Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case-control study

BACKGROUND

Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture.

METHODS

A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out.

OUTCOMES

A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95%CI: 1.07-111.50; P=.007), thrombocytopenia (OR: 27.72; 95%CI: 3.48-221.01; P=.002), history of thromboembolism event (OR: 8.80; 95%CI: 1.31-59.38; P=.026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95%CI: 3.65-125.12; P=.001) and liver disease (OR: 32.04; 95%CI: 2.59-396.29; P=.007).

CONCLUSIONS

Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.

[Translated article] Risk factors associated with periprosthetic infection in patients with femoral neck fracture: A case-control study

BACKGROUND

Infection is one of the most important local complications in the patient with femoral neck fracture treated with arthroplasty. The aim of the present study is to describe and analyze possible risk factors that could be involved in periprosthetic infection in the patient with femoral neck fracture.

METHODS

A retrospective case-control study was performed including patients with femoral neck fractures treated with arthroplasty in the period between January 2015 and December 2017. Cases were defined as patients with femoral neck fracture who after undergoing arthroplasty (hemiarthroplasty or total hip arthroplasty) had a periprosthetic infection, whose diagnosis was carried out according to the major and minor criteria described in the International Consensus on Musculoskeletal Infections (Philadelphia 2018). In order to mitigate the influence of variables that could be considered confounding variables, a multivariate analysis was carried out.

OUTCOMES

A statistically significant association was found between periprosthetic infection and certain variables present at the time of admission, including the presence of moderate or severe anaemia (OR: 10.91; 95% CI: 1.07-111.50; P = .007), thrombocytopenia (OR: 27.72;95% CI: 3.48-221.01; P = .002), history of thromboembolism event (OR: 8.80; 95% CI: 1.31-59.38; P = .026), anxious-depressive disorder in treatment with two or three drugs (OR: 21.36; 95% CI: 3.65-125.12; P = .001) and liver disease (OR: 32.04; 95% CI: 2.59-396.29; P = .007).

CONCLUSIONS

Periprosthetic infection in the patient with femoral neck fracture treated with arthroplasty could be related to the presence of certain variables at the time of hospital admission, including moderate or severe anaemia, thrombocytopenia, history of thromboembolic event, anxious-depressive disorder in treatment with two or three drugs or liver disease.

Clinical validity of the intraoperative histology in the diagnosis of prosthetic joint infection

BACKGROUND AND AIM

Different authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyze the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement.

MATERIAL AND METHODS

We present a retrospective study including 133 hip and knee prosthetic replacements performed in our center between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined.

OUTCOMES

The clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%.

CONCLUSIONS

The determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.

[Translated article] Clinical validity of the intraoperative histology in the diagnosis of prosthetic joint infection

BACKGROUND AND AIM

Different authors have demonstrated the usefulness of the histological analysis in the diagnosis of prosthetic joint infection; however, its clinical validity is still controversial. The aim of this article is to describe and analyse the clinical validity of histological analysis in the diagnosis of prosthetic infection in patients undergoing hip or knee prosthetic replacement.

MATERIAL AND METHODS

We present a retrospective study including 133 hip and knee prosthetic replacements performed in our centre between 2008 and 2020. A descriptive, bivariate statistical analysis was performed and the clinical validity of the histological analysis was determined.

OUTCOMES

The clinical validity of the intraoperative histology offered a sensitivity of 48%, a specificity of 91%, a positive predictive value of 55% and a negative predictive value of 88%.

CONCLUSIONS

The determination of the clinical validity of histological analysis shows a high specificity. This analysis is an appropriate diagnostic tool for detecting healthy patients, with no infection.

[Influence of medical outliers in patients with femoral neck fracture]

OBJECTIVES

The objective is to describe and analyze how outlier admission influences hospital stay and the appearance of complications in patients with a femoral neck fracture treated with arthroplasty.

MATERIAL AND METHOD

A historical cohort study was carried out in which the group of patients with a displaced fracture of the femoral neck who had an outlier admission was defined as an exposed cohort, that is, they were admitted to a hospitalization area not belonging to the Orthopedic Surgery and Traumatology department, unlike the unexposed cohort, that included patients admitted to a hospitalization area assigned to the Orthopedic Surgery and Traumatology department.

RESULTS

Outlier admission was a risk factor for requiring a postoperative transfusion (RR 1.52, 95% CI 1.05-2.21; P=.035), to have a postoperative stay longer than 5 days (RR 1.35, 95% CI 1.04-1.74; P=.038) and to suffer general postoperative complications (RR 1.35, 95% CI 1.02-1.78; P=.048).

CONCLUSIONS

Outlier admission is a threat to the quality and safety of health care. In patients over 80 years of age, medical outliers is a risk factor for postoperative transfusion and systemic postoperative complications.

Biomechanical models of in vitro constructs for spinopelvic osteosynthesis

Spinopelvic lesions are the result of high-energy vertical trauma with axial skeletal overload where the spine impacts onto the sacrum, dissociating the lumbar spine from the pelvis. Therefore, lumbopelvic instrumentations are aimed to counteract these vertical forces, although various biomechanical aspects of the combinations of different constructs (with or without iliosacral screws) or the number of lumbar fixation levels (L5 or the combination of L5 with L4) are subject to controversy. The number of patients in each published series is too short, and the nature of the fixation is very different from one article to another, making comparison very difficult. In this paper the methodology for laboratory studies is discussed. The design of the test bench fixture, biomechanical testing protocol and data analysis are very important when inference to the clinical setting is desired.

Seasonality in incidence and mortality of hip fracture

OBJECTIVES

To determine whether there is a seasonal relationship in the incidence and in-hospital mortality of patients with hip fracture.

PATIENTS AND METHODS

Longitudinal descriptive study of cases that included 1104 patients older than 64years admitted for fracture of the proximal extremity of the femur in the Hospital HCU Virgen de la Victoria during a period of 30months The epidemiological characteristics of the patients were recorded and the monthly incidence of fractures was related with the month of the year in which it occurred, as well as with the meteorological conditions, temperature and rainfall.

RESULTS

The study population comprised a total of 1104 patients, with a greater proportion of women (75.1%). The average age was 82.3years. A tendency towards an increased incidence of these fractures was found. The in-hospital annual mortality rate was 2.97%, higher for men and in the age group over 84years. Seasonality was found in terms of the incidence of fractures above the average in the month of October and below this in the month of February. On the other hand, mortality was lower than the average in the month of March and higher in August. In both, a low correlation with temperature and rainfall was found.

CONCLUSIONS

The seasonal distribution of hip fractures presented an increase over the average in the month of October and a decrease in February. Mortality increased over the average in the month of August and decreased in March.

Adult stem cells applied to tissue engineering and regenerative medicine

Regeneration takes place in the body at a moment or another throughout life. Bone, cartilage, and tendons (the key components of the structure and articulation in the body) have a limited capacity for self-repair and, after traumatic injury or disease, the regenerative power of adult tissue is often insufficient. When organs or tissues are irreparably damaged, they may be replaced by an artificial device or by a donor organ. However, the number of available donor organs is considerably limited. Generation of tissue-engineered replacement organs by extracting stem cells from the patient, growing them and modifying them in clinical conditions after re-introduction in the body represents an ideal source for corrective treatment. Mesenchymal stem cells (MSCs) are the multipotential progenitors that give rise to skeletal cells, vascular smooth muscle cells, muscle (skeletal and cardiac muscle), adipocytes (fat tissue) and hematopoietic (blood)-supportive stromal cells. MSCs are found in multiple connective tissues, in adult bone marrow, skeletal muscles and fat pads. The wide representation in adult tissues may be related to the existence of a circulating blood pool or that MSCs are associated to the vascular system.

Long-term results of the Boytchev procedure for the treatment of recurrent dislocation of the shoulder

The authors present the long-term results obtained with the Boytchev technique in the treatment of recurrent anterior dislocation of the shoulder. Recurrence, clinical outcome and functional limitations were evaluated. A total of 27 shoulders in 25 patients were studied. The average follow-up period was 13.3 years. There were no immediate neurovascular complications and no residual pain. The average recovery time was 4.3 months. Dislocation recurred in five shoulders (18%) and 18.5% of the patients were left with restricted mobility. All patients resumed their previous employment although sporting capacity recovered to pre-injury levels in only 9 of 15 patients. The results were classified as good in 18.5% and as excellent in 40.7% of the patients, but the remaining 40.7% had a fair or poor result. In conclusion, the recurrence rate is high and nearly 20% of the patients are left with limited shoulder mobility. Furthermore, although all the patients were able to return to their job, only 60% of those engaged in sports regained their previous level. This technique, although attractive, is better avoided.

Closed suction drainage after knee arthroplasty. A prospective study of the effectiveness of the operation and of bacterial contamination

A prospective investigation was designed to determine the volume and the evolution of bleeding after closure of the surgical wound following knee arthroplasty, as well as the incidence of infection and bacterial contamination in relation with the time that the suction drain was left in place. The drain was removed either 12, 24 or 48 hours after the operation. The presence of any signs of clinical infection was recorded. The tip of the drain, 1 cm of its subcutaneous portion and a sample from the collecting bottle were studied for bacterial contamination. In the 12-hr group, no microorganisms were isolated in cultures either from the tip, the subcutaneous portion or the bottle of the drain. In the 24-hr group, 87% of the total postoperative bleeding was collected during the first 12 hours. In two cases, the samples obtained from the tip and the subcutaneous portion of the drain were positive for Staphylococcus epidermidis. In the 48-hr group, 91% and 97% of the total bleeding volume was collected during the first 12 and 24 hours, respectively. In two cases, St. epidermidis was isolated in cultures from the subcutaneous portion of the drain. The clinical evaluation of wound healing was comparable in all three groups.

Viladot's operation in the treatment of the child's flatfoot

We present the results of observations on a series of 77 flat feet treated by Viladot's surgical technique and prosthesis between 1981 and 1989. The correction was evaluated by photopodograms and radiographs. In the final evaluation, 45 cases (58.44%) were judged to have excellent results, 24 (29.87%) good results, 2 (2.59%) fair results, and 7 (9.09%) poor results.