Physical activity before and after primary total hip arthroplasty: a registry-based study.

OBJECTIVE: Detailed assessment of activity before and after total hip arthroplasty (THA) including a long-term followup period is lacking. Our objectives were to evaluate patient activity levels prior to disease onset, prior to THA, and at 5 and 10 years after surgery, and to determine the predictors of high activity 5 years after surgery. METHODS: We included elective primary THAs performed between 1996 and 2012. A cross-sectional analysis compared mean University of California, Los Angeles (UCLA) activity scores over 4 periods: prior to symptom onset of osteoarthritis, prior to surgery, 5 years after surgery, and 10 years after surgery. Analyses of activity levels were performed and stratified by sex, age, body mass index (BMI), American Society of Anesthesiology (ASA) classes, and preoperative activity level. A prospective study was conducted to identify baseline characteristics associated with a high activity level (UCLA score ≥7) 5 years after surgery using logistic regression. RESULTS: The mean UCLA activity scores prior to symptom onset (n = 189), prior to THA (n = 203), 5 years after surgery (n = 1,085), and 10 years after surgery (n = 757) were 6.9, 3.5, 5.7, and 5.5, respectively. Postoperative scores were close to values prior to symptom onset in patients ages ≥55 years, but were lower in those who were younger. High activity was reported by 49% of patients prior to symptom onset, 5% of patients prior to surgery, and 28% of patients at both 5 and 10 years after surgery. The predictors of high activity at 5 years were younger age, male sex, a lower BMI, a lower ASA score, and an active lifestyle prior to surgery. CONCLUSION: Five and 10 years after primary THA, physical activity levels were substantially higher in men and women and in all age categories as compared to before surgery.

No need for broad-spectrum empirical antibiotic coverage after surgical drainage of orthopaedic implant infections.

PURPOSE: Empirical broad-spectrum antibiotic treatment for orthopaedic implant infections after surgical lavage is common practice while awaiting microbiological results, but lacks evidence. METHODS: This was a single-centre cohort study from 1996 to 2010 with a follow-up of two years. RESULTS: We retrieved 342 implant infections and followed them up for a median of 3.5 years (61 recurred, 18%). Infected implants were arthroplasties (n = 186), different plates, nails or other osteosyntheses. The main pathogens were S. aureus (163, 49 methicillin-resistant) and coagulase-negative staphylococci (60, 45 methicillin-resistant). Median duration of empirical antibiotic coverage after surgical drainage was three days before switching to targeted therapy. Vancomycin was the most frequent initial empirical agent (147), followed by intravenous co-amoxiclav (44). Most empirical antibiotic regimens (269, 79%) proved sensitive to the causative pathogen, but were too broad in 111 episodes (32%). Cephalosporins and penicillins were used only in 44 and ten cases, respectively, although they would have covered 59% of causative pathogens identified later. Multivariate Cox regression analysis showed that neither susceptible antibiotic coverage (compared to non-susceptible; hazard ratio 0.7, 95% confidence interval 0.4-1.2) nor broad-spectrum use (hazard ratio 1.1, 0.8-1.5) changed remission rates. CONCLUSIONS: Provided that surgical drainage is performed, broad-spectrum antibiotic coverage does not enhance remission of orthopaedic implant infections during the first three days. If empirical agents are prescribed from the first day of infection, narrow-spectrum penicillins or cephalosporins can be considered to avoid unnecessary broad-spectrum antibiotic use.

Statins may reduce femoral osteolysis in patients with total Hip arthroplasty.

In experimental studies, statin use has been associated with reduction of osteoclastic activity and promotion of bone formation around implants. Moreover, a large clinical study recently reported a substantially reduced risk of revision for aseptic loosening among statin users with THA. Our objective was to evaluate the influence of statin use on the development of femoral osteolysis within 5 years after THA. We conducted a case-cohort study including all THAs presenting with femoral osteolysis at the 5 year visit (cases) and compared them with those without osteolysis (controls). Cases and controls were identified from a cohort of primary THAs operated between 2001 and 2005. Seven hundred thirty-five THAs were included, mean age 68 years. Five years after surgery osteolysis had developed around the femoral component of 40 THAs (5.4%). Ever-use of statins was much less frequent among cases (5 of 40, 12.5%) than among controls (199 of 695, 28.6%). The crude risk ratio of femoral osteolysis among statin users was 0.36 (95% CI 0.14; 0.92). After adjusting for age, sex, activity level, BMI, diagnosis, bearing surface, and type of stem, the adjusted risk ratio was 0.38 (95% CI 0.15; 0.99). In conclusion, statin use was associated with a reduced risk of developing femoral osteolysis 5 years after THA. Statins may be useful for reducing the risk of implant failure following THA.

[Musculoskeletal tumours misdiagnosed as sport injuries]. / Tumeurs musculo-squelettiques diagnostiquées a tort comme lésions sportives.

During our medical activity, we would necessarily be confronted with sport related complaints. Most of the diagnosed pathologies belong to the inflammation category and other traumas. However, as we will see in this review, we sometimes discover musculoskeletal tumours from different origins. One should never underestimate non-developing or slowly developing conditions among athletes, and to keep in mind a possible oncologic diagnosis. A critical assistance for diagnosis is given by the medical imagery with MRI being the leading technique. The aim is to avoid any delay in making the correct diagnosis, and therefore to avoid a more severe prognosis that would lead to a more radical surgery for either benign or malign tumours.