Extraction of the Wichita Fusion Nail after Knee Arthrodesis.

To avoid a new exposition and partial damage of a knee arthrodesis site due to the removal of the Wichita fusion nail (WFN), a new extraction technique was developed, using a femoral osteotomy at the proximal end of the nail. Fixing the osteotomy with an Ilizarov frame offered the possibility to perform an additional correction of length and/or alignment if necessary.

Intra-articular versus serum C-reactive protein analysis in suspected periprosthetic knee joint infection.

The purpose of this study was to investigate the comparative diagnostic strength of C-reactive protein (CRP) values in synovial fluid and serum in patients with presumed periprosthetic joint infection. We collected 44 synovial fluid samples and 24 serum samples from 43 patients. Patients were judged to be uninfected or infected based on standardized criteria. Synovial and serum samples were obtained simultaneously. We determined the diagnostic strength of our assay by using receiver operating characteristic curve analysis, calculated the cutoff value and calculated the difference in diagnostic strength for periprosthetic joint infection between synovial fluid and blood serum analysis. The area under the curve was 0.977 for intra-articular CRP analysis and 0.979 for serum CRP analysis. The cutoff points for intra-articular CRP analysis where 1.8 mg/L and 2.8 mg/L. Both tests showed a very high diagnostic strength; the difference in diagnostic strength between synovial fluid and blood serum analysis was not significant (p = 0.66).

Two-stage revision of an infected total hip arthroplasty: a follow-up of 136 patients.

BACKGROUND AND PURPOSE: Periprosthetic infection of a total hip arthroplasty (THA) is commonly treated with a two-stage revision procedure. After resection of the infected THA and placement of a cement spacer loaded with antibiotics, a THA is inserted at a second procedure to restore hip function and mobility. Revision surgery carries a significant risk of complications. This study focuses on hip function, rate of complications and reinfection after two-stage revision surgery for an infected THA. PATIENTS AND METHODS: From January 1996 to April 2010, 136 patients underwent revision surgery after removal of an infected THA. Follow-up ranged from 2 years to more than 15 years. Hip function was evaluated using the modified Harris Hip Score (mHHS) and the Hip disability and Osteoarthritis Outcome Score (HOOS). Visual Analogue Scale (VAS) measured pain. Annual follow-up included radiographs of the affected hip and blood sampling for inflammatory parameters. RESULTS: After revision surgery, average mHHS was 63% and average HOOS was 54%. VAS pain averaged 26.8 on a 100-point scale and 40% of patients had no pain. Prosthesis-related complications unrelated to sepsis occurred in 32%. Most common were periprosthetic fractures, leg length discrepancy and dislocation. Reinfection occurred in 13% of these patients and Coagulase Negative Staphylococcus (CNS) was isolated in 67%. CONCLUSION: Two-stage evision surgery is an accepted treatment for infected THAs. However, complications are common and hip function afterwards is modest. As previous studies have shown, CNS is an important microorganism in reinfection.

Surgical treatment algorithm for infected shoulder arthroplasty: a retrospective analysis of 17 cases.

There is no consensus regarding treatment of periprosthetic shoulder infections. We retrospectively reviewed 17 patients diagnosed with a periprosthetic shoulder infection. Patient demographics, preoperative diagnostics, therapeutic management and functional outcome were evaluated. The Constant-Murley score (CMS), Simple Shoulder Test (SST), Visual Analogue Score (VAS) and Disabilities of the Arm, Shoulder and Hand score (DASH) were used to assess clinical outcome. Pre-and intraoperative culture results and laboratory data, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were analyzed. Three patients were treated by two-stage revision arthroplasty, 5 by resection arthroplasty with implantation of a cement spacer, 8 by resection arthroplasty without spacer and one patient underwent polyethylene exchange and serial debridement. The mean follow-up was 4.7 years (range : 1-93). The CMS was 27.8 for the resection arthroplasty group, 22.7 for the two-stage revision group and 20.6 for the resection arthroplasty with spacer group. No patients received chronic antibiotic suppression. Mean CRP value was 3.7 mg/L (range: 0.2 -11.1). Infection was monobacterial in 8 patients and polymicrobial in 9. The most common organisms were Coagulase negative staphylococcus (CNS) (13/17) and Propionibacterium spp. (7/17). Complications included two humeral fractures. At a mean follow-up of 4.7 years, all but one patient were considered free of infection. Worst functional results were seen with the implantation of a definitive cement spacer. Two-stage revision arthroplasty remains the gold standard in chronic infections, but is associated with a high complication rate. One-stage revision to a reverse shoulder arthroplasty (RSA) is an attractive alternative in selected cases. A surgical treatment algorithm for infected shoulder arthroplasty is proposed.

What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series.

PURPOSE: Controversy still exists as to the best surgical treatment for periprosthetic shoulder infections. The aim of this multi-institutional study was to review a continuous retrospectiveseries of patients treated in four European centres and to assess the respective eradication rate of various treatment approaches. METHODS: Forty-four patients were available for this retrospective follow-up evaluation. Functional and clinical evaluation of treatment for infection was performed using the Constant-Murley score, visual analogue scale and patient satisfaction Neer score. Erythrocyte sedimentation rate, serum leucocyte count and C-reactive protein were measured and shoulder X-ray examination performed prior to surgery and at the latest follow-up. RESULTS: At a mean follow-up of 41 months (range 24­98),42 of 44 patients (95.5%) showed no signs of infection recurrence/persistence. Comparable eradication rates were observed after resection arthroplasty (100%; 6/6), two-stage revision (17/17) or permanent antibiotic-loaded spacer implant (93.3%; 14/15). No patient was treated by one-stage revision. On average, both functional and pain scores improved significantly; the worst joint function was observed after resection arthroplasty. CONCLUSIONS: This retrospective analysis conducted on the largest published series of patients to date shows comparable infection eradication rates after two-stage revision, resection arthroplasty or permanent spacer implant for the treatment of septic shoulder prosthesis.

Resection arthroplasty of the shoulder as a salvage procedure for deep shoulder infection: does the use of a cement spacer improve outcome?

HYPOTHESIS: Resection arthroplasty can be performed for recalcitrant shoulder infection. It is unclear whether a spacer has any benefit. We hypothesized that spacers would increase infection control and improve clinical results. MATERIALS AND METHODS: Twenty-one patients were evaluated retrospectively at a mean follow-up of 46.4 months: 11 patients did not receive a spacer (group A), and 10 patients did receive a spacer (group B). Patients were assessed clinically and with radiographs. Patients were scored using the Visual Analog Scale (VAS), Constant-Murley Score (CMS), Simple Shoulder Test, and Disabilities of Arm, Shoulder and Hand. RESULTS: Infection was eradicated in 19 patients without additional surgery. Two patients had elevated C-reactive protein and erythrocyte sedimentation rate and were considered to have low-grade infections. Neither patient received a spacer and had not been revised. Infectious control was not significantly different between group A and group B (P = .48). Fourteen patients found the result good or acceptable. The VAS decreased from 6.5 to 2.6. The CMS increased significantly from 17.8 to 40.4. Active abduction averaged 78.1° and active flexion averaged 85.5°. External rotation was 21.0°. DISCUSSION: No significant difference was shown between group A and group B. Preservation of the tuberosities was identified as a prognosticator for a good result. Unacceptable pain resulted in 5 patients with a spacer undergoing delayed reimplantation of a prosthesis. CONCLUSION: Resection arthroplasty can be offered to patients with long-standing deep shoulder infection that was unresponsive to previous surgical treatment. Control of infection did not differ significantly between the groups. No improvement in outcome was demonstrated with the use of cement spacers.

The value of pre-operative aspiration in the diagnosis of an infected prosthetic knee: a retrospective study and review of literature.

The purpose of this study was to compare the results of cultures of preoperative aspiration samples with those of swabs taken intra-operatively. The records of 70 revision arthroplasties of the knee from 69 patients, 49 females and 20 males, were reviewed. The mean age of the patients at time of revision arthroplasty was 67 years (range: 34 to 89). Sixty-eight knees from 67 patients were included. There were 32 true positives, 17 true negatives, 6 false positives and 13 false negatives. This led to a specificity, sensitivity and accuracy of 57%, 84% and 72%, respectively. Based on these findings, pre-operative aspiration has a positive predictive value of 71% and a negative predictive value of 74%. When the aspiration sample yields a positive culture, the chances are high that the prosthetic knee is infected. When aspiration is negative, infection cannot be ruled out. Our study suggests that, in such cases, a coagulase negative Staphylococcus (CNS) infection has to be considered.