Aims. Delayed postoperative inoculation of orthopaedic implants with persistent wound drainage or bacterial seeding of a haematoma can result in periprosthetic joint
Aims. Periprosthetic joint
Acute bone and joint
Aims. The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related
Aims. The aim of this study was to examine whether socioeconomic status (SES) is associated with a higher risk of
Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant
Aims. Open discectomy (OD) is the standard operation for lumbar disc herniation (LDH). Percutaneous endoscopic lumbar discectomy (PELD), however, has shown similar outcomes to OD and there is increasing interest in this procedure. However despite improved surgical techniques and instrumentation, reoperation and
Aims. The aim of this study was to estimate the 90-day periprosthetic joint
The rate of surgical site
Aims. The diagnosis of periprosthetic joint
Aims. Deep surgical site
Aims. To evaluate the histopathological examination of peri-implant tissue samples as a technique in the diagnosis of postoperative spinal implant
Aims. This study aimed to investigate the role of quantitative histological
analysis in the diagnosis of fracture-related
Aims. Removal of infected components and culture-directed antibiotics are important for the successful treatment of chronic periprosthetic joint
Aims. To assess the diagnostic value of C-reactive protein (CRP), leucocyte count (LC), and erythrocyte sedimentation rate (ESR) in late fracture-related
Aims. To determine whether there is any difference in
In England and Wales more than 175 000 hip and
knee arthroplasties were performed in 2012. There continues to be a
steady increase in the demand for joint arthroplasty because of
population demographics and improving survivorship. Inevitably though
the absolute number of periprosthetic
Aims. The aim of this study was to identify risk factors for prosthetic
joint
Aims. Lifestyle risk factors are thought to increase the risk of infection
after acute orthopaedic surgery but the evidence is scarce. We aimed
to investigate whether smoking, obesity and alcohol overuse are
risk factors for the development of
Aims. To investigate the outcomes of treatment of streptococcal periprosthetic
joint
Louis Pasteur once said that: “Fortune favours
the prepared mind.” As one of the great scientists who contributed
to the fight against
The treatment of peri-prosthetic joint infection
(PJI) of the ankle is not standardised. It is not clear whether
an algorithm developed for hip and knee PJI can be used in the management
of PJI of the ankle. We evaluated the outcome, at two or more years
post-operatively, in 34 patients with PJI of the ankle, identified
from a cohort of 511 patients who had undergone total ankle replacement.
Their median age was 62.1 years (53.3 to 68.2), and 20 patients
were women.
Aims.
Treatment of an infected total elbow replacement
(TER) is often successful in eradicating or suppressing the
Most animal studies indicate that early irrigation
and debridement reduce
Aims. We describe the use of a protocol of irrigation and debridement
(I&
D) with retention of the implant for the treatment of periprosthetic
infection of a total elbow arthroplasty (TEA). This may be an attractive
alternative to staged re-implantation. . Patients and Methods. Between 1990 and 2010, 23 consecutive patients were treated in
this way. Three were lost to follow-up leaving 20 patients (21 TEAs)
in the study. There were six men and 14 women. Their mean age was
58 years (23 to 76). The protocol involved: component unlinking,
irrigation and debridement (I&
D), and the introduction of antibiotic
laden cement beads; organism-specific intravenous antibiotics; repeat
I&
D and re-linkage of the implant if appropriate; long-term
oral antibiotic therapy. . Results. The mean follow-up was 7.1 years (2 to 16). The infecting micro-organisms
were Staphylococcus aureus in nine, coagulase-negative Staphylococcus in
13, Corynebacterium in three and other in six cases.
Re-operations included three repeat staged I&
Ds, two repeat
superficial I&
Ds and one fasciocutaneous forearm flap. One patient
required removal of the implant due to persistent
Aims. The importance of accurate identification and reporting of surgical
site
Peri-prosthetic
Periprosthetic joint
We undertook a retrospective case-control study
to assess the clinical variables associated with
We have designed a prospective study to evaluate
the usefulness of prolonged incubation of cultures from sonicated
orthopaedic implants. During the study period 124 implants from
113 patients were processed (22 osteosynthetic implants, 46 hip
prostheses, 54 knee prostheses, and two shoulder prostheses). Of
these, 70 patients had clinical
Aims. The principle strategies of fracture-related
Aims. Despite numerous studies focusing on periprosthetic joint
Aims. We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint
Aims. The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for
Aims. There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint
Aims. Histology is widely used for diagnosis of persistent
Aims. A higher failure rate has been reported in haematogenous periprosthetic joint
Aims. This study aims to assess the relationship between history of pseudotumour formation secondary to metal-on-metal (MoM) implants and periprosthetic joint
Aims. The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal
Periprosthetic joint
Aims. This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site
Aims. Gram-negative periprosthetic joint
Aims. The aim of the present study was to assess the outcomes of the induced membrane technique (IMT) for the management of infected segmental bone defects, and to analyze predictive factors associated with unfavourable outcomes. Methods. Between May 2012 and December 2020, 203 patients with infected segmental bone defects treated with the IMT were enrolled. The digital medical records of these patients were retrospectively analyzed. Factors associated with unfavourable outcomes were identified through logistic regression analysis. Results. Among the 203 enrolled patients,
Aims. Fungal periprosthetic joint
Aims. Total femoral arthroplasty (TFA) is a rare procedure used in cases of significant femoral bone loss, commonly from cancer,
Aims. This study compares the re-revision rate and mortality following septic and aseptic revision hip arthroplasty (rTHA) in registry data, and compares the outcomes to previously reported data. Methods. This is an observational cohort study using data from the German Arthroplasty Registry (EPRD). A total of 17,842 rTHAs were included, and the rates and cumulative incidence of hip re-revision and mortality following septic and aseptic rTHA were analyzed with seven-year follow-up. The Kaplan-Meier estimates were used to determine the re-revision rate and cumulative probability of mortality following rTHA. Results. The re-revision rate within one year after septic rTHA was 30%, and after seven years was 34%. The cumulative mortality within the first year after septic rTHA was 14%, and within seven years was 40%. After multiple previous hip revisions, the re-revision rate rose to over 40% in septic rTHA. The first six months were identified as the most critical period for the re-revision for septic rTHA. Conclusion. The risk re-revision and reinfection after septic rTHA was almost four times higher, as recorded in the ERPD, when compared to previous meta-analysis. We conclude that it is currently not possible to assume the data from single studies and meta-analysis reflects the outcomes in the ‘real world’. Data presented in meta-analyses and from specialist single-centre studies do not reflect the generality of outcomes as recorded in the ERPD. The highest re-revision rates and mortality are seen in the first six months postoperatively. The optimization of perioperative care through the development of a network of high-volume specialist hospitals is likely to lead to improved outcomes for patients undergoing rTHA, especially if associated with
Aims. The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any
Aims. The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint
Aims. One-stage exchange for periprosthetic joint
Aims. The aim of this study was to determine if a three-month course of microorganism-directed oral antibiotics reduces the rate of failure due to further
Aims. Periprosthetic joint
Aims. The diagnosis of periprosthetic joint
Aims. The purpose of this study was to evaluate unexpected positive cultures in total hip arthroplasty (THA) revisions for presumed aseptic loosening, to assess the prevalence of low-grade
Aims. The aim of this study was to evaluate the optimal deep tissue specimen sample number for histopathological analysis in the diagnosis of periprosthetic joint
Aims. Periprosthetic joint
Aims. Bacterial
Aims. The aim of this study was to evaluate the diagnostic accuracy of the absolute synovial polymorphonuclear neutrophil cell (PMN) count for the diagnosis or exclusion of periprosthetic joint
Aims. Debridement, antibiotics, and implant retention (DAIR) remains one option for the treatment of acute periprosthetic joint
Aims. Surgical site
Aims. Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of hip arthroplasty necessitate removal of all bone cement from the femur. In our two centres, we have been using a cement-in-cement technique, leaving the distal femoral bone cement in selected patients for septic hip revision surgery, both for single and the first of two-stage revision procedures. A prerequisite for adoption of this technique is that the surgeon considers the cement mantle to be intimately fixed to bone without an intervening membrane between cement and host bone. We aim to report our experience for this technique. Methods. We have analyzed patients undergoing this cement-in-cement technique for femoral revision in
The critical relationship between airborne microbiological contamination in an operating theatre and surgical site
Aims. Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint
Aims. Accurate diagnosis of chronic periprosthetic joint
Aims. This systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates. Methods. A systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, and patellar retaining. RCTs that compared patellar resurfacing versus unresurfaced in primary TKA were included for further analysis. Studies were evaluated using the Scottish Intercollegiate Guidelines Network assessment tool for quality and minimization of bias. Data were synthesized and meta-analysis performed. Results. There were 4,135 TKAs (2,068 resurfaced and 2,027 unresurfaced) identified in 35 separate cohorts from 33 peer-reviewed studies. Anterior knee pain rates were significantly higher in unresurfaced knees overall (odds ratio (OR) 1.84; 95% confidence interval (CI) 1.20 to 2.83; p = 0.006) but more specifically associated with CR implants (OR 1.95; 95% CI 1.0 to 3.52; p = 0.030). There was a significantly better Knee Society function score (mean difference (MD) -1.98; 95% CI -1.1 to -2.84; p < 0.001) and Oxford Knee Score (MD -2.24; 95% CI -0.07 to -4.41; p = 0.040) for PS implants when patellar resurfacing was performed, but these differences did not exceed the minimal clinically important difference for these scores. There were no significant differences in complication rates or
Aims. Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint
Aims. Tibial tubercle osteotomy (TTO) facilitates surgical exposure and protects the extensor mechanism during revision total knee arthroplasty (rTKA). The purpose of this study was to determine the rates of bony union, complications, and reoperations following TTO during rTKA, to assess the functional outcomes of rTKA with TTO at two years’ minimum follow-up, and to identify the risk factors of failure. Methods. Between January 2010 and September 2020, 695 rTKAs were performed and data were entered into a prospective database. Inclusion criteria were rTKAs with concomitant TTO, without extensor mechanism allograft, and a minimum of two years’ follow-up. A total of 135 rTKAs were included, with a mean age of 65 years (SD 9.0) and a mean BMI of 29.8 kg/m. 2. (SD 5.7). The most frequent indications for revision were
Periprosthetic joint
Aims. The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic joint
Aims. Debridement, antibiotics, and implant retention (DAIR) is a widely accepted form of surgical treatment for patients with an early periprosthetic joint
Aims. To compare rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications), and compare these with primary arthroplasty and re-revision arthroplasty. Methods. Patients undergoing primary knee arthroplasty were identified in the national Hospital Episode Statistics (HES) between 1 April 1997 to 31 March 2017. Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes, including
Aims. Use of molecular sequencing methods in periprosthetic joint
Aims. The aims of this study were to report the efficacy of revision surgery for patients with co-infective bacterial and fungal prosthetic joint infections (PJIs) presenting to a single institution, and to identify prognostic factors that would guide management. Patients and Methods. A total of 1189 patients with a PJI were managed in our bone infection service between 2006 and 2015; 22 (1.85%) with co-infective bacterial and fungal PJI were included in the study. There were nine women and 13 men, with a mean age at the time of diagnosis of 64.5 years (47 to 83). Their mean BMI was 30.9 kg/m. 2. (24 to 42). We retrospectively reviewed the outcomes of these PJIs, after eight total hip arthroplasties and 14 total knee arthroplasties. The mean clinical follow-up was 4.1 years (1.4 to 8.8). Results. The median number of risk factors for PJI was 5.5 (interquartile range (IQR) 3.25 to 7.25). All seven patients who initially underwent debridement and implant retention (DAIR) had a recurrent
Aims. The success of total knee arthroplasty (TKA) is usually measured using functional outcome scores and revision-free survivorship. However, reporting the lifetime risk of revision may be more meaningful to patients when gauging risks, especially in younger patients. We aimed to assess the lifetime risk of revision for patients in different age categories at the time of undergoing primary TKA. Methods. The New Zealand Joint Registry database was used to obtain revision rates, mortality, and the indications for revision for all primary TKAs performed during an 18-year period between January 1999 and December 2016. Patients were stratified into age groups at the time of the initial TKA, and the lifetime risk of revision was calculated according to age, sex, and the American Society of Anesthesiologists (ASA) grade. The most common indications for revision were also analyzed for each age group. Results. The overall ten-year survival rate was 95.6%. This was lowest in the youngest age group (between 46 and 50 years) and increased sequentially with increasing age. The lifetime risk of requiring revision was 22.4% in those aged between 46 and 50 years at the time of the initial surgery, and decreased linearly with increasing age to 1.15% in those aged between 90 and 95 years at the time of surgery. Higher ASA grades were associated with increased lifetime risk of revision in all age groups. The three commonest indications for revision were aseptic loosening,
Aims. The aims of this study were to develop an in vivo model of periprosthetic joint
Aims. The preoperative diagnosis of periprosthetic joint
Aims. Pin-site
Aims. Fungal and mycobacterial periprosthetic joint
Aims. In cases of severe periprosthetic joint
Aims. This study aimed to describe the use of revision knee arthroplasty in Australia and examine changes in lifetime risk over a decade. Methods. De-identified individual-level data on all revision knee arthroplasties performed in Australia from 2007 to 2017 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population data and life tables were obtained from the Australian Bureau of Statistics. The lifetime risk of revision surgery was calculated for each year using a standardized formula. Separate calculations were undertaken for males and females. Results. In total, 43,188 revision knee arthroplasty procedures were performed in Australia during the study period, with a median age at surgery of 69 years (interquartile range (IQR) 62 to 76). In 2017, revision knee arthroplasty rates were highest for males aged 70 to 79 years (102.9 procedures per 100,000 population). Lifetime risk of revision knee arthroplasty for females increased slightly from 1.61% (95% confidence interval (CI) 1.53% to 1.69%) in 2007 to 2.22% (95% CI 2.13% to 2.31%) in 2017. A similar pattern was evident for males, with a lifetime risk of 1.43% (95% CI 1.36% to 1.51%) in 2007 and 2.02% (95% CI 1.93% to 2.11%) in 2017. A decline in procedures performed for loosening/lysis (from 41% in 2007 to 24% in 2017) and pain (from 14% to 9%) was evident, while
Aims. Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19
Aims. It remains difficult to diagnose early postoperative periprosthetic joint
Aims.
Aims. This multicentre, retrospective study aimed to improve our knowledge
of primary pyogenic spinal
Aims. The management of periprosthetic joint
Aims. As a proven and comprehensive molecular technique, metagenomic next-generation sequencing (mNGS) has shown its potential in the diagnosis of pathogens in patients with periprosthetic joint
Aims. To compare the functional outcome, health-related quality of life (HRQoL), and satisfaction of patients who underwent primary total hip arthroplasty (THA) and a single debridement, antibiotics and implant retention (DAIR) procedure for deep
Aims. Calprotectin (CLP) is produced in neutrophils and monocytes and released into body fluids as a result of inflammation or
Aims. Metagenomic next-generation sequencing (mNGS) is useful in the diagnosis of infectious disease. However, while it is highly sensitive at identifying bacteria, it does not provide information on the sensitivity of the organisms to antibiotics. The purpose of this study was to determine whether the results of mNGS can be used to guide optimization of culture methods to improve the sensitivity of culture from intraoperative samples. Methods. Between July 2014 and October 2019, patients with suspected joint
Aims. The aim of this study was to evaluate the diagnostic value of preoperative serum CRP, white blood cell count (WBC), percentage of neutrophils (%N), and neutrophil to lymphocyte ratio (NLR) when using the fracture-related
Aims. The success rates of two-stage revision arthroplasty for
Aims. Intra-articular administration of antibiotics during primary total knee arthroplasty (TKA) may represent a safe, cost-effective strategy to reduce the risk of acute periprosthetic joint
Aims. The aim of this study was to use national registry database information to estimate cumulative rates and relative risk of revision due to
Aims. Monocyte-lymphocyte ratio (MLR) or neutrophil-lymphocyte ratio (NLR) are useful for diagnosing periprosthetic joint
Aims. To describe the risk of periprosthetic joint
Aims. The aim of this study was to determine the diagnostic accuracy of α defensin (AD) lateral flow assay (LFA) and enzyme-linked immunosorbent assay (ELISA) tests for periprosthetic joint
Deep
Aims. The results of irrigation and debridement with component retention (IDCR) in the treatment of acutely infected total knee arthroplasties (TKAs) have been variable. The aim of this study was to assess the outcome after IDCR when combined with chronic antibiotic suppression. We also evaluated survivorship free from subsequent
Aims. This study sought to compare the rate of deep surgical site