and ions can induce indirect DNA damage and chromosome aberrations in human cells on the other side of a cellular barrier in tissue culture. This occurs by intercellular signalling across the barrier. We now show that the threshold for this effect depends on the metal form and the particle composition. Ionic cobalt and chromium induced single strand breaks at concentrations equivalent to those found in the blood of patients with well functioning metal on metal hip prostheses. However, they only caused double strand breaks if the chromium was present as chromium (VI), and did not induce chromosome aberrations. Nanoparticles of cobalt chromium alloy caused DNA double strand breaks and chromosome aberrations, of which the majority were tetraploidy. Ceramic nanoparticles induced only single strand breaks and/or alkaline labile sites when indirectly exposed to human fibroblasts. The assessment of reproductive risk from maternal exposure to biomaterials, especially those liberated by orthopaedic implants, is not yet possible with epidemiology. Whilst the barrier model used here differs from the in vivo situation in several respects, it may be useful as a framework to evaluate biomaterial induced damage across physiological barriers.
