Allografts used in orthopedic surgery have steadily increased. With concerns regarding tissue safety and processing, governing entities have increased their regulation. This review articles discusses current testing and processing of allografts as well as the rules of their handling.
The literature contains few descriptions of the infective organisms and diagnostic issues associated with musculoskeletal infections in patients with HIV. We retrospectively reviewed 19 patients with HIV treated at our musculoskeletal infection ward for septic arthritis. The mean CD4 count was 154/mm (range, 7-482/mm), and 11 patients had a CD4 count < 200/mm and were diagnosed with AIDS. The most common pathogen (six patients) was oxacillin-resistant Staphylococcus aureus. Mycobacterial infections occurred in three patients but no fungal pathogens were identified. Septic arthritis was monoarticular in 14 patients and involved the knee in eight patients, the hip in three patients, and the wrist in three patients. Five patients presented with polyarticular septic arthritis. All mycobacterial infections and four of the five polyarticular infections occurred in patients with a CD4 count < 200/mm. Patients with CD4 count < 200/mm had a lower joint fluid WBC count compared to patients with a CD4 count > 200/mm (40,500 vs 69,000/mm). Oxacillin-resistant Staphylococcus aureus was the most common pathogen. A high index of suspicion for Mycobacterium. tuberculosis arthritis and polyarticular septic arthritis is necessary in patients with HIV and a CD4 count < 200/mm.
We asked whether adjacent osteomyelitis with acute septic knee arthritis explained a lack of response to initial management, and whether patient comorbidities predisposed to the nonresponsiveness. From 147 adult patients (151 knees) with septic arthritis, we identified 29 patients (33 knees) who had persistence or recurrence of symptoms after surgical drainage. Adjacent osteomyelitis was present in 31 (94%) of the 33 knees (27 of 29 patients) with poor response to treatment. Patients with adjacent osteomyelitis had more comorbid conditions (23 of 27 patients, 85%) than patients without osteomyelitis (64 of 120, 53%). The most common comorbid conditions in patients with adjacent osteomyelitis were diabetes mellitus (10 patients, 37%) and intravenous drug use (eight patients, 30%). We identified Staphylococcus aureus in 19 of 31 knees (61%) with osteomyelitis, eight (26% of total cases) of which were methicillin-resistant. Persistence of clinical signs of infection after surgical management of septic knee arthritis in adults should raise the suspicion of adjacent osteomyelitis, especially in patients with comorbid conditions. Additional imaging studies may be necessary to evaluate the distal femur and proximal tibia.
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