This multicentre, retrospective study aimed to improve our knowledge
of primary pyogenic spinal infections in children by analyzing a
large consecutive case series. The medical records of children with such an infection, treated
at four tertiary institutions between 2004 and 2014, were analyzed
retrospectively. Epidemiological, clinical, paraclinical, radiological,
and microbiological data were evaluated. There were 103 children,
of whom 79 (76.7%) were aged between six months and four years.Aims
Patients and Methods
Peri-prosthetic infection remains a leading cause
of revision surgery. Recent publications from the American Musculoskeletal
Infection Society have sought to establish a definition of peri-prosthetic
infection based on clinical findings and laboratory investigations.
The limitations of their approach are discussed and an alternative
definition is proposed, which it is felt may better reflect the
uncertainties encountered in clinical practice.
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:
Neuropathic changes in the foot are common with
a prevalence of approximately 1%. The diagnosis of neuropathic arthropathy
is often delayed in diabetic patients with harmful consequences
including amputation. The appropriate diagnosis and treatment can
avoid an extensive programme of treatment with significant morbidity
for the patient, high costs and delayed surgery. The pathogenesis
of a Charcot foot involves repetitive micro-trauma in a foot with impaired
sensation and neurovascular changes caused by pathological innervation
of the blood vessels. In most cases, changes are due to a combination
of both pathophysiological factors. The Charcot foot is triggered
by a combination of mechanical, vascular and biological factors
which can lead to late diagnosis and incorrect treatment and eventually
to destruction of the foot. This review aims to raise awareness of the diagnosis of the Charcot
foot (diabetic neuropathic osteoarthropathy and the differential
diagnosis, erysipelas, peripheral arterial occlusive disease) and
describe the ways in which the diagnosis may be made. The clinical
diagnostic pathways based on different classifications are presented. Cite this article:
The diagnosis of periprosthetic joint infection (PJI) remains
demanding due to limitations of all the available diagnostic tests.
The synovial fluid marker, α-defensin, is a promising adjunct for
the assessment of potential PJI. The purpose of this study was to
investigate the qualitative assessment of α-defensin, using Synovasure
to detect or exclude periprosthetic infection in total joint arthroplasty. We studied 50 patients (28 women, 22 men, mean age 65 years;
20 to 89) with a clinical indication for revision arthroplasty who
met the inclusion criteria of this prospective diagnostic study.
The presence of α-defensin was determined using the qualitative
Synovasure test and compared with standard diagnostic methods for
PJI. Based on modified Musculoskeletal Infection Society (MSIS)
criteria, 13 cases were categorised as septic and 36 as aseptic revisions.
One test was inconclusive.Aims
Patients and Methods
To determine the pattern of mutations of the A total of 15 patients with clinical features of PPD were enrolled in this study. Genomic DNA was isolated and polymerase chain reaction performed to amplify the Objectives
Patients and Methods
The treatment of septic arthritis of the shoulder is challenging.
The infection frequently recurs and the clinical outcome can be
very poor. We aimed to review the outcomes following the use of
continuous negative pressure after open debridement with a large
diameter drain in patients with septic arthritis of the shoulder. A total of 68 consecutive patients with septic arthritis of the
shoulder underwent arthrotomy, irrigation and debridement. A small
diameter suction drain was placed in the glenohumeral joint and
a large diameter drain was placed in the subacromial space with
continuous negative pressure of 15 cm H2O. All patients
received a standardised protocol of antibiotics for a mean of 5.1
weeks (two to 11.1).Aims
Patients and Methods
Instability is a common indication for early
revision after both primary and revision total knee arthroplasty
(TKA), accounting for up to 20% in the literature. The number of
TKAs performed annually continues to climb exponentially, thus having
an effective algorithm for treatment is essential. This relies on
a thorough pre- and intra-operative assessment of the patient. The
underlying cause of the instability must be identified initially
and subsequently, the surgeon must be able to balance the flexion
and extension gaps and be comfortable using a variety of constrained
implants. This review describes the assessment of the unstable TKA, and
the authors’ preferred form of treatment for these difficult cases
where the source of instability is often multifactorial. Cite this article:
A successful outcome following treatment of nonunion requires the correct identification of all of the underlying cause(s) and addressing them appropriately. The aim of this study was to assess the distribution and frequency of causative factors in a consecutive cohort of nonunion patients in order to optimise the management strategy for individual patients presenting with nonunion. Causes of the nonunion were divided into four categories: mechanical; infection; dead bone with a gap; and host. Prospective and retrospective data of 100 consecutive patients who had undergone surgery for long bone fracture nonunion were analysed.Objectives
Methods
An extensive review of the spinal and arthroplasty
literature was undertaken to evaluate the effectiveness of local
antibiotic irrigation during surgery. The efficacy of antibiotic
irrigation for the prevention of acute post-operative infection
after total joint arthroplasty was evaluated retrospectively in
2293 arthroplasties (1990 patients) between January 2004 and December
2013. The mean follow-up was 73 months (20 to 139). One surgeon
performed all the procedures with minimal post-operative infection. The intra-operative protocol included an irrigation solution
of normal saline with vancomycin 1000 mg/l and polymyxin 250 000
units/l at the rate of 2 l per hour. No patient required re-admission
for primary infection or further antibiotic treatment. Two morbidly obese
patients (two total hip arthroplasties) developed subcutaneous fat
necrosis requiring debridement and one was revised because the deep
capsular sutures were contaminated by the draining subcutaneous
haematoma. One patient who had undergone total knee arthroplasty
had unrecognised damage to the lateral superior geniculate artery
and developed a haematoma that became infected secondarily four
months after the surgery and underwent revision. The use of antibiotic irrigation during arthroplasty surgery
has been highly effective for the prevention of infection in the
author’s practice. However, it should be understood that any routine
prophylactic use of antibiotics may result in resistant organisms,
and the wise stewardship of the use of antibiotics is an important
part of surgical practice. Cite this article:
The December 2015 Research Roundup360 looks at: Biomarkers in periprosthetic joint infection; HbA1c and complications in arthroplasty; Getting to the bottom of biofilms; Effective antibiosis for biofilms; Stem cells and avascular necrosis; Predicting LOS in total joint arthroplasty; Long-term antibiotics reduce recurrence in periprosthetic infection
Induced membrane technique is a relatively new technique in the reconstruction of large bone defects. It involves the implantation of polymethylmethacrylate (PMMA) cement in the bone defects to induce the formation of membranes after radical debridement and reconstruction of bone defects using an autologous cancellous bone graft in a span of four to eight weeks. The purpose of this study was to explore the clinical outcomes of the induced membrane technique for the treatment of post-traumatic osteomyelitis in 32 patients. A total of 32 cases of post-traumatic osteomyelitis were admitted to our department between August 2011 and October 2012. This retrospective study included 22 men and ten women, with a mean age of 40 years (19 to 70). Within this group there were 20 tibias and 12 femurs with a mean defect of 5 cm (1.5 to 12.5). Antibiotic-loaded PMMA cement was inserted into the defects after radical debridement. After approximately eight weeks, the defects were implanted with bone graft.Objectives
Methods
Given the increasing number of total hip arthroplasty
procedures being performed annually, it is imperative that orthopaedic
surgeons understand factors responsible for instability. In order
to treat this potentially complex problem, we recommend correctly
classifying the type of instability present based on component position, abductor
function, impingement, and polyethylene wear. Correct classification
allows the treating surgeon to choose the appropriate revision option
that ultimately will allow for the best potential outcome. Cite this article:
The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature ≥ 38.5°C), inability to bear weight, white blood-cell count >
12.0 × 109 cells/L and ESR ≥ 40 mm/hr; CRP ≥ 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
A delay in the diagnosis of paediatric acute
and subacute haematogenous osteomyelitis can lead to potentially devastating
morbidity. There are no definitive guidelines for diagnosis, and
recommendations in the literature are generally based on expert
opinions, case series and cohort studies. All articles in the English literature on paediatric osteomyelitis
were searched using MEDLINE, CINAHL, EMBASE, Google Scholar, the
Cochrane Library and reference lists. A total of 1854 papers were
identified, 132 of which were examined in detail. All aspects of
osteomyelitis were investigated in order to formulate recommendations. On admission 40% of children are afebrile. The tibia and femur
are the most commonly affected long bones. Clinical examination,
blood and radiological tests are only reliable for diagnosis in
combination. Most studies were retrospective and there is a need for large,
multicentre, randomised, controlled trials to define protocols for
diagnosis and treatment. Meanwhile, evidence-based algorithms are
suggested for accurate and early diagnosis and effective treatment.
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:
Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
Methods