Bilateral periprosthetic joint infection with Ureaplasma urealyticum in an immunocompromised patient.

This case study discusses how we diagnosed and treated a patient with a late haematogenous bilateral periprosthetic joint infection (PJI) after total knee arthroplasties caused by Ureaplasma urealyticum. This has never been reported before. We will discuss how we used a PET-CT, synovial fluid cell count, and synovial fluid analysis by 16S rRNA gene sequencing to diagnose this PJI. We will also discuss how we treated this patient to obtain full recovery.

Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.

BACKGROUNDS AND AIMS: There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state. MATERIAL AND METHODS: To establish what should be the treatment of first choice, a prospective randomised clinical study was performed on 60 demented patients with displaced intracapsular femoral neck fractures, comparing internal fixation (n = 31) with hemiarthroplasty (n = 29). RESULTS: There was no significant difference in the mortality rate of both groups. Hemiarthroplasty was associated with significantly more loss of blood and more wound complications. Reoperation for secondary displacement of the fracture after internal fixation occurred in four patients. Although not-statistically significant, failure of internal fixation seemed to be higher after an inadequate osteosynthesis. CONCLUSION: Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.

Outcome after hemi-arthroplasty for displaced intracapsular femoral neck fracture related to mental state.

This study was performed to assess mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures in relation to mental state. Between 1991 and 1995, 202 consecutive patients over 70 years of age were followed for at least two years or until death. Thirty-nine patients were known with senile dementia at the time of admission. The four-month mortality rate was 11.7% for the mentally normal patients and 33.3% for the mentally impaired patients. After one year the mortality rate was 19. 6% for the mentally normal patients and 43.6% for the mentally impaired patients. This difference is statistically significant (p<0. 001). Of the 141 surviving mentally normal patients, who had been mobile before operation, 16 (11.3%) were not mobile four months after operation. Of the 24 surviving mentally impaired patients, who had been mobile before operation, 18 (75.0%) were not mobile four months after operation. This difference is statistically significant (p<0.001). The conclusion of our study is that mental state has a statistically significant effect on mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures. For demented patients, hemi-arthrplasty is a too major operation and less invasive methods of internal fixation should be considered.

Clinical and pathological changes in the knee after accidental chlorhexidine irrigation during arthroscopy. Case reports and review of the literature.

We describe six knees in five patients, referred to us after accidental irrigation with chlorhexidine 1% in aqueous solution during arthroscopy. All six knees developed persisting pain, swelling and crepitus with loss of range of movement. Radiographs showed loss of joint space in all three compartments due to extensive chondrolysis, with many loose bodies and synovitis. Histological examination showed partial necrosis of the cartilage, with slight non-specific inflammation and fibrosis of synovial specimens. Care is needed in checking irrigation fluids, and these should have a distinctive colour.