Aim

Two-stage replacement is a frequent procedure in patients with chronic PJI. However, results in the literature after this procedure differ, ranging from 54% to 100% of infection eradication. Positive cultures at reimplantation, when performing the second stage, are perceived as a risk factor for reinfection. This study aims to determine the impact of positive cultures during the second stage on the outcome of patients undergoing a 2-stage septic replacement and the impact of antibiotic holidays between the first and the second stage.

Aim

The demonstration of the in vivo bactericidal efficacy of a new bone cement with rifampicin contained in microcapsules and its intra-articular release profile.

Introduction: The osteoporotic vertebral fracture is a pathology with an increasing incidence, being nowadays the most frequent osteoporotic fracture with an important sanitary cost. Parallel to these sanitary demands new surgical techniques, such as the vertebroplasty and the kyphoplasty, have been developed in order to improve the analgesic control, diminish the spinal angular deformities and improve the quality of life of patients. The purpose of this study is to describe our preliminary clinical and radiological results of a new system of kyphoplasty.

Material and Methods: Retrospective study in 18 patients diagnosed of vertebral fracture A1.1 and A1.2 (AO classification) at a single level, lumbar or lower thoracic (D10-12), with an integrity of the posterior wall, treated by kyphoplasty with stent (VBS^®, Synthes). The average age of the patients was 77,6 years (range, 69 – 87 years.). The average follow-up time was 7 months (range, 6 – 8 months). Presurgical and postsurgical plain X-ray films were taken to measure the height of the front, middle and posterior props, the regional saggital angle and Cobb’s saggital angle. A vertebral re-expansion measurement was defined as pre to post surgical difference in height of the middle prop. Pre and postsurgical VAS pain and analgesic-seizure medication were monitored and the average hospital stay was determined.

Results: 10 patients type A1.1 and 8 patients type A2.2. The average hospital stay was 48h (range, 24–72 h). Pre-surgically, the regional saggital angle was 14,45° (range, 9 –22°) and, postsurgically, 9,82° (5 –17°) (p < 0,05). Cobb’s saggital angle presurgical was 13,8° (range, 6°–30°) and postsurgically 8,94°(p < 0,05). No differents in the height of the front props were found. The vertebral re-expansion was 16,23 mm (range, 16–20 mm). Pain measured by VAS was 9,1 (range, 7–10), presurgical, and 4,9 (range, 2–7) postsurgical with a statistically significant decrease (p < 0,05). Only two cases of asymptomatic cement fugue were registered and no patient reintervention was necessary.

Conclusions: The VBS^® system is a useful alternative to the conventional surgical treatment of osteoporotic vertebral fractures, diminishing the need for taking analgesic medication and improving the radiographic parameters and producing a in the analyzed with a low level of morbi/mortality.