The outcomes of acute periprosthetic joint infection following unicompartmental knee replacement managed with early debridement, Antibiotics, and implant retention

BACKGROUND

Periprosthetic joint infection (PJI) following unicompartmental knee replacement (UKR) is an uncommon, yet serious, complication. There is a paucity of evidence regarding the effectiveness of Debridement-Antibiotics-and-Implant-Retention (DAIR) in this setting. The aim of this study is to investigate the effectiveness of DAIR for acute UKR PJI.

METHOD

Between 2006 and 2019, 5195 UKR were performed at our institution. Over this period, sixteen patients underwent DAIR for early, acute PJI. All patients met MSIS PJI diagnostic criteria. The median age at DAIR was 67 years (range 40-73) and 12 patients were male (75.0%). The median time to DAIR was 24 days (range 6-60). Patients were followed up for a median of 6.5 years (range1.4-10.5) following DAIR.

RESULTS

0.3% (16/5195) of UKR in our institution had a DAIR within 3 months. 15 of 16 patients (93.8%) were culture positive, with the most common organism MSSA (n = 8, 50.0%). Patients were treated with an organism-specific intravenous antibiotic regime for a median of 6 weeks, followed by oral antibiotics for a median duration of 6 months. The Kaplan-Meier survivor estimate for revision for PJI was 57% (95%CI: 28-78%) at five years, and survivor estimate for all cause revision 52% (95%CI: 25-74%).The median Oxford Knee Score for patients with a viable implant at final follow-up was 45 points (range 39-46).

CONCLUSION

Early, acute PJI after UKR is rare. DAIR had a moderate success rate, with infection-free survivorship of 57% at 5 years. Those successfully treated with DAIR had excellent functional outcome and implant survival.

Effects of partially replacing barley with sugar beet pulp, with and without roasted canola seeds, on performance, rumen histology and fermentation patterns in finishing Arabian lambs

This study investigated the effects of partially replacing barley grains with sugar beet pulp (SBP), with and without roasted canola seed (RCS) on ruminal pH, ruminal volatile fatty acid (VFA) concentrations, ruminal histomorphometric characteristics, and performance in finishing lambs fed a high concentrate diet. Twenty-four Arabian male lambs (23.7 ± 2.5 kg bodyweight, 118 ± 10 days in age) were used for 99 days in a completely randomised design with a 2 × 2 factorial arrangement. Lambs were fed with a high concentrate diet containing (1) 68% barley (B) (2) barley plus 7% RCS (B + RCS) (3) 36% SBP, (4) SBP plus 7% RCS (SBP + RCS). Ruminal fluid pH and VFA concentrations were determined at 0, 2, 4 and 8 h post-feeding 1 day before slaughter day. Tissue samples were collected for histomorphometric study at slaughter day. Average daily gain of the lambs was not affected by partial replacement of barley with SBP, however it was improved by RCS inclusion (P < 0.05). Diets with RCS had significantly lower (P < 0.05) neutral detergent fibre and acid detergent fibre digestibility values than diets without RCS (P < 0.05). Both SBP and RCS increased ruminal pH, molar proportions of acetate, isobutyrate but decreased molar proportion of propionate in rumen content (P < 0.05). The height, width, epithelial thickness and tunica muscularis of rumen papilla and reticulum folds were increased by SBP (P < 0.05). Density of reticulum folds were higher in lambs fed by higher SBP (P < 0.05). Inclusion of RCS significantly increased papillae height and thickness of epithelium (P < 0.05). In conclusion, partially replacing barley with SBP as well as RCS inclusion prevented a drop in the ruminal pH, and improved the morphology of the rumen-reticulum in finishing lambs fed a high concentrate diet.

Severe tardy ulnar nerve palsy caused by traumatic cubitus valgus deformity: functional outcome of subcutaneous anterior transposition

Ten male patients with McGowan's grade III ulnar neuropathy due to traumatic cubitus valgus deformity underwent anterior subcutaneous ulnar transposition. Evaluation was performed using subjective and objective measures, and a modified Bishop score. After operation, subjective sensory and motor disturbances were improved or resolved in most of the patients, while objective measures improved less well. Improvement in two-point discrimination (2PD) was consistently associated with symptom relief. All of the patients reported satisfaction with the operation. There were no complications or recurrences. The results of ulnar nerve transposition in our patients were comparable to the results of this operation in patients with severe idiopathic cubital tunnel syndrome. Although the outcome of surgery is not always satisfactory in severe ulnar neuropathy, symptom relief may justify performing the operation.

(32)P colloid radiosynovectomy in treatment of chronic haemophilic synovitis: Iran experience

Repeated intra-articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with (32)P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6-28). There were three repeat injections. According to Fernandez-pallazi and Cavilgia clinical classification (Table 1) [23], nine joints were Stage II and 46 were Stage III. In latest follow-up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment (P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy (P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using (32)P effectively reduces the intra-articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment.

Operative treatment of anterior heterotopic bone formation of the elbow in a patient with severe haemophilia A

There is no statistical data on the incidence of heterotopic ossification among patients with haemophilia, and a few reports documenting this entity in haemophilia are available. Although post-traumatic heterotopic ossification about the elbow is a well-recognized complication, we are not aware of any previously reported case in haemophiliacs. An 8-year-old boy with severe haemophilia A presented with fixed elbow in 80 degrees of flexion. Radiographs disclosed a mature anterior heterotopic ossification in the form of complete ulnohumeral bony bridge. Surgical excision of the heterotopic bone was performed. A full elbow range of motion was obtained after long-term physiotherapy. We conclude that this surgery is safe and successful in haemophilic patients, if performed at the right time under optimal situation.