Aim

Prosthetic joint infection (PJI) is a much feared complication to arthroplasty with significant patient morbidity. Rifampin is increasingly used in staphylococcal PJIs treated with debridement and retention of the prosthesis. The evidence supporting rifampin combination therapy in PJIs is limited due to the lack of controlled studies. The aim of this study is to evaluate the effect of adding rifampin to conventional antimicrobial therapy in early staphylococcal PJIs treated with debridement and retention.

Aim

The incidence of prosthetic joint infections can be severe to monitor, as they are rare events. Recent publications from National registries points toward a significant underestimation of reported infections. The aim of this project was to develop a complication register that could report the “true” and momentaneous incidence of prosthetic infections after total knee and hip arthroplasty.

Aims: The symptoms of aseptic and septic prosthetic joint loosening may be similar, and identification of low-grade prosthetic infection based only on clinical history and physical examination has a reported low sensitivity. In a prospective study we explored to what extent a thorough examination of the patient’s history of sickness and a standardized preoperative clinical examination could help the surgeon to identify cases of septic loosening.

Methods: We included 54 patients undergoing revision surgery due to loosening of a total hip or knee prosthesis. Preoperatively a standardized form which included data regarding the patient’s history of sickness was obtained and a physical examination was performed.

Postoperatively a final diagnose was made based on microbiological testing, which in addition to routine culture, included sonication of the prosthesis and nucleic acid based diagnostics (PCR). Data from the preoperative examination was evaluated in relation to the final diagnose (chi-square test and Student’s t-test), and the sensitivity and specificity for diagnosing a septic loosening was calculated for each preoperative finding.

Results: According to the final diagnose, 21 patients had a septic loosening and 33 patients had an aseptic loosening. In the septic group and aseptic group the following anamnestic data was registered: Pain during rest: 16/21 vs. 7/33 (p < 0.001). Prior history of soft tissue debridement: 11/21 vs. 4/33 (p = 0.001). Prior prosthetic revision surgery: 13/21 vs. 8/33 (p = 0.006). Time from index operation to revision: 45 (5 – 144) moths vs. 159 (22–390) moths, (p = 0.02). Time from index operation to debut of prosthetic assosiated dyscomfort: 10 (0–110) moths vs. 120 (0–240) moths, (p < 0.001). The calculated sensitivity (se) and spesifisity (sp) for the pre-operative findings were: Existence of prosthetic related pain during rest: 79% se, 79% sp; history of soft tissue revision in the affected joint 52% se, 88% sp; history of prior exchange prosthetic revision in the affected joint 62% se, 76% sp, respectively.

Conclusion: We advise a carefully obtained history from every patient presenting with loosening of implanted prosthetic components for identification of a potential low grade infection. In particular, pain during rest has a notable sensitivity and specificity. A prior history of soft tissue revision also strongly indicates a septic prosthetic loosening.

Introduction: We have previously reported on an incidence of diabetic amputations of 4, 4 per 1.000 diabetic subjects per year in the city of Trondheim, Norway, 1994–1997. As a consequence of that study, Trondheim Diabetic Foot Team was established January 1st 1996. The Diabetic Foot Team has been an integrated part of the Outpatient clinic, Department of Orthopaedic Surgery, St. Olavs University Hospital. We report on the incidence of diabetic amputations ten years later (2004–2007).

Material and Methods: The University Hospital is the only hospital in Trondheim, and all amputations are performed at the Department of Orthopaedic Surgery. In 2004–2007 we registered consecutively all diabetic amputations. During the two study periods, 1994–1997 and 2004–2007, the population of Trondheim was 143.300 and 159.000 inhabitants, respectively. The total number of diabetic subjects in Trondheim during the two study periods was 3.600 and 4.600, respectively.

Changes in incidence rates were analyzed using Poisson regression with decade as covariate. Two sided p-values < 0.05 were considered significant. Analyses were performed in State version10.0.

Results: During the decade the number of diabetic amputations/1000 diabetics/year decreased 40 percent from 4, 4 to 2, 8 (p= 0.04). In the same period, 779 patients with diabetes were screened at the Diabetic Foot Team, and 5915 consultations due to diabetic foot problems were performed. From 1996 to 2006 the number of invasive and non-invasive vascular intervention per year in patients with diabetes living in Trondheim did not change.

Discussion: Although other factors may be involved, we attribute the decrease in the incidence of diabetic amputations to the activity of the Diabetic Foot Team. Every department of orthopaedic surgery should make priority to the implementation of a multidisciplinary program for prevention and treatment of diabetic foot ulcers.