Despite its decreasing incidence, prosthesis-related infections remain a research, diagnostic, therapeutic and
cost-related problem. Our study aim was to compare the diagnostic accuracy of conventional periprosthetic
tissue culture and culture of sonication fluid of the explanted hardware and to investigate the role of patientrelated factors affecting the sensitivity of the sonication method. We investigated 70 patients undergoing
revision hip or knee arthroplasty, at our institution. Patients’ medical history and demographic
characteristics were recorded. We compared the culture of samples obtained by sonication of explanted hip
and knee prostheses with conventional culture of periprosthetic tissue for the microbiological diagnosis of
prosthetic-joint infection. Thirty-two patients had septic loosening and 38 aseptic loosening (48 hip
prostheses and 22 knee prostheses). The sensitivities of sonication fluid culture and conventional tissue
cultures were 81.25% and 56.25%, respectively (p-value = 0.043). The sensitivity of the sonication method
was statistically higher in obese, diabetic patients, with age above 60, in uncemented arthroplasties and in
arthroplasties because of primary osteoarthritis (p-values < 0.05). The sonication method has a greater
sensitivity than the conventional periprosthetic tissue cultures for the periprosthetic infections, especially in
obese, diabetic patients, with age above 60, in uncemented arthroplasties and in arthroplasties because of
primary osteoarthritis.
Although successful and well-established procedures, hip operations whether elective or trauma are coupled with a variety of complications. Among the most uncommon complications are injuries to intra-abdominal or intra-pelvic organs which could prove potentially life-threatening. While there are various reports of such injuries in the literature, we aimed to perform a systematic review in order to examine the causes and relationships between intra-abdominal and intra-pelvic complications and the mechanism of injury, the pattern of presentation, identification, the course of management and outcomes. We identified 69 reports describing a total of 84 complications in intra-pelvic and intra-abdominal contents in 75 patients. These involved six major categories, including the intestinal tract, the urinary tract, the genital tract, the vascular system, the viscera and peripheral nerves. The most commonly injured system was the urinary (33.33%), followed by the vascular (29.76%) and the intestinal (22.62%). Among these systems, the most prevalent complications involved injury to the urinary bladder (32.14%), the large intestine (68.42%) and the external iliac artery (44%). The majority of recorded complications were postoperative with 71 incidents in 63 cases (84.52%). In intra-operative complications the most prevalent injury was due to hardware penetration (53.85%), while in postoperative it was due to hardware migration (92.06%). The management of injuries varied widely, with the most common approach being open exploration and direct repair (77.33%). The reported management outcomes included death (8%) and Girdlestone resection (2.67%), while the majority of the patients healed uneventfully (82.67%) owing mostly to immediate intervention. Despite being rare, such complications may still occur in a variety of settings and may subsequently lead to potential life-threatening situations. Thus, in order to avoid catastrophic outcomes we emphasize the need for prompt identification, immediate intervention and a multidisciplinary approach when necessary.
Our aim was to evaluate the effectiveness of tumour necrosis factor (TNF) inhibitors as add-on therapy for knee synovitis that did not respond to disease-modifying antirheumatic drugs (DMARDs) and other standard treatments in patients with peripheral spondyloarthritis (SpA). We retrospectively studied 27 SpA patients, in whom an anti-TNF agent was added for active peripheral arthritis with knee synovitis refractory to DMARDs and treatment with low-dose oral corticosteroids and/or nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) corticosteroids. As response of knee synovitis, were considered the absence of swelling, tenderness, and decreased range of movement in the clinical examination, after 4 months of anti-TNF therapy. In twenty-four (88.9%) of the patients there was response of knee synovitis. No statistical differences in gender (P = 0.53), age (P = 0.88), disease subtype (P = 0.22), and pattern of arthritis (P = 0.20) between knee synovitis responders and nonresponders were found. Fourteen patients managed to stop DMARD therapy and six, all of whom were initially on DMARDs combination, to decrease the number of DMARDs to one, maintaining simultaneously the response of knee synovitis. Our results imply a beneficial effect of adjunctive anti-TNF therapy on knee synovitis not responding to DMARDs and other standard treatments in patients with peripheral SpA.
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