Dithiotreitol pre-treatment of synovial fluid samples improves microbiological counts in peri-prosthetic joint infection.

Purpose: Synovial fluid cultures of periprosthetic joint infections (PJI) may be limited by bacteria living in the fluids as biofilm-aggregates. The antibiofilm pre-treatment of synovial fluids with dithiotreitol (DTT) could improve bacterial counts and microbiological early stage diagnosis in patients with suspected PJI.

Methods: Synovial fluids collected from 57 subjects, affected by painful total hip or knee replacement, were divided into two aliquots, one pre-treated with DTT and one with normal saline.

Is debridement really the best we can do for periprosthetic joint infections following total ankle replacements? A systematic review and meta-analysis.

Background: Ankle periprosthetic joint infections are rising in number, but an evidence-based gold standard treatment has not been defined yet.

Methods: We made a systematic review about the operative treatment of infections following total ankle arthroplasty. Proportional meta-analysis was used to summarize effects of the surgical techniques included.

Two-stage cementless hip revision for peri-prosthetic infection with an antibacterial hydrogel coating: results of a comparative series.

Purpose: The aim of this study was to investigate the hypothesis that a two-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, may provide better infection cure rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic hip infection.

Methods: In this case-control study, 27 patients, treated with a two-stage procedure, using cementless implants coated with an antibiotic-loaded hydrogel (DAC®, "Defensive Antibacterial Coating"), were compared with 27 matched controls, treated with a two-stage cementless revision procedure, without the coating.

Results: At a mean follow-up of 2.

ICS classification system of infected osteosynthesis: Long-term results.

The best treatment strategy for infected osteosyntheses is still debated. While hardware removal or eventually early device exchange may be necessary in most of the cases, temporary hardware retention until fracture healing can be a valid alternative option in others. Aim of the present study is to report the long-term results of 215 patients with infected osteosyntheses, treated according to the ICS (Infection, Callus, Stability) classification in two Italian hospitals.

Managing large bone defects in children: a systematic review of the 'induced membrane technique'.

Unlabelled: Thirty years after its description by Masquelet in 1986, this is the first systematic review aiming to critically evaluate the 'induced membrane technique' effectiveness in achieving bone union in children. Only six papers fulfilled our inclusion criteria (54 patients). The relatively small number of reported cases did not allow a formal meta-analysis.

The Concept of Biofilm-Related Implant Malfunction and "Low-Grade Infection".

Biofilms have a tremendous impact on industrial machines working in moist environments, while in biological systems their effect is further complicated by the host's response.Implant-related infections are a complex process, starting with bacterial adhesion and biofilm formation, followed by the variable interaction between host, implant, microorganisms and their by-products. Depending on the balance of these factors, different clinical presentations are observed, which may eventually, at times, shift from one into the other.

Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama.

Implanted biomaterials play a key role in current success of orthopedic and trauma surgery. However, implant-related infections remain among the leading reasons for failure with high economical and social associated costs. According to the current knowledge, probably the most critical pathogenic event in the development of implant-related infection is biofilm formation, which starts immediately after bacterial adhesion on an implant and effectively protects the microorganisms from the immune system and systemic antibiotics.

Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial.

Purpose: The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery.

Methods: This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded.

Role for irrigation and debridement in periprosthetic infections.

Irrigation and debridement (I&D) has been described as a possible option to eradicate early postoperative periprosthetic hip and knee infections, as well as late, acute, and hematogenous ones. Still, the literature fails to uniquely assess the effectiveness of this procedure and often provides conflicting evidence. To reconcile this difference, a systematic review of the available literature from 1970 to 2013 was undertaken.

Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis: long-term results.

Purpose: Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA).

Methods: Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes.

Results: Spacer exchange was necessary for infection persistence in one case.

Bioactive glass BAG-S53P4 for the adjunctive treatment of chronic osteomyelitis of the long bones: an in vitro and prospective clinical study.

Background: This study aimed to explore the in vitro antibacterial activity of the bioglass BAG S53P4 against multi-resistant microorganisms commonly involved in osteomyelitis and to evaluate its use in surgical adjunctive treatment of osteomyelitis.

Methods: In vitro antibacterial activity of BAG-S53P4 against methicillin resistant Staphylococcus aureus and Staphylococcus epidermidis, Pseudomonas aeruginosa and Acinetobacter baumannii isolates was evaluated by means of time kill curves, with colony counts performed after 24, 48 and 72 hours of incubation. In vivo evaluation was performed by prospectively studying a cohort of 27 patients with a clinically and radiologically diagnosed osteomyelitis of the long bones in an observational study.

Use of dithiothreitol to improve the diagnosis of prosthetic joint infections.

Diagnosis of prosthetic joint infections (PJIs) remains a challenge for microbiologists, despite new techniques for bacteria isolation have been developed in recent years. A widely recognized standard method has not yet been indicated mainly because of limitations due difficult procedures and need of dedicated instrumentation. We evaluated the ability of a sulfhydryl compound routinely used in microbiology laboratories, dithiothreitol (DTT), to dislodge bacteria from biofilm, keeping them alive and cultivable for identification and antibiotic susceptibility testing.

Antibiofilm agents and implant-related infections in orthopaedics: where are we?

Orthopaedics is currently the largest market of biomaterials worldwide and implant-related infections, although relatively rare, remain among the first reasons for joint arthroplasty and osteosynthesis failure. Bacteria start implant infection by adhering to biomaterials and producing biofilms, which represent a major reason for bacterial persistence, in spite of antibiotic treatment and host's defence. In the last two decades, a number of different antibiofilm agents have been studied and both in vitro and in vivo results appear now promising, even if their effective role in orthopaedics remains to be assessed.

Value of digital telethermography for the diagnosis of septic knee prosthesis: a prospective cohort study.

Background: Diagnosis of peri-prosthetic infection remains challenging, often requiring a combination of different tests.

Methods: In this prospective, case-control study, the diagnostic accuracy of telethermography was evaluated in a group of seventy patients who had had a total knee replacement and were undergoing a reoperation because of infection or another implant-related problem, after a minimum of one year from implant.

Results: An average differential temperature of the affected versus not affected knee of 1.

Value of debridement and irrigation for the treatment of peri-prosthetic infections. A systematic review.

Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however the effective ability of this procedure to avoid recurrent infection is still debated. In this systematic review of the literature we reviewed full-text papers published from 1970 through 2011, that reported the success rate of infection eradication after debridement and irrigation with prosthesis retention for the treatment of early septic complications (within six weeks from surgery) or late acute haematogenous infections after hip or knee prosthesis. In all, 14 original articles, reporting the results of 710 patients were retrieved.

Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results.

Two-stage revision is the most widely accepted and performed intervention for chronically infected hip prosthesis and different interim spacers have been proposed. In recent years, antibiotic-loaded preformed spacers have become available on the market. The aim of this retrospective study was to assess the long-term results of two-stage revision with preformed spacers and uncemented hip prosthesis for the treatment of septic hip prosthesis.

Antineuropathic and antinociceptive drugs combination in patients with chronic low back pain: a systematic review.

Purpose. Chronic low back pain (LBP) is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach.

Successful staged hip replacement in septic hip osteoarthritis in osteopetrosis: a case report.

Background: Osteopetrosis is a rare, inherited, bone disorder, characterized by osteosclerosis, obliteration of the medullary cavity and calcified cartilage. The autosomal dominant form is compatible with a normal life span, although fractures often result from minimal trauma, due to the pathologic nature of bone. Osteomyelitis is common in patients with osteopetrosis because of a reduced resistance to infection, attributed to the lack of marrow vascularity and impairment of white cell function.

Bone and joint infections in adults: a comprehensive classification proposal.

INTRODUCTION AND METHODS: Ten currently available classifications were tested for their ability to describe a continuous cohort of 300 adult patients affected by bone and joint infections. Each classification only focused, on the average, on 1.3 ± 0.

Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study.

Background: Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol.

Methods: Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008.

Healing of surgical site after total hip and knee replacements show similar telethermographic patterns.

Background: Isolated reports indicate the efficacy of infrared thermography for monitoring wound healing and septic complications, but no long-term analysis has ever been performed on this, and there are no data on the telethermographic patterns of surgical site healing after uncomplicated total hip prosthesis and after knee prosthesis.

Materials And Methods: In this prospective, observational, nonrandomized cohort study, two groups with forty consecutive patients each, who were operated on respectively for total hip and for total knee replacements, underwent telethermographic examination of the operated and contralateral joints prior to and at fixed intervals for up to 1 year after uncomplicated surgery. A digital, portable telethermocamera and dedicated software were used for data acquisition and processing.

Septic versus aseptic hip revision: how different?

Background: The few available studies directly comparing aseptic and septic joint revision surgery report conflicting results. We investigated whether two-stage revision of septic hip prosthesis with a preformed antibiotic-loaded spacer and an uncemented prosthesis provides hip function and quality of life similar to those provided by aseptic revision surgery in the medium term, as well as the associated direct hospital costs.

Materials And Methods: We prospectively evaluated the hip function (Harris hip score) and quality of life (WOMAC and SF-12 scores) of 80 patients who underwent one-stage revision for aseptic loosening (Group A, 40 patients) or two-stage revision for septic total hip prostheses (Group S, 40 patients).

Long-stem versus short-stem preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty.

Two-stage revision is the most widely accepted and performed intervention for chronically infected hip prostheses. In recent years short and long stem antibiotic-loaded preformed spacers have become available on the market. The aim of this prospective, comparative study was to assess the safety and efficacy of long stem versus short stem preformed spacers.

Pregabalin, celecoxib, and their combination for treatment of chronic low-back pain.

Background: The efficacy and safety of the association of celecoxib [a selective cyclooxygenase-2 (COX-2) inhibitor] and pregabalin (commonly used to control neuropathic pain), compared with monotherapy of each, were evaluated for the treatment of chronic low-back pain, a condition known to be due to neuropathic as well as nociceptive pain mechanisms.

Materials And Methods: In this prospective randomized trial, 36 patients received three consecutive 4-week treatment regimes, randomly assigned: celecoxib plus placebo, pregabalin plus placebo, and celecoxib plus pregabalin. All patients were assessed by using a visual analogue scale (VAS, 0-100 mm) and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale by an investigator blinded to the administered pharmacological treatment.

Combined Diagnostic Tool for joint prosthesis infections.

While diagnosing infection of a joint prosthesis often requires a multi-modal approach, evaluation of combined multiple diagnostics is still a rather subjective process. Based on the known sensitivity and specificity of commonly performed tests for joint prosthesis infection, we developed the Combined Diagnostic Tool, a software program that automatically allows the Combined Tests Index (CTI) to be calculated. The CTI indicates, in a given subject, the relative probability of a combined series of positive tests being true compared to negative tests.