Debridement, antibiotics and implant retention (DAIR): An effective treatment option for early prosthetic joint infections.

INTRODUCTION: Debridement, antibiotics and implant retention (DAIR) is an attractive treatment option for prosthetic joint infections (PJIs). However, reported success rates and predictors of DAIR failure vary widely. The primary aim of this study is to report the outcome of DAIR in patients with hip and knee PJIs receiving short course of antibiotic therapy. The secondary aim is to identify risk factors for DAIR failure. METHODS: We performed a retrospective analysis of prospectively collected data of all hip and knee PJIs consecutively diagnosed at Quadrante Orthopedic Center, an Italian orthopedic hospital highly specialized in prosthetic surgery, from January 1, 2013 to January 1, 2019, and we analyzed those treated with DAIR. RESULTS: Forty-seven PJIs occurred after 5102 arthroplasty procedures. Twenty-one patients (45%) aged 71 years were treated with DAIR for hip (62%) and knee (38%) PJIs. These were classified as early PJIs in 76% cases, delayed in 19% and late in 5%. Median time from PJI-related symptoms onset to implant revision surgery was 12 days (IQR, 7-20 days). The median duration of antibiotic treatment after surgery was 63 days (IQR, 53-84 days). Sixteen (76%) patients were cured after a median follow-up of 2197 days (IQR, 815-2342 days), while 5 (24%) experienced failure. At multivariate analysis, delayed/late PJIs were significantly associated with failure (OR = 12.51; 95% CI 1.21-129.63, p = 0.03). CONCLUSIONS: DAIR represents an effective strategy for the treatment of early PJIs in spite of short course of antibiotic therapy.

Quantitative evaluation of functional limitation of upper limb movements in subjects affected by ataxia.

BACKGROUND AND PURPOSE: The design of useful and effective treatment strategies for movement disorders largely depends on the ability to objectively quantify changes in performances, providing reliable outcome measures. Evaluation of ataxia remains mainly assigned to different clinical scales, providing a semi-quantitative assessment. The aim of this study was to quantitatively characterize functional changes in upper limb movements in ataxic patients, using an optoelectronic system for objective measurements. METHODS: Fourteen patients with cerebellar ataxia and 27 healthy subjects were analyzed using an optoelectronic system with passive markers during pointing task and hand-to-mouth movement. Quantitative parameters capable of characterizing ataxic movements were defined using recorded kinematics. RESULTS: In both the considered functional movements, ataxic patients showed increased adjustment during the last phase of movement. The movement was less smooth than that in controls, with a fragmented trajectory presenting more direction changes than controls. CONCLUSIONS: The proposed protocol allows the quantitative characterization of the motion pattern of ataxic subjects in a non-invasive way. We believe that this analysis could represent a good tool for ataxia evaluation in a clinical context such as neurorehabilitation.