Clorpactin: An Alternative Irrigation Method for Total Knee Arthroplasty Joint Infection Revisions.

Different combinations of irrigation solutions have been used in attempt to eradicate microorganisms for the prevention and treatment of prosthetic joint infections (PJIs). Clorpactin WCS-90 was evaluated as an alternative irrigation intraoperative technique for the treatment of PJI using both debridement, antibiotics, and implant retention (DAIR) and 2-stage total knee arthroplasty (TKA) procedures. We retrospectively reviewed PJIs irrigated with Clorpactin between January 2015 and January 2020. We found 13 patients who underwent a DAIR procedure for an acutely infected primary TKA, 18 patients underwent a 2-stage procedure for a chronically infected primary TKA, two patients underwent a DAIR procedure for an acutely infected revision TKA, and 18 patients underwent a 2-stage procedure for a chronically infected revision TKA. The odds of reinfection and need for additional surgery were analyzed at a mean follow-up of 20 to 26 months between groups. Only one patient (7.69%) became reinfected in the acute infected primary TKA group, three patients (16.67%) in the chronic infected primary TKA group, 0 patients (0%) in the acute infected revision TKA group, and six patients (33.33%) in the chronic infected revision TKA group. When the acute primary TKA infection group was compared with the chronic revision TKA infection group, the odds of reinfection (Chi-square test [χ2] = 21.7, df 3, p < 0.001) and odds of additional surgery (χ2 = 13.6, df 3, p < 0.003) were significantly higher for the chronic revision TKA infection group. Overall, the reinfection rate for DAIR revisions was 6.67% (range = 0-7.69) and 2-stage revisions was 25.00% (range = 16.67-33.33). The use of Clorpactin WCS-90 irrigation prior to wound closure is a useful option for the treatment of acute and chronic knee PJIs. Our study provides evidence that infection eradication with the use of Clorpactin is comparable to other irrigation methods and surgical techniques in reported literature.

Bicortical Titanium Tenodesis Button With Double-Row Fixation for the Treatment of Proximal Rectus Femoris Avulsion: Review of Literature and Surgical Technique.

In adult populations, rectus femoris avulsions are reported in professional soccer and football players but are noted to be exceptionally rare. No gold standard or recommendations exist for this injury; however, in cases of avulsion at the anterior inferior iliac spine, positive outcomes appear to result from rest, immobilization, and rehabilitation. Surgery is typically reserved for cases with large retractions of bone fragments or unsuccessful nonoperative treatment. Surgical treatment methods vary from direct suture repair to single- and double-row bone suture placement and even muscle-muscle repair. We present our technique using a bicortical tenodesis button with double-row fixation for the treatment of a severely retracted rectus femoris tendon avulsion in a high-level athlete.

An Alternative One-Stage Exchange Arthroplasty Technique: For the Chronic Infected Total Hip.

Background There are various algorithms for the treatment of prosthetic joint infections (PJI). Currently, a two-stage hip exchange is considered the "gold standard" of care for treatment of chronic hip PJIs. However, there has been recent debate whether a one- or two-stage exchange offers the correct treatment. One-stage exchange arthroplasty has particularly gained interest due to less morbidity, mortality, and functional impairment. Methods In a retrospective case series, the outcome of patients with chronic hip PJIs treated with our one-stage exchange arthroplasty was analyzed. Between January 2015 and January 2020, eight patients underwent a one-stage exchange hip arthroplasty by a single surgeon at a single institution for a chronically infected total hip arthroplasty (THA). Original diagnosis of PJI was made in accordance with the 2011 version of the Musculoskeletal Infection Society (MSIS) criteria. The femoral stem was cemented with antibiotic-impregnated cement, and the polyethylene acetabular liner was cemented directly onto the acetabular bone with antibiotic-impregnated cement. Results Of the eight patients, three were female and five were male with a mean age of 70.5 years (SD 11.2, range 53-87). Six patients (75%) had infection eradication with retention of a stable implant and no additional surgery at a mean follow-up of 35.7 months (range 17-50). One patient (12.5%) underwent closed reduction for a dislocated THA at one month; however, this patient remained infection-free at the most recent follow-up of 41 months. One patient (12.5%) who was the oldest patient (87 years) died 18 days postoperatively. Overall, all living patients (87.5%) retained their one-stage exchange THA. One patient (12.5%, CI 95% 0.3-52.7) required additional surgery in the form of a closed reduction and zero patients (0.0%, CI 95% 0.0-36.9) required additional open surgery.  Conclusion Single-stage exchange arthroplasty with an antibiotic-impregnated cemented femoral stem and antibiotic-impregnated cemented polyethylene acetabular liner may be a useful option for the treatment of chronic hip PJIs. Our case series provides evidence that infection eradication and function preservation are possible using our one-stage exchange arthroplasty technique in a chronically infected THA. However, a multi-center study with randomization is necessary to further validate our results.