Point of care testing for the diagnosis of periprosthetic joint infections: a review.

BACKGROUND: Periprosthetic joint infection (PJI) remains a major complication following total joint arthroplasties (TJA), significantly affecting patient outcomes and healthcare costs. Despite advances in diagnostic techniques, challenges persist in accurately diagnosing PJI, underscoring the need for effective point-of-care testing (POCT). METHODS: This review examines the current literature and latest developments in POCT for diagnosing PJI, focusing on biomarkers such as alpha-defensin, leukocyte esterase, calprotectin, and C-reactive protein (CRP). Criteria from various societies like the Musculoskeletal Infection Society, Infectious Diseases Society of America, and the International Consensus Meeting were compared to evaluate the effectiveness of these biomarkers in a point-of-care setting. RESULTS: POCT provides rapid results essential for the timely management of PJI, with alpha-defensin and leukocyte esterase showing high specificity and sensitivity. Recent advancements have introduced novel biomarkers like calprotectin, which demonstrate high diagnostic accuracy. However, challenges such as the variability in test performance and the need for validation under different clinical scenarios remain. DISCUSSION: While POCT for PJI shows promising results, their integration into clinical practice requires standardized protocols and further validation. The evolution of these diagnostic tools offers a potential shift toward more personalized and immediate care, potentially improving outcomes for patients undergoing TJA.

Three-Dimensional Printed Calcaneus Implant for Open Calcaneal Fracture with Extensive Bone Loss: A Case Report and Literature Review.

Open calcaneal fractures with extensive bone loss and severe soft tissues injuries are very rare. There is no treatment protocol for these severe injuries. The incidence of infection, osteomyelitis, and amputation is high compared to closed calcaneal fractures. An independent prognostic factor for increased complications is the high type of fracture according to Gustillo and Anderson's classification. A one-stage or two-stage procedure with open reduction and internal fixation, external fixation, percutaneous pinning, minimally invasive procedures, and subtalar arthrodesis are treatment options. We present a case of open type IIIB fracture of the calcaneus with extensive bone loss managed with a two-stage procedure. First, a cement spacer was inserted to fill the void and then, after the soft tissue envelope had healed with no sign of infection, a three-dimensional (3D) printed custom-made calcaneus implant was inserted. This is the first report in the literature of using a 3D custom-made calcaneal implant for a severe open calcaneal fracture with extensive osseous defect. At one-year follow-up, plain radiographs of the foot showed the calcaneus implant in place. The American Orthopedic Foot and Ankle score (AOFAS) was 76, and the patient had mild restrictions to his daily activities due to mild heel pain.