The worldwide COVID-19 pandemic is directly impacting the field of orthopaedic surgery and traumatology with postponed operations, changed status of planned elective surgeries and acute emergencies in patients with unknown infection status. To this point, Germany's COVID-19 infection numbers and death rate have been lower than those of many other nations. This article summarizes the current regimen used in the field of orthopaedics in Germany during the COVID-19 pandemic. Internal university clinic guidelines, latest research results, expert consensus, and clinical experiences were combined in this article guideline.Aims
Methods
A timely isolation of the causative bacterial species is of paramount importance in the treatment of periprosthetic joint infection (PJI). Sonication of the explanted endoprosthesis and the microbiological culture of sonicate fluid (SFC) has been proven to increase the rate of bacterial isolations in comparison to the conventional microbiological methods. The cultivation of aspired synovial fluid in blood culture bottles (BCB) has been shown to yield a higher rate of bacterial isolations and produce a lower rate of contaminants than cultivation on conventional agar plates. The primary aim of this study was to investigate whether the inoculation of BCB with sonicate fluid leads to a higher rate of bacterial isolations than the culture on agar plates. Secondly, we wanted to investigate whether the utilization of BCB leads to an earlier identification of the causative bacterial species. To our knowledge this is the first study to investigate the effects of BCB use on SFC. We performed a retrospective analysis comparing the results of the two different culture methods. To detect slow growing species all microbiological cultures, regardless of the culture method, were incubated for 14 days.Introduction
Methods
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
Acetabular retroversion has been implicated as a risk factor for the development of early hip osteoarthritis. In clinical practice standard osseous signs such as the cross-over sign (COS) and the posterior wall sign (PWS) are widely used to establish the diagnosis of acetabular retroversion on plain radiographs. Despite standardized radiological evaluation protocols, an increased pelvic tilt can lead to a misdiagnosis of acetabular retroversion in AP radiographs and 2D MR or CT scans. Previous studies have shown that the elimination of observer bias using a standardized methodology based on 3D-CT models and the anterior pelvic plane (APP) for the assessment of COS and PWS results in greater diagnostic accuracy. Using this method a prevalence of 28% for COS and 24% for PWS has been found in a cohort of patients with symptoms indicative of FAI, however the prevalence of both signs in asymptomatic adults remains unknown. This study therefore sought to establish the prevalence of the COS and PWS in relation to the APP in an asymptomatic population using a reliable and accurate 3 D-CT based assessment. A large pool of consecutive CT scans of the pelvis undertaken in our department for conditions unrelated to disorders of the hip was available for analysis. Scans in subjects with a Harris hip score of less than 90 points were excluded leaving a sample of 100 asymptomatic subjects (200 hips) for this study. A previously established 3D analysis method designed to eliminate errors resulting from variations in the position and orientation of the pelvis during CT imaging was applied to determine in order to assess the prevalence of the COS and PWS in relation to the APP. Here, the acetabuli were defined as retroverted if either the COS, PWS or both were positive.INTRODUCTION:
METHODS:
Sonicate fluid cultures (SFC) are more sensitive than conventional microbiological methods in identifying periprosthetic joint infections (PJI), because sonication enables a sampling of the causative bacteria directly from the surface of the endoprosthetic components. Because of their high sensitivity SFC can be positive while all other microbiological methods remain negative. It is therefore difficult to interpret a single SFC as being truly or falsely positive. The aim of this prospective study was to improve the interpretation of SFC in the diagnosis of PJI in patients after total hip arthroplasty through the use of multiple SFC. 102 patients of which 37 had a defined PJI according to the following criteria were included: intraarticular pus or a sinus tract, a periprosthetic membrane (PM) indicative of infection, or a positive microbiological culture in a minimum of 2 separate microbiological samples. A single positive microbiological sample was classified as false positive. In 35 patients multiple SFC were acquired from the separate endoprosthetic components.Introduction
Material and methods
