Cement Loaded With High-Dose Gentamicin and Clindamycin Reduces the Risk of Subsequent Infection After One-Stage Hip or Knee Arthroplasty Exchange for Periprosthetic Infection: A Preliminary Study.

Background: The use of antibiotic-loaded acrylic cement for treating periprosthetic joint infections remains controversial. We hypothesized that the raw rate of surgical site infection (SSI) is lower after using cement loaded with high-dose gentamicin and clindamycin than after using cement loaded with standard-dose gentamicin for implant fixation during 1-stage hip and knee revision arthroplasty for infection.

Methods: One hundred seventy-one continuous patients operated by 2 experienced surgeons during a 2-year period were included in the study.

Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection.

Background: The management of prosthetic joint infection usually consists of a combination of surgery and antimicrobial therapy. The appropriate duration of antimicrobial therapy for this indication remains unclear.

Methods: We performed an open-label, randomized, controlled, noninferiority trial to compare 6 weeks with 12 weeks of antibiotic therapy in patients with microbiologically confirmed prosthetic joint infection that had been managed with an appropriate surgical procedure.

Bone penetration of daptomycin in diabetic patients with bacterial foot infections.

Objectives: Daptomycin has shown clinical efficacy in diabetic foot infections (DFI). However, only limited data are available on its bone penetration in this particular population. The aim of this study was to determine daptomycin bone concentrations in patients with DFI undergoing surgery after multiple daptomycin infusions and to determine bone daptomycin inhibitory quotients (IQs) for the predominant gram-positive species involved in DFI.

Routine one-stage exchange for chronic infection after total hip replacement.

Purpose: We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange.

Methods: Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence.

Primary musculoskeletal hydatid cyst of the thigh: Diagnostic and curative challenge for an unusual localization.

Primary muscular echinococcosis is an uncommon localization of hydatid cysts. The nonspecific clinical presentation and possible post-therapeutic complications lead to problems for the diagnosis of this infection and the support of the patient. The authors describe an unusual case of double hydatid cyst of the vastus intermedius muscle.

High infection control rate and function after routine one-stage exchange for chronically infected TKA.

Background: Many surgeons consider two-stage exchange the gold standard for treating chronic infection after TKA. One-stage exchange is an alternative for infection control and might provide better knee function, but the rates of infection control and levels of function are unclear.

Questions/purposes: We asked whether a one-stage exchange protocol would lead to infection control rates and knee function similar to those after two-stage exchange.

Navigated non-image-based registration of the position of the pelvis during THR. An accuracy and reproducibility study.

The precise recording of the position of the pelvis is a prerequisite for total hip replacement (THR). The anterior pelvic plane is an accepted reference for determining the 3D pelvic orientation. We hypothesized that cutaneous palpation of this plane was accurate and reproducible.

Navigated non-image-based positioning of the acetabulum during total hip replacement.

We tested the hypothesis that the non-image-based navigation system used in our department was able to measure accurately the 3D positioning of the acetabular cup of a total hip replacement (THR) and to increase the accuracy of its implantation during THR. We studied 50 consecutive navigated implantations of a THR and compared the intra-operative measurement of the cup by the navigation system to the post-operative measurement by computed tomography (CT) scan. The mean difference between the navigated and CT scan measurements for cup inclination was 2 degrees .

The rationale for navigated minimally invasive unicompartmental knee replacement.

Computer-aided systems have been developed recently to improve the precision of implantation of unicompartmental or total knee replacements. Minimally invasive techniques were developed to decrease the surgical trauma related to prosthesis implantation. However, there are concerns about loss of implant positioning accuracy with minimally invasive techniques.

Results of treatment of septic knee arthritis: a retrospective series of 40 cases.

We studied a consecutive series of 40 patients presenting a septic knee arthritis, with a mean age of 49 +/- 20 (range 19-81) years. The aetiologies were: 18 postoperative arthritis, 12 haematogenous infections, 7 arthritis following aspiration or infiltration, and 3 articular wounds. The most common organisms were Staphylococcus aureus and epidermidis (23 cases).

Reproducibility of intra-operative measurement of the mechanical axes of the lower limb during total knee replacement with a non-image-based navigation system.

Objective: The restoration of a normal mechanical axis of the lower limb following total knee prosthesis (TKP) depends on the accuracy of the intra-operative measurement of the femoro-tibial angle. We have studied the reproducibility of intra-operative measurement of the coronal mechanical femoro-tibial axis with the OrthoPilot (Aesculap, Tuttlingen, Germany) non-image-based navigation system.

Material And Methods: A consecutive series of 20 TKP (Aesculap SEARCH Evolution prosthesis) implanted by the same surgical team of two senior orthopedic surgeons was analyzed.

Coronal alignment of the lower limb.

Background: The coronal alignment of the lower limb is important for knee reconstruction procedures. However, normal alignment is hard to define because of its wide variation among normal individuals. Our hypothesis was that the variation in the normal anatomy as assessed by radiography is greater than commonly accepted.

Should plain X-rays be routinely performed after blunt knee trauma? A prospective analysis.

Background: We tested the hypothesis that it was possible to decrease the number of performed x-rays after a knee trauma without delayed fracture diagnosis by using the Ottawa knee rules.

Methods: Patients had routine x-rays of the injured knee during the first stage of the study and selective x-rays during the second stage. All patients were followed up to 6 months after the trauma.

Low reproducibility of the intra-operative measurement of the transepicondylar axis during total knee replacement.

Background: The transepicondylar axis is often used for positioning of the femoral component in knee replacement.

Methods: We studied the reproducibility of the intra-operative palpation of the transepicondylar axis for rotational alignment of the femoral component in 20 total knee replacement (TKR) implantations with a non-image-based navigation system. 2 surgeons defined the transepicondylar axis 3 times each without changing the reference plane.

Unicompartmental knee prosthesis implantation with a non-image-based navigation system: rationale, technique, case-control comparative study with a conventional instrumented implantation.

The accuracy of implantation is an accepted prognostic factor for the long-term survival of unicompartmental knee prostheses (UKP). We developed a non-image-guided navigation system for UKP implantation without any extramedullary or intramedullary guiding device. The 30 patients operated on with the navigation system (group A) were matched to 30 patients operated on with the conventional technique (group B) using age, sex, body mass index, preoperative coronal mechanical femorotibial angle, and severity of the preoperative degenerative changes.

Accuracy of implantation of a unicompartmental total knee arthroplasty with 2 different instrumentations: a case-controlled comparative study.

The accuracy of implantation is an accepted prognostic factor for the long-term survival of unicompartmental total knee arthroplasties (UKAs). We adapted the conventional instruments for tricompartmental total knee arthroplasty implantation, with intramedullary femoral and extramedullary tibial guiding rods, to a UKA implantation. A total of 52 patients in whom a UKA was implanted with this instrumentation were matched (using age, sex, body mass index, preoperative coronal mechanical femorotibial angle, and severity of preoperative degenerative changes according to Ahlback) with 52 patients operated with the alternative instruments.