Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis.

OBJECTIVES: To describe the clinical and microbiological characteristics and outcomes after antibiotic treatment of a national cohort of patients with Lyme arthritis confirmed by PCR testing on synovial fluid and by serology, when available. METHODS: Using the French National Reference Center for Borrelia database, patients with a positive PCR on synovial fluid for Borrelia were identified. Patient clinical and biological characteristics were reviewed from patient records. Long-term outcomes after treatment were studied through a questionnaire and with follow-up data. RESULTS: Among 357 synovial fluid testing by PCR between 2010 and 2016, 37 (10.4%) were positive for Borrelia. Patients' median age was 36 years (range 6-78) with 61% of men and 28% patients under 18. The presentation was monoarticular in 92% and the knee was involved in 97%. Contrary to the Borrelia species repartition in European ticks, B. burgdorferi sensu stricto was the most prevalent species found in synovial fluid (54%) followed by B. azfelii (29%) and B. garinii (17%). Antibiotic treatments were mainly composed of doxycycline (n = 24), ceftriaxone (n = 10) and amoxicillin (n = 6), for a median duration of 4 weeks (range 3-12). Despite a properly conducted treatment, 34% of patients (n = 12) developed persistent synovitis for at least 2 months (median duration 3 months, range 2-16). Among those, 3 developed systemic inflammatory oligo- or polyarthritis in previously unaffected joints with no signs of persistent infection (repeated PCR testing negative), which mandated Disease-Modifying Antirheumatic Drugs (DMARD) introduction, leading to remission. CONCLUSION: In France and contrary to ticks ecology, Lyme arthritis is mainly caused by B. burgdorferi sensu stricto. Despite proper antibiotic therapy, roughly one third of patients may present persistent inflammatory synovitis and a small proportion may develop systemic arthritis. In such cases, complete remission can be reached using DMARD.

Medium-term comparison of results in obese patients and non-obese hip prostheses with Metha® short stem.

INTRODUCTION: Total hip arthroplasty is one of the most successful orthopedic surgeries in terms of results. However, the prevalence of obesity has nearly doubled between 1980 and 2008. There is limited and controversial data on hip replacement results in obese patients. The Metha® prosthesis, introduced in 2004, is a short stem midway between devices maintaining the femoral neck and metaphyseal implants. The purpose of this study was to evaluate the influence of obesity on clinical and radiological results at medium term. MATERIALS AND METHODS: Eighty-two patients were retrospectively divided into two cohorts based on their BMI. Mean BMI were, respectively, 35.22 kg/m2 in the obese group [30.02-57.79] and 26.15 [23.25-28.72] in the other cohort. Follow-up were 47.16 [26.10-74.33] and 54.06 [28.17-77.73]. The mean ages at surgery were 55 years [39.8-67.8] and 54 [31.3-70.4]. We used self-assessment questionnaires WOMAC and Oxford; two clinical scores Harris Hip Score and Postel-Merle d'Aubigné. ARA score was used for osseointegration evaluation. RESULTS: Operative times were comparable. The self-assessment questionnaires and clinical scores showed significant poorer results in the obese cohort. HHS were 87.54 [56-100] and 92.49 [25-100]. However, the clinical improvement obtained between pre- and postoperative was identical in both groups: 52 [19-73] and 52 [-6 to 90]. Radiological ARA scores were good or excellent for 97.56 and 92.68%. Survival analysis was comparable with more than 0.96 at 50 months follow-up. CONCLUSION: The Metha® prosthesis can be implanted at the forefront of primary total hip arthroplasty in normal subjects as well as in obese subjects. However, we cannot yet claim we will reach the same durability we experience with standard prostheses.