ABSTRACT
INTRODUCTION: Total ankle arthroplasty (TAR) procedures have become more reliable and incidence is increasing. A growing number of postoperative complications can be expected and should be correctly addressed. PRESENTATION OF CASE: A 43-year-old woman suffering from severe ankle osteoarthritis underwent TAR (Stryker's Infinity with Prophecy alignment guides, uncemented tibial component and cemented talus component). After a fall, one month after the surgery, she presented with a fracture of the medial malleolus and an anterior periprosthetic fracture of the tibia, with anterior dislocation of the tibial prosthetic component. Fracture fixation and partial revision surgery was planned using the same anterior surgical access. To restore length, rotation and joint articulation, the medial malleolus was first reduced and synthesized with a plate and 6 screws through additional minimally invasive medial ankle incisions. Once the medial malleolus was stabilized, the already mobilized tibial component was removed. Freehand cuts under fluoroscopic guidance on the anterior surface of the tibia were performed. After a final check with a trial component, a Stryker's Inbone II stem, which matched the previously inserted talar component, was implanted and partially cemented to fill the remaining bone gaps. DISCUSSION: Only few case reports of periprosthetic ankle fractures exist, and none of them were similar to ours. There are no published precedents for this revision approach from a stemless to a stemmed tibial implant without changing the talar implant. CONCLUSION: Partial revision after a complex periprosthetic fracture results in a satisfactory outcome if surgery is performed in specialized centers.
ABSTRACT
Pasteurella multocida, a zoonotic infectious organism, has most often been described in patients after an animal bite. It can cause a variety of infections ranging from superficial skin infections to more serious systemic infections, such as sepsis and meningitis. P. multocida is a rare but well-recognized cause of prosthetic joint infections. Here, we report the first implant-associated infection caused by drug-resistant (penicillin, ampicillin, amoxicillin/clavulanic acid) P. multocida, which was cured with targeted antimicrobial treatment and debridement, exchange of mobile parts, and retention of the prosthesis. Patients undergoing arthroplasty should be informed of the risks of close contact with pets, especially in light of the worrying phenomena of drug resistance spreading among animals due to the addition of antibiotics in animal feed.
ABSTRACT
Obesity and adipose tissue contribute to local and systemic inflammation. However the role of the inflammatory mediator bradykinin (BK) in this context is not known. We therefore evaluated the effect of BK on adipokines secretion in human preadipocytes during the course of differentiation and characterized the receptors involved. Results obtained from antibody array and ELISA experiments showed that several adipokines are released by human preadipocytes under basal conditions while BK specifically stimulated the production of interleukin(IL)-6 and IL-8. The effect of BK diminished with the progression of differentiation, being almost inactive on adipocytes. In preadipocytes, BK also induced a rapid and transient [Ca²âº](i) mobilization, a rapid and sustained increase in ERK1/2 activation and enhanced forskolin-stimulated cAMP accumulation. BK was without effect on cell proliferation and viability as assessed by bromodeoxyuridine incorporation, WST-1 conversion, or lactate dehydrogenase leakage and was without effect on adipogenesis as measured by triglyceride accumulation, GPDH activity and leptin release. The B1 receptor agonist, Lys-[des-Arg9]-BK, displayed poor activity or was without effect while overall BK effects were prevented by the selective B2 receptor antagonist, fasitibant chloride, but not by the B1 selective antagonist, Lys-[Leu8][des-Arg9]-BK. Immunoblot analysis and immunofluorescence studies showed that the kinin B2 receptor was essentially expressed at the beginning of the differentiation program. In conclusion, human preadipocytes expressed kinin B2 receptors linked to multiple signaling pathways, IL-6 and IL-8 production, and BK proinflammatory response in adipose tissue could be prevented by fasitibant chloride.
