BackgroundSerum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are important tests in the initial diagnosis of periprosthetic joint infection. Many surgeons also use these tests to determine if infection has resolved between stages of a 2-stage procedure, but little data exist regarding this practice.MethodsA retrospective review of our institutional total joint databases was conducted to determine sensitivity, specificity, and predictive values of elevated ESR and/or CRP to diagnose persistent infection between stages.ResultsAmong 16 knees and 5 hips, sensitivity was 50% for CRP, 75% for ESR, and 100% when combined. The negative predictive value of persistent infection was 100% when neither test was elevated.ConclusionsResults of this study support the use of CRP and ESR as indicators of the resolution of periprosthetic joint infection between stages of 2-stage revision.
Intramedullary injection of local bisphosphonate solutions could be implemented to improve osseointegration in cementless arthroplasty. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Patients find existing exo-prostheses utilizing traditional socket connections uncomfortable and irritating, as they do not provide the dexterity and proprioception which is often expected by active patients. Transcutaneous osseointegrated implants are a potential solution, but carry risk of infection at the skin–implant interface. Histological and observational studies previously demonstrated that textured implants have both improved epidermal ingrowth and decreased skin retraction. This study aimed to determine effects on mechanical integration, barrier to bacterial colonization, and infection of the skin–implant interface using additive manufacturing and post-manufactured surface modifications. In this study, titanium alloy implants were made by either computer numerical control machining (CNC) or electron beam melting (EBM). Implants in each group were left either unaltered (CNC-control and EBM-control), acid etched (CNC-micro and EBM-micro), or oxidatively treated (CNC-nano and EBM-nano) creating six distinct surface textures. This study was divided into two phases, each utilizing 10 rats. Six implants—one of each texture—randomized for position were placed in each rat. Phase 1 animals healed for three weeks and skin-implant mechanical pull-off strength was measured. Phase 2 animals were challenged by S. aureus inoculation during the three-week healing process and serial dilutions of the sonicated implants were performed to quantify bacterial colonization. The three EBM implant groups had 830% greater force at pull-off compared to the three CNC groups. Additionally, the pull-off force of EBM-micro implants was 101% and 83% stronger, respectively, than EBM-nano and EBM-control implants. There was negligible mechanical attachment of skin to any CNC implant. Bacterial colonization counts were collectively 63% (P < 0.05) lower for EBM implants relative to CNC implants. CNC-control implants exhibited 90% (P < 0.01) greater bacterial colonization than EBM-controls. No significant differences in bacterial colonization were noted between the other implant groups. Both manufacturing technique and post-manufacturing surface texture modification affected the skin-implant interface’s mechanical integration and effectiveness as a barrier to infection. EBM manufacturing produced markedly superior transcutaneous implants compared to machining.
The most common operative treatment of proximal humerus fractures is internal fixation with fixed-angle locking plates. Although this surgical technique has been refined, a significant failure rate remains. This study aimed to determine whether the number of locking screws in the humeral head affects the biomechanical strength and stability of the construct in bone from elderly individuals. Ten pairs of embalmed cadaveric humeri were osteotomized in a gap model and fixed with periarticular locking plates placed in the standard position. Five or 7 proximal locking screws were inserted. Mechanical testing was performed, and cyclic displacements and maximum force to failure were recorded. No significant difference was found between 5 and 7 locking screws in mean cyclic displacement on the medial (1.09 mm vs 1.12 mm, P=.834) or posterior (0.45 mm vs 0.42 mm, P=.791) sides of the fracture model. On testing to failure, 7 and 5 screws showed similar stiffness (336 N/mm vs 292 N/mm, P=.176), force at ultimate load (745 N vs 662 N, P=.309), and displacement at ultimate load (5.90 mm vs 4.36 mm, P=.080). All samples failed at diaphyseal fixation, and no screw cutout or varus collapse was observed. Results from this study suggest that there is no significant difference between 5 and 7 metaphyseal locking screws for stiffness of fixation of proximal humeral fractures in elderly patients. With the inherent possibility of screw penetration of the humeral head, fewer screws may lead to fewer complications. [Orthopedics. 2018; 41(5):306-311.].
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