Global forum: The burden of bone and joint infections: A growing demand for more resources

The rate and severity of septic complications following joint replacement surgery and the incidence of post-traumatic infections are projected to increase at a faster pace because of a tendency to operate on high-risk patients, including older patients, patients with diabetes, and patients who are immunocompromised or have comorbidities. Musculoskeletal infections are devastating adverse events that may become life-threatening conditions. They create an additional burden on total health-care expenditures, and can lead to functional impairment, long-lasting disability, or even permanent handicap, with the inevitable social and economic burdens. The scientific community should take a more active role to draw public attention to the plight of hundreds of thousands of people across the globe who experience complications, become disabled, and, in some cases, die, and it should highlight what could be achieved if the global community takes decisive steps to improve access, early detection, and appropriate care. However, mitigating the adverse personal, clinical, and socioeconomic effects of these conditions requires increasing financial resources provided by both governments and funding organizations. Furthermore, a targeted action plan from the providers and the professional societies should be put in place so that the burden created by bone and joint infections is included in the agenda for global healthcare priorities. Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated

Successful Mining of Important Data from Patient Archives with Natural Language Processing: Commentary on an article by Caroline P. Thirukumaran, MBBS, MHA, PhD, et al.: "natural Language Processing for the Identification of Surgical Site Infections in Orthopaedics"

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Hand surgery in Greece

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Infection in total knee arthroplasty

Total knee arthroplasty (TKA) has been proven one of the most successful operations of all medicine with very good and long-lasting functional outcome in patients who suffer from osteoarthritis of the knee. The number of TKAs worldwide has increased dramatically. Prosthetic joint infection after TKA is a very serious and challenging complication that can drastically affect patients' lives, as it may lead to persistent pain and disability, multiple operations with attendant morbidity, and prolonged convalescent periods. The reported incidence for TKA varies from 1% to 2% at 2 years post-operatively, but becomes higher with longer f-up nearing to 7% after revision surgery. Risk factors include presence of systemic or local active infection in an arthritic knee; previous operative procedures in the same knee, diabetes mellitus, malnutrition, smoking, alcohol consumption, co-morbidities, and immunosuppression; end-stage renal disease on hemodialysis, liver disease, intravenous drug abuse, and low safety operative room environment. Diagnosis is established when two cultures of periprosthetic tissue turn positive with identical organisms, or in the presence of sinus tract communicating with the joint or when three of the following minor criteria exist: an elevated serum CRP and ESR, an elevated synovial fluid white blood cell count and ++change on the leukocyte esterase test strip, or a positive alpha-defensin test in the joint aspirate, elevated synovial fluid polymorphonuclear neutrophil percentage, a positive histological analysis of periprosthetic tissue, or a single positive culture. Management of the infected TKA remains difficult for both a surgeon and a patient. It includes continuous suppression with antibiotic antiadministration in selected patients, exchange (revision) TKA in one- or two-stages, arthrodesis of the knee or even amputation. If the appropriate indications are followed, the outcome of management of an infected TKA can be very satisfactory. © 2017 Elsevier Ltd All rights reserved

Postacute sequelae of SARS-CoV-2 infection. Osteonecrosis must not be overlooked

Recovery from COVID-19 is not always uneventful, especially in critically ill hospitalized patients. Persistent symptoms including fatigue/ weakness, shortness of breath, anxiety, and depression have been described at one-year follow-up. Furthermore, symptoms from the musculoskeletal system like joint pain or stiffness are underreported in studies with long-term follow-up of up to one year. Infection with SARS-CoV-2 itself has been associated with endothelial damage, and together with high-dose corticosteroid treatment, it is predisposed to the dissemination of microthrombi and the development of femoral head osteonecrosis (FHOn), as it has been shown during the previous (2003–2004) coronavirus outbreaks. A resurgence of FHOn cases is anticipated but this is not reflected in the existing studies with long-term follow-up. Prompt diagnosis is critical for early treatment and possibly for the hip joint preservation. Patients with COVID-19 treated with corticosteroids should be screened for avascular necrosis early after discharge from the hospital. Every healthcare worker involved in the management of these patients should maintain a high level of suspicion and should be alert when patients report symptoms such as vague aches at the buttocks, hip area, adductors, and/or above the knee. Studies are needed to identify risk factors for FHOn including disease severity, type of steroid, cumulative dose, and duration of treatment. © 202

Clinical, functional and radiographic outcomes after revision total hip arthroplasty with tapered fluted modular or non-modular stems: a systematic review

Purpose: The aim of the study was to systematically evaluate clinical outcomes of tapered fluted stems, either monoblock or modular, in revision total hip arthroplasty. Methods: PubMed, EMBASE and Web of Science and Cochrane databases were systematically searched by 2 researchers. Clinical studies reporting primarily on survival and re-revision rates, and secondarily on subsidence, dislocation, intraoperative fractures, periprosthetic fractures and infection were included. 2 investigators assessed the quality of the studies. Results: 46 studies were included in this review, reporting on 4601 stem revisions. The pooled re-revision rate was 5.1% and long-term survival ranged from 75% to 98.5%. No differences were observed between monoblock and modular stems regarding re-revision rate, dislocation rate, periprosthetic fracture rate or infection rates. Monoblock stems exhibited more subsidence and modular stems displayed more intraoperative fractures. Conclusions: Satisfactory results can be obtained with the use of tapered fluted end-bearing stems. Monoblock stems offer the same clinical results as modular stems. © The Author(s) 2021