Ceramic on ceramic total hip arthroplasties have been developed and widely used during last decades because of their long-term survival and biomechanical properties. One of the most dangerous complication of these implants is the fracture of the ceramic components. The management of this condition should be carefully planned and the choice of the new implant is crucial. We describe a rare case of severe hip synovitis due to massive metallosis in sequelae of mismanaged prosthetic revision for fracture of the ceramic acetabular liner with an unusual clinical presentation that simulate a periprosthetic infection.
Purpose
This study aims to evaluate 30–60–90-day mortality of operated proximal femur fractures (PFFs) suffering from COVID-19 and correlation with patients’ clinical presentation and comorbidities.
Methods
Between February 1, 2020, and December 31, 2020, patients with COVID-19 infection and surgically treated PFF were included. Patients’ demographic characteristics, oxygen (O2) therapy, comorbidities, and AO type fracture were collected. Chi-square test or Fisher test and hazard ratio were used to assessing the correlation between mortality rate, patient characteristics, and COVID-19 status. Kaplan-Meyer curve was used to analyze 30–60–90-day mortality. Level of significance was set as
p
< 0.05.
Results
Fifty-six patients (mean age of 82.7 ± 8.85 years) were included. Thirty-day mortality rate was 5%, which increased to 21% at 60 days and 90 days. Eleven patients died, eight due to AO type A-like and three due to AO type B-like fractures. No significant difference in mortality rate between patients with cardiopulmonary comorbidity or no cardiopulmonary comorbidity was found (
p
= 0.67); a significant difference in patients with chronic obstructive pulmonary disease (COPD) or history of pulmonary embolism (PE) and patients without COPD was found (
p
= 0.0021). A significant difference between asymptomatic/mild symptomatic COVID-19 status and symptomatic COVID-19 status was found (
p
= 0.0415); a significant difference was found for O2 therapy with < 4 L/min and O2 therapy ≥ 4 L/min (
p
= 0.0049).
Conclusion
Thirty-day mortality rate of COVID-19 infection and PFFs does not differ from mortality rate of non-COVID-19 PFFs. However, patients with pre-existing comorbidities and symptomatic COVID-19 infection requiring a high volume of O2 therapy have a higher incidence of 60–90-day mortality when surgically treated.
Case: A 51-year-old man was affected by a fracture-related infection after a bicolumnar acetabular fracture. A significant alteration of the anatomy was present; thus, a 3D-printed model was useful for planning. A two-stage treatment was planned: in the first stage, implant removal with irrigation and debridement was performed, while in the second stage, a new osteosynthesis and implant of a THA were planned. During the second stage, the patient suffered a cardiogenic shock, so a third surgical procedure was necessary to implant THA. Targeted antibiotic therapy was administered eight weeks after the first stage, with the resolution of the infection. Conclusions: The infection was resolved following the recent guidelines and treating it like a periprosthetic infection with a two-stage revision. A collaboration between specialists in orthopaedics and infectious disease, respectively, and using multidisciplinary approach, were mandatory.
The Osteonecrosis of the Jaw (ONJ) is a bone disease only recently recognized (since 2003) and reported in association with use of bisphosphonates (BPs), denosumab, and other drugs mostly in patients with cancer, myeloma, and osteoporosis.
Not all clinicians are aware of ONJ epidemiology, risk factors, treatment, preventive measures. On 2005, oncologists and haematologists together with other specialists, nurses and data managers founded a multidisciplinary team for study, treatment and prevention of ONJ at Alessandria Hospital (North-Western Italy).
The work of the group was included since 2010 within a Multidisciplinary Osteoncology Team (Gruppo Interdisciplinare Cure – Osteoncologia) caring patients with cancer and myeloma patients suffering for bone metastases, cord compression, bone-related pain, bone fractures, osteopenia, osteoporosis, and other diseases, together with specialists of other units (Radiotherapy, Orthopaedics, Rheumatology, Physiatry and Rehabilitation, Pain Control Unit, Palliative Care, etc). We report about the activity of the group and demonstration of importance of ONJ disease in the multidisciplinary osteoncology team work burden.
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