Staphylococcus aureus is the most common microbe in prosthetic joint infections (PJIs). Debridement, antimicrobials, and implant retention (DAIR) are often-recommended treatment modality for acute PJIs, even though it has had relatively poor outcomes in some studies. In this study, we wanted to examine treatment results with a multidisciplinary team in a specialised centre and obtain further information for treatment decisions in acute Staphylococcus aureus PJIs.
All consecutive haematogenous late acute and postoperative early acute hip and knee Staphylococcus aureus PJIs treated with DAIR during 2011-2016 were included in this retrospective study. DAIR within three weeks from symptom onset and the exchange of modular parts were required.
Eighty-five acute Staphylococcus aureus PJIs were treated with DAIR in 83 patients: 28 late acute and 57 early acute PJIs. The late acute PJI patients were older and had malignancies more often than the early acute PJI patients. Bacteraemia was present in 50.6% of Staphylococcus aureus PJI patients, more often in late acute (73.1%) than in early acute (40.4%) patients (p = .006). The implant was retained in 80.0%: 89.3% of the late acute and 75.4% of the early acute PJIs. In 17 joints, DAIR failed and the joint had to be removed. Fourteen of these joints were successfully replaced. One infection-related death occurred. The one-year all-cause mortality rate was 3.6%. Suppressive antimicrobial treatment was given to 22 (26.5%) patients.
Reasonably good treatment results for acute Staphylococcus aureus PJIs are achievable by DAIR in a specialised centre with a strict treatment protocol and a multidisciplinary team. If the DAIR fails, a two-stage exchange is usually still possible, with good results.

BACKGROUND: Haematogenous septic arthritis is a major cause of morbidity and mortality in foals. Previous research has demonstrated a variable prognosis for athletic performance in foals diagnosed with septic arthritis.
OBJECTIVE: To determine the racing prognosis for Thoroughbred foals, 6 months of age or less with single septic joint of presumed haematogenous origin without recognised systemic sepsis or other serious comorbidity compared with a group of maternal sibling controls.
METHODS: Retrospective cohort study.
METHODS: Data were collected from Rood and Riddle Equine Hospital in-patient records from 2009 to 2016. Parameters evaluated included: diagnostic tests, therapeutic regimens, final diagnosis and outcome. Racing records were obtained from a public archive for cases and two maternal siblings. Univariable analyses of categorical variables were conducted.
RESULTS: Ninety-five cases of Thoroughbred foals 6 months of age or less were included in this study. The last measured synovial cell count prior to hospital discharge or euthanasia (OR 0.5, p value 0.002, 95% CI: 0.3-0.8) was an indicator of poor prognosis for survival to discharge. Overall, the prognosis for survival was high (93%). Total winnings per career were the only statistically significant racing performance variable between cases and paired controls (IRR 0.7, p value, 0.05, 95% CI: 0.5-0.99).
CONCLUSIONS: Retrospective study, evaluation of one regional population, potential for unknown prior exclusionary treatment on farm, unknown chronicity, no data on acute phase proteins and proportion of neutrophils of synovial fluid and unknown medical records of controls.
CONCLUSIONS: While total winnings were reduced compared with maternal siblings, Thoroughbred foals with single joint septic arthritis have a favourable prognosis for both survival and starting in a race.
UNASSIGNED: Artrite séptica hematogênica é a maior causa de morbidade e mortalidade em potros. Estudos prévios demonstraram um prognóstico variável para a performance atlética de potros diagnosticados com artrite séptica.
OBJECTIVE: Determinar o prognóstico atlético de potros Puro Sangue Inglês, de seis meses de idade ou menos, com uma única articulação séptica de origem presumida hematogênica, sem nenhum sinal sistêmico de sepse reconhecido e sem outras comorbidades sérias, comparados com um grupo de irmãos maternos como controle.
UNASSIGNED: Estudo coort retrospectivo. MÉTODOS: Dados foram coletados de pacientes do Rood and Riddle Equine Hospital de 2009 a 2016. Os parâmetros avaliados incluíram: testes diagnósticos, tratamentos, diagnóstico final e sobrevivência à alta hospitalar. Os dados das corridas foram obtidos do equibase.com para os casos clínicos e dois irmãos maternos. Análise univariável de variantes categóricas foi realizada.
RESULTS: Noventa e cinco potros Puro Sangue Inglês de seis meses de idade ou menos foram incluídos nesse estudo. A última mensuração da contagem de células no líquido sinovial antes da alta hospitalar ou eutanásia (OR 0.5, p-value 0.002, 95% CI: 0.3 a 0.8) foi um indicador estatisticamente significante de prognóstico ruim para sobrevivência. O prognóstico para sobrevivência foi alto (93%). O ganho total por carreira foi o único fator estatisticamente diferente entre casos e controles (IRR 0.7, p-value, 0.05, 95% CI: 0.5 a 0.99). PRINCIPAIS LIMITAÇÕES: Estudo retrospectivo, avaliação de uma população em uma única região, chances de um tratamento desconhecido na fazenda, cronicidade desconhecida, ausência de resultados de proteínas de fase aguda e concentração de neutrófilos no líquido sinovial, e ausência de controles dos registros médicos. CONCLUSÕES: Apesar do ganho total ser menor quando comparado com os irmãos maternos, potros Puro Sangue Inglês com uma única articulação séptica têm um prognóstico favorável para sobrevivência e para iniciar uma corrida.

OBJECTIVE: Recognition of infectious origin of haematogenous periprosthetic joint infections (PJI) is crucial. We investigated the primary focus and characteristics of haematogenous PJI.
METHODS: Consecutive patients who presented with haematogenous PJI between 01/2010 and 01/2018 were retrospectively analysed. Haematogenous PJI was defined by diagnosis of infection ≥1 month after surgery, acute manifestation after a pain-free period and positive blood or prosthetic-site culture and/or evidence of distant infectious focus consistent with the pathogen. Fisher\'s exact, Student\'s t and Mann-Whitney U tests were used, as appropriate.
RESULTS: A total of 106 episodes of PJI were included, involving 59 knee, 45 hip, one shoulder and one elbow prostheses. The median time from last surgery until haematogenous PJI was 47 months (range, 1-417 months). The pathogen was identified in 105 episodes (99%), including Staphylococcus aureus (n = 43), streptococci (n = 32), enterococci (n = 13), Gram-negative bacteria (n = 9) and coagulase-negative staphylococci (n = 8). Gram-negative bacteria were significantly more often found in hip joints than in knee joints. Blood cultures grew the pathogen in 43 of 70 episodes (61%). The primary infectious focus was identified in 72 episodes (68%) and included infections of intravascular devices or heart valves (22 episodes), skin and soft tissue (16 episodes), the oral cavity (12 episodes), urogenital (12 episodes) or gastrointestinal tract (seven episodes) and other sites (three episodes).
CONCLUSIONS: In acute PJI manifesting after a pain-free period, the haematogenous infection route should be considered and the primary infectious focus should be actively searched for. The cardiovascular system, skin and soft tissue, oral cavity, urogenital and gastrointestinal tracts were common origins of haematogenous PJI.

BACKGROUND: Radial club hand deformity acquired post haematogenous osteomyelitis of radius bone is a very rare disease. Resulting in functional and cosmetic deficit of upper limb which is similar to congenital cases. For a long-time various surgeons attempted to reconstruct the deformity by bone grafting, plating, Ilizarov, monorail external fixator, callus distraction and so on. Keeping in mind that creating single bone forearm we proposed centralization of ulna on wrist to correct the deformity.
METHODS: In our institute, we conducted a rare study involving small number of patients ( n = 5), between February 2013 and November 2106. The study participants comprised four male children and one female child whose average age was 1.8 months. Participant inclusion criteria were no active infection, no distal end of radius (cartilage remnant) and only haematogenous osteomyelitis. Exclusion criteria were congenital radial club hand and active infection.
RESULTS: Decrease in the angle of radial deviation (radiologically) preoperatively from 54° to 5° and angle of volar flexion from 34° to 4° were measured. Preoperatively no ulnar angulations were observed. Length of ulna remains similar to the opposite side. No neurovascular complication noted and full range of movement regained.
CONCLUSIONS: Our case series is unique in terms of massive bone loss, that is, distal metaphysic and epiphysis, so we followed the statement of Ono et al. and did centralization of ulna over carpus and achieved good functional and cosmetic outcome at the cost of loss of motion at the wrist, concluding that treatment is primarily considered as salvage only.

OBJECTIVE: To investigate the outcomes of treatment of streptococcal periprosthetic joint infection (PJI) involving total knee and hip arthroplasties.
METHODS: Streptococcal PJI episodes which occurred between January 2009 and December 2015 were identified from clinical databases. Presentation and clinical outcomes for 30 streptococcal PJIs in 30 patients (12 hip and 18 knee arthroplasties) following treatment were evaluated from the medical notes and at review. The Kaplan-Meier survival method was used to estimate the probability of infection-free survival. The influence of the biofilm active antibiotic rifampin was also assessed.
RESULTS: The infection was thought to have been acquired haematogenously in 16 patients and peri-operatively in 14. The median follow-up time for successfully treated cases was 39.2 months (12 to 75), whereas failure of the treatment occurred within the first year following treatment on every occasion. The infection-free survival at three years with 12 patients at risk was 59% (95% confidence interval 39% to 75%). Failure of the treatment was observed in ten of 22 PJIs (45%) treated with a two-stage revision arthroplasty, two of six (33%) treated by debridement and prosthesis retention, and in neither of the two PJIs treated with one-stage revision arthroplasty. Streptococcal PJI treated with or without rifampin included in the antibiotic regime showed no difference in treatment outcome (p = 0.175).
CONCLUSIONS: The success of treatment of streptococcal PJI in our patient cohort was poor (18 of 30 cases, 59%). New therapeutic approaches for treating streptococcal PJI are needed. Cite this article: Bone Joint J 2017;99-B:653-9.

Primary total hip replacement has become a routine procedure these days. With improvement in surgical techniques and implant designs, the survival rate of prosthesis has increased significantly but unfortunately, prosthetic infections though uncommon continue to be a threatening complication. We present a detailed review of the literature along with a case report of infected total hip prosthesis in a 36-year-old female who had been operated 6 years back. The causative organism was found to be Actinomyces israelii which was related to an infected intrauterine device used for contraception that had been forgotten after being implanted 8 years earlier.

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Clinical experience suggests fluctuation in the occurrence of osteoarticular infections. We performed a single-centre study during 2004-2012, dividing each year into the four seasons according to the Gregorian calendar. A total of 455 episodes of osteoarticular infections were retrieved. There were 91 prosthetic joint infections (45 of haematogenous origin) and 159 cases of septic arthritis. The median period between early symptoms and diagnosis of infection was 27 days. The overall number of infections per season, cumulated over the 8-year study period, was 119 in spring, 129 in summer, 95 in fall, and 112 in winter, which did not reflect any significant seasonal fluctuation. None of the different subgroups of infections, namely arthroplasties (p for trend = 0.755), haematogenous arthroplasty infections (p = 0.493), gram-negative episodes or arthritis (p = 0.290), showed any season-related fluctuation. We conclude that osteoarticular infections, including haematogenous prosthetic joint infections, do not show any significant seasonality.