Introduction

We report 10-year clinical outcomes of a prospective randomised controlled study on uni-compartmental knee arthroplasty using an active constraint robot.

Measuring the clinical impact of CAOS systems has generally been based around surrogate radiological measures with currently few long-term functional follow-up studies reported. We present 10 year clinical follow up results of robotic vs conventional surgery in UKA.

Surgical treatment of distal tibia fractures is usually associated with extensive soft tissue compromise and high complication rates (infection, delayed or non-union, ankle stiffness and osteoarthritis). Wound infection is one of the most common complication (deep infection rates up to 15%) and can develop into an infected non-union.

In 1973, Papineau described a staged technique for treating infected non-union of long bones, consisting of (1) surgical debridement of necrotic tissue, temporary splinting, specific antibiotic treatment, postoperative wet-to-dry wound dressing changes; (2) packing of the bone defect with cortico-cancellous autograft; (3) closure of the soft-tissue wound by a flap or secondary intent.

The authors aim to report a clinical case of a successful treatment of a distal tibia infected non-union with the Papineau technique and negative-pressure wound therapy.

Woman, 56 years-old, referred to Orthopaedic consultation on October 2013 for wound dehiscence and infection with a methicillin-resistant Staphylococcus aureus, one month after open reduction and internal fixation of an open distal tibia fracture.

On November 2013 she underwent surgical debridement, removal of osteosynthesis material, osteotaxis with external fixator, negative-pressure wound therapy and antibiotic treatment with intravenous vancomycin 1g 12/12h (1st stage of Papineau procedure)

On December, she underwent autologous iliac crest cancellous bone grafting and wound care, daily irrigated with saline solution (2nd stage).

On February 2014, she underwent a partial thickness skin graft for wound closure (3rd stage).

On April, the external fixator was removed and there was still no evidence of union. She had pain, disuse osteoporosis, ankle and midfoot stiffness, and was sent to physical therapy.

On April 2015, she can full weight bear with mild pain, the soft tissue envelope is in good condition, the fracture has united and she has an Ankle AOFAS Score of 83.

The Papineau technique has been used for the management of infected non-unions with bony defects, with high success rates. Complete necrotic tissue debridement and targeted antibiotics are fundamental for obtaining a viable and healthy tissue, able to receive the bone graft. Negative-pressure wound therapy is important in reducing the bacterial load, improving the microcirculation and enhancing the granulation tissue.

In the present case, the combination of the two techniques probably acted together in achieving successful eradication of the infection, reconstruction of the bone defect and soft tissue closure.

The aim of this study was to assess the incidence of low-grade infections in total hip arthroplasty revisions and the clinical outcomes after two-time revision surgery.

Retrospective study of total hip arthroplasty revision surgery between January of 2012 and December of 2013. Inclusion criteria: two-time revision surgery, PCR (pre and post-op) white blood cells count and microbiological culture. The diagnosis of low-grade infection was based on the Academy of Orthopedic Surgeons’ (AAOS) guidelines. All patients were evaluated with the Harris Hip Score (HHS).

Between this period were revised a total of 79 hips, none of them bilateral, of these fourteen full-filled the inclusion criteria, eight women and six men. The mean time between primary arthroplasty and revision surgery was 4.5 years. The interface was metal-on-polyethilene in thirteen and metal-on-metal in one. All patients had at least three episodes at the urgency department with permanent hip pain in the last six months. Ten have done a course of antibiotics previous to surgery. Intra-articular pus was present in four patients. The agent isolated was S. Aureus in five and S. Epidermidis in two. An elevated PCR and leucocytosis was present in all patients. The mean PCR was 18.1 and leucocytes countage 7600. The HHS was good in four patients, fair in seven patients and poor in three. These three patients with poor had another surgical intervention due to recurrent dislocation.

Periprosthetic joint infection is a common complication after total hip arthroplasty (THA). The incidence is approximately 1% after primary replacement and about 4% revision arthroplasty. As stated by Hanssen successful treatment outcomes require precise assessment of the infecting organism, the immune status of the patient, and the condition of the bone and soft tissues around the joint. With this study we tried to establish a protocol in our service: patient with a THA, interface metal-on-polyethilene, persistent coxalgia and elevated PCR will be diagnosed with low-grade infection, however we need further revision of our experience.

Surgical Site Infection (SSI) is one of the most frequent nosocomial infections and depends on many factors: patient, microorganism, antiseptic solution use, antibiotic prophylaxis, hand scrubbing, wound care or hospital stay lenght.

With the present paper the authors aim to study the SSI incidence after Total Knee (TKA) or Hip Arthroplasty (THA).

All patients who underwent primary TKA or THA between January 2011 and May 2012 at our institution were considered. Patients who died within 1 year after the procedure of unrelated causes were excluded. Data collected included ASA classification, type of procedure, total and post-operative hospital stay, type and duration of antibiotic prophylaxis.

Data were collected from the consultation at 1 month and 1 year post-operative, clinical registries and telephone interview. SSI was defined according to the Centers for Disease Control and Prevention criteria. Suspected cases of SSI included antibiotic administration longer than 5 days or absence of antibiotic prescription, hospital stay after the procedure longer than 9 days, patient referring infection symptoms, and clinical data reports of infection or re-intervention.

During the studied period and after exclusion of 5 cases, a total of 251 surgeries (104 TKA, 147 THA) were performed, of which 2 were urgent.

For both TKA and THA, the average total hospital stay was 9 days (8 days post-operative). The majority were American Society of Anesthesiologists (ASA) classification 2 and 3.

There were 4 SSI (1,60%), 2 TKA (1,92%) and 2 THA (1,36%), all of them after discharge. Their average total hospital stay was 10,5 days.

Antibiotic prophylaxis was used in 93% of the patients (97,4% a cephalosporin), with an average length of 5,7 days.

Recommended hospital stay after a TKA or THA is about 5 days. On HELICS-CIRURGIA 2006–2010 report it was 10 days, similar to ours. In infected patients, our total hospital stay was lower (10,5 vs 26).

Recommended duration of antibiotic prophylaxis is 24h. On HELICS-CIRURGIA more than 50% had it for more than 24h, which also happened with us; our antibiotic coverage was similar.

Comparing to HELICS-CIRURGIA, the predominance of ASA 2 and 3 classifications was similar, but the overall SSI rate was lower (1,6% vs 2,24%).

We conclude we must reduce hospital stay and antibiotic duration and keep the surveillance of SSI after TKA or THA.