BACKGROUND: The detection of causative pathogens plays a crucial role in the diagnosis and targeted treatment of periprosthetic joint infections (PJI). While there have been improvements in analytic methods in the past, pre-analytical procedures have not yet been sufficiently investigated. The objective of this study was to compare the culture yield of four different pre-analytical procedures.
METHODS: Patients with perioperative diagnosis of PJI were included in a single center cross-sectional study (2021-2022). Tissue samples (n = 20) of each patient were randomly and equally distributed to each of the four study arms. Tissue samples were either send to the laboratory without culture medium (group A) or were transported in thioglycolate medium immediately after sampling at three different temperatures (room temperature, 4 °C, 37° for 24 h; group B-D). Culture media were investigated for growth on days 1, 3, 7, 12, 14. All organisms, the number of positive samples and the time to positivity were recorded and compared between the study arms. Single positive cultures were considered as contamination.
RESULTS: In total, 71 patients were included. The proportions of culture negative samples (10-15%) and polymicrobial infections (51-54%) were comparable between the four arms. Seven patients (10%) were culture-negative in group A, but showed growth in thioglycolate media (group B-D). Furthermore, 13% of patients showed growth in all groups, but additional organisms were cultured in thioglycolate. There was growth beyond day 7 of culturing only in thioglycolate, but not in group A. A storage temperature of 4 °C showed a longer time to positivity compared to the other groups (p < 0.001).
CONCLUSIONS: Pre-analytical storage of tissue samples in thioglycolate broth did not improve the culture yield and did not detect additional cases of infection compared to the standard (pre-analytical storage in sterile containers). However, including a thioglycolate medium to the sampling algorithm reduced the rate of culture-negative infections and helped to identify additional organisms.

UNASSIGNED: Revision hip arthroplasty in the presence of complex acetabular deficiencies is challenging. Cement, allograft, reconstruction rings and porous trabecular metal now provide versatile options for acetabular fixation and restoration of acetabular offset. We compare acetabular impaction bone grafting (AIBG) and trabecular metal (TM) cups at long-term follow-up.
UNASSIGNED: 53 patients who underwent revision hip arthroplasty were retrospectively reviewed from local joint registry data. 36 patients were revised using AIBG and 17 with TM. Median clinical follow-up was 9.57 (2.46-18.72) years and 9.65 (7.22-12.46) years, respectively. 82% of the TM group and 63% of the AIBG group were ⩾ Paprosky 2C. Re-revision was considered failure. Radiographs demonstrating 5 mm of femoral head migration and 5° of acetabular component inclination change were considered loose.
UNASSIGNED: Patients receiving AIBG were younger (68 vs. 74 years) with a longer interval from initial arthroplasty to revision (17 vs. 13 years). Revisions in both groups were indicated most commonly for failed cementing (AIBG 88.9% vs. TM 70.5%). No TM reconstructions underwent re-revision, with only 1 failing at 6.3 years, compared with 9 AIBG re-revisions. When revising for sepsis, 33% of AIBG revisions failed.
UNASSIGNED: AIBG demonstrated high failure rates at long-term follow-up when compared to TM constructs. We recommend the use of AIBG in small cavitary defects only. We strongly advise against its use in the setting of significant bony defects and for prosthetic joint infection.

BACKGROUND: The increasing global performance of total hip arthroplasty (THA) has led to a corresponding rise in revision surgeries, primarily due to cup implant failure, with aseptic loosening and periprosthetic infection being common causes. Various techniques and implants, including jumbo cups (JCs), are employed to manage residual bone loss post-cup removal, facilitating enhanced surface area for improved host bone contact and biological osteointegration. The purpose of the present study was to determine the outcomes of acetabular revision arthroplasty using JC implants over a 20-year follow-up period by reporting overall survival, complications leading to re-revision surgery, and surgical strategy in the case of re-revision.
METHODS: A cohort study based on a large regional registry was conducted, examining revision THA surgeries utilizing JCs between 2000 and 2020. The study included all the revision acetabular procedures performed with cementless JCs, identified with a diameter ≥ 62 mm in women or ≥ 66 mm in men. All iliac fixation cups were excluded. Data on demographics, revision surgery indications, components, fixation types, causes of failure, and reintervention strategies were collected and analyzed. A total of 541 JCs implanted from January 2000 to December 2020 were evaluated. The most common revision indications were \"cup aseptic loosening\" (54.5%) and \"total aseptic loosening,\" which included both the cup and stem (32%).
RESULTS: Jumbo cup survival rates were 92.5% at 5 years, 85.8% at 10 years, and 81.5% at 15 years. Among the 70 failures, the main causes were \"cup aseptic loosening\" (40%), \"total aseptic loosening\" (17.1%), and \"septic loosening\" (12.8%). Revisions primarily involved acetabular cup revision surgery (54 cases), component explantation (11 cases), or insert/head revision (5 cases).
CONCLUSIONS: This registry-based study of JCs in revision THA demonstrates excellent 15-year survival rates and acceptable failure rates. It supports JCs as a viable option, offering relative surgical simplicity compared to alternatives like anti-protrusion cages, bone grafts, and augments.

BACKGROUND: UKA is a well-established treatment option for anteromedial osteoarthritis of the knee, resulting in superior functional outcomes but also higher revision rates than TKA. This study aimed to compare the outcomes of UKA, TKA, UKA converted to TKA using identical standard implants and revised TKA to support clinical decision-making.
METHODS: In this study, we retrospectively examined 116 patients who underwent UKA, 77 patients who received TKA, 28 patients whose UKA was converted to TKA using identical standard implants, and 21 patients who had a one-stage revision of TKA. The mean age at operation was 66.5 years (39-90 years), with a mean BMI of 28.8 kg/m2 (17.4-58.8) and a mean follow-up period of four years (0.9-9.9 years). We assessed various PROMs, including Oxford Knee Score, UCLA score, KSS score, and a modified WOMAC-Score as well as patient satisfaction and ability to resume daily activities, work, and sports.
RESULTS: The highest patient satisfaction was seen in the UKA. All scores were significantly higher for UKA than for TKA, converted UKA, and revised TKA. None of the scores showed a significant inferiority of converted UKA to TKA. In the case of revision, two scores showed significantly better results for converted UKA than for revised TKA.
CONCLUSIONS: Our results indicated that patients initially treated with UKA did not have significantly worse functional outcomes after conversion to TKA, given the use of identical standard implants. This highlights the effectiveness of UKA as a therapeutic option with outcomes superior to those of primary TKA and the importance of a bone-sparing procedure. Conversely, revision TKA is linked to poorer functional outcomes compared to both primary arthroplasties.

Increasing antibiotic resistance has been reported as an issue in the treatment of periprosthetic joint infection (PJI). A repeat two-stage revision for recurrent PJI is at high risk of reinfection. However, it is unclear if the microorganism profile plays a role with potentially more resistant or polymicrobial infections. This is a retrospective, single-center analysis of two-stage revisions performed between 2011 and 2017. We identified 46 patients who underwent a repeat resection arthroplasty for recurrent PJI of the same joint after a previous two-stage revision of the same joint at the same department. All microbiological findings were analyzed focusing on microbiological spectrum and resistance testing as well as the potential impact on reinfection-free survival. The most common organism found at the time of recurrent PJI were coagulase-negative Staphylococci (39%) followed by Gram-negative organisms (28%). The risk of polymicrobial infections, difficult-to-treat resistant organisms, and Gram-negative infections increased significantly. Among staphylococcal infections, there was a high percentage of methicillin-resistant species and resistance to oral antibiotics. Patients with Gram-negative organisms had a reduced infection-free survivorship, while resistant organisms were not associated with decreased survival. Patients who undergo a repeat two-stage revision for recurrent PJI have more polymicrobial and resistant organisms, although the impact on survivorship is unclear.

UNASSIGNED: Shoulder arthroplasty has become an increasingly common procedure used to treat degenerative, inflammatory, and traumatic conditions of the glenohumeral joint. With a significant increase in primary anatomic and reverse total shoulder arthroplasty, revision procedures have likewise increased. Updates in shoulder arthroplasty have allowed for the convertibility of implants, which allows for the retention of both glenoid and humeral components during revision surgery. This review aims to highlight the epidemiology, indications, and outcomes of convertible-platform total shoulder arthroplasty procedures.
UNASSIGNED: A review of the current literature surrounding convertible-platform shoulder arthroplasty was completed to highlight the advantages and disadvantages of commercially available instrumentation and implant systems as well as their outcomes.
UNASSIGNED: Leading causes of shoulder arthroplasty revision surgery include glenoid failure, implant instability, and rotator cuff dysfunction. Variations in implant design between inlay and onlay humeral components and metal-backed glenoid components are important considerations at the time of revision surgery. Advantages of convertible-platform systems include increased efficiency and decreased complications during revision procedures as well as shorter recovery, lower cost, and better functional outcomes. Limitations of convertible systems include poorly positioned components during the index procedure, excessive soft-tissue tensioning, and problems associated with metal-backed glenoid implants. Changes in arm length have also been documented. These findings indicate the benefit of additional research and design to improve the effectiveness and utility of convertible-platform shoulder arthroplasty systems.

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Background: Although Total Ankle Arthroplasty (TAA) is primarily performed for post-traumatic ankle arthritis with joint disruption, anatomical landmarks for Joint Line (JL) level are typically preserved. However, severe Post-Traumatic Bone Loss (PTBL) or TAA revision may render some landmarks unidentifiable, challenging JL restoration. Methods: Patients undergoing customized TAA for severe PTBL or revision were enrolled. Custom-made implants, based on 3D CT scans, were designed to address bone defects and provide adequate bone support. Evaluated parameters, measured on bilateral ankle weight-bearing radiographs taken preoperatively and 6-8 months postoperatively, included JL Height Ratio (JLHR) and the distances from JL to the Lateral Malleolus apex (LM-JL), the posterior colliculus of the Medial Malleolus (MM-JL), and the Gissane Calcaneal Sulcus (CS-JL). Reproducibility and variability were assessed, and comparisons were made between radiological parameters measured at TAA and those at the contralateral ankle. Results: Thirteen patients were included. Intra- and interobserver reliability demonstrated excellent values. The least variability was observed in the LM-JL distance. Statistically significant correlations were found between CS-JL and MM-JL distances in the operated limb and between the CS-JL of the operated limb and the contralateral ankle. While TAA parameters did not show statistically significant differences compared with the contralateral ankle, a trend toward proximalization of the JL was noted. Conclusions: This study demonstrated good reproducibility of the analyzed parameters for evaluating JL in TAA among patients with severe PTBL or undergoing revision surgery. However, these parameters cannot be deemed fully reliable. Given their potential weaknesses, it is crucial to identify more reproducible values, preferably ratios.

BACKGROUND: Periprosthetic joint infection (PJI) is a rare, yet devastating complication with high mortality rates, unpredictable treatment outcomes, and high costs. The purpose of this study was to determine 90-day and 1-year mortality rates at a specialized PJI center, assess the impact of delayed referral to a PJI center on outcomes, and determine the cost of PJI treatment prior to referral to a PJI center.
METHODS: A review of our institution\'s PJI registry was performed to identify patients who had a chronic PJI treated with a 2-stage exchange arthroplasty at our PJI Center from 2017 to 2021. Patients not referred from an external location were excluded. Mortality at 90 days and 1 year was collected. The date of infection diagnosis until the date of referral was recorded. Outcomes were documented as failure of treatment at the final clinical follow-up. The number and type of prior infection treatments were documented for each patient. The estimated cost was calculated using established PJI literature.
RESULTS: There were 172 patients (182 joints) who met inclusion criteria during this timeframe. The 90-day and 1-year mortality rates were 0 and 3.9%, respectively. There was a higher failure rate in patients referred >90 days after the diagnosis of chronic PJI (23 versus 11%, P = 0.031). The total cost of PJI treatment prior to referral for this group of patients was $6.9 million.
CONCLUSIONS: Implementation of a specialized PJI referral center leads to lower mortality rates, improved outcomes, and decreased cost for the health-care system.

UNASSIGNED: The treatment of failed ankle replacements is debated, and little is published about the medium- and long-term results of revision implants. We wanted to examine prosthesis survival and physical function at least 5 years after insertion of the Salto XT revision prosthesis.
UNASSIGNED: All consecutive patients operated with a Salto XT revision prosthesis underwent clinical and radiologic examinations preoperatively and after 3, 12, 24, and 60 months. Complications and reoperations are described, and changes in patient-reported outcome measures and clinical scores are reported.
UNASSIGNED: Thirty patients were operated with a Salto XT revision prosthesis between March 2014 and March 2017. Three of these were revised (1 to a fusion and 2 to a new prosthesis), and 3 patients were reoperated with screw removal. A concurrent subtalar fusion was performed on 13 patients, and there was 1 case of likely nonunion after these procedures, but no reoperations. The mean AOFAS score increased from 39.2 (95% CI 30.8-47.5) preoperatively to 75.1 (95% CI 67.3-82.9) after 5 years, and the mean improvement was 34.2 points (95% CI 23.8-44.6). Mean EQ-5D increased from 0.36 (95% CI 0.30-0.42) preoperatively to 0.74 (95% CI 0.64-0.85) after 5 years, an improvement of 0.34 (95% CI 0.19-0.49). Radiolucent lines were present in all but 3 patients. Five-year prosthesis survival was 93% (83.6-100).
UNASSIGNED: This is the first study to present medium-term results of this implant. We found good improvement in outcome scores and good implant survival, but also a high prevalence of radiolucent lines.