Biofilm formation is intrinsic to prosthetic joint infection (PJI). In the current study, we evaluated the effects of silver-containing hydroxyapatite (Ag-HA) coating and vancomycin (VCM) on methicillin-resistant Pure titanium discs (Ti discs), Ti discs coated with HA (HA discs), and 3% Ag-HA discs developed using a thermal spraying were inoculated with MRSA suspensions containing a mean in vitro 4.3 (SD 0.8) x 106 or 43.0 (SD 8.4) x 105 colony-forming units (CFUs). Immediately after MRSA inoculation, sterile phosphate-buffered saline or VCM (20 µg/ml) was added, and the discs were incubated for 24 hours at 37°C. Viable cell counting, 3D confocal laser scanning microscopy with Airyscan, and scanning electron microscopy were then performed. HA discs and Ag HA discs were implanted subcutaneously in vivo in the dorsum of rats, and MRSA suspensions containing a mean in vivo 7.2 (SD 0.4) x 106 or 72.0 (SD 4.2) x 105 CFUs were inoculated on the discs. VCM was injected subcutaneously daily every 12 hours followed by viable cell counting.Aims
Methods
As well as debridement and irrigation, soft-tissue coverage, and osseous stabilization, systemic antibiotic prophylaxis is considered the benchmark in the management of open fractures and considerably reduces the risk of subsequent fracture-related infections (FRI). The direct application of antibiotics in the surgical field (local antibiotics) has been used for decades as additional prophylaxis in open fractures, although definitive evidence confirming a beneficial effect is scarce. The purpose of the present study was to review the clinical evidence regarding the effect of prophylactic application of local antibiotics in open limb fractures. A comprehensive literature search was performed in PubMed, Web of Science, and Embase. Cohort studies investigating the effect of additional local antibiotic prophylaxis compared with systemic prophylaxis alone in the management of open fractures were included and the data were pooled in a meta-analysis.Objectives
Methods
The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years.Aims
Patients and Methods
We studied the impact of direct anterior (DA) A total of 6086 consecutive patients undergoing primary total hip arthroplasty (THA) at a single institution between 2013 and 2016 were retrospectively evaluated. Data obtained from electronic patient medical records included age, sex, body mass index (BMI), medical comorbidities, surgical approach, and presence of deep PJI. There were 3053 male patients (50.1%) and 3033 female patients (49.9%). The mean age and BMI of the entire cohort was 62.7 years (18 to 102, Aims
Patients and Methods
The aim of this study was to analyze drain fluid, blood, and urine simultaneously to follow the long-term release of vancomycin from a biphasic ceramic carrier in major hip surgery. Our hypothesis was that there would be high local vancomycin concentrations during the first week with safe low systemic trough levels and a complete antibiotic release during the first month. Nine patients (six female, three male; mean age 75.3 years (sd 12.3; 44 to 84)) with trochanteric hip fractures had internal fixations. An injectable ceramic bone substitute, with hydroxyapatite in a calcium sulphate matrix, containing 66 mg of vancomycin per millilitre, was inserted to augment the fixation. The vancomycin elution was followed by simultaneously collecting drain fluid, blood, and urine.Objectives
Methods
The objective of this study was to investigate bone healing after
internal fixation of displaced femoral neck fractures (FNFs) with
the Dynamic Locking Blade Plate (DLBP) in a young patient population
treated by various orthopaedic (trauma) surgeons. We present a multicentre prospective case series with a follow-up
of one year. All patients aged ≤ 60 years with a displaced FNF treated
with the DLBP between 1st August 2010 and December 2014 were included.
Patients with pathological fractures, concomitant fractures of the
lower limb, symptomatic arthritis, local infection or inflammation,
inadequate local tissue coverage, or any mental or neuromuscular
disorder were excluded. Primary outcome measure was failure in fracture
healing due to nonunion, avascular necrosis, or implant failure
requiring revision surgery.Aims
Patients and Methods
Prophylactic antibiotics can decrease the risk
of wound infection and have been routinely employed in orthopaedic surgery
for decades. Despite their widespread use, questions still surround
the selection of antibiotics for prophylaxis, timing and duration
of administration. The health economic costs associated with wound
infections are significant, and the judicious but appropriate use
of antibiotics can reduce this risk. This review examines the evidence behind commonly debated topics
in antibiotic prophylaxis and highlights the uses and advantages
of some commonly used antibiotics. Cite this article:
In 2013, we introduced a specialized, centralized, and interdisciplinary team in our institution that applied a standardized diagnostic and treatment algorithm for the management of prosthetic joint infections (PJIs). The hypothesis for this study was that the outcome of treatment would be improved using this approach. In a retrospective analysis with a standard postoperative follow-up, 95 patients with a PJI of the hip and knee who were treated with a two-stage exchange between 2013 and 2017 formed the study group. A historical cohort of 86 patients treated between 2009 and 2011 not according to the standardized protocol served as a control group. The success of treatment was defined according to the Delphi criteria in a two-year follow-up.Aims
Patients and Methods
Surgical site infection (SSI) is a common complication of surgery
with an incidence of about 1% in the United Kingdom. Sutures can
lead to the development of a SSI, as micro-organisms can colonize
the suture as it is implanted. Triclosan-coated sutures, being antimicrobical,
were developed to reduce the rate of SSI. Our aim was to assess
whether triclosan-coated sutures cause a reduction in SSIs following
arthroplasty of the hip and knee. This two-arm, parallel, double-blinded study involved 2546 patients
undergoing elective total hip (THA) and total knee arthroplasty
(TKA) at three hospitals. A total of 1323 were quasi-randomized
to a standard suture group, and 1223 being quasi-randomized to the
triclosan-coated suture group. The primary endpoint was the rate
of SSI at 30 days postoperatively.Aims
Patients and Methods
Aims
Patients and Methods
Chronic osteomyelitis may recur if dead space management, after
excision of infected bone, is inadequate. This study describes the
results of a strategy for the management of deep bone infection
and evaluates a new antibiotic-loaded biocomposite in the eradication
of infection from bone defects. We report a prospective study of 100 patients with chronic osteomyelitis,
in 105 bones. Osteomyelitis followed injury or surgery in 81 patients.
Nine had concomitant septic arthritis. 80 patients had comorbidities
(Cierny-Mader (C-M) Class B hosts). Ten had infected nonunions. All patients were treated by a multidisciplinary team with a
single-stage protocol including debridement, multiple sampling,
culture-specific systemic antibiotics, stabilisation, dead space
filling with the biocomposite and primary skin closure. Aims
Patients and Methods
Recurrent infection following two-stage revision total hip arthroplasty
(THA) for prosthetic joint infection (PJI) is a devastating complication.
The purpose of this study was to report the survival of repeat two-stage
revision hip arthroplasty, describe complications, and identify
risk factors for failure. We retrospectively identified 19 hips (19 patients) that had
undergone repeat two-stage revision THA for infection between 2000
to 2013. There were seven female patients (37%) and the mean age
was 60 years (30 to 85). Survival free from revision was assessed
via Kaplan–Meier analysis. The patients were classified according
to the Musculoskeletal Infection Society (MSIS) system, and risk
factors for failure were identified. Mean follow-up was four years
(2 to 11).Aims
Patients and Methods
The aims of this study were to establish whether composite fixation
(rail-plate) decreases fixator time and related problems in the
management of patients with infected nonunion of tibia with a segmental
defect, without compromising the anatomical and functional outcomes
achieved using the classical Ilizarov technique. We also wished
to study the acceptability of this technique using patient-based
objective criteria. Between January 2012 and January 2015, 14 consecutive patients
were treated for an infected nonunion of the tibia with a gap and
were included in the study. During stage one, a radical debridement
of bone and soft tissue was undertaken with the introduction of
an antibiotic-loaded cement spacer. At the second stage, the tibia
was stabilized using a long lateral locked plate and a six-pin monorail
fixator on its anteromedial surface. A corticotomy was performed
at the appropriate level. During the third stage, i.e. at the end
of the distraction phase, the transported fragment was aligned and
fixed to the plate with two to four screws. An iliac crest autograft
was added to the docking site and the fixator was removed. Functional
outcome was assessed using the Association for the Study and Application
of Methods of Ilizarov (ASAMI) criteria. Patient-reported outcomes
were assessed using the Musculoskeletal Tumor Society (MSTS) score.Aims
Patients and Methods
We wanted to investigate regional variations in the organisms
reported to be causing peri-prosthetic infections and to report
on prophylaxis regimens currently in use across England. Analysis of data routinely collected by Public Health England’s
(PHE) national surgical site infection database on elective primary
hip and knee arthroplasty procedures between April 2010 and March
2013 to investigate regional variations in causative organisms.
A separate national survey of 145 hospital Trusts (groups of hospitals
under local management) in England routinely performing primary
hip and/or knee arthroplasty was carried out by standard email questionnaire.Objectives
Methods
We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells. We seeded mouse skeletal muscle cells C2C12 on the hydroxyapatite/calcium sulphate biomaterial and the phenotype of the cells was analysed. To mimic surgical conditions with leakage of extra cellular matrix (ECM) proteins and growth factors, we cultured rat bone cells ROS 17/2.8 in a bioreactor and harvested the secreted proteins. The secretome was added to rat muscle cells L6. The phenotype of the muscle cells after treatment with the media was assessed using immunostaining and light microscopy.Objectives
Materials and Methods
Calcium sulphate has traditionally been used as a filler of dead space arising during surgery. Various complications have been described following the use of Stimulan bio-absorbable calcium sulphate beads. This study is a prospective observational study to assess the safety profile of these beads when used in revision arthroplasty, comparing the complication rates with those reported in the literature. A total of 755 patients who underwent 456 revision total knee arthroplasties (TKA) and 299 revision total hip arthroplasties (THA), with a mean follow-up of 35 months (0 to 78) were included in the study.Aims
Methods
A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery.Aims
Patients and Methods
