A two-stage exchange of an infected prosthetic joint (PJI) is considered the most effective surgical treatment of chronic PJIs, particularly in North America. However, reinfection rates are unacceptably high (10–20%). This could be the consequence of a persistent infection or a new infection introduced during the first or second stage of the exchange arthroplasty. We aimed to determine: i) the prevalence of positive cultures at reimplantation, ii) whether there is an association between positive cultures at reimplantation and reinfection during follow-up, and iii) if there is a microbiological correlation between primary infections, reimplantations and reinfections. We retrospectively evaluated all two-stage exchange procedures performed at two academic centers between 2000 and 2015. Primary culture-negative PJIs and cases in whom no intraoperative cultures were obtained during reimplantation were excluded from the analysis. One or more positive intraoperative cultures during reimplantation were considered positive for infection. Reinfection was defined as the need for additional surgical intervention after reimplantation or the need for antibiotic suppressive therapy due to persistent clinical signs of infection.Aim
Method
The use of a tourniquet during total knee arthroplasty (TKA) is controversial. Return to function and pain are believed to be affected by the use of a tourniquet. The hypothesis of this study was that use of a tourniquet (T) would delay postoperative functional recovery and increase pain as compared to no tourniquet use (NT). 200 patients were recruited for this prospective, double-blinded, randomized controlled trial. All surgeries were performed by one of two fellowship trained arthroplasty surgeons at our institution. Patients were randomized to either undergo TKA with T or NT and blinded to group allocation. An otherwise standardized perioperative protocol was followed. The primary outcome measures were functional assessment testing using the timed up-and-go (TUG) and stair-climb (SC) tests and visual analog scale pain (VAS-P) scores. Secondary outcome measures included blood loss and range-of-motion (ROM). Patients completed outcomes measures preoperatively, in hospital, and postoperatively at 4–6 weeks and 6–8 months. Minimal detectable change (MDC) and Student's T-test, alpha of p < 0.05, were used to determine significance. No significant differences were seen in postoperative TUG, SC, VAS-P, or ROM at any time point. NT patients were seen to have significantly more calculated blood loss (means: T 1,370.04mL, NT 1,743.85mL; p < 0.001), without a significant increase in transfusion events. Tourniquet use during TKA significantly decreases blood loss and does not adversely affect early postoperative outcomes. Tourniquet use during routine TKA is safe and effective and concerns over deleterious effects on function and pain may not be justified.
