Patterns of surgical complications after delayed fixation of peripartum pubic symphysis rupture: a report of 5 cases.

BACKGROUND: The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless, there are cases where surgical intervention is necessary. We analyzed five surgical cases treated in our department and performed a literature review. CASE PRESENTATIONS: Five women, ranging in age from 25 to 38, who experienced peripartum symphysis rupture were primarily treated with a conservative approach. Patients who did not show improvement and met certain criteria, such as experiencing pain starting from childbirth, having a separation in the pubic bone of more than 10 mm, and/or having a vertical instability greater than 5 mm, were recommended to undergo surgery. The average length of time between childbirth and surgery was 5.6 months, ranging from 1 to 14 months. One patient was treated with an external fixator, another patient received a combination of an external fixator and an anterior plate, and three patients were treated with anterior plates. In four cases, we observed a failure in fixation and a partial or complete loss of reduction. The plate and screws were removed in one case, and in three cases, revision surgery was performed. One case involved using a larger plate, while the other used 90-90 plating, known as "box plate fixation." The mean follow-up was 7.4 years. Two cases had good results, and two had excellent results on the Lindahl scale. CONCLUSION: For patients with peripartum pubic symphyseal dislocation, our case series and literature review demonstrated that early reduction and fixation correlate with improved clinical outcomes and lower implant failure. For patients with subacute/chronic injuries, there was a higher incidence of implant failure. Orthogonal plate fixation and/or pubic symphysiodesis was associated with improved clinical outcomes.

Femoral nerve palsy as a complication due to COVID-19 coagulopathy and iliopsoas muscle hematoma - case report.

BACKGROUND: COVID-19 (Coronavirus disease 2019) pandemic is the main medical problem around the world from the end of 2019. We found until now many symptoms of this disease, but one of the most problematic was thrombosis. Wide recommendation on COVID-19 treatment was pharmacological thromboprophylaxis. In some papers we found that clinicians face the problem of bleeding in those patients. Is still unknown that coronavirus could led to the coagulopathy. CASE PRESENTATION: We described case report of patient who with COVID-19 disease present femoral nerve palsy caused by the iliopsoas hematoma. There were no deviations in coaguology parameters, patient got standard thromboprophylaxis, besides above probably COVID-19 was risk factor of hematoma formation. Non-operative treatment was applied, thrombophylaxis was discontinued. In the follow up in the radiological exam we saw reduction of the haematoma and patient report decrease of symptoms. CONCLUSIONS: We should assess individually patient with COVID-19 according to thrombosis risk factors. Probably we should be more careful in ordering thrombophylaxis medications in COVID-19 patients.

A prospective randomized study, use of closed suction drainage after revision hip arthroplasty may lead to excessive blood loss.

Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.

Literature Analysis Regarding the Combination of Substances: Glucosamine + Chondroitin in the Treatment of Osteoarthritis.

An essential component of joint quality is cartilage. Therefore, the protection of this is a prerequisite for maintaining the condition of each joint. The assessment of the presence of articular cartilage is shown by X-ray of both joints in the standing position. Cartilage protection is possible for 1, 2 and 3 degree of cartilage damage according to the Kellgren and Lawrence scale.The challenge for the physician is to identify the cause of OA in accordance with the principles of Evidence Based Orthopedics/Traumatology, and not merely treat symptomatically, which is usually ineffective.In order to objectively present treatment methods, indications and the period of their implementation, it is biologically reasonable to refer to the needs of cartilage tissue resulting from the analysis of the causes of its damage and indications for justified methods of its protection.Biomechanical and biological elements are important in the process of implementing articular cartilage protection.The biomechanical elements are: limb axis disorders, differences in length, distortions at the level of the support quadrilateral, pelvic triangle and shoulder triangle, as well as balance disorders resulting from disturbances in the segmental proportion of the Fi number according to Leonardo da Vinci.There are many biological elements of the discussed disorder and they concern: the state of articular cartilage structure, matrix structure, matrix biophysical elements, molecular sponge mechanism, chondrocytes, cartilage nutrition and the severity of osteoarthritis (OA).The improvement of the conditions of the biological elements of damaged articular cartilage is considered fundamental and concerns the positive impact on numerous cartilage matrix proteins by chondroprotection. This element of treatment consists in the use of chondroitin sulphate and glucosamine as a drug, administered together in the appropriate dose and for a long time depending on the degree of degradation of the articular cartilage, usually from several to several months. The combination of chondroitin sulfate with glucosamine causes the activation of a much larger number of matrix proteins than each of the preparations separately.The pharmacokinetics of chondroitin sulfate and glucosamine are positive and favor their chondroprotective effect.The pharmacoproteomics of chondroitin sulfate and glucosamine administered together result from the activation of as many joint cartilage matrix proteins as possible. The development of proteomic techniques creates completely new therapeutic possibilities and is used to study the action of individual molecules.A clinically significant fact is that both chondroitin and glucosamine are natural, endogenous components of bone tissue and articular cartilage, so the use of both drugs is biologically compatible and results in numerous elements of cartilage protection.

Comparative study of suction drainage placement in cementless hip replacement among patients undergoing extended thromboprophylaxis: a prospective randomized study.

BACKGROUND: The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis. METHODS: In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days. RESULTS: The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. CONCLUSIONS: We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings. TRIAL REGISTRATION: The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264  03 April 2020.

Induced Biological Response in Contact with Ag-and Cu-Doped Carbon Coatings for Potential Orthopedic Applications.

Silver and copper as additives of various biomaterials have been reported as the potential solutions for biomedicine applications, mostly because of inducing bactericidal effects. The application of those admixtures in diamond-like carbon (DLC) coatings may be desirable for orthopedic implants. In the present manuscript, the biological effect of coatings with up to about 7 at.% and 14 at.% of, respectively, Cu and Ag is compared. The morphology, chemical structure, and composition of films deposited on AISI 316LVM and Ti6Al7Nb is characterized. The live/dead analysis conducted with Escherichia coli shows a higher bactericidal potential of silver than copper. Although the Cu-doped coatings can positively affect the proliferation of Saos-2 and EA.hy926 cell lines, the results of XTT test are on the verge of 70% of viability. Biological effect of silver on EA.hy926 cell lines is negative but that admixture ensures high proliferation of osteoblasts in contact with coatings deposited on titanium alloy (over 20% better than for substrate material). In that case, the viability is reaching about 85% for Ag-doped coatings on AISI 316LVM and 75% on Ti6Al7Nb. The results indicate that for the sake of bactericidal coatings that may promote osteointegration, the candidates are DLC with silver content no higher than 10 at.%.

Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases.

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

Usefulness of ultrasonography in the diagnosis of hematoma after primary hip arthroplasty.

INTRODUCTION: To date, suction drainage has been routinely used after hip joint replacement. Currently, the validity of this practice is questioned in the literature. Hematoma is a risk factor of periprosthetic infection. Post-operative ultrasonography enables precise assessment of hip joint hematoma. AIM: The aim of the study was to evaluate the usefulness of hip joint ultrasonography with respect to the validity of using suction drainage after primary hip arthroplasty. MATERIAL: Inclusion criteria: coxarthrosis. Exclusion criteria: primary and secondary coagulopathy, renal or hepatic failure and history of venous or arterial thrombosis. In total, 90 patients were enrolled. METHODS: The study was prospective. The patients were assigned into groups in accordance with simple randomization. On the third day postsurgery, an ultrasound examination was conducted in all patients. RESULTS: Deep infection was found in two patients with suction drainage. Hematoma was almost twice bigger in the drainage group. There were no statistically significant differences in the Harris Hip Score between the groups. No statistically significant differences were found between the groups in: complete blood count parameters and C-reactive protein values in the first and third day after surgery, the amount of transfused packed red blood cells, duration of hospital stay, cost of hospital stay and the relationship between osteophyte removal and hematoma size. CONCLUSIONS: Ultrasonography performed after hip replacement surgeries is useful in the assessment of hematoma. The randomized study did not reveal statistically significant differences between the group with and without drainage, thus suggesting that this practice can be abandoned, except for selected cases. Due to a short hospital stay, it is recommended to conduct an ultrasound scan in addition to routine radiography and laboratory tests in order to reduce the risk of complications.

Results of the Treatment of Infected Nonunions of the Lower Limbs Using the Ilizarov Method.

BACKGROUND: Infected nonunion is a complex complication of the treatment of long bone fractures. An in creased incidence of injuries, including high energy injuries (often open ones), contributes to a higher incidence of nonunion. These primarily infected injuries cause osteomyelitis, which prevents bone union, resulting in an infected nonunion. The Ilizarov method meets the biological and biomechanical treatment requirements, opti mising the process of inflammation healing and producing bone union. MATERIAL AND METHODS: A total of 54 patients were treated in 2000-2014 for nonunion in the lower limbs with the Ilizarov method, which was used after previous treatment had failed. The subjects underwent intra operative resection of the locus of infection, sequestrectomy and a Judet procedure, followed by the use of the Ilizarov apparatus and bone transport, depending on the defect. RESULTS: Inflammation healed in 52 patients (96%) and bone union was achieved in 46 patients (86%). Good outcomes with healed inflammation and bone union were reported in 76% of the cases, fair outcomes with tem porary elimination of the inflammation and without bone union in 16%, and poor outcomes without inflam ma tion healing and without bone union in 7%. CONCLUSIONS: Treatment of infected nonunion can only be effective after eliminating endogenous inflamma tory foci, covering skin defects, ensuring a good condition of the skin and soft tissues, restoring normal blood supply to the bone fragments, and good biomechanical fixation of the fragments with dynamisation or compression. The Ilizarov method is a method of choice in the treatment of cases of infected nonunion where other treatments have failed.

Magnetic Resonance Imaging in Differentatial Diagnosis of Pyogenic Spondylodiscitis and Tuberculous Spondylodiscitis.

BACKGROUND: Infectious spondylodiscitis is characterized by the involvement of two adjacent vertebrae and the intervening disc. Incidence rate of the disease is estimated at 0.4-2 cases per 100000 per year. Staphylococcus aureus is the most common infectious agent causing pyogenic spondylodiscitis. Non-pyogenic infections of the spine are most frequently caused by Mycobacterium tuberculosis, and fungi. Clinical symptoms are nonspecific. Early diagnosis and appropriate treatment can prevent unfavorable irreversible sequela for the patient. Significant developments in techniques of imaging of pathological tissues raised expectations among the clinicians regarding possibility to distinguish between tuberculous spondylodiscitis and pyogenic spondylodiscitis on MR images. The aim of this study was to identify and differentiate between features of tuberculous and pyogenic spondylodiscitis on MR images. MATERIAL/METHODS: We performed retrospective analysis of MR images obtained from 34 patients with confirmed spondylodiscitis (18 with pyogenic spondylodiscitis, and 16 with tuberculous spondylodiscitis). Data acquisition was performed using 1.5 T MRI scanners where images were obtained using similar protocols. T2 TIRM and T1-weighted images with and without contrast enhancement were subject to assessment in coronal, axial and sagittal planes. RESULTS: Characteristic features of pyogenic spondylodiscitis include: involvement of the lumbar spine, ill-defined paraspinal abnormal contrast enhancement, diffuse/homogeneous contrast enhancement of vertebral bodies, low-grade destruction of vertebral bodies, hyperintense/homogeneous signal from the vertebral bodies on T2 TIRM images. Prevailing features of tuberculous spondylodiscitis included: involvement of the thoracic spine, involvement of 2 or more adjacent vertebral bodies, severe destruction of the vertebral body, focal/heterogeneous contrast enhancement of vertebral bodies, heterogeneous signal from the vertebral bodies on T2 TIRM images, well-defined paraspinal abnormal contrast enhancement, paraspinal and epidural abscesses, meningeal enhancement at the affected spine level. CONCLUSIONS: Comparison of MR images of patients diagnosed with pyogenic spondylodiscitis and tuberculous spondylodiscitis allowed identification of individual characteristics for preliminary differentiation between TB and infectious spondylodiscitis and thereby enabling proper treatment.

The effect of unilateral osteoarthritis of the hip on postural balance disorders.

BACKGROUND: Postural stability is of great importance because imbalances and muscle weakness are significant risk factors for falls experienced by the elderly. Hip arthrosis, which causes pain and gait disorders that affect balance control, is common in the ageing population. AIM: The aim of this study was to assess postural stability in patients with unilateral hip arthrosis before total hip arthroplasty. METHODS: The study population consisted of 52 patients with hip arthrosis (study group) and 47 subjects with no history of clinical symptoms of hip pain. The groups did not differ statistically in terms of age and BMI. Static balance was assessed by conducting a quantitative analysis of balance reaction parameters in a quiet standing position with the eyes open and closed. RESULTS: Analysis of the collected data revealed numerous statistically significant differences between patients with unilateral hip arthrosis before total hip arthoplasty and the asymptomatic group for parameters tested with eyes closed (p<0.05). We observed higher values of total length of centre of pressure (COP), sway path (SP), length of COP path in the medial-lateral plane (SPML), maximal amplitude between the 2 most distant points in the medial-lateral plane (MaxML), mean COP velocity (MV), and mean COP velocity in medial-lateral (MVML) in the study group.

Spinal tuberculosis with severe neurological symptoms as a complication of intravesical BCG therapy for carcinoma of the bladder.

INTRODUCTION: Non-invasive bladder cancer is effectively treated with intravesical BCG therapy. The administration of the BCG vaccine is to destroy the neoplastic lesion or prevent further recurrences. The activity of the vaccine involves boosting the immune system through the stimulation of the inflammation in the bladder. Adverse reactions after this immunotherapy are rare. The aim of the study was to present complications in the form of spinal tuberculosis and serious neurological symptoms that occurred during intravesical BCG immunotherapy for carcinoma of the bladder. The manuscript also describes a method for neurosurgical spinal cord decompression of the thoracic spine. MATERIAL AND METHODS: In the first patient, aged 66, after intravesical BCG therapy for bladder carcinoma, back pain and spastic paralysis of the lower limbs were observed. The MRI and CT revealed destruction of the intervertebral disc and vertebral endplates Th11-Th12. Mycobacterium tuberculosis complex bacilli were cultured from the material obtained by puncture aspiration. In the second patient, aged 35 years, during intravesical BCG immunotherapy for carcinoma of the bladder, girdle thoracic spine pain was observed. The MRI and CT of the spine showed visible lesions characteristic of tuberculosis. Immobilization in a plaster corset and implementation of antituberculous treatment resulted in quick relief of the pain and healing of the tuberculosis focus in the spine. CONCLUSION: The cases described in the work are the first documented reports in the Polish literature of spinal tuberculosis which occurred as a complication of intravesical administration of bacilli Calmette-Guérin. The diagnosis was based on the finding of BCG vaccine bacillus with molecular methods or PCR. Full antimycobacterial treatment was implemented.

Analysis of Risk Factors for Periprosthetic Joint Infection in Clinical Data.

BACKGROUND: Progress in orthopaedics has now made it possible to improve the functional status of damaged hip joints with hip arthroplasty and eliminate the associated pain. The constantly growing number of hip replacement procedures is, however, associated with a proportional rise in the number of subsequent surgery-related complications. The most important complication is septic loosening of the implant. The treatment of septic complications is often ineffective and recovery becomes impossible. In that setting, an awareness of the risk factors of septic complications and an ability to prevent periprosthetic joint infection (PJI) are becoming necessary. AIM: The aim of the study was to analyse the risk factors of PJI as an essential element of the prophylaxis of septic complications. MATERIAL AND METHODS: We analysed the data of 142 patients treated for PJI at the Ward of Bone and Joint Infections, Department of Orthopaedics, Medical Centre of Postgraduate Education in Otwock, between 2008 and 2010. Their medical records were analysed retrospectively. The diagnosis was evidence-based, relying on case histories, physical examination and accessory investigations, including imaging studies and biochemical and microbiological testing. RESULTS: The analysis of clinical data served to identify factors that appeared repetitively in the patients with PJI treated at the Ward. Those elements constitute the combination of risk factors for PIJ. CONCLUSIONS: 1. An awareness of risk factors for septic complications and their early elimination are necessary in daily orthopaedic care. 2. The pre-surgery checklist is a very effective tool to eliminate the most common risk factors of PJI.

A Retrospective Analysis of Bacteriological Studies of Surgical Site Infections in a Monoprofile, Multidepartmental Orthopedic Hospital.

BACKGROUND: Despite improvements in surgical techniques, aseptics and prevention of infections, hospital surgical site infections (SSI) still remain one of the main reasons for failure in therapeutic musculoskeletal surgery. This study aimed to conduct a retrospective analysis of microbiological examinations and determine pathogen sensitivity to antibiotics as the basis for selecting methods for preventing and treating complicating infections. MATERIAL AND METHODS: The study is a retrospective analysis of bacteriological tests performed in the departments of the Public Clinical Hospital of the Medical Centre of Postgraduate Education in Otwock. Importantly, our monoprofile hospital specialising in musculoskeletal pathology is a reference centre, admitting patients from the entire country. Often these are patients transferred from Intensive Care Units at other hospitals with internally infected local emergencies (infections with local, complex, multidrug resistant bacterial flora). Bacteriological mapping of the hospital covered the period from 2009 to 2013 to indicate so called "strategic departments" demonstrating the most complex multidrug-resistant bacterial flora. Surgical site infections were managed by surgery with targeted antibiotic therapy. RESULTS: Analysis of patients' profiles revealed that SSIs detected across hospital departments in SPSK CMKP in Otwock mostly came from other medical centers where patients were initially hospitalized. The Osteomyelitis Department and the Department of Pelvic Pathology and Traumatology were identified as "strategic departments". CONCLUSIONS: 1. The analysis indicated that methicillin-sensitive Staphylococcus aureus (MSSA) was the most common pathogen responsible for complicating infections in our hospital. 2. The percentage of bacterial resistance to methicillin signifi -cantly increased in patients with multi-organ injuries who had previously been hospitalized at other centres. 3. Credible prevention and diagnosis of inflammatory risk factors in the preoperative period was of key importance in reducing the percentage of complicating infections.

Stimulation of bone union with dynamic beams of Konzal's "R" external fixator.

BACKGROUND: Treatment of septic long bone non-union remains a complex therapeutic problem. External stabilisation with Konzal's "R" fixator has been used in the Orthopaedic Department of CPME for years and allows for rigid stabilisation of bone fragments and good mutual alignment. Tried and tested in the treatment of osteitis, the fixator, however, offers limited possibilities for dynamisation and interfragmental compression. The following article presents a modernised design of Konzal's "R" with dynamic beams. MATERIAL AND METHODS: The efficacy of dynamisation of the fixator with the modernised design was compared with that of the earlier technique of eccentric shifting of static beams by assessing the time of bone union, the average number of pin restabilisations required, and the percentage of "partial unions" in two groups treated with the different methods. RESULTS: In the dynamic beam group, mean time to bone union was shorter by 5.1 months on average. This group also recorded a significantly lower percentage of "partial unions" (<50% of diaphysial circumference) as well as a lower count of necessary pin restabilisations per patient. There was no correlation between time to bone union and the duration of active inflammation prior to the surgical treatment or the presence of an open fistula. CONCLUSIONS: 1. The modernised design allows for dynamic load bearing by the bone tissue between the fragments rather than by the fixator's static beams. 2. The biomechanical principle of the fixator provides for optimal bone healing and shortens the time to bone union.

Characteristics of selected parameters of body posture in patients with hip osteoarthritis.

BACKGROUND: Osteoarthritis is the most common disorder of the musculoskeletal system. A unilateral change in the hip joint changes the position of the pelvis and spine, and therefore the patient's body posture. Due to the uneven loading of the lower limbs asymmetry occurs in the trunk. Detailed dependencies of that have not been thorougly described in the available literature. The aim of the study was to characterize the posture parameters in patients with unilateral osteoarthritis of the hip. MATERIAL AND METHODS: The study population consisted of 40 patients with unilateral hip osteoarthritis. There were 21 women and 19 men in the group, aged 41-80 years. The mean patient age was 65.39+/-8.69, the mean body mass was 82.98 ± 11.79 kg, the mean body height was 167.64 ± 8.59, and the mean Body Mass Index (BMI) was 29.6 ± 4.36. RESULTS: Statistically significant differences were found on a number of parameters: lumbar inclination, thoraco-lumbar inclination and torso inclination were lower in patients with hip arthrosis, comparing to control group. Angle of thoracic kyphosis, depth of thoracic kyphosis, angle of lumbar lordosis, depth of lumbar lordosis were smaller in patients with hip arthrosis. Pelvic asymmetry in coronal plane was bigger in patients with hip arthrosis. CONCLUSION: Body posture in patients with unilateral osteoarthritis characterizes a decrease of lumbar lordosis and thoracic kyphosis while the whole body tilt forward. The asymmetry of the pelvis and trunk settings should be taken be taken into account during physical therapy of patients with coxarthrosis also during the post-operative postural re-education process.

An analysis of complex, life-threatening infectious complications of hip and knee joint arthroplasty based on departmental data.

BACKGROUND: The growing popularity of arthroplasty results in an increase in the number of infectious complications. The clinical course of inflammation, silent initial symptoms of the disease and non-medical factors, such as poor public awareness and difficulty in finding specialist care, lead patients to postpone the decision about surgical intervention. This results in a state of imminent threat to health or life by endangering other organs of the body. The purpose of this study was to analyze extreme cases of vital organ damage due to infections following hip and knee replacement procedures. MATERIAL AND METHODS: Retrospective analysis of selected cases of life-threatening infectious complications resulting in vital organ damage (urinary tract, large vessels, cardiorespiratory system, etc.) treated at the Department of Orthopedics at the Center of Postgraduate Medical Education (CPME) over the past 12 years. RESULTS: Establishment of an early diagnosis, and above all, confirmation of periprosthetic infection are extremely important. This allows for a biologically reasonable, early and radical management with the best possible treatment options and prevents the risk of life-threatening complications. CONCLUSIONS: Universal access to antibiotics, suppression rather than treatment of infections, silent and unusual course of septic joint loosening and the lack of sufficient awareness of the problem among physicians, contribute to the reoccurrence of such cases and cause significant treatment challenge. They require management at multidisciplinary centers specializing in such cases and rarely end successfully.