Organism profile and C-reactive protein (CRP) response are different in periprosthetic joint infection in patients with hepatitis.

PURPOSE: Hepatitis B and C are important and relatively common health issues. It is known that many patients who underwent total knee and hip arthroplasty were also diagnosed with hepatitis. These patients are at higher risk of periprosthetic joint infection (PJI). This study aimed to investigate the differences in PJI cases in hepatitis B and C patients. METHODS: This is a retrospective case-controlled single-center study. A total of 270 patients with hepatitis and non-hepatitis (control group) who underwent one-stage septic exchange to the hip and knee joints were included in the study. All patients' previous surgical histories, infective organisms, C-reactive protein (CRP) values before septic exchange, and demographic data were evaluated. All microbiological and laboratory evaluations were performed separately for knee and hip arthroplasty. RESULTS: The mean CRP levels of Hep B- and C-positive patients, who underwent one-stage septic exchange in the knee joint, were 23.6 mg/L. In the control group, this value was 43.1 mg/L and a statistically significant difference was found between the groups (p = 0.004). Gram-negative organisms were identified in a larger proportion of patients with hepatitis who developed PJI in both hip and knee joints and underwent one-stage septic exchange (p = 0.041/p = 0.044). CONCLUSION: PJIs caused by Gram-negative bacteria are encountered more frequently in patients with hepatitis than in the control group. In addition, the CRP rise is less in patients with hepatitis compared to PJI cases in the control group. Patient-specific evaluation is required in cases of PJI in patient groups with co-existing hepatitis.

Densitometric evaluation of bone remodelling around Trabecular Metal Primary stem: a 24-month follow-up.

BACKGROUND: Today, an increasing number of total hip arthroplasty (THA) procedures are being performed. Osseointegration is a physiological phenomenon that leads to the direct anchorage of an implant by the formation of bony tissue around the implant without the growth of fibrous tissue at the bone-implant interface. Several factors may affect this phenomenon: some of these depend on the patient and others may depend on implant design and materials. Variations in periprosthetic bone mineral density (BMD) can be studied through several scans by dual energy X-ray absorptiometry (DEXA) around the femoral stem. AIMS: The purpose of this study is to investigate correlations between periprosthetic BMD and the factors affecting osseointegration. METHODS: We retrospectively analysed patients who underwent primary THA. In all the patients, Trabecular Metal Primary (TMP), a standard uncemented tapered stem with a proximal porous tantalum coating, was implanted. Preoperatively, postoperatively, 3 and 6 months, 1 year and 2 years after implantation, DEXA scans were performed around the femoral stem. The patients were matched for diagnosis, sex, BMD of the lumbar spine and contralateral femur, Body Mass Index and age. RESULTS: One hundred and eight patients (51 males and 57 females) with a mean age of 73 years were studied. Different BMD changing patterns were observed and a greater bone resorption was noted in all the conditions associated with poor bone quality. DISCUSSION: The proximal coating of Trabecular Metal Primary (TMP) seemed to be effective in promoting new bone formation in the proximal femur also in the conditions associated with poor bone quality. CONCLUSIONS: At the present time, DEXA is considered the most reliable tool for evaluating bone remodelling after THA.

Conservative surgery for the treatment of osteonecrosis of the femoral head: current options.

The prevention of femoral head collapse and the maintenance of hip function would represent a substantial achievement in the treatment of osteonecrosis of the femoral head; however it is difficult to identify appropriate treatment protocols to manage patients with pre-collapse avascular necrosis in order to obtain a successful outcome in joint preserving procedures. Conservative treatments, including pharmacological management and biophysical modalities, are not supported by any evidence and require further investigation. The appropriate therapeutic approach has not been identified. The choice of surgical procedures is based on patient clinical conditions and anatomopathological features; preservation of the femoral head by core decompression may be attempted in younger patients without head collapse. Biological factors, such as bone morphogenetic proteins and bone marrow stem cells, would improve the outcome of core decompression. Another surgical procedure proposed for the treatment of avascular necrosis consists of large vascularized cortical bone grafts, but its use is not yet common due to surgical technical issues. Use of other surgical technique, such as osteotomies, is controversial, since arthroplasty is considered as the first option in case of severe femoral head collapse without previous intervention.

Total hip arthroplasty revision in elderly patients.

In the last years, the number of total hip arthroplasty is increased both in young patients and elderly with a poor bone quality due to extension of surgical indications. According to this trend, also revision surgery showed a growth of its number, especially in elderly patients, because of implant loosening, failed osseointegration of prosthetic components, errors in biomechanical restoration and infections. The aim of this study is to analyze life quality improvement through evaluation of articular functionality and postoperative pain, and to examine osseointegration of implant components with periprosthetic bone. During total hip arthroplasty revision, the orthopedic surgeon often has to face complex cases, especially in elderly patients with a preexisting status of poor bone quality and sarcopenia. In these cases, a correct planning and a surgical procedure well-executed are able to ensure a good outcome that led to pain relief and functional recovery. Furthermore anti-osteoporotic therapy surely represents a useful resource both in primary total hip arthroplasty and in revisions, mainly for elderly patients with a poor bone quality.

Patient-reported outcome measures (PROMs) in patients undergoing patellofemoral arthroplasty and total knee replacement: A comparative study.

BACKGROUND: Incongruity in the evaluation of outcomes between patients and surgeons has led to an increasing utilization of patient-reported outcome measures (PROMs) as an evaluation method of outcome. OBJECTIVE: The aim of this study was to compare Oxford Knee Score (OKS), KOOS-PS and Kujala Score results in patients who received either PFA or TKA with and without patella resurfacing in the tretament of knee osteoarthritis. METHODS: A total of 50 patients (PFA = 19 patients; TKA with patelloplasty = 15 patients; TKA with patellar resurfacing = 16 patients) undergone surgery between 2011 and 2014 and were included for final analysis. RESULTS: No statistical significance was found for OKS, KOOS-PS and Kujala scores between the three groups. However, although patients with PFA experienced higher levels of pain. CONCLUSIONS: According to our results, it is essential to discuss the treatment options and quality of life expectations with the patient prior joint replacement surgery in order to reduce patient dissatisfaction. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Osteosynthesis of fragility fractures.

The deepening knowledge about bone pathophysiology, together with the development of less invasive bone implants, fitted for the treatment of fragility fractures, the continuous advances in the creation of osteoconductive and osteoinductive biomaterials, the availability of bone active agents, capable of modulating fracture healing, actually represent the orthopaedic "weapons" to improve the surgical outcome and quality of life in patients with osteoporosis.