Abstracted/indexed

This paper presents a series of patients with complex periprosthetic joint infection of the knee and concomitant soft tissue defects managed with revision knee surgery and a gastrocnemius flap. We show that this flap can be safely performed by appropriately trained orthopaedic surgeons and confirmed the previous literature findings that patients presenting with this problem have high rates of persistent infection.

We report on an 83-year-old woman who had an open removal of a baker's cyst several months after total knee arthroplasty. The following wound healing problem was first misinterpreted as being superficial. With an injection of methylene blue and a contrast medium, we showed the extent of the sinus tract, proving the periprosthetic joint infection.

Chronic osteomyelitis is a bone infection and was treated with a combination of antibiotics and two surgeries. With the introduction of the biomaterial S53P4 bioactive glass, these infections can be treated with antibiotics and one surgery. This study shows 85 % success in the treatment of these bone infections. Together with the fundamentally different antibacterial mechanisms without antibiotic resistance, S53P4 bioactive glass is recommendable for the treatment of these infections.

The use of calcium sulfate as an antibiotic delivery vehicle is a growing treatment option used by surgeons in the face of infection following joint replacement surgery. Calcium sulfate can be mixed with antibiotics and formed into small beads, which can be delivered during surgery to the local site of infection. We performed a mixing study to formalize mixing methods for individual and combined antibiotics with a synthetic calcium sulfate product. We report our mixing formulas and set times.

This paper describes an ultrasound guided technique for aspiration of hip arthroplasties that has not been published. We believe this technique is important because it yields useful fluid 99 % of the time with low contamination rate (2 %). Ultrasound, although common in Europe, is gaining popularity in the United States. Besides teaching a useful technique, this paper also discusses findings of lavage-obtained samples which are rarely discussed in other aspiration papers.

The sternoclavicular joint is an uncommon location for septic arthritis and exceedingly rare in the healthy population. Diagnosis is often delayed by poorly localized symptoms and misdiagnosis, as was observed in our patient and which can result in life-threatening complications. We highlight the importance of proper clinical examination and adequate imaging for diagnosis and identification of its complications, as well as the need for multidisciplinary collaboration during treatment.

This study provides a comprehensive overview of a frequently used treatment strategy for chronic prosthetic joint infection of the hip and knee. Forty-seven patients met the inclusion criteria. Successful eradication was achieved in 36 of 47 cases. Multiple variables were analysed to explore their influence on the outcome of two-stage revision surgery. No variables were found to have a significant influence. Mean follow-up of over 10 years provides a good perspective of the long-term outcome.

Implant-associated infections (IAIs) in orthopaedic surgery are associated with high morbidity and mortality. Slow-growing anaerobic bacteria are increasingly being recognized as potential causative agents in such infections, but their diagnosis is difficult. The purpose of this review is to summarize the current knowledge of IAIs with these bacteria. In particular, the review gives an overview of the current methodology in the diagnosis of such infections, to serve as a guide for clinicians.

This was written to outline Mayo Clinic guidelines on prophylactic antibiotics prior to invasive procedures in patients with prosthetic joints. There is an emphasis on maintaining optimal oral health to reduce the risk of infection to minimize the patient’s risk of PJI.

Tenosynovitis due to Histoplasma capsulatum in an immunocompromised host warrants special attention. Following surgical debridement, the patient initially improved on antifungal therapy, but as immunosuppression was decreased, she presented with a flare, requiring further debridement. With negative fungal cultures and declining antigenemia, it was felt that her interim worsening was as a consequence of immune reconstitution inflammatory syndrome (IRIS).

This study shows that hip fractures that are complicated with infection are associated with higher mortality and worse outcomes. Delay in fracture management increases the risk of infection. Hip fractures should be treated with urgency not only to reduce mortality but also to reduce the risk of infection after the operation.

Costs related to off-label expensive antibiotics used to treat bone and joint infections (BJIs) in a referral centre in France were analysed in this cohort study. Despite the large increase in the number of patients treated with these antibiotics, the overall costs remained stable (approximately EUR 1 million) and were helped by the appearance of generic molecules at lower prices. Production of generic antibiotics at low cost is essential to limit the financial burden of the management of BJIs.

Infection after total hip (THA) or total knee (TKA) arthroplasty can be treated by a so-called DAIR procedure within 4 weeks after surgery. However, could a DAIR be successful up to 3 months? In the Dutch Arthroplasty Register we found a re-revision rate of 8% within 4 weeks after THA and 9% re-revisions between 4 and 12 weeks. After TKA we found 9% re-revisions within 4 weeks and 17% failures after 4–12 weeks. We show no difference for DAIRs performed within 4 weeks or between 4 and 12 weeks.

The aim of this study is to summarize and improve knowledge regarding fracture-related infection caused by Candida (CFRI) through a systematic review on the topic, accompanied by a case report. Candida infections in fractures are rare but difficult-to-treat events. The existing fracture-related infection treatment algorithm combined with long-term systemic antifungal therapy has an anecdotal value and needs more extensive studies to be validated.

Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.