Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital’s website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance.Aims
Methods
We studied the outcomes of hip and knee arthroplasties in a high-volume arthroplasty centre to determine if patients with morbid obesity (BMI ≥ 40 kg/m2) had unacceptably worse outcomes as compared to those with BMI < 40 kg/m2. In a two-year period, 4,711 patients had either total hip arthroplasty (THA; n = 2,370), total knee arthroplasty (TKA; n = 2,109), or unicompartmental knee arthroplasty (UKA; n = 232). Of these patients, 392 (8.3%) had morbid obesity. We compared duration of operation, anaesthetic time, length of stay (LOS), LOS > three days, out of hours attendance, emergency department attendance, readmission to hospital, return to theatre, and venous thromboembolism up to 90 days. Readmission for wound infection was recorded to one year. Oxford scores were recorded preoperatively and at one year postoperatively.Aims
Methods
Fungal peri-prosthetic infections of the knee
and hip are rare but likely to result in devastating complications.
In this study we evaluated the results of their management using
a single-stage exchange technique. Between 2001 and 2011, 14 patients
(ten hips, four knees) were treated for a peri-prosthetic fungal
infection. One patient was excluded because revision surgery was
not possible owing to a large acetabular defect. One patient developed
a further infection two months post-operatively and was excluded
from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients
were available for follow-up. One patient, undergoing revision replacement
of the hip, had a post-operative dislocation. Another patient, undergoing
revision replacement of the knee, developed a wound infection and
required revision 29 months post-operatively following a peri-prosthetic femoral
fracture. The mean Harris hip score increased to 74 points (63 to 84; p
<
0.02) in those undergoing revision replacement of the hip,
and the mean Hospital for Special Surgery knee score increased to
75 points (70 to 80; p <
0.01) in those undergoing revision replacement
of the knee. A single-stage revision following fungal peri-prosthetic infection
is feasible, with an acceptable rate of a satisfactory outcome. Cite this article:
