Global Forum: The Burden of Bone and Joint Infections: A Growing Demand for More Resources.

The rate and severity of septic complications following joint replacement surgery and the incidence of posttraumatic infections are projected to increase at a faster pace because of a tendency to operate on high-risk patients, including older patients, patients with diabetes, and patients who are immunocompromised or have comorbidities. Musculoskeletal infections are devastating adverse events that may become life-threatening conditions. They create an additional burden on total health-care expenditures, and can lead to functional impairment, long-lasting disability, or even permanent handicap, with the inevitable social and economic burdens. The scientific community should take a more active role to draw public attention to the plight of hundreds of thousands of people across the globe who experience complications, become disabled, and, in some cases, die, and it should highlight what could be achieved if the global community takes decisive steps to improve access, early detection, and appropriate care. However, mitigating the adverse personal, clinical, and socioeconomic effects of these conditions requires increasing financial resources provided by both governments and funding organizations. Furthermore, a targeted action plan from the providers and the professional societies should be put in place so that the burden created by bone and joint infections is included in the agenda for global health-care priorities.

The effect of osteoporotic treatment on the functional outcome, re-fracture rate, quality of life and mortality in patients with hip fractures: a prospective functional and clinical outcome study on 520 patients.

Numerous high quality studies have shown the positive effects of various osteoporotic medical treatment regimens on bone mass and on the reduction of risk for new spinal, hip and non-spinal fractures in osteoporotic patients. However, the effect of osteoporotic treatment on the functional and clinical outcome of patients who have sustained hip fractures and been treated surgically has not yet been addressed. Five hundred and twenty patients out of 611 who were admitted (2009-2011), operated on due to a hip fracture and completed their follow-up evaluations were included in this study. Data related to functional outcome scores, re-fracture rate, quality of life and mortality rate were prospectively recorded, analysed and correlated to osteoporotic medical treatment. There were 151 (25%) men and 369 (71%) women with a mean age of 80.7 years (range, 60 to 90 years). At a mean follow-up of 27.5 months (range, 24 to 36 months) a mortality rate of 23.6% at 2 years was recorded. Mean values of functional and quality of life scores were found to have progressively improved within two years after surgery. Seventy-eight (15%) patients were taking osteoporotic treatment before their hip fracture and 89 (17.1%) started afterwards. Osteoporotic treatment proved to be an important predictor of functional recovery (all p values<0.05), re-fracture rate (p=0.028) and quality of life (EQ-5D, all dimensions, p values<0.05). Osteoporotic treatment did not affect post-fracture mortality rates. Osteoporotic treatment taken before or initiated after fracture is a strong predictor of functional and clinical outcome in patients with hip fractures treated surgically.

Repair of an anteroinferior glenoid defect by the latarjet procedure: quantitative assessment of the repair by computed tomography.

PURPOSE: The purpose of this study was to determine quantitatively whether the Latarjet procedure (coracoid transfer to the glenoid) is sufficient to restore a significant defect area of the glenoid. METHODS: Fourteen cadaveric shoulders were used (mean age, 76 years; range, 72 to 87 years). An anteroinferior glenoid defect was created and then the coracoid osteotomized to its angle and transferred to the defect. A 3-dimensional computed tomography scan was used to calculate the surface area of (1) the intact glenoid, (2) the osteotomized glenoid, and (3) the reconstructed glenoid. RESULTS: The mean area of the intact inferior glenoid was 734 +/- 89 mm(2). After creation of the defect, the surface area of the glenoid was reduced significantly to 523 +/- 55 mm(2) (P = .011). The mean defect area was 28.7% +/- 6% of the intact glenoid. After coracoid transfer, the mean surface area of the reconstructed glenoid was 708 +/- 71 mm(2) but it was not significantly smaller than that of the intact glenoid (P = .274). The mean surface area of the coracoid that was used to repair the defect was 198 +/- 34 mm(2), or 27% +/- 5% of the intact glenoid. CONCLUSIONS: In our cadaveric model, a mean 29% defect size of the inferior glenoid was restored to normal after coracoid transfer by use of the Latarjet procedure. CLINICAL RELEVANCE: In the clinical scenario, the existence of a glenoid bone defect of more than 25% to 30% is very rare in patients with anterior shoulder instability. Therefore, when clinically indicated, large bony defects of the anterior glenoid can be adequately treated by the Latarjet procedure.

Femoral head osteonecrosis: volumetric MRI assessment and outcome.

Effective treatment of femoral head osteonecrosis (FHON) requires early diagnosis and accurate assessment of the disease severity. The ability to predict in the early stages the risk of collapse is important for selecting a joint salvage procedure. The aim of the present study was to evaluate the outcome in patients treated with vascularized fibular grafts in relation to preoperative MR imaging volumetry. We studied 58 patients (87 hips) with FHON. A semi-automated octant-based lesion measurement method, previously described, was performed on the T1-w MR images. The mean time of postoperative follow-up was 7.8 years. Sixty-three hips were successful and 24 failed and converted to total hip arthroplasty within a period of 2-4 years after the initial operation. The rate of failures for hips of male patients was higher than in female patients. The mean lesion size was 28% of the sphere equivalent of the femoral head, 24+/-12% for the successful hips and 37+/-9% for the failed (p<0.001). The most affected octants were antero-supero-medial (58+/-26%) and postero-supero-medial (54+/-31%). All but postero-infero-medial and postero-infero-lateral octants, showed statistically significant differences in the lesion size between patients with successful and failed hips. In conclusion, the volumetric analysis of preoperative MRI provides useful information with regard to a successful outcome in patients treated with vascularized fibular grafts.