This study explores the relationship between
delay to surgical debridement and
Sixty-eight patients suffering
Our aim was to review the efficacy of the wound vacuum-assisted closure (VAC) system in the treatment of
We reviewed a series of 91 patients with
Exchange operation is recommended as the treatment of choice for most
A retrospective review of 1542 Charnley low-friction arthroplasties was carried out to compare the incidence of
We have investigated whether the use of laminar-flow theatres and space suits reduced the rate of revision for early
Treatment of an infected total elbow replacement
(TER) is often successful in eradicating or suppressing the infection.
However, the extensor mechanism may be compromised by both the infection
and the surgery. The goal of this study was to assess triceps function
in patients treated for
Periprosthetic joint infection (PJI) complicates
between 0.5% and 1.2% primary total hip arthroplasties (THAs) and
may have devastating consequences. The traditional assessment of
patients suffering from PJI has involved the serological study of
inflammatory markers and microbiological analysis of samples obtained
from the joint space. Treatment has involved debridement and revision
arthroplasty performed in either one or two stages. We present an update on the burden of PJI, strategies for its
diagnosis and treatment, the challenge of resistant organisms and
the need for definitive evidence to guide the treatment of PJI after
THA. Cite this article:
We have carried out in 24 patients, a two-stage revision arthroplasty of the hip for infection with massive bone loss. We used a custom-made, antibiotic-loaded cement prosthesis as an interim spacer. Fifteen patients had acetabular deficiencies, eight had segmental femoral bone loss and one had a combined defect. There was no recurrence of infection at a mean follow-up of 4.2 years (2 to 7). A total of 21 patients remained mobile in the interim period. The mean Merle D’Aubigné and Postel hip score improved from 7.3 points before operation to 13.2 between stages and to 15.8 at the final follow-up. The allograft appeared to have incorporated into the host bone in all patients. Complications included two fractures and one dislocation of the cement prosthesis. The use of a temporary spacer maintains the function of the joint between stages even when there is extensive loss of bone. Allograft used in revision surgery after septic conditions restores bone stock without the risk of recurrent infection.
The aim of this study was to identify the incidence of positive
cultures during the second stage of a two-stage revision arthroplasty
and to analyse the association between positive cultures and an
infection-free outcome. This single-centre retrospective review of prospectively collected
data included patients with a periprosthetic joint infection (PJI)
of either the hip or the knee between 2013 and 2015, who were treated
using a standardised diagnostic and therapeutic algorithm with two-stage
exchange. Failure of treatment was assessed according to a definition
determined by a Delphi-based consensus. Logistic regression analysis
was performed to assess the predictors of positive culture and risk
factors for failure. The mean follow-up was 33 months (24 to 48).Aims
Patients and Methods
This study evaluates the long-term survival of
spinal implants after surgical site infection (SSI) and the risk
factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients
who had undergone a posterior spinal fusion with instrumentation
between January 2006 and December 2008, and who consecutively developed
an acute deep surgical site infection. All were appropriately treated
by surgical debridement with a tailored antibiotic program based
on culture results for a minimum of eight weeks. A ‘terminal event’ or failure of treatment was defined as implant
removal or death related to the SSI. The mean follow-up was 26 months
(1.03 to 50.9). A total of ten patients (23.3%) had a terminal event.
The rate of survival after the first debridement was 90.7% (95%
confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95%
CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78)
at two, three and four years. Four of nine patients required re-instrumentation
after implant removal, and two of the four had a recurrent infection
at the surgical site. There was one recurrence after implant removal
without re-instrumentation. Multivariate analysis revealed a significant risk of treatment
failure in patients who developed sepsis (hazard ratio (HR) 12.5
(95% confidence interval (CI) 2.6 to 59.9); p <
0.001) or who
had >
three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03).
Implant survival is seriously compromised even after properly treated
surgical site infection, but progressively decreases over the first
24 months. Cite this article:
The Control of Infection Committee at a specialist orthopaedic hospital prospectively collected data on all episodes of bacteriologically-proven
Aims. Infection following total hip or knee arthroplasty is a serious
complication. We noted an increase in post-operative infection in
cases carried out in temporary operating theatres. We therefore
compared those cases performed in standard and temporary operating
theatres and examined the
We retrospectively reviewed 21 patients (22 shoulders) who presented with
Aims. Open tibial fractures are limb-threatening injuries. While limb loss is rare in children,
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
Aims. The sacroiliac joint (SIJ) is the only mechanical connection between the axial skeleton and lower limbs. Following iliosacral resection, there is debate on whether reconstruction of the joint is necessary. There is a paucity of data comparing the outcomes of patients undergoing reconstruction and those who are not formally reconstructed. Methods. A total of 60 patients (25 females, 35 males; mean age 39 years (SD 18)) undergoing iliosacral resection were reviewed. Most resections were performed for primary malignant tumours (n = 54; 90%). The mean follow-up for surviving patients was nine years (2 to 19). Results. Overall, 27 patients (45%) were reconstructed, while 33 (55%) had no formal reconstruction. There was no difference in the use of chemotherapy (p = 1.000) or radiotherapy (p = 0.292) between the groups. Patients with no reconstruction had a mean larger tumour (11 cm (SD 5) vs 8 cm (SD 4); p = 0.014), mean shorter operating times (664 mins (SD 195) vs 1,324 mins (SD 381); p = 0.012), and required fewer blood units (8 (SD 7) vs 14 (SD 11); p = 0.012). Patients undergoing a reconstruction were more likely to have a