Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection

During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intra-operative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218days after re-implantation, but only four pre- or intraoperative invasive joint samples had grown a pathogen in cultures. In at least seven recurrent PJIs (58%), patients had a normal C-reactive protein (CRP, <10mg/l) level before re-implantation. The sensitivity, specificity, positive predictive and negative predictive values of pre-operative invasive joint aspiration and CRP for the prediction of PJI recurrence was 0.58, 0.88, 0.5, 0.84 and 0.17, 0.81, 0.13, 0.86, respectively. As a conclusion, pre-operative joint aspiration, intraoperative bacterial sampling, surgical exploration and serum inflammatory markers are poor predictors of PJI recurrence. The onset of reinfection usually occurs far later than reimplantatio

Conflit fémoro-acétabulaire chez le sportif : prise en charge et traitement

Diverses pathologies autour de la hanche sont diagnostiquées chez des sportifs de tous niveaux. Le conflit fémoro-acétabulaire (CFA) est responsable d’une baisse de performance lors de la pratique sportive ainsi que d’arthrose précoce de l’articulation de la hanche. Cet article se concentre sur le diagnostic et le traitement rapide du CFA chez les jeunes sportifs. Il a pour but d’attirer l’attention de la communauté médicale sur cette pathologie récente et d’éviter ainsi les résultats délétères pour l’articulation coxo-fémorale associés au diagnostic tardif

Options chirurgicales conservatrices dans l'arthrose

Joint-preserving surgery aims to correct the mechanical disbalances leading to the inhomogenous load distribution across joint lines, potentially leading to osteoarthritis. The possibilities of axial corrections at the knee have been known for years. A better pathophysiologic understanding of the disbalances leading to coxarthrosis has, more recently, allowed for the development of joint-preserving approaches, for instance in situations of excessive (impingement) or insufficient (dysplastic) femoro-acetabular coverage. On the opposite, in the absence of a mechanical defect, or if osteoarthritis is already present, joint-preserving surgery has little chances of success

Total hip arthroplasty through an anterior approach: The pros and cons

Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients.Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay.No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches.Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes. Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023

Rééducation des conflits fémoroacétabulaires et retour au sport

Les conflits fémoro-acétabulaires sont assez fréquents chez les jeunes sportifs. Il convient de les identifier rapidement afin de ne pas laisser s’aggraver des lésions labro-cartilagineuses. Le traitement conservateur ne doit pas forcer les amplitudes mais rétablir un bon équilibre musculaire autour de la hanche ainsi qu’un meilleur contrôle dynamique du membre inférieur. Il convient aussi d’éduquer le patient à mieux contrôler ses fins d’amplitude de hanche durant ses activités. Si l’approche conservatrice n’est pas satisfaisante, un traitement chirurgical est proposé. La rééducation postopératoire, adaptée au type de correction effectuée, procède par phases, du contrôle moteur au renforcement et jusqu’au retour au sport. L’aspect préventif devrait être mieux étudié afin de préserver la hanche chez le jeune en croissance

Docteur, ma fracture est-elle solide?

The adequate treatment of fractures consists of a conservative or surgical approach whose goal is to assure a rapid solidity of the fracture site that will lead to a durable complete healing without complications. Fracture healing criteria remain controversial. In this article we are trying to present the tools used in the evaluation of bone consolidation and propose therapeutical guidelines aiming at the return to daily activities in full security

Le point sur la prothèse totale de hanche

Total hip arthroplasty (THA) is one of the most common surgical procedures performed by orthopedic surgeons. Frequent indications for THA include osteoarthrosis of the hip joint that can be primary origin or secondary to dysplasia or traumatic origin, as well as fractures of the femoral neck in active patients. Other common indications include rheumatoid arthritis and osteonecrosis of the femoral head. It is a surgical intervention giving very good results giving patients pain relief and mobility with a success rate in more than 90% of cases. The point of this article is to inform the medical community on the actual situation of hip prosthetics in fields including epidemiology, clinical results, indications, contraindications, different types of prosthetic materials as well as surgical approaches