We retrospectively reviewed 30 two-stage revision procedures in 28 patients performed for fungal peri-prosthetic joint infection (PJI) after a primary total knee replacement. Patients were followed for at least two years or until the infection recurred. The mean follow-up for patients who remained free of infection was 4.3 years (2.3 to 6.1). Overall, 17 patients were assessed as American Society of Anesthesiologists grade 3 or 4. The surgical protocol included removal of the infected implant, vigorous debridement and insertion of an articulating cement spacer. This was followed by at least six weeks of antimicrobial treatment and delayed reimplantation in all patients. The mean interval between removal of the prosthesis and reimplantation was 9.5 weeks (6 to 24). After reimplantation, patients took antifungal agents orally for a maximum of six months. Two knees became reinfected at one and two months post-operatively, respectively: one of these subsequently required arthrodesis because of uncontrolled infection.Fungal PJIs can be treated successfully by removal of all infected material, appropriate antimicrobial treatment and delayed reimplantation.Peri-prosthetic joint infection (PJI) is one of the most serious complications of total knee replacement (TKR).

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We reviewed 87 patients who had undergone expansive cervical laminoplasty between 1999 and 2005. These were divided into two groups: those who had diabetes mellitus and those who did not. There were 31 patients in the diabetes group and 56 in the control group. Although a significant improvement in the Japanese Orthopaedic Association score was seen in both groups, the post-operative recovery rate in the control group was better than that of the diabetic group. The patients' age and symptom duration adversely affected the rate of recovery in the diabetic group only. Smoking did not affect the outcome in either group. A logistic regression analysis found diabetes and signal changes in the spinal cord on MRI to be significant risk factors for a poor outcome (odds ratio 2.86, 3.02, respectively). Furthermore, the interaction of diabetes with smoking and/or age increased this risk. We conclude that diabetes mellitus, or the interaction of this with old age, can adversely affect outcome after cervical laminoplasty. However, smoking alone cannot be regarded as a risk factor.

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Idiopathic scoliosis is the most common cause of three-dimensional deformities of the spine. Most of the previous studies have been cross-sectional studies to estimate the prevalence in the general population. An age-matched, population-based study is performed using nationwide databases between 2011 and 2015. The incidence rates of idiopathic scoliosis by age group, sex, and region are identified. We also investigate the pattern of medical institution use and the surgery rate of patients with idiopathic scoliosis. Our results show that a total of 268,372 patients were diagnosed with idiopathic scoliosis. The overall incidence was 0.497%, and the incidence for females was 1.44 times higher than for males. By age group, the incidence of adolescent idiopathic scoliosis in patients aged 10–14 years was 0.821% compared to 0.029%, 0.192%, and 0.709% for those patients aged 0–2, 3–9, and 15–19 years, respectively. Both male and female urban populations had higher incidences than rural populations with no age differences at diagnosis. Survival analysis confirmed that 0.7% of diagnosed patients underwent surgical treatment within five years. Understanding the epidemiology of idiopathic scoliosis is helpful in diagnosing high risk patients and monitoring surgical interventions.