Experience with debridement and prosthesis retention in early prosthetic joint infections (PJI) due to Staphylococcus aureus is scarce. The present study aimed to evaluate the outcome and predictors of failure. Patients prospectively registered with an early PJI due to S. aureus and 2 years of follow-up were reviewed. Demographics, co-morbidity, type of implant, clinical manifestations, surgical treatment, antimicrobial therapy and outcome were recorded. Remission was defined when the patient had no symptoms of infection, the prosthesis was retained and C-reactive protein (CRP) was ≤ 1 mg/dL. Univariate and multivariate analysis were performed. Fifty-three patients with a mean ± SD age of 70 ± 10.8 years were reviewed. Thirty-five infections were on knee prosthesis and 18 were on hip prosthesis. The mean ± SD duration of intravenous and oral antibiotics was 10.6 ± 6.7 and 88 ± 45.9 days, respectively. After 2 years of follow-up, 40 (75.5%) patients were in remission. Variables independently associated with failure were the need for a second debridement (OR 20.4, 95% CI 2.3-166.6, p 0.006) and a CRP > 22 mg/dL (OR 9.8, 95% CI 1.5-62.5, p 0.01). The onset of the infection within the 25 days after joint arthroplasty was at the limit of significance (OR 8.3, 95% CI 0.8-85.6, p 0.07). Debridement followed by a short period of antibiotics is a reasonable treatment option in early PJI due to S. aureus. Predictors of failure were the need for a second debridement to control the infection a CRP > 22 mg/dL and the infection onset within the first 25 days after joint arthroplasty.

The aim of our study was to evaluate the outcome of acute prosthetic joint infections (PJIs) due to gram-negative bacilli (GNB) treated without implant removal. Patients with an acute PJI due to GNB diagnosed from 2000 to 2007 were prospectively registered. Demographics, comorbidity, type of implant, microbiology data, surgical treatment, antimicrobial therapy, and outcome were recorded. Classification and regression tree analysis, the Kaplan-Meier survival method, and the Cox regression model were applied. Forty-seven patients were included. The mean age was 70.7 years, and there were 15 hip prostheses and 32 knee prostheses. The median number of days from the time of arthroplasty was 20. The most frequent pathogens were members of the Enterobacteriaceae family in 41 cases and Pseudomonas spp. in 20 cases. Among the Enterobacteriaceae, 14 were resistant to ciprofloxacin, while all Pseudomonas aeruginosa isolates were susceptible to ciprofloxacin. Acute postoperative prosthetic joint infection (PJI) is an uncommon but severe complication after joint arthroplasty. The infection rate is 1 to 3%, and the most frequently isolated microorganisms are gram-positive cocci, including Staphylococcus aureus, coagulase-negative staphylococci, and Streptococcus spp. (12). However, it is of note that gram-negative bacilli (GNB) are isolated in 10% of cases of PJIs, and these infections are frequently polymicrobial (9).The rate of success achieved by treatment with open debridement without implant removal and a prolonged course of antibiotics for staphylococcal acute PJIs is higher than 75% (2, 13, 17). However, there has been little experience with the use of the same surgical and antibiotic treatment for infections due to GNB (3,8). In addition, a major concern associated with PJIs due to GNB is the emergence of strains resistant to many antibiotics and the lack of alternative treatments (15).The aims of the present study were to review our experience with the treatment of acute PJIs due to GNB by the use of open debridement and retention of the implant, followed by antibiotic treatment, and to analyze those factors associated with the outcome. MATERIALS AND METHODSFrom January 2000 to December 2007, all patients with a PJI (hip hemiarthroplasty, total hip and knee arthroplasty) were prospectively registered in a database and the cases were retrospectively reviewed. All patients were treated in the bone and joint infection unit of the same hospital, which includes orthopedic surgeons and infectious disease specialists. Relevant information about each patient's demographics, comorbidity, type of implant (hip or knee prosthesis), clinical manifestations, leukocyte count, C-reactive protein (CRP) concentration at the time of admission for infection, surgical treatment, the microorganism isolated, antimicrobial therapy, and outcome were recorded. In the present study, only those cases with an acute, mono-or polymicrobial PJI due to GNB were included.In the present study, an acute PJI due to GNB was defined by the presence of loc...

We can conclude that the use of PRP is an effective treatment method for patients with plantar fasciitis who do not respond to conservative treatment because PRP demonstrates an efficacy equal to that of steroids. However, the cost and the time for preparation the PRP are two of the disadvantages of this treatment.

Aim: Management of osteoarthritis (OA) is basically symptomatic. Recently, stem cells (SC) have been used in the search for an optimum treatment. We decided to conduct a controlled clinical trial to determine if a single intra-articular injection of in vivo stimulated bone marrow SC could lead to an improvement in pain management and quality of life in patients with knee OA.Method: This was a prospective, open-label, phase I/II clinical trial to assess the safety and efficacy of a single intra-articular injection of autologous stimulated bone marrow stem cells (BM-SC) in patients with knee OA. Individuals of both genders older than 30 years with confirmed diagnosis of OA who signed informed consent were included in two groups: SC group received in vivo BM stimulation with subcutaneous administration of granulocyte colony stimulating factor (G-CSF). SC were obtained by BM aspiration and administered in a single intra-articular injection. The control group received exclusively oral acetaminophen. Visual analogue scale and Western Ontario and McMaster Universities Osteoarthritis Index scores were performed at 1 week, 1 month and 6 months in both groups. This trial was registered in ClinialTrials.gov NCT01485198.Results: A total of 61 patients were included. Socio-demographic characteristics, OA grades and initial scores were similar in both groups. The BM-SC group showed significant improvement in knee pain and quality of life during the 6-month follow-up. Conclusion:The study demonstrates feasibility and supports efficacy of a completely ambulatory procedure in treatment of knee OA.