The purpose of this study was to evaluate the infection-free outcome of patients underwent revision of total joint arthroplasty (TJA) for presumed aseptic causes, with positive intra-operative cultures. A retrospective cohort study was assembled with 130 patients undergoing revision knee (21 cases) or hip arthroplasty (109 cases) for presumed aseptic causes. For all patients five to seven separate intra-operative cultures were obtained and prosthesis sonication was done. Patients were diagnosed with a previously unsuspected prosthetic joint infection (PJI) if two or more cultures were positive or a positive prosthesis sonication. Data were reviewed for demographic details, preoperative laboratory results and culture results. The endpoint was infection-free implant survival at 24 months.Aims
Patients and Methods
Diagnosis of periprosthetic joint infection (PJI) is challenging given the limitations of available diagnostic tests. Recently, several studies have shown a role of the long pentraxin PTX3 as a biomarker in inflammatory diseases and infections. This single-center prospective diagnostic study evaluated the diagnostic ability of synovial fluid and serum PTX3 for the infection of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Consecutive patients undergoing revision surgery for painful THA or TKA were enrolled. Patients with antibiotic therapy suspended for less than 2 weeks prior to surgery and patients eligible for metal-on-metal implant revision or spacer removal and prosthesis re-implantation were excluded. Quantitative assessment of synovial fluid and serum PTX3 was performed with ELISA method. Musculoskeletal Infection Society (MSIS) criteria were used as reference standard for diagnosis of PJI. Continuous data values were compared for statistical significance with univariate unpaired, 2-tailed Student's t-tests. Receiver operating characteristic (ROC) curve analyses was performed to assess the ability of serum and synovial fluid PTX3 concentration to determine the presence of PJI. Youden's J statistic was used to determine optimum threshold values for the diagnosis of infection. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratio, area under the ROC curve (AUC) were calculated.Aim
Method
Diagnosis of periprosthetic joint infection (PJI) is still challenging due to limitations of available diagnostic tests. Many efforts are ongoing to find out novel methods for PJI diagnosis. Recently, several studies have shown a role of the long pentraxin PTX3 as a biomarker in inflammatory diseases and infections. This pilot diagnostic study evaluated the diagnostic ability of synovial fluid and serum PTX3 for the infection of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Consecutive patients undergoing revision surgery for painful THA or TKA were enrolled. Patients with antibiotic therapy suspended for less than 2 weeks prior to surgery and patients eligible for spacer removal and prosthesis re-implantation were excluded. Quantitative assessment of synovial fluid and serum PTX3 was performed with ELISA method. Musculoskeletal Infection Society (MSIS) criteria were used as reference standard for diagnosis of PJI. Continuous data values were compared for statistical significance with univariate unpaired, 2-tailed Student's t-tests. Receiver operating characteristic (ROC) curve analyses was performed to assess the ability of serum and synovial fluid PTX3 concentration to determine the presence of PJI. Youden's J statistic was used to determine optimum threshold values for the diagnosis of infection. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values, positive (LR+) and negative (LR-) likelihood ratio, area under the ROC curve (AUC) were calculated.Aim
Method
Wrong-level surgery is a unique pitfall in spinal
surgery and is part of the wider field of wrong-site surgery. Wrong-site
surgery affects both patients and surgeons and has received much
media attention. We performed this systematic review to determine
the incidence and prevalence of wrong-level procedures in spinal
surgery and to identify effective prevention strategies. We retrieved
12 studies reporting the incidence or prevalence of wrong-site surgery
and that provided information about prevention strategies. Of these,
ten studies were performed on patients undergoing lumbar spine surgery
and two on patients undergoing lumbar, thoracic or cervical spine procedures.
A higher frequency of wrong-level surgery in lumbar procedures than
in cervical procedures was found. Only one study assessed preventative
strategies for wrong-site surgery, demonstrating that current site-verification protocols
did not prevent about one-third of the cases. The current literature
does not provide a definitive estimate of the occurrence of wrong-site
spinal surgery, and there is no published evidence to support the
effectiveness of site-verification protocols. Further prevention
strategies need to be developed to reduce the risk of wrong-site surgery.
Osteoporotic vertebral compression fractures
(VCFs) are an increasing public health problem. Recently, randomised
controlled trials on the use of kyphoplasty and vertebroplasty in
the treatment of these fractures have been published, but no definitive conclusions
have been reached on the role of these interventions. The major
problem encountered when trying to perform a meta-analysis of the
available studies for the use of cementoplasty in patients with
a VCF is that conservative management has not been standardised.
Forms of conservative treatment commonly used in these patients
include bed rest, analgesic medication, physiotherapy and bracing. In this review, we report the best evidence available on the
conservative care of patients with osteoporotic VCFs and associated
back pain, focusing on the role of the most commonly used spinal
orthoses. Although orthoses are used for the management of these patients,
to date, there has been only one randomised controlled trial published
evaluating their value. Until the best conservative management for
patients with VCFs is defined and standardised, no conclusions can
be drawn on the superiority or otherwise of cementoplasty techniques
over conservative management.
