Abstracted/indexed

In total hip arthroplasty, infection remains one of the most devastating postoperative complications. It can be difficult to treat and eradicate. Currently there are several validated methods of combating infection but complications both during and after the process can derail the patient's recovery. We seek to determine complications that occur during the infection eradication process and the stage they occur in to bring awareness to possible reasons for failure of the revision.

Osteomyelitis is an infection of bone and is often treated with surgical debridement. This results in a bone defect which requires the use of a void filler. This study evaluated the use of a gentamicin-impregnated ceramic void filler (CERAMENT G) and compared it to the same void filler without antibiotic (CERAMENT) and no void filler in a rat model of osteomyelitis. CERAMENT G was found to decrease the rate of persistent infection and grow more new bone than CERAMENT or an empty defect.

This case series highlights our treatment strategy for pubic symphysis osteomyelitis of aggressive local debridement with local antibiotic therapy. Additionally, debridement of the pubic symphysis without subsequent internal fixation did not result in pelvic instability, as determined by pelvic radiographs and ability to fully weight bear postoperatively.

Clinical prognostic models are tools that predict treatment outcomes for individual patients. For adults with bone and joint infection treated with surgery and implant removal, this review found no existing unbiased clinical prediction models that took modifiable health factors into account to estimate prognosis. Developing a clinical prognostic model may help treatment decisions and future targeted research in orthopaedic infection.

We report on a clinical case of rapid progressive destruction of the femoral head after joint injection in rheumatoid arthritis.

Periprosthetic joint infection (PJI) is one of the most challenging complications following total joint arthroplasty. PJI infections are primarily caused by antibiotic-tolerant biofilms on the surface of the implant. Bacterial toxin antitoxin systems are believed to play a critical role in biofilm antibiotic tolerance and resistance. The objective of this study was to identify the role of the S. aureus toxin YoeB in biofilm formation, antibiotic susceptibility, and virulence.

We report an intriguing and challenging case of severe skin necrosis, in the setting of a periprosthetic knee infection, after the beginning of low-molecular-weight heparin. Our multidisciplinary approach and the results can be useful for other orthopaedic surgeons that may face a similar case.

Determining whether periprosthetic joint infections are acute or chronic can be a challenge for the arthroplasty surgeon. We present data that support the use of the ratio between the ESR and CRP in patients with PJI. Using this simple calculation of the ESR / CRP ratio, surgeons may have more confidence in determining whether an infection is acute or chronic, which can aid in treatment decisions.

Cutibacterium acnes infections in hip arthroplasty may be underdiagnosed. Cemented components in THA seem to protect from colonization of Cutibacterium acnes. Post-operative infections are preferably surgically treated with DAIR within a month after hip replacement but infection eradication may still not be excluded at an extended time in some cases. Further large-scale studies are needed to confirm our results.

Our objective was to analyze if patients with larger soft-tissue thickness measured in X-rays have greater risk of acute infection after hip arthroplasty. We reviewed acute-infection patients in our institution over 6 years and selected 2 patients with similar demographics that were not infected for each case. Larger measurements showed association with acute infection. This easily obtainable measurement might provide helpful data in making preoperative risk assessments and prevention programs.

Non-typeable Haemophilus influenzae (NTHi) is here described for the first time as responsible for an invasive infection involving blood, vertebral and joint infection in a 79-year-old woman. It was triggered by an asymptomatic sinus condition. Surgical drainage and antibiotic therapy allowed recovery. This case shows that a full cartography of NTHi infection is unavoidable and may reveal unknown dissemination mechanisms.

This paper provides further evidence that treatment of osteomyelitis by serial debridement without the use of local antimicrobials has high recurrence rates (20 %–30 %). The addition of bioglass did not improve this compared to using bone graft alone. Additional systemic antibiotic was required in many cases, increasing the risk of antimicrobial resistance. Recent series of single-stage surgery with local antibiotic delivery have reported better outcomes.

Irrigation and debridement in the treatment of periprosthetic joint infection (PJI) serves an integral role in the eradication of bacterial burden and subsequent re-infection rates. Identifying the optimal irrigation agent, however, remains challenging, as there is limited data on superiority. Future clinical studies are needed to identify ideal irrigation solutions with optimal bactericidal properties and low cytotoxicity for PJI treatment.

Osteomyelitis is commonly observed in the pediatric population across sub- Saharan Africa. This 44-patient case series presents vascularized fibula flap (VFF) as a viable option for reconstruction of post-osteomyelitis defects of pediatric long bones in low-income countries. VFF achieves good radiological and functional outcomes, although postoperative complications are common. There was no recurrence of the bone infection in any of our cases. Further prospective studies are needed.

We describe the second known case of unifocal thoracic osteomyelitis due to Bartonella henselae, which presented as a thoracic tumor.

Periprosthetic joint infection (PJI) is associated with increased morbidity and mortality but can be difficult to diagnose. Our aim is to analyse common diagnostic tests, specifically joint aspiration culture performed for suspected PJI by a single practitioner. We suggest that hip aspiration culture performs similarly to less invasive tests to rule out infection, recommend caution in interpreting a positive culture and suggest that hip aspiration should be used only with other synovial tests.

Antibiotics are frequently used in bone cement during joint replacements or treatment of bone and joint infections. Amikacin is rarely used in bone cement, particularly the liquid formulation. We describe a series of patients in which liquid amikacin was incorporated into bone cement. We did not observe the occurrence of adverse drug reactions definitively attributed to its use. All patients had favorable outcomes.