We report the five year outcomes of a two-stage
approach for infected total hip replacement. This is a single-surgeon
experience at a tertiary centre where the more straightforward cases
are treated using single-stage exchange. This study highlights the
vital role of the multidisciplinary team in managing these cases. A total of 125 patients (51 male, 74 female) with a mean age
of 68 years (42 to 78) were reviewed prospectively. Functional status
was assessed using the Harris hip score (HHS). The mean HHS improved
from 38 (6 to 78.5) pre-operatively to 81.2 (33 to 98) post-operatively.
Staphylococcus species were isolated in 85 patients (68%). The rate of control of infection was 96% at five years. In all,
19 patients died during the period of the study. This represented
a one year mortality of 0.8% and an overall mortality of 15.2% at
five years. No patients were lost to follow-up. We report excellent control of infection in a series of complex
patients and infections using a two-stage revision protocol supported
by a multidisciplinary approach. The reason for the high rate of
mortality in these patients is not known. Cite this article:
The last decade has seen a considerable increase
in the use of in total ankle arthroplasty (TAA) to treat patients
with end-stage arthritis of the ankle. However, the longevity of
the implants is still far from that of total knee and hip arthroplasties. The aim of this review is to outline a diagnostic and treatment
algorithm for the painful TAA to be used when considering revision
surgery. Cite this article:
The aims of this study were to evaluate the clinical and radiological
outcomes of the Universal-2 total wrist arthroplasty (TWA) in patients
with rheumatoid arthritis. This was a retrospective review of all 95 Universal-2 TWAs which
were performed in our institution between 2003 to 2012 in patients
with rheumatoid arthritis. A total of six patients were lost to
follow-up and two died of unrelated causes. A total of ten patients
had bilateral procedures. Accordingly, 75 patients (85 TWAs) were
included in the study. There were 59 women and 16 men with a mean
age of 59 years (26 to 86). The mean follow-up was 53 months (24
to 120). Clinical assessment involved recording pain on a visual
analogue score, range of movement, grip strength, the Quick Disabilities
of the Arm, Shoulder and Hand (DASH) and Wrightington wrist scores.
Any adverse effects were documented with particular emphasis on
residual pain, limitation of movement, infection, dislocation and
the need for revision surgery. Radiographic assessment was performed pre-operatively and at
three, six and 12 months post-operatively, and annually thereafter.
Arthroplasties were assessed for distal row intercarpal fusion and
loosening. Radiolucent zones around the components were documented
according to a system developed at our institution.Aims
Patients and Methods
This article presents an overview of mycetoma
and offers guidelines for orthopaedic surgeons who may be involved in
the care of patients with this condition. Cite this article:
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 infection; 32 had received antibiotics
at least seven days before removal of the implant. A total of 54 patients
had sonicated samples that produced positive cultures (including
four patients without infection). All of them were positive in the
first seven days of incubation. No differences were found regarding
previous antibiotic treatment when analysing colony counts or days
of incubation in the case of a positive result. In our experience, extending
incubation of the samples to 14 days does not add more positive
results for sonicated orthopaedic implants (hip and knee prosthesis
and osteosynthesis implants) compared with a conventional seven-day incubation
period. Cite this article:
Extendible endoprostheses have been available for more than 30
years and have become more sophisticated with time. The latest generation
is ‘non-invasive’ and can be lengthened with an external magnetic
force. Early results have shown a worryingly high rate of complications
such as infection. This study investigates the incidence of complications
and the need for further surgery in a cohort of patients with a
non-invasive growing endoprosthesis. Between 2003 and June 2014, 50 children (51 prostheses) had a
non-invasive growing prosthesis implanted for a primary bone sarcoma.
The minimum follow-up was 24 months for those who survived. Their
mean age was 10.4 years (6 to 14). The incidence of complications
and further surgery was documented.Aims
Patients and Methods
The objective of this study is to determine an optimal antibiotic-loaded
bone cement (ALBC) for infection prophylaxis in total joint arthroplasty
(TJA). We evaluated the antibacterial effects of polymethylmethacrylate
(PMMA) bone cements loaded with vancomycin, teicoplanin, ceftazidime,
imipenem, piperacillin, gentamicin, and tobramycin against methicillin-sensitive Objectives
Methods
Cite this article: A. A. Abubakar, M. M. Noordin, T. I. Azmi, U. Kaka, M. Y. Loqman. The use of rats and mice as animal models in
Peri-prosthetic infection is amongst the most
common causes of failure following total knee replacement (TKR).
In the presence of established infection, thorough joint debridement
and removal of all components is necessary following which new components
may be implanted. This can be performed in one or two stages; two-stage revision
with placement of an interim antibiotic-loaded spacer is regarded
by many to be the standard procedure for eradication of peri-prosthetic
joint infection. We present our experience of a consecutive series of 50 single-stage
revision TKRs for established deep infection performed between 1979
and 2010. There were 33 women and 17 men with a mean age at revision
of 66.8 years (42 to 84) and a mean follow-up of 10.5 years (2 to
24). The mean time between the primary TKR and the revision procedure
was 2.05 years (1 to 8). Only one patient required a further revision for recurrent infection,
representing a success rate of 98%. Nine patients required further
revision for aseptic loosening, according to microbiological testing
of biopsies taken at the subsequent surgery. Three other patients
developed a further septic episode but none required another revision. These results suggest that a single-stage revision can produce
comparable results to a two-stage revision. Single-stage revision
offers a reduction in costs as well as less morbidity and inconvenience
for patients. Cite this article:
Periprosthetic joint infection (PJI) is a devastating
complication for patients and results in greatly increased costs
of care for both healthcare providers and patients. More than 15
500 revision hip and knee procedures were recorded in England, Wales
and Northern Ireland in 2013, with infection accounting for 13%
of revision hip and 23% of revision knee procedures. We report our experience of using antibiotic eluting absorbable
calcium sulphate beads in 15 patients (eight men and seven women
with a mean age of 64.8 years; 41 to 83) as part of a treatment
protocol for PJI in revision arthroplasty. The mean follow-up was 16 months (12 to 22). We report the outcomes
and complications, highlighting the risk of hypercalcaemia which
occurred in three patients. We recommend that serum levels of calcium be routinely sought
following the implantation of absorbable calcium sulphate beads
in orthopaedic surgery. Cite this article:
Infection is a leading indication for revision
arthroplasty. Established criteria used to diagnose prosthetic joint infection
(PJI) include a range of laboratory tests. Leucocyte esterase (LE)
is widely used on a colorimetric reagent strip for the diagnosis
of urinary tract infections. This inexpensive test may be used for
the diagnosis or exclusion of PJI. Aspirates from 30 total hip arthroplasties
(THAs) and 79 knee arthroplasties (KA) were analysed for LE activity. Semi-quantitative
reagent strip readings of 15, 70, 125 and 500 white blood cells
(WBC) were validated against a manual synovial white cell count
(WCC). A receiver operating characteristic (ROC) curve was constructed
to determine the optimal cut-off point for the semi-quantitative
results. Based on established criteria, six THAs and 15 KAs were
classified as infected. The optimal cut-off point for the diagnosis
of PJI was 97 WBC. The closest semi-quantitative reading for a positive
result was 125 WBC, achieving a sensitivity of 81% and a specificity
of 93%. The positive and negative predictive values of the LE test
strip were 74% and 95% respectively. The LE reagent strip had a high specificity and negative predictive
value. A negative result may exclude PJI and negate the need for
further diagnostic tests. Cite this article:
The purpose of this study was to evaluate whether
the serum level of interleukin 6 (IL-6) could be used to identify the
persistence of infection after the first stage of a two-stage revision
for periprosthetic joint infection. Between 2010 and 2011, we prospectively studied 55 patients (23
men, 32 women; mean age 69.5 years; 36 to 86) with a periprosthetic
joint infection. Bacteria were identified in two intra-operative
tissue samples during re-implantation in 16 patients. These cases
were classified as representing persistent infection. To calculate a precise cut-off value which could be used in everyday
clinical practice, a 3 x 2 contingency table was constructed and
manually defined. We found that a serum IL-6 ≥ 13 pg/mL can be regarded as indicating
infection: its positive-predictive value is 90.9%. A serum IL-6 ≤ 8
pg/mL can be regarded as indicating an absence of infection: its
negative predictive value is 92.1%. The serum IL-6 level seems to be a reasonable marker for identifying
persistent infection after the first stage of a revision joint arthroplasty
and before attempting re-implantation. Cite this article:
In this retrospective observational cohort study,
we describe 17 patients out of 1775 treated for various fractures who
developed mycobacterium tuberculosis (MTB) infection after surgery.
The cohort comprised 15 men and two women with a mean age of 40
years (24 to 70). A total of ten fractures were open and seven were
closed. Of these, seven patients underwent intramedullary nailing
of a fracture of the long bone, seven had fractures fixed with plates,
two with Kirschner-wires and screws, and one had a hemiarthroplasty
of the hip with an Austin Moore prosthesis. All patients were followed-up
for two years. In all patients, the infection resolved, and in 14
the fractures united. Nonunion was seen in two patients one of whom
underwent two-stage total hip arthroplasty (THA) and the other patient
was treated using excision arthoplasty. Another patient was treated
using two-stage THA. With only sporadic case reports in the literature,
MTB infection is rarely clinically suspected, even in underdeveloped
and developing countries, where pulmonary and other forms of TB
are endemic. In developed countries there is also an increased incidence
among immunocompromised patients. In this paper we discuss the pathogenesis
and incidence of MTB infection after surgical management of fractures
and suggest protocols for early diagnosis and management. Cite this article:
This prospective study reports the 15-year survival and ten-year
functional outcome of a consecutive series of 1000 minimally invasive
Phase 3 Oxford medial UKAs (818 patients, 393 men, 48%, 425 women,
52%, mean age 66 years; 32 to 88). These were implanted by two surgeons
involved with the design of the prosthesis to treat anteromedial
osteoarthritis and spontaneous osteonecrosis of the knee, which
are recommended indications. Patients were prospectively identified
and followed up independently for a mean of 10.3 years (5.3 to 16.6). At ten years, the mean Oxford Knee Score was 40 (standard deviation
( This is the only large series of minimally invasive UKAs with
15-year survival data. The results support the continued use of
minimally invasive UKA for the recommended indications. Cite this article:
Demineralised bone matrix (DBM) is rarely used for the local
delivery of prophylactic antibiotics. Our aim, in this study, was
to show that a graft with a bioactive glass and DBM combination,
which is currently available for clinical use, can be loaded with
tobramycin and release levels of antibiotic greater than the minimum
inhibitory concentration for Antibiotic was loaded into a graft and subsequently evaluated
for drug elution kinetics and the inhibition of bacterial growth.
A rat femoral condylar plug model was used to determine the effect
of the graft, loaded with antibiotic, on bone healing.Aims
Materials and Methods
Tissue responses to debris formed by abrasion of polymethylmethacrylate
(PMMA) spacers at two-stage revision arthroplasty for prosthetic
joint infection are not well described. We hypothesised that PMMA
debris induces immunomodulation in periprosthetic tissues. Samples of tissue were taken during 35 two-stage revision arthroplasties
(nine total hip and 26 total knee arthroplasties) in patients whose
mean age was 67 years (44 to 85). Fourier transform infrared microscopy
was used to confirm the presence of PMMA particles. Histomorphometry
was performed using Sudan Red and Haematoxylin-Eosin staining.
CD-68, CD-20, CD-11(c), CD-3 and IL-17 antibodies were used to immunophenotype
the inflammatory cells. All slides were scored semi-quantitatively
using the modified Willert scoring system.Aims
Patients and Methods
The aims of this retrospective study were to
compare the mid-term outcomes following revision total knee replacement
(TKR) in 76 patients (81 knees) <
55 years of age with those
of a matched group of primary TKRs based on age, BMI, gender and
comorbid conditions. We report the activity levels, functional scores,
rates of revision and complications. Compared with patients undergoing
primary TKR, those undergoing revision TKR had less improvement
in the mean Knee Society function scores (8.14 (–55 to +60) Young patients undergoing revision TKR should be counselled that
they can expect somewhat less improvement and a higher risk of complications
than occur after primary TKR. Cite this article:
Charcot neuro-osteoarthropathy (CN) of the midfoot
presents a major reconstructive challenge for the foot and ankle
surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and
recommended for patients who have a deformity of the medial column
of the foot due to CN. We present the results from the first nine
patients (ten feet) on which we attempted to perform fusion of the
medial column using this bolt. Six feet had concurrent hindfoot fusion
using a retrograde nail. Satisfactory correction of deformity of
the medial column was achieved in all patients. The mean correction
of calcaneal pitch was from 6°
(-15° to +18°) pre-operatively to 16° (7° to 23°) post-operatively;
the mean Meary angle from 26° (3° to 46°) to 1° (1° to 2°); and
the mean talometatarsal angle on dorsoplantar radiographs from 27°
(1° to 48°) to 1° (1° to 3°). However, in all but two feet, at least one joint failed to fuse.
The bolt migrated in six feet, all of which showed progressive radiographic
osteolysis, which was considered to indicate loosening. Four of
these feet have undergone a revision procedure, with good radiological
evidence of fusion. The medial column bolt provided satisfactory correction
of the deformity but failed to provide adequate fixation for fusion
in CN deformities in the foot. In its present form, we cannot recommend the routine use of this
bolt. Cite this article:
