[Arthroplasty and oral health-an overview]. / Endoprothetik und Mundgesundheit ­ ein Überblick.

Despite limited evidence for a preoperative dental screening examination and needs-based focal rehabilitation, as well as the need for antibiotic prophylaxis prior to invasive dental procedures, oral health is and remains a relevant topic in arthroplasty. The aspect of oral health should not be neglected in the future in connection with periprosthetic infections and should continue to be the subject of intensive research. The frequency of conspicuous dental findings in middle and old age underlines the importance of this problem. A dental examination prior to arthroplasty implantation can generally contribute to minimizing the risk of arthroplasty infection. It would be desirable for further studies to provide evidence on this topic in order to make recommendations for action. Independently of this, the development of an interdisciplinary guideline (arthroplasty and dentistry) on this topic should be encouraged. This could help to ensure that standardized treatment procedures are integrated into everyday clinical practice across the board.

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections-A Retrospective Single-Center Study.

Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.

Subtotal diaphyseal replacement of the femur with modular mega-endoprosthesis following interprosthetic fracture. A case report.

Mega-endoprostheses enable wide management options in the treatment of primary and periprosthetic fracture of the lower extremities. In this study, we report on the use of custom-made subtotal diaphyseal endoprosthetic replacement in treatment of interprosthetic femoral fracture. This procedure is off-label, but in this particular case, it was the safest and most stress-stable treatment option. The implant was delivered within three weeks. The surgical procedure for subtotal replacement of the femoral diaphysis was performed without any intra- or postoperative complication. The duration for the surgical intervention was one hour and 40 minutes. The patient was then mobilized with full weight bearing. At one-year follow-up, the patient did not complain of any pain. The Harris Hip Score HHS improved from 26 to 83 at one-year follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index WOMAC improved from 88 to 16. Mega-endoprostheses enable a wide range of management options in the treatment of primary, peri- and interprosthetic fractures of the lower extremities. In many cases, an individual therapeutic plan is necessary ranging up to the use of custom-made implants.

Intramedullary arthrodesis of the knee joint with additional femoral neck screw to prevent periprosthetic fracture of the proximal femur. A case report.

Arthrodesis of the knee joint has proven effective in the treatment of chronic periprosthetic infections as well as in cases of previous multiple revision surgery after total knee replacement with insufficiency of the extensor apparatus. In this case report, we report on the use of a custom-made intramedullary arthrodesis nail of the knee joint following multiple revisions due to aseptic loosening after total knee replacement. Surgery was performed according to preoperative computerized planning. Microbiological and histological samples obtained intraoperatively showed no evidence of infection. Yet, the patient presented postoperatively with complete loss of active dorsiflexion of the ipsilateral foot. On one-year follow-up, the patient did not complain of any pain. The radiological findings one year after surgery showed no sign of loosening or any other pathological findings. The neurological lesion has completely recovered. The Harris Hip Score HHS improved from 24 (prior to implantation of the arthrodesis) to 75 on one-year follow-up, the Western Ontario and McMaster Universities Osteoarthritis Index WOMAC improved from 86 to 20. The particularity of this case lies in the fact that an additional femoral neck screw was brought in to prevent periprosthetic fracture of the proximal femur. Careful preoperative planning as well as surgical performance were necessary to adjust the rotation of the femoral nail to allow adequate positioning of the femoral neck screw. Intramedullary arthrodesis of the knee is a suitable management option following multiple revision surgery after total knee replacement with insufficiency of the extensor apparatus. In many cases, an individual therapeutic plan is necessary ranging up to the use of custom-made implants.