Successful Debridement of a Knee Joint Prosthesis Infected with Listeria Monocytogenes. Case Report and Review of Current Literature.

According to the relevant literature, prosthetic joint infections caused by Listeria monocytogenes require two stage revision surgery or prosthesis removal for a successful outcome. We present the case of a patient who suffered such an infection after Total Knee Replacement surgery and was successfully treated with antibiotics, joint lavage, debridement and retention of the prosthesis.

Treatment of pseudotumors after metal-on-metal hip resurfacing based on magnetic resonance imaging, metal ion levels and symptoms.

Peri-prosthetic pseudotumor formation can be a severe complication following Metal-on-Metal hip resurfacing arthroplasty (MoMHRA), with limited data on the optimal management of this complication. The aims of this study were (1) to evaluate the prevalence and severity of pseudotumors in a consecutive cohort of 248 MoMHRA (214 patients, mean follow-up 4.6 years, range: 1 - 8.2), and (2) to present a clinical guideline for their treatment based on severity grading with Metal Artefact Reduction Sequence Magnetic Resonance Imaging, metal ion levels and symptoms. Pseudotumor prevalence was 36.3%: 61 mild, 25 moderate and four were graded severe. Five revisions followed, all in symptomatic patients with elevated metal ion levels. Pseudotumor severity grading allowed us to be conservative with revision surgery for mild and moderate MoM disease.

Coccidioidomycosis infection of a total knee arthroplasty in a nonendemic region.

Fungal prosthetic joint infections are rare and difficult to treat. There is an ongoing discussion about the type and duration of antifungal treatment and the necessity of prosthesis removal. We report the first European case of an infected total knee arthroplasty with Coccidioides immitis. Treatment consisted of lifelong treatment with oral fluconazole at a dose of 400 mg/d, without total knee arthroplasty removal. After 6 months, the initial complaints of pain and swelling were completely resolved. This case report clearly states that a travel history and culturing for fungi are helpful in patients with persisting complaints after joint arthroplasty.

High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol.

We intensified our screening protocol for the presence of pseudotumours in a consecutive series of patients with a hip resurfacing arthroplasty (HRA), to establish whether we should be alert to the presence of 'silent' pseudotumours. Patients categorised with high risk (11 hips) and low risk (10 hips) for pseudotumour development and a control group (23 hips) were screened with metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI). The Anderson classification to grade any metal-on-metal (MoM) disease present on MARS-MRI images was used. In 15 out of 44 MRI scans pseudotumours were observed (34.1%), of which six were graded with mild (13.6%), eight with moderate (18.2%) and one with severe MoM disease (2.3%). Twelve pseudotumours were present in asymptomatic patients (27.3%). Metal ion levels were normal in 80% of the MARS-MRI screened patients. As a consequence of our intensified screening protocol, one patient was revised for pseudotumour formation and another patient was scheduled for revision. Silent pseudotumours were observed in all three groups. Before our intensified screening protocol was initiated, no pseudotumours were encountered in our cohort of 289 HRAs. We concluded that clinical outcomes and plain radiographs for screening MoM patients underestimates the presence of pseudotumours in MoM patients. The true clinical relevance of these pseudotumours is still unclear.

Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system.

BACKGROUND: The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients) who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA) in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. METHODS: Mean follow up was 3.3 years (1.0 to 6.3) and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. RESULTS: There were 16 revisions and four patients reported a Harris Hip Score <70 points at their latest follow up. There were no pending revisions. Kaplan-Meier implant survival probability, with revision for any reason as endpoint, was 93.5% at six years follow-up (95%-CI: 88.8-95.3). There were no revisions for Adverse Reactions to Metal Debris (ARMD) and no indications of ARMD in symptomatic non-revised patients, although diagnostics were limited to ultrasound scans. CONCLUSIONS: This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00603395.