Microbiological profiles in periprosthetic joint infections after total knee arthroplasty: a comparative analysis of diabetic and non-diabetic patients.

AIM OF THE STUDY: The purpose of this study is to conduct a comparative analysis of the microbiological profiles in periprosthetic joint infections (PJIs) after total knee arthroplasty (TKA) between diabetic and non-diabetic patients. The study aims to address what are the variations in microbial colonization and infection patterns between diabetic and non-diabetic patients undergoing total knee arthroplasty. METHODS: A retrospective analysis of 2,569 culture-positive cases of PJIs post-TKA was conducted, comparing outcomes between diabetic (n = 321) and non-diabetic (n = 2,248) patients. Demographic, clinical, and microbiological data were collected and analyzed using descriptive statistics, chi-squared tests, logistic regression, and other statistical tests. RESULTS: Diabetic patients exhibited distinct microbial colonization patterns, with a higher prevalence of pathogens such as Staphylococcus aureus (p = 0.033), Pseudomonas aeruginosa (p < 0.001), Streptococcus spp. (Streptococcus agalactiae and Streptococcus dysgalactiae; p = 0.010, 0.016 respectively), Candida spp. (p = 0.010), and Corynebacterium spp. (p = 0.024). Additionally, diabetic patients were at increased risk of polymicrobial infections. Comorbidities associated with diabetes, including chronic pulmonary disease, renal insufficiency, and peripheral artery disease, were significantly more prevalent in diabetic patients and further complicated PJI outcomes. CONCLUSION: This study underscores the importance of tailored perioperative antimicrobial strategies and vigilant infection control measures in diabetic patients undergoing TKA. Understanding the differential microbial profiles and associated comorbidities can inform targeted interventions to mitigate the risk of PJIs and improve outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and optimize management strategies for diabetic patients undergoing TKA.

Microbial Diversity of Periprosthetic Joint Infections in Diabetic and Non-Diabetic Patients Following Hip Arthroplasty.

BACKGROUND: Periprosthetic joint infection (PJI) is a major complication following hip arthroplasty, leading to prolonged hospital stays, increased healthcare costs, and major morbidity. Diabetes mellitus is a prevalent comorbidity among hip arthroplasty patients, contributing to an increased risk of surgical complications, including infections. However, limited evidence exists regarding the microbial profiles of PJIs in diabetic patients compared to non-diabetic counterparts. METHODS: We conducted a retrospective cohort study to investigate the microbial diversity of PJIs in diabetic and non-diabetic patients following hip arthroplasty. Medical records of patients who underwent hip arthroplasty procedures between 1996 and 2021 were reviewed. Patients diagnosed with PJI, based on the international consensus meeting (ICM), were included in the study. Microbiological data, including culture results, and risk factors were collected and analyzed. A total of 4,261 culture-positive patients diagnosed with PJI following hip arthroplasty were included in the analysis. RESULTS: Microbiological analysis revealed a diverse spectrum of microbial pathogens, with Staphylococcus species being the most commonly isolated pathogen. Comparison between diabetic and non-diabetic patients revealed differences in the microbial profiles of PJIs, with diabetic patients more likely to be infected with specific pathogens, including Candida albicans (P = 0.01 OR [odds ratio] 2.8, CI [confidence interval] 1.2 to 6.2), Klebsiella pneumoniae (P = 0.03 OR 2.4, CI 1.0 to 5.6), Staphylococcus aureus (P = 0.04 OR 1.3, CI 1.0 to 1.8), Staphylococcus epidermidis (P < 0.001 (R 1.7, CI 1.4 to 2.2), Polymicrobial infections (P < 0.001 OR 1.5, CI 1.2 to 1.8), and Clostridium perfringens (P = 0.04 OR 5.9, CI 1.0 to 33.1). CONCLUSION: Our study provides valuable insights into the microbial diversity of PJIs in diabetic and non-diabetic patients following hip arthroplasty. The identification of a tendency to different microbial profiles in diabetic patients underscores the need for tailored approaches to infection prevention and management in this high-risk population. Further research is needed to elucidate the underlying mechanisms and develop targeted interventions to improve patient outcomes.

Clinical differences between nasogastric tube and Hunter's rod for staged Zone II flexor tendon reconstruction.

OBJECTIVES: This study aims to compare the outcomes of two-stage flexor tendon reconstruction in Zone II of the hand and to evaluate the results of a nasogastric tube as a potential alternative to Hunter's rod. PATIENTS AND METHODS: Between November 2012 and January 2022, a total of 45 patients (26 males, 19 females; median age: 31 years; range, 12 to 61 years) who underwent two-stage flexor tendon reconstruction were retrospectively analyzed. Of the patients 24 underwent nasogastric tube reconstruction (NT group) and 21 underwent Hunter's rod reconstruction (HR group). Patients' demographic and clinical characteristics, the number of surgeries, the occurrence of complications, the presence of infection during the procedure, and the range of motion of the finger joints at the final follow-up examination were recorded. The assessment of the cases was conducted using the total active motion system. RESULTS: Twenty-four digits underwent two-stage flexor tendon reconstruction with the nasogastric tube. Among these, three index fingers, nine middle fingers, seven ring fingers, and five little fingers were operated. Twenty-one digits underwent two-stage flexor tendon reconstruction using Hunter's rod. Among these, two index fingers, eight middle fingers, six ring fingers, and five little fingers were operated. In the NT group, excellent results were observed in 58.3% (14 digits), good results in 25% (six digits), fair results in 8.3% (two digits), and poor results in 8.3% (two digits). In the HR group, excellent results were seen in 57.1% (12 digits), good results in 33.3% (seven digits), fair results in 4.7% (one digit), and poor results in 4.7% (one digit). CONCLUSION: The utilization of a nasogastric tube offers a convenient and cost-effective option to Hunter's rod in the two-stage flexor tendon reconstruction, leading to favorable outcomes characterized by high rates of excellence and improvement, while effectively minimizing the occurrence of complications.

The effect of single plate and double plate application on union and functional results in humeral diaphyseal nonunions.

In this study, we assessed and compared the outcomes of two different fixation techniques for humeral diaphyseal fracture nonunions. A retrospective evaluation of 22 patients who underwent single-plate and double-plate fixation due to humeral diaphyseal nonunions was conducted. Union rates, union times, and functional outcomes of the patients were assessed. There was no significant difference between single- plate and double-plate fixation in terms of union rates or union times. The double-plate fixation group achieved significantly better functional outcomes. Nerve damage or surgical site infection were not encountered in either group.Due to its considerable effect on stability, double-plate fixation, offers both patients and surgeons confidence in terms of early adaptation to daily life in the postoperative period.

Comparison of the Modified Moberg Flap Versus First Dorsal Metacarpal Artery Flap for Thumb Pulp Reconstruction.

ABSTRACT: We assessed and compared outcomes of 2 different flap techniques for thumb pulp defect reconstruction. Twenty-three patients who underwent modified Moberg and first dorsal metacarpal artery flap because of thumb pulp defect were retrospectively evaluated. Flap survival; venous congestion; cold intolerance; static 2-point discrimination (s2-PD); Semmes-Weinstein monofilament (SWM) test scores; paresthesia; defect size; time to return to work; interphalangeal and metacarpophalangeal joint flexion of the thumb; Disability of the Arm, Shoulder and Hand questionnaire scores; and follow-up time were evaluated. Flap survival, venous congestion, time to return to work, paresthesia, defect size, SWM test scores, range of motion of the proximal interphalangeal and metacarpophalangeal joints, and Disability of the Arm, Shoulder and Hand questionnaire scores were similar in both groups. Cold intolerance and s2-PD were found to be statistically better in the modified Moberg flap group. Although these techniques provided similar results, the modified Moberg was found to be superior in terms of cold intolerance and s2-PD.