One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6-20.7) and 32.3 (95% CI 27.3-38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58-5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip

Utilitat de la histologia en el diagnòstic de la infecció de l’artroplàstia de maluc

[cat] Aquesta tesi està dedicada a l’estudi de la utilitat del nombre de leucòcitspolimorfonuclears en els teixits periprotètics pel diagnòstic de la infecció, a determinarquin es el punt de tall per definir infecció i a estudiar quina relació hi ha entre el númerode leucòcits polimorfonuclears trobats en les membranes periprotètiques i elmicroorganisme aïllat en els cultius convencionals.El primer objectiu avalua la utilitat de la histologia segons el criteri de Mirra iadaptat per Feldman (≥5 leucòcits polimorfonuclears per camp de gran augment) en tressituacions; recanvi protètic per sospita d’afluixament asèptic, per sospita d’afluixamentsèptic o reimplantació d’una pròtesi després d’un primer temps sèptic. En el cas delrecanvi per afluixament asèptic i en el moment de la reimplantació d’una pròtesi desprésd’un primer temps sèptic, la histologia presenta una sensibilitat baixa per tald’identificar una infecció. En canvi en el cas d’un recanvi amb la sospita d’afluixamentsèptic, la histologia es mostra com un test vàlid, ja que en la majoria de les situacionsconfirma aquesta sospita preoperatòria.El segon objectiu estudia si un punt de tall més baix (≥1 leucòcitspolimorfonuclears per camp de gran augment) és més eficaç en el diagnòstic de lainfecció. El resultat demostra que aquesta modificació fa que la histologia sigui méssensible però comporta un descens de l’especificitat.El tercer objectiu analitza la relació entre el número de leucòcitspolimorfonuclears i el tipus de microorganisme aïllat. L’aïllament d’estafilococscoagulasa-negativa es va associar a una menor infiltració de leucòcits polimorfonuclearsen els teixits periprotètics que amb altres microorganismes com Staphylococcus aureuso Bacils Gram-negatius com Escherichia coli o Pseudomonas spp

The Socioeconomic Determinants of Health : Economic Growth and Health in the OECD Countries during the Last Three Decades

In times of economic crisis, most countries face the dual challenge of fighting unemployment while restraining social expenditures and closing budget deficits. The spending cuts and lack of employment affect a large number of decisions that have a direct or indirect impact on health. This impact is likely to be unevenly distributed among different groups within the population, and therefore not only health levels may be at risk, but also their distribution. The main purpose of this paper is to explore links between unemployment, economic growth, inequality, and health. We regress a measure of health, the Health Human Development Index (HHDI), against a set of explanatory variables accounting for the countries' economic performance (GDP growth, unemployment, and income inequality), and some institutional factors related to welfare spending and the nature of the health systems for the past three decades. In addition, we explore the causes for different results obtained using an inequality-adjusted HHDI, vs. the unadjusted HHDI. We describe a panel data model, estimated by random effects, for 32 countries from 1980-2010, in five-year intervals. Our conclusion is that the high economic growth observed in the last decades, together with an increase in the levels of income inequality and/or poverty, explain the observed changes of our index, particularly when this indicator is weighted by health inequality. The remaining institutional variables (the share of social spending, health care expenditure, and the type of health systems) show the expected sign but are not statistically significant. A comment on the methodological pitfalls of the approach completes the analysis

One-Stage Hip Revision Arthroplasty Using Megaprosthesis in Severe Bone Loss of The Proximal Femur Due to Radiological Diffuse Osteomyelitis

Managing substantial proximal and/or distal femoral bone defects is one of the biggest challenges in chronic hip periprosthetic joint infection. Most authors use two-stage arthroplasty with a temporary antibiotic-loaded cement spacer for the management of these patients. In this study, we show our experience with one-stage exchange arthroplasty in managing severe bone defects due to radiological-extensive proximal femoral osteomyelitis. Two patients were included in the study. They showed radiological-extensive proximal femoral osteomyelitis, and they were treated with one-stage exchange arthroplasty using megaprosthesis. Diffuse osteomyelitis was confirmed in both cases; in one case, the histology was compatible with osteomyelitis, and the other case had a positive culture identified in a bone sample. At a minimum of a four-year follow-up, the patients did not reveal any clinical, radiological or laboratory signs of infection. In conclusion, one-stage exchange arthroplasty and megaprosthesis is an option for the treatment of chronic hip periprosthetic joint infection associated with radiological-diffuse proximal femoral osteomyelitis

Fracture of Ceramic Liner and Head in a Total Hip Arthroplasty with a Sandwich Type Cup

Due to its advantages, ceramic-on-ceramic bearings have been widely used in young patients for almost 30 years. Long-term survivorship, low wear, and low biological reactivity to particles are some of its characteristics. Even though this material has had a lot of improvements, the risk of fracture is one of the concerns. There have been reports of fracture of ceramic in the acetabular liner and head but no fractures of both in the same patient. We report a case of a fracture in a sandwich type acetabular liner and the ceramic head in a patient involving ankylosing spondylitis. It occurred three years after the operation and with no history of direct trauma. We decided to change the bearing surfaces to metal polyethylene without removing the metal back. The patient is satisfied by the clinical results after a 5-year followup

The socioeconomic determinants of health: economic growth and health in the OECD countries during the last three decades

In times of economic crisis, most countries face the dual challenge of fighting unemployment while restraining social expenditures and closing budget deficits. The spending cuts and lack of employment affect a large number of decisions that have a direct or indirect impact on health. This impact is likely to be unevenly distributed among different groups within the population, and therefore not only health levels may be at risk, but also their distribution. The main purpose of this paper is to explore links between unemployment, economic growth, inequality, and health. We regress a measure of health, the Health Human Development Index (HHDI), against a set of explanatory variables accounting for the countries’ economic performance (GDP growth, unemployment, and income inequality), and some institutional factors related to welfare spending and the nature of the health systems for the past three decades. In addition, we explore the causes for different results obtained using an inequality-adjusted HHDI, vs. the unadjusted HHDI. We describe a panel data model, estimated by random effects, for 32 countries from 1980–2010, in five-year intervals. Our conclusion is that the high economic growth observed in the last decades, together with an increase in the levels of income inequality and/or poverty, explain the observed changes of our index, particularly when this indicator is weighted by health inequality. The remaining institutional variables (the share of social spending, health care expenditure, and the type of health systems) show the expected sign but are not statistically significant. A comment on the methodological pitfalls of the approach completes the analysis

Moxifloxacin plus rifampin as an alternative for levofloxacin plus rifampin in the treatment of a prosthetic joint infection with staphylococcus aureus

OBJECTIVES: The combination of a fluorquinolone with rifampin is one of the cornerstones in the treatment of a prosthetic joint infection (PJI) caused by staphylococci. Moxifloxacin is highly active against methicillin susceptible S. aureus (MSSA), and therefore, an attractive agent to use. However, several studies reported a lowering in serum moxifloxacin levels when combined with rifampin. The clinical relevance remains unclear. We determined the outcome of patients with an early acute PJI caused by MSSA treated either with moxifloxacin/rifampin or levofloxacin/rifampin. METHODS: Medical files of patients treated with moxifloxacin/rifampin (University Medical Center Groningen) or levofloxacin/rifampin (Hospital Clínic Barcelona) were retrospectively reviewed (2005-2015). Treatment failure was defined as the need for revision surgery and/or suppressive therapy, death by infection or a relapse of infection during follow-up. RESULTS: Differences in baseline characteristics between both cohorts were observed, but prognostic parameters for failure, as defined by the KLIC-score (Kidney failure, Liver cirrhosis, Index surgery, C-reactive protein and Cemented prosthesis), were similar between both groups (2.9 (1.5 SD) for the moxifloxacin group versus 2.2 (1.2 SD) for the levofloxacin group (p 0.16)). With a mean follow-up of 50 months (36 SD) in the moxifloxacin group, and 67 months (50 SD) in the levofloxacin group (p 0.36), treatment was successful in 89% versus 87.5%, respectively (p 0.89). None of the failures in the moxifloxacin group were due to rifampin or moxifloxacin resistant S. aureus strains. CONCLUSION: Our data suggest that moxifloxacin combined with rifampin, is as clinically effective as levofloxacin/rifampin for early acute PJI caused by MSSA