Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition.

Purpose: Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision.

In vitro evaluation of antibacterial efficacy of vancomycin-loaded suture tapes and cerclage wires.

Usage of implants containing antibiotic agents has been a common strategy to prevent implant related infections in orthopedic surgery. Unfortunately, most implants with microbial repellent properties are characterized by accessibility limitations during daily clinical practice. Aim of this in vitro study was to investigate whether suture tapes and cerclage wires, which were treated with vancomycin, show a sustainable antibacterial activity.

Do not exchange the spacer during staged TKA exchange!

Purpose: The aim of this study was to investigate the reinfection rate and risk factors for septic failure after two-stage exchange for chronic periprosthetic joint infections of primary total knee arthroplasties. Reinfections should be classified as new infection or as infection recurrence after two-stage exchange.

Methods: We performed a retrospective study of 60 knees with chronic periprosthetic joint infections.

Why compromise the patella? Five-year follow-up results of medial patellofemoral ligament reconstruction with soft tissue patellar fixation.

Purpose: This study investigates the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament (MPFL) reconstruction with soft tissue patellar fixation for patella instability.

Methods: Patients were retrospectively identified and knees were evaluated for trochlea dysplasia according to Dejour, for presence of patella alta and for presence of cartilage lesion at surgery. At a minimum follow-up of five years, information about an incident of redislocation was obtained.

Infection control and outcome of staged reverse shoulder arthroplasty for the management of shoulder infections.

Background: The treatment of septic arthritis, caused by either hematogenous seeding, injections, or surgery, can be challenging. Staged reverse shoulder arthroplasty (RSA) with temporary implantation of an antibiotic-loaded spacer is widely accepted but still discussed controversially. This study investigated the shoulder-specific bacterial spectrum, infection control rate, functional outcome, and infection-free survival rate after staged RSA in the mid- to long-term follow-up.

Cement-augmented screw fixation for calcaneal fracture treatment: a biomechanical study comparing two injectable bone substitutes.

Background: The role of cement-augmented screw fixation for calcaneal fracture treatment remains unclear. Therefore, this study was performed to biomechanically analyze screw osteosynthesis by reinforcement with either a calcium phosphate (CP)-based or polymethylmethacrylate (PMMA)-based injectable bone cement.

Methods: A calcaneal fracture (Sanders type IIA) including a central cancellous bone defect was generated in 27 synthetic bones, and the specimens were assigned to 3 groups.

Acetabular Revision With Intramedullary and Extramedullary Iliac Fixation for Pelvic Discontinuity.

Background: Parallel to the increase in revision hip procedures surgeons face more and more complex anatomical challenges with pelvic discontinuity (PD) being one of the worst-case scenarios. Here we report on our clinical results using an asymmetric acetabular component for the treatment of PD. The implant is armed in a monoblock fashion with an extramedullary iliac flange and provides the possibility to augment it with an intramedullary iliac press-fit stem.

Revision arthroplasty with rotating hinge systems for total knee arthroplasty instability.

Objective: Restoring stability after total knee arthroplasty (TKA) and improving joint function using a cemented rotating hinge system.

Indications: Ligament instability and/or osseous defects (including Anderson Orthopaedic Research Institute [AORI] classification type II defects) after primary TKA or TKA revision surgery.

Contraindications: Distal femoral or proximal tibial bowing requiring implant systems that provide femoral or tibial offset stems.

Is debridement beneficial for focal cartilage defects of the knee: data from the German Cartilage Registry (KnorpelRegister DGOU).

Introduction: Focal cartilage defects of the knee are often treated with arthroscopic debridement. Existing literature discussing the benefit of debridement for small articular cartilage lesions is scarce, especially if the debridement was not part of a combined operative cartilage procedure including meniscal and ligament repair. The purpose of this study was to examine the patients´ benefit after arthroscopic debridement for the treatment of isolated focal chondral defects with or without partial meniscus resection.

The posterior-anterior-flexed view is essential for the evaluation of valgus osteoarthritis. A prospective study on 134 valgus knees.

Background: Radiographic imaging is an important tool to assess osteoarthritis (OA). Lateral compartment osteoarthritis (valgus OA) usually starts with cartilage degeneration along the posterior aspect of the lateral femoral condyle. There is evidence that the posterior-anterior (PA)-flexed view is more sensitive when diagnosing early stages of valgus OA compared to the anterior-posterior (AP) view.

Vitamin D Deficiency in Patients With Idiopathic and Traumatic Osteochondritis Dissecans of the Talus.

Background: Low vitamin D levels are common in patients with foot and ankle disorders. We have previously demonstrated that juveniles diagnosed with osteochondritis dissecans (OCD) have a high prevalence of vitamin D deficiency. Moreover, there is evidence that OCD might be related to vitamin D deficiency in general.

Antibiotic elution and compressive strength of gentamicin/vancomycin loaded bone cements are considerably influenced by immersion fluid volume.

The effect of doubling the immersion fluid (eluate) volume on antibiotic concentrations and on mechanical stability from vancomycin and gentamicin loaded bone cements was investigated in vitro. Antibiotic loaded bone cements containing premixed 1.34% gentamicin antibiotic concentration in the cement powder (wt), premixed 1.

Comparison of Elution Characteristics and Compressive Strength of Biantibiotic-Loaded PMMA Bone Cement for Spacers: Copal® Spacem with Gentamicin and Vancomycin versus Palacos® R+G with Vancomycin.

Purpose: Copal® spacem is a new PMMA bone cement for fabricating spacers. This study compares elution of gentamicin, elution of vancomycin, and compressive strength of Copal® spacem and of Palacos® R+G at different vancomycin loadings in the powder of the cements. We hypothesized that antibiotic elution of Copal® spacem is superior at comparable compressive strength.

Synovial Fluid Aspiration Should Not Be Routinely Performed during the Two-Stage Exchange of the Knee.

Purpose: Detection of infection persistence during the two-stage exchange of the knee for periprosthetic joint infection is challenging. Synovial fluid culture (SFC) and synovial white blood cell count (SWBCC) before joint reimplantation are widespread diagnostic means for this indication. The sensitivity and specificity of SFC and of SWBCC for infection persistence before planned reimplantation were evaluated.

Revision knee arthroplasty with rotating hinge systems in patients with gross ligament instability.

Purpose: The clinical and radiographic outcomes after revision total knee arthroplasty (TKA) for instability with two rotating hinge knee prostheses were compared.

Methods: Fifty-one patients revised for TKA instability were prospectively randomized to either the Link Endo-Model (N = 26) or the EnduRo (N = 25). Clinical and radiographic outcome scores were compared pre-operatively and at 12 months' follow-up.

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers.

Background: Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.

Loading with vancomycin does not decrease gentamicin elution in gentamicin premixed bone cement.

Antibiotic loaded bone cements are used as drug delivery systems for the treatment of periprosthetic joint infections. They can be loaded with antibiotics during industrial component production (premixing) and during cement preparation (manually blending). Although double premixed antibiotic loaded bone cements are available, manually blending of a gentamicin premixed antibiotic loaded bone cement with vancomycin is still popular.

Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures: a retrospective clinical study.

Purpose: Treating acetabular fractures with open reduction and internal fixation (ORIF) may lead to poorer outcomes in older patients. As data for osteoporotic acetabular fractures are limited, we compared primary total hip replacement (THR) with ORIF for treating osteoporotic acetabular fractures, including those with posterior column instability.

Methods: All patients with osteoporotic acetabular fractures, treated with ORIF or primary THR from 2005 to 2015, were assessed retrospectively for clinical and radiologic outcomes.

Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials.

Plastic deformation of sutures creates an irreversible extension during load. To test our hypothesis that such plastic deformation causes gap formation after tendon repair, we determined the plasticity of five different suture materials commonly used in tendon surgery. Prolene, Polydioxanone (PDS), Ethibond, Vicryl, and FiberWire sutures were biomechanically tested to determine their offset yield strength, initial extension, creep, relaxed elongation, peak-to-peak displacement, stiffness, and maximum tensile strength under static, constant, and cyclic loading.

Calcinosis Universalis of the Elbow: A Rare Case with Classical Presentation.

Juvenile Dermatomyositis (JDM) is a rare autoimmune disease in children and adolescents. In these patients calcinosis might be the most characteristic symptom. However there are only few reported cases of intramuscular calcinosis in Dermatomyositis.