ABSTRACT Routine surgical antibiotic prophylaxis (SAP) is frequently used to prevent surgical site infections, although its benefit in clean elective upper limb soft-tissue surgery remains questionable due to the low baseline risk of infection. This issue is particularly relevant in resource-limited settings, where concerns about infection and limited locally generated evidence often sustain routine antibiotic use. This study evaluated whether SAP provides clinical benefit in this context using a randomized, double-blind, placebo-controlled design. A total of 110 adult patients undergoing clean outpatient upper limb surgery were allocated to receive either a single preoperative dose of antibiotics or placebo. Surgical site infection rates were low and equivalent in both groups (1.8%), with no meaningful differences in postoperative wound complications. These findings suggest that routine SAP does not improve outcomes in this setting and support more judicious, evidence-based antibiotic use in low-risk surgical procedures, even in environments where perceived infection risk remains a concern. Trial registration: ClinicalTrials.gov NCT05990842.

Although evidence supports clinicians to "safely do less" for febrile infants assessed as low risk of serious bacterial infection (SBI), early discharge may increase caregiver concern and reduce satisfaction with care. We captured the self-reported satisfaction and concerns for families enrolled in the study of fever, blood cultures and readiness for discharge in infants less than 3months old (FeBRILe3), a prospective safety assessment of early discharge of low-risk febrile infants, to aid evaluation of this practice. An updated local policy was implemented at 2 Western Australian hospitals allowing febrile infants (<3months old) fulfilling low-risk criteria for SBI to be discharged from 24 hours after admission. An electronic survey was administered 7 to 10days postdischarge to caregivers of 500 febrile infants admitted August 2019 to December 2021. The survey included free-text and 5-point Likert-scale questions on hospitalization/discharge experiences. Responses were evaluated by length of stay (LOS; <36 hours, 36 hours to <48 hours, or >=48 hours) and risk-stratification (low-risk or nonlow-risk) groups. Caregiver responses were obtained for 298 infants (60%). Fifty-one infants (17%) were discharged before 36 hours, including 7 of 38 infants fulfilling low-risk criteria. Sixty-eight infants (23%) were discharged between 36 hours and less than 48 hours. Ninety-one percent of caregivers "agreed" or "strongly agreed" their infant was ready for home at time of discharge. Responses were comparable for low-risk infants discharged before 36 hours (86%) vs after 36 hours (93%). Most caregivers (84%) "agreed" or "strongly agreed" that discharge timing enabled a quick return to family routine. Caregivers of low-risk infants discharged before 36 hours missed fewer workdays (median 1.5 vs 2.5days for LOS >=36 hours). Free-text feedback identified the importance to caregivers of clear communication and shared decision-making. Early discharge was related to high caregiver satisfaction, regardless of risk stratification, supporting continued implementation of this policy. Strengthening communication and streamlining discharge processes may further enhance satisfaction and support early discharge.

To explore glucocorticoid (GC) tapering target in patients with acute/subacute anti-synthetase syndrome-associated interstitial lung disease (ASyS-ILD). We retrospectively analysed 86 patients with newly diagnosed acute/subacute ASyS-ILD from the MYKO cohort. Patients were grouped using prednisolone-equivalent dose thresholds of 15, 12.5, and 10 mg/day at 6 months. Exploratory three-group analyses categorised patients into ≤12.5, 12.5-15, and >15 mg/day. Matching weights adjusted for baseline confounders. Cox proportional-hazards models evaluated 5-year all-cause mortality and event-free survival for disease flares and infections requiring hospitalisation. A multivariable logistic regression assessed factors associated with achieving ≤15 mg/day at 6 months. In two-group analyses, the ≤15 mg/day group had a lower infection risk (hazard ratio (HR) 0.18, 95% confidence interval (CI) 0.04-0.81), whereas analyses using other thresholds showed no clear differences. In the three-group analyses, patients receiving 12.5-15 mg/day tended to have the lowest flare risk. Female sex was associated with achieving ≤15 mg/day at 6 months (odds ratio 3.29, 95% CI 1.09-10.13). Tapering to a prednisolone-equivalent dose of 12.5-15 mg/day at 6 months may represent a reasonable target to balance risks of flares and infections in patients with acute/subacute ASyS-ILD.

More than 80% of patients with advanced malignancy experience pain as they approach death, and up to 30% fail to achieve adequate relief from systemic analgesics or cannot tolerate their side effects. For these patients, externalized epidural or intrathecal catheters offer a targeted alternative, delivering analgesic agents directly to the neuraxis. This narrative review examines patient selection, technical approaches, pharmacological regimens, clinical outcomes, and complications associated with externalized epidural and intrathecal catheter systems for refractory cancer pain at end of life. The available literature comprises predominantly small, single-center retrospective cohort studies and prospective case series, with one double-blind randomized controlled trial identified. Neuraxial analgesia was consistently associated with three benefits: reductions in pain intensity from severe baseline levels (NRS 7-10) to mild-to-moderate ranges (NRS 2-5), with some patients achieving near complete relief; opioid-sparing effects, including systemic opioid discontinuation in a subset of patients; and functional improvements sufficient to support discharge to home or hospice. Infectious complications were the leading cause of early catheter removal, with epidural abscess rates as high as 12% reported in one cohort; tunneled subcutaneous port systems appeared to confer lower infectious risk than percutaneous catheters. Externalized catheters provide meaningful pain relief, opioid sparing, and functional benefits for carefully selected patients with refractory cancer pain at the end of life. Given the heterogeneity of study designs and inconsistent outcome reporting, prospective multicenter studies employing standardized pain, functional, and complication metrics are needed to better define the role of neuraxial analgesia in this population.

COVID-19 vaccine effectiveness (VE) is typically studied in the context of reducing the risk of severe illness and death. Few studies have estimated VE in preventing transmission and infection with current levels of SARS-CoV-2 population immunity. To estimate COVID-19 VE against transmission and infection within households. This cohort study was a prospective, case-ascertained household transmission study (performed in New York, Tennessee, and Washington) in which the first household member with confirmed SARS-CoV-2 infection (primary case participant) was identified through outpatient settings and enrolled with their household contacts from January 1, 2024, to January 31, 2025. Participants provided demographic information, and COVID-19 vaccination history was verified by study staff. After enrollment, participants were instructed to collect daily nasal swabs for 10 days regardless of symptoms. Nasal swabs were tested for SARS-CoV-2 via reverse transcription-polymerase chain reaction. COVID-19 vaccination history in primary case participants and household contacts categorized as time from most recent vaccination to COVID-19 onset in the primary case participant (≤6 months, 7-12 months, >12 months, and unvaccinated [reference group]). Household contacts were considered infected if at least 1 swab tested positive for SARS-CoV-2. Secondary infection risk was calculated as the number of infected contacts divided by the total number of contacts. Adjusted relative risk (ARR) of infection was estimated using a multivariable Poisson regression model, with generalized estimating equations accounting for household-level clustering. Vaccine effectiveness was calculated as 1 minus the ARR of the primary case participant and household contacts' vaccination status to estimate VE against transmission and against infection, respectively. This analysis included 362 primary case participants (median [IQR] age, 35 [10-53] years; 199 female [55.0%]) and 763 household contacts (median [IQR] age, 29 [12-44] years; 399 female [52.3%]). SARS-CoV-2 infection was detected in 476 household contacts during follow-up for a secondary infection risk of 62.4% (95% CI, 58.7%-65.5%). Household contacts of primary case participants vaccinated 6 months or less before onset had a lower infection risk compared with contacts of unvaccinated primary case participants (ARR, 0.57 [95% CI, 0.35-0.93]). There was no statistically significant difference in infection risk based on vaccination status of household contacts. In this cohort study, recent COVID-19 vaccination was associated with a reduced risk of SARS-CoV-2 transmission. These findings suggest that COVID-19 vaccination may have an indirect benefit of decreasing transmission and thus reducing overall exposure to SARS-CoV-2.

Extensive population testing played a crucial role in mitigating the COVID-19 pandemic. However, scaling up testing capacity requires a considerable workforce and infrastructure. Furthermore, sampling and testing delays can hinder timely interventions. We therefore sought to improve pre-test triage through an ensemble model based on self-reported information. We trained an XGBoost classifier to predict individual risk of COVID-19 infection for higher education students in Leuven (Belgium) from real-world social and health data related to 38,180 test results. The model could recommend isolation, testing, or release of individuals at high, moderate, or low risk of infection, respectively, based on two parametrizable probability thresholds. We then studied the epidemiological impact of the ensemble triage tool in silico, by simulating its implementation in our context to control an epidemic over time. The predictive model achieved a ROC AUC of [Formula: see text], but its performance varied across rolling retraining windows. The epidemiological simulations highlight the potential of the ensemble-enhanced triage system to control a surge of infections in the student population of Leuven. Given a rapid implementation at the onset of an infection surge, it could reduce the effective reproduction number below 1.0 while reducing the testing requirements by [Formula: see text]. The predictions of the ensemble model were strongly influenced by the number of contacts which individuals reported, the reason for testing, and the onset of symptoms. Our study suggests that pre-test triage guided by ensemble models could play an important role in allocating testing resources efficiently. Given timely implementation and isolation compliance within the population, it could also help rapidly control a surge of infections. Future research could validate this approach for other pathogens, in other settings, and with deep learning models.

Infliximab (IFX) for inflammatory bowel disease (IBD) treatment may increase the risk of hepatitis B virus (HBV) reactivation, particularly in areas with high HBV prevalence such as China. This study aimed to evaluate HBV reactivation/infection, liver dysfunction, vaccination efficacy and strategies in IBD patients undergoing IFX therapy. This retrospective, multicenter study included 4183 IBD patients from 15 hospitals across China, who were divided into six groups according to the HBV status. Demographic features, HBV vaccination status, reactivation/infection rates, and liver dysfunction outcomes were collected, with data collection performed from 2009 to 2022. We found that HBV reactivation rate was notably higher in HBsAg positive group than other groups (P < 0.05) despite antiviral treatment. Although only 29% of patients were immunized at IFX initiation and almost no patients got vaccinated against HBV during IFX treatment, no patients experienced HBV infection in the susceptible population group. The study underscores a critical need for rigorous HBV screening before IFX initiation. Despite antiviral prophylaxis, the importance of continuous monitoring of HBV DNA is necessary for HBsAg positive patients. HBsAg negative patients, including the susceptible population, had a very low risk of new HBV infection, thus reassuring patients and physicians of the safety of IFX in this cohort.

Evaluate the association between preoperative SIRI and early postoperative SSI and to assess its diagnostic performance. Retrospective cohort study was conducted including 500 consecutive adult patients who underwent posterior fusion lumbar spine surgery for degenerative pathology. Preoperative neutrophil, lymphocyte, and monocyte counts were used to calculate SIRI. The primary outcome was early acute deep postoperative SSI. Associations were analyzed using univariate and penalized multivariate logistic regression. Discriminatory performance was assessed using receiver operating characteristic curve analysis. Early postoperative SSI occurred in 27 patients (5.4%). Patients who developed infection had significantly higher preoperative SIRI values than those without infection (median 1.78 [IQR, 1.02-3.41] vs. 1.12 [IQR, 0.62-2.04]; p = 0.031). In the multivariate logistic regression model, log-transformed SIRI remained independently associated with infection (adjusted OR 1.93; 95% CI 1.02-3.67; p = 0.044). Preoperative SIRI demonstrated moderate discriminatory ability for early SSI, with an AUC of 0.66 (95% CI, 0.54-0.77; p = 0.03). The optimal cutoff value of 1.29 yielded a sensitivity of 63.0% and a specificity of 68.3%. Preoperative SIRI is independently associated with early postoperative SSI following instrumented lumbar spine surgery for degenerative pathology. Although its discriminatory performance is moderate, SIRI represents a simple, inexpensive, and readily available adjunctive marker for preoperative risk stratification, particularly useful for identifying patients at low risk of postoperative infection.

Objective: To study the role of antibiotic prophylaxis in septoplasty. Study design: Quasi-experimental study. Place and Duration of Study: Department of Otolaryngology Surgery, Combined Military Hospital (CMH), Murree, Pakistan, from July 2022 to July 2024. Methodology: This study evaluated the necessity of prophylactic antibiotics in septoplasty, where a total of 60 patients, with symptomatic deviated nasal septum were randomly assigned to two groups, Group A (n=30) and Group B (n=30). Both groups received a 1.20 g test dose of intravenous (I/V) co-amoxiclav, followed by a main dose 30 minutes before surgery, while postoperatively, Group A continued with co-amoxiclav 625 mg orally every 8 hours for five days, while Group B received no further antibiotics. Clinical parameters, including pain, fever, and nasal discharge, were assessed on postoperative days 1, 7, and 14 following nasal pack removal. Statistical analysis of all collected data was done using Statistical Package for the Social Sciences (SPSS) version 26.00. Results: In Group A, 93.00% of participants experienced mild symptoms, while 7.00% had moderate symptoms. In Group B, 90.00% reported mild symptoms, while 10.00% had moderate symptoms. No cases of severe symptoms were observed in either group. Statistical analysis revealed no significant difference in symptom severity between the two groups (p = 0.64). These findings suggest that routine postoperative antibiotic use in septoplasty may not be necessary. Conclusion: Septoplasty is a clean contaminated procedure and does not need antibiotic prophylaxis in the post-operative period because of the low risk of infection.

Background: Total hip arthroplasty (THA) for the late sequelae of childhood septic hip arthritis is technically demanding, and infection-related risk remains incompletely defined. This systematic review and meta-analysis address the research question: "In adults undergoing THA after childhood septic arthritis of the hip, what is the incidence of post-THA infection, revision, and mechanical/neurologic complications?" We systematically reviewed and meta-analyzed outcomes after THA in patients with septic hip arthritis diagnosed at ≤18 years. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 31 December 2025 (PRISMA). Eligible studies reported THA outcomes after childhood septic arthritis and met a Methodological Index for Non-Randomized Studies (MINORS) threshold (≥9). A random-effects meta-analysis of events per hip was performed. Results: Nine studies were included; eight contributed to the quantitative synthesis (343 hips). The pooled incidence of any post-THA infection was 1.55% (95% CI 0.38-3.48; I2 = 23.8%; 5/343); when microbiology was available, no relapse due to the index organism was reported and events were classified as new infections. The pooled incidence of revision for any cause was 4.99% (95% CI 2.27-8.70; I2 = 43.4%; 15/334). Non-infectious complications were clinically relevant, including intraoperative fracture (6.95%) and nerve palsy (4.84%). Evidence was limited by retrospective designs and heterogeneous reporting. Conclusions: THA after childhood septic hip arthritis demonstrates a low risk of postoperative infection, with relapse of the original pathogen appearing rare in carefully selected quiescent cases, but a clinically meaningful burden of mechanical and neurologic complications. These findings underscore the importance of careful preoperative assessment, meticulous surgical technique, and highlight the limitations of the current evidence. The protocol was registered in PROSPERO (ID: CRD420261298181). No external funding was received.

Flexible cystoscopy is a common urological procedure with a low infectious risk. Current guidelines recommend selective rather than routine antibiotic prophylaxis (AP), reserving its use for patients with well-defined risk factors. However, real-world adherence to these recommendations remains uncertain. The objective was to assess adherence of urologists to guideline-directed AP use before flexible cystoscopy and to identify physician-related predictors of non-compliance. A nationwide anonymous questionnaire was distributed to all urology specialists practicing in Israel. The survey consisted of 18 structured items examining demographic, academic, and clinical characteristics, as well as AP prescribing patterns and risk-factor considerations. Descriptive statistics, chi-square tests, and multivariate logistic regression were used to evaluate associations between physician characteristics and prophylactic antibiotic use. Of 300 urologists, 75 responded (25%). Overall, 20% routinely prescribed AP for all patients undergoing cystoscopy, regardless of risk stratification. Academic rank was significantly associated with non-compliance; 41% of associate and full professors prescribed AP routinely (p = 0.012), and academic rank remained the only independent predictor on multivariate analysis (p = 0.009). Older age showed a trend toward increased non-adherence (p = 0.07), while gender, subspecialty, fellowship status, workplace, and procedure volume were not associated with prescribing practices. Guideline-based risk factors most frequently prompting AP use included immunosuppression (51%), chronic catheterization (48%), and recurrent urinary tract infections (37%). A significant number of urologists continue to prescribe AP prior to flexible cystoscopy, contrary to guideline recommendations. Academic rank was the strongest predictor of non-adherence, potentially reflecting workflow pressures and habitual practice patterns. Improved awareness, stewardship initiatives, and standardized protocols may enhance evidence-based AP utilization and reduce unnecessary antibiotic exposure.

Abstract Transvenous and epicardial pacing in children carries significant risks of lead failure and infection. Leadless pacing is an alternative with lower risks of infection, lead failure, and longer battery longevity. A retrievable leadless pacemaker was implanted in an 8-year-old, 24 kg patient with heart block. A systematic review evaluated procedural success and the safety of leadless pacemakers in preadolescents weighing less than 30 kg.

ABSTRACTBackgroundGastrointestinal (GI) parasitic infections are a common health concern in captive snakes, potentially affecting their well‐being. This study aimed to determine the prevalence and associated risk factors of helminth and protozoan infections in venomous and non‐venomous snakes.MethodsA total of 174 faecal samples were collected from venomous and non‐venomous captive snakes housed at the Venom Research Centre of Chattogram, Bangladesh, between September 2024 and January 2025. Venomous snakes were housed individually in climate‐controlled terrariums and received biannual deworming; faecal samples were collected six months post‐treatment. In contrast, non‐venomous snakes were not dewormed and were kept either individually in climate‐controlled terrariums or group‐housed in unregulated terrariums. All collected faecal samples underwent routine coproscopy to identify the eggs and oocysts of helminths and protozoan parasites.ResultsResults demonstrated that the overall prevalence of GI parasitic infections was 39.1% (95% CI: 31.8–46.8). Helminths were significantly more prevalent (100%) than protozoa (8.8%). Non‐venomous snakes exhibited a higher prevalence of parasitic infections (70.8%) than venomous snakes (34%). Multiple infections were more common in non‐venomous snakes (76.5%) than in venomous snakes (47.1%). Nematodes were the most frequently detected helminths (91.2%), while Cestodes were found only in venomous snakes. Among venomous snakes, Ophiophagus hannah had the highest infection rate (66.7%), while among non‐venomous species, Python molurus and Ptyas mucosa showed the highest prevalence (80%). Risk factor analysis revealed that juveniles had significantly higher odds of infection (aOR = 2.55, p = 0.005), while snakes housed in controlled terrariums had lower infection risks (aOR = 0.143, p = 0.001).ConclusionThis study provides the first record of GI parasitic infections in venomous and non‐venomous captive snakes in Bangladesh, highlighting the need for regular monitoring and appropriate therapeutic measures to mitigate their impact.

Estimating the transmissibility of asymptomatic Mycobacterium tuberculosis infection can clarify its contribution to tuberculosis (TB) spread. We conducted a prospective cohort study in Lima, Peru, enrolling index TB patients and their household contacts (HHCs) and classifying patients by the presence of symptoms including cough, night sweats, weight loss, or fever. We followed HHCs with serial tuberculin skin testing and clinical evaluations. Among 4,296 child HHCs, adjusted estimates for baseline infection (prevalence ratio 0.62 [95% CI 0.37-1.03]), incident infection at 6 months (hazard ratio (aHR) 0.63 [95% CI 0.27-1.49]), and TB disease during 1 year of follow-up (aHR 0.74 [95% CI 0.35-1.56]) were all consistent with lower risk for infection and disease progression among HHCs of asymptomatic compared with symptomatic index patients. Although asymptomatic infections may be less transmissible than symptomatic infections, the high prevalence of asymptomatic patients in national surveys suggest that they may contribute substantially to transmission.

The aim of the study was to determine the incidence of COVID-19 infection among healthcare workers (HCWs) at Reina Sofia University Hospital (RSUH) in Cordoba, Spain, from the first to the sixth wave of the pandemic. Additionally, we analysed the characteristics of infections across different age groups, genders, professional categories, hospital services, and COVID-19 vaccination status. An observational, longitudinal, analytical, and retrospective study was conducted, considering characteristics of person, time, HCWs category, and diagnostic test. The results of the tests of RSUH HCWs between March 2020 and March 2022 were analysed. Socio-demographic and clinical data were collected from the Alert Network of the Epidemiological Surveillance System of Andalusia. The study included 6,794 HCWs, of whom 1,513 (22.3%) tested positive for COVID-19. The distribution of COVID-19 cases among HCWs across the six waves was as follows: first wave - 150 cases (9.9%), second wave - 597 cases (39.4%), third wave - 225 cases (14.9%), fourth wave - 24 cases (1.6%), fifth wave - 121 cases (8%), and sixth wave - 396 cases (26.2%). The mean age of confirmed cases was 46.32 years (SD = 11.53), with a lower infection risk among HCWs aged 61-70 years. Only 16.9% of cases had received two vaccine doses at the time of infection. Nursing was the most affected professional category (30%). COVID-19 infection risk varies by age and HCWs category, decreasing in older HCWs but increasing among residents and certain specialties. During the Omicron variant's dominance, vaccines seemed less effective in reducing transmission. Health education programmes for both patients and HCWs are necessary to limit the spread of the disease.

Antibiotic resistance represents a major public health problem driven by inappropriate antimicrobial use. Cystoscopy is a common urological procedure associated with a low risk of urinary tract infection (UTI), and the role of routine antibiotic prophylaxis remains controversial. To evaluate the effectiveness of antibiotic prophylaxis in preventing post-cystoscopy UTI. A prospective observational comparative study including 297 patients undergoing outpatient cystoscopy. Patients were assigned to Group A (no prophylaxis, n=161) and Group B (cefuroxime 500 mg prophylaxis, n=136). Urine cultures were obtained one hour before and one week after cystoscopy. Significant bacteriuria was defined as >104 CFU/ml. Risk factors were analyzed according to current literature. Fisher's exact test and multivariate logistic regression were performed. Statistical analysis was performed using SPSS/R. UTI occurred in 5.59% of patients without prophylaxis and 5.88% with prophylaxis (p=1.00). Antibiotic prophylaxis did not reduce infection risk (OR 0.95; 95% CI 0.36-2.53). Baseline characteristics and risk factors were similar betweengroups. No independent predictor reached statistical significance. Routine antibiotic prophylaxis does not reduce post-cystoscopy UTI incidence in low-risk patients, supporting restrictive and rational antimicrobial use.

PurposeProstate biopsy is the reference standard for confirming prostate cancer in men with clinical suspicion. The transrectal (TR) route is widely used but carries a risk of infectious complications and may sample anterior regions less effectively. Transperineal (TP) biopsy has emerged as a safer alternative with lower infectious risk. However, real-world comparative evidence between the routes is limited in some settings. The objective is to compare the diagnostic yield, tissue quality, and complications of systematic TR versus TP prostate biopsy in a Moroccan tertiary center.MethodsIn this retrospective study, 139 men with suspected prostate cancer underwent systematic biopsy via TR or TP biopsy. Analyses were restricted to systematic cores. Biopsy quality was assessed by median core length. Complications were graded using the Clavien–Dindo classification.ResultsA total of 139 men underwent systematic biopsy. Baseline clinical characteristics were similar across most variables, except DRE, between groups. TP yielded a longer median core length than TR (p = 0.02). In contrast, detection rates of clinically significant prostate cancer (csPCa) were similar (40.3% for TR vs 38.9% for TP). Several clinical factors were associated with csPCa detection, including higher PSA, higher PSA density, suspicious DRE, and higher PI-RADS category. In contrast, anterior lesion location was associated with a lower risk of csPCa. Regarding complications, infectious complications were more common after TR biopsy (7.5% compared to 1.4%). Additionally, acute urinary retention was seen in 6.0% of TR cases and 8.3% of TP cases. No Clavien–Dindo grade III or higher events were reported.ConclusionTP systematic biopsy provides csPCa detection comparable to TR biopsy, yields longer cores, and shows a lower observed rate of infectious complications, supporting TP adoption to reduce infectious morbidity without compromising diagnostic performance.

PurposeAdolescent idiopathic scoliosis (AIS) is the most common spinal deformity in children. While posterior spinal fusion is the standard treatment for curves ≥45°, anterior vertebral body tethering (VBT) has emerged as an alternative for some patients. This study explores the experiences of patients who underwent VBT, focusing on decision-making, recovery, and long-term concerns.Patients and MethodsSemi-structured interviews were conducted with twenty patients diagnosed with progressive AIS and a spinal deformity less than 60° at the time of surgery. All participants underwent VBT, completed three years of follow-up, and had reached skeletal maturity. Recruited from a single orthopaedic institute and treated by the same physician, participants averaged 18 years of age, 85% were women. Interview transcripts were analyzed using collaborative content analysis.ResultsKey decision-making factors included pain, worsening condition, brace use, and concerns about appearance. VBT was preferred over fusion due to perceived benefits such as preserved flexibility, less invasiveness, shorter recovery, and lower risk of infection. Decisions were also influenced by family, physicians, and experiences of others. Recovery experiences were mixed. Some participants described difficult early recovery but felt positive overall; others recalled prolonged pain and physical limitations. Most reported reduced anxiety post-surgery, though concerns about long-term effects and future surgeries remained.ConclusionThis study offers insight into the lived experience of individuals who underwent VBT and underscores the importance of patient-centered care in surgical decision-making and recovery. Findings highlight opportunities to support patients considering VBT versus fusion and the need for comparative effectiveness studies focused on long-term outcomes and quality of life.

Periprosthetic joint infection (PJI) remains a severe complication in arthroplasty. Unicompartmental knee arthroplasty (UKA) may have lower PJI rates than total knee arthroplasty (TKA) because of smaller implants and less extensive surgical exposure. However, PJI treatment after UKA is challenging due to restricted debridement and limited options for local antibiotic delivery. This study compared the revision rate for PJI and the failure rate of implant-retaining revision for PJI between UKA and TKA in the Swiss national joint registry (SIRIS). A retrospective analysis was conducted using SIRIS data from 2012 to 2024, examining the first revision after primary UKA or TKA and the re-revision rate after debridement with isolated inlay exchange for PJI. Both analyses assessed revisions for any cause and specifically for PJI. Kaplan-Meier survival curves and hazard ratios (HR) were calculated. Among 35’286 primary UKA and 188’952 primary TKA, 149 and 1’546 were revised for PJI, respectively. Revision rates for any cause were higher for UKA than TKA (HR 1.29, p < 0.001), whereas PJI-related revisions were about half as frequent (HR 0.53, p < 0.001). Following implant-retaining revision for PJI, repeat revision rates increased more rapidly for UKA than TKA, reaching 34.8% and 32.1%, respectively (HR 1.56, p = 0.099). The statistical precision for UKA was limited by small numbers. In SIRIS, the revision rate for PJI after primary UKA was about half that after primary TKA, while the revision rate for any cause was higher. These findings support the hypothesis that smaller implants and less extensive surgery may be associated with lower infection risk. Despite limited debridement options, implant-retaining revision for PJI after UKA was as successful as after TKA. Nonetheless, failure rates for such procedures remain high in Switzerland, at roughly one-third.

Device Infection Using Chlorhexidine Irrigation vs an Antibacterial Envelope: A Propensity Score-Matched Analysis.