Successful two-stage primary total knee arthroplasty for infective arthritis of the knee - our experience.

BACKGROUND: The incidence of septic arthritis is 2-10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection. PATIENTS AND METHODS: Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation. DISCUSSION: With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same. Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2ndstage reducing hospital stay, morbidity, and cost.Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection.Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information. CONCLUSION: All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.

Understanding Painful Hip in Young Adults: A Review Article.

A wide number of disorders, including pathologies outside the hip, can cause and refer pain to hip. However, determining the cause of a painful hip can be a major challenge to orthopedic surgeons. Failure to diagnose and appropriately investigate pathologies of the hip in adults may result in delayed management and prolonged patient morbidity. A systematic approach to investigating the etiology of hip pain in adults (e.g., history, careful clinical and radiographic examination), will help identify the majority of clinically important pathologies which can cause hip pain. Conservative treatment and selective use of injection therapies has proven quite successful for the treatment of most causes of hip pain.

A Rare Case of Heterotopic Ossification of the Patella Tendon in an Adolescent Presenting with Tendon Rupture.

Heterotopic ossification is the abnormal formation of mature, lamellar bone in nonosseous tissue such as tendons, ligaments, muscles, and soft tissue. We discuss a rare case of a young adolescent with patellar tendon rupture postheterotopic ossification. A 13-year-old male presented to us with knee pain and inability to extend for 6 weeks following trivial trauma. Preliminary radiological investigations revealed a high riding patella with ossification in the patella tendon. The magnetic resonance scan confirmed the same with patellar tendon disruption and heterogeneous ossification. He underwent surgery with patella tendon repair, augmentation with autograft, and had complete recovery at 6 months' follow-up.