Abstracted/indexed

Deep periprosthetic joint infection following knee replacement is a serious complication feared by surgeons. Our aim was to investigate if seasonality of deep infection incidence exists in a national registry of knee replacement patients. We extracted data from over 100 000 procedures, investigating if patients operated on during the summer had increased risk of re-operation due to infection. We found no signal of periodicity, meaning the summer season is not a risk factor for deep infection.

This case highlights clinical and laboratory diagnostic challenges encountered with mycobacterial osteoarticular infections. Specifically, we focus on a rare complication of prosthetic joint infection following BCG therapy for non-muscle-invasive bladder cancer. We emphasize awareness of host risk factors to encourage consideration of mycobacteria in the relevant context.

To evaluate bone and tissue concentrations following intraosseous vancomycin administration, eight pigs were injected with 500 mg vancomycin into the tibia followed by a 12 h sampling period. This provided high concentrations in the tibia bone nearby the injection site the entire period, though with a wide range of peak concentration. The systemic absorption was high and immediate, thus mirroring an intravenous administration. Low mean concentrations were found in adjacent tissue compartments.

Literature reporting on the effectiveness of DAIR (debridement, antibiotics and implant retention) procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI-related revision arthroplasty) is scarce. Infection control rates of a DAIR procedure after primary arthroplasty (n = 51) and after prior PJI-related revision arthroplasty (n = 16) were 69 % and 56 %, respectively. No statistically significant difference is found in infection control after 1 year.

A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.

We compared the outcome of bioactive glass S53P4 as bone substitute versus autologous bone grafts for filling defects in patients with infected non-union. Our comparison of the outcomes revealed no significant differences between the groups with respect to recurrence of infection, bone healing, full weight bearing, or complications in general. Our results are promising. BAG seems to be an appropriate bone substitute. Further studies with larger numbers of patients are required.

Chronic bone infections often present with major bone and soft tissue loss which can be difficult to manage. In this study, we treated the most complex infections using surgery which reconstructed all of the tissues in one operation. We showed that this was a safe approach with very good outcomes. All of the bones healed and 96.5 % of patients were infection-free at final follow-up. This type of surgery requires close cooperation of a multidisciplinary team with expertise in major infections.

This stepwise quality improvement project sought to reduce unnecessary preoperative testing for asymptomatic bacteriuria prior to elective arthroplasty. A new guideline removing routine urine testing from preoperative assessment was successfully implemented and there was a sustained reduction in the number of unnecessary preoperative urine cultures performed. This study is useful to other centres as an example of how implementation methodology can be used to challenge outdated clinical practice.

We report on a patient with septic arthritis of the knee with Pantoea agglomerans after a penetrating black locust thorn injury. Antibiotics alone or in combination with an arthroscopy may be insufficient for achieving source control. Accurate medical history and open debridement with a search for a thorn fragment are key to successful treatment. This publication includes a thorough literature review which analyses the outcome of all reported cases worldwide.

We present the first reported case of prosthetic joint infection caused by Trueperella pyogenes. This animal pathogen rarely causes human infection. Our patient was successfully treated with single-stage exchange and 12 weeks of rifampicin and moxifloxacin.