Aim

Diagnosis of periprosthetic joint infection (PJI) is challenging given the limitations of available diagnostic tests. Recently, several studies have shown a role of the long pentraxin PTX3 as a biomarker in inflammatory diseases and infections. This single-center prospective diagnostic study evaluated the diagnostic ability of synovial fluid and serum PTX3 for the infection of total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Aim

Diagnosis of periprosthetic joint infection (PJI) is still challenging due to limitations of available diagnostic tests. Many efforts are ongoing to find out novel methods for PJI diagnosis. Recently, several studies have shown a role of the long pentraxin PTX3 as a biomarker in inflammatory diseases and infections. This pilot diagnostic study evaluated the diagnostic ability of synovial fluid and serum PTX3 for the infection of total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Primary total knee arthroplasty (TKA) is a reliable procedure with reproducible long-term results. Nevertheless, there are conditions related to the type of patient or local conditions of the knee that can make it a difficult procedure. The most common scenarios that make it difficult are discussed in this review. These include patients with many previous operations and incisions, and those with severe coronal deformities, genu recurvatum, a stiff knee, extra-articular deformities and those who have previously undergone osteotomy around the knee and those with chronic dislocation of the patella.

Each condition is analysed according to the characteristics of the patient, the pre-operative planning and the reported outcomes.

When approaching the difficult primary TKA surgeons should use a systematic approach, which begins with the review of the existing literature for each specific clinical situation.

Cite this article: Bone Joint J 2015;97-B(10 Suppl A):30–9.

Introduction: Acetabular bone defects are critical and frustrating issue; indeed is possible to obtain good reconstruction with conventional Methods: (i.e. bulk graft, cage and cement) but good results are limited to short and mid term. Aim of this paper is to present reconstructive method based on filling the defect with an augment made of tantalum (augmentation technique).

Methods: We analized 42 cases from February 2005 to March 2009 with an average age of 63 years old with acetabular defect, scored 3A or more (4 patients had pelvic disjunction) according Paprosky classification.

The average age was very low, with 12 cases under 60 years (28,57%) and 21 under 70 (50%). 18 patients were re-revision (at time of surgery were at third or fourth surgical procedure) representing 54,2% of cases. Complete clinical, radiographic evaluation and survivorship analysis for the entire study cohort was performed from an average follow up of 26 months (min 6–max 55 months).

Results and Discussion: Preliminar results are encouraging: in only two case we had poor results with step pain and prescribed partial load and walking with two crutches, slight radiographic sign of migration where present at the last follow-up. These patients were previously submitted to many surgical procedures with significant bone loss, soft tissue damages and both with history of previous infection, classified as pelvic disjunction. One of these reported a ischiatic palsy.

In the remaining cases we obtained good functional recover, no failures at two years average of follow-up. 40 patients didn’t show hip or groin pain during stance position or walking, no bone resorption or implant mobilization were seen at radiographic follow-up. The HHS increases from 23,04 pre op to 85,15 post op. In no case were found clinical, radiographic, or biochemical signs of infection.

According with literature the rationale of augmentation technique with trabecular metal should give long lasting favourable results for its excellent bone ingrowth and mechanical properties.

Our results almost match the results of other authors. These brilliant results, partially due to osteoconductive proprieties of tantalum (despite we require time to confirmate), are certainly obtained thank to the optimal centre of rotation reconstruction, always close the physiological one.

The aim of this study is to evaluate techniques which may reduce intra and Post-Operative (PO) bleeding in hip surgery.

Methods: In this prospective study, from 9/2005 to 6/2006, we evaluated Blood Loss (BL) after primary total hip arthroplasty. Exclusion criteria were anti-coagulant drugs not discontinued 10 days before surgery and patients whose condition precluded weight bearing PO. We included total hip arthroplasty with posterior surgical approach, spinal anaesthesia, hypotensive surgery and peri-operative blood salvage (Ortho PAS, Euroset). When appropriate, the Mini-Invasive Approach (MIA) was used. In a different sub-set of patients, including some of the minimally invasive patients, a new bipolar Radio-Frequency sealer (TissueLink) was used. The PO program had pain control, LMWH for prevention of DVT, exercise from the day of surgery and walking on crutches from the next day. We analysed: blood loss after surgery and for 3 days; haemoglobin values (g/dL) before surgery and for 5 days PO; thigh circumference pre-op and at 5 days and adverse events such as transfusions and luxation. For the statistical evaluation the paired “t-test” was used, with a level of significance set at 95%. Differences and p values of < 0.05 were considered significant.

Results: 324 patients (mean age 68; range 23 to 89; 179 F & 145 M) were admitted to the study. Mean BL was 305ml intraoperative, 501ml at 6 hours PO, 304ml at 1day PO, 132ml at 2 days PO and trace at 3 days. Rather than simple unit measures, we analyzed the Percent Change in Hb from preoperative levels (%CHb). The patients had a mean %CHb of 23,09% at 1day PO, 26,67% at 2 days PO, 28,13% at 3 days and 29,07% at 5 days. Transfusion rates (TR; trigger set at Hb< 8g/dL) were related to the preoperative Hb and age. Overall TR was 15% (51/324), the prevalence of homologous transfusion was 7% (24/324). The TR for each Hb value: 21% (15/69) for Hb=12–13, 20% (20/98) for Hb=13–14, 17% (15/88) for Hb=14–15 and 5% (1/29) for Hb=15–16. The mean value of pain during rehabilitation was 3,11(VAS). MIA (53/324) was associated with reduced BL (mean %CHb at 1st day PO 19.12; TR 9%), but with high variability. The use of bipolar sealer (58/324) was associated with a significant reduction in overall BL (mean %CHb at 1st day PO 15.83; TR 5%) as well as a reduction of thigh swelling (37%) and of mean rehabilitation pain (30%; VAS=2.15).

Discussion: Reduced blood loss, reduced post-operative pain and a faster functional resumption are obtained with both the minimally invasive approach and the TissueLink sealer approach. In addition, MIA provides muscle preservation and the use of the TissueLink sealer provides reduced post-operative swelling.

Conclusion: This study shows that both the minimally invasive surgical approach and the use of an irrigated RF bipolar sealer can lead to reduced blood loss and faster functional resumption following hip surgery.