Open reduction and internal fixation vs acute total hip arthroplasty for geriatric acetabular fractures: A multicenter matched cohort study.

Failure modes of mechanically aligned versus kinematically aligned total knee arthroplasty.

The re-infection rate over time following two-stage revision knee arthroplasty for peri-prosthetic joint infection: A retrospective review of 130 knees at minimum 4-year follow-up.

Hip resurfacing arthroplasty (HRA) is a femoral bone-preserving alternative to total hip arthroplasty (THA) for younger, active patients. However, complications such as fractures, loosening, and metal wear can require conversion to THA. In some cases, revision of both the acetabular and femoral components is required. We conducted a retrospective review of 15 patients who underwent conversion of HRA to THA at a single, academic tertiary care centre between January 2011 and April 2024. Demographic data, surgical details, implant characteristics, and indications for conversion were collected. Postoperative outcomes including complications, reoperations, and revisions were investigated. Revision-free survival was estimated using Kaplan-Meier analysis. The mean age was 53.2 years and mean time to conversion was 6.7 years. Indications for conversion included adverse reaction to metal debris (ARMD; n = 6), mechanical loosening (n = 3), component positioning and impingement (n = 3), periprosthetic fracture (n = 1), osteolysis/wear (n = 1), and prosthetic joint infection (PJI; n = 1). Common reasons for acetabular cup revision included ARMD (n = 6), loosening (n = 4), and positioning (n = 3). Dual-mobility (DM) constructs were used in 11 cases (73.3%). There were no dislocations. There was 1 90-day readmission due to persistent wound drainage which underwent debridement, antibiotics, and implant retention (DAIR) 14 days post-conversion. The average follow-up duration after the conversion procedure was 6.1 years. Kaplan-Meier analysis demonstrated 93% revision-free survival at one-year, which remained stable through 13 years. In this study of 15 both-component HRA conversions, we observed 93% revision-free survivorship at mid-term follow-up. While the small cohort size limits definitive conclusions, our findings suggest that revision of the acetabulum during conversion, particularly with dual-mobility constructs, may be an effective strategy to mitigate instability and manage metal-on-metal failure in appropriate patients. Further research with larger cohorts is warranted to confirm our findings.

Tsukamurellaspecies are rare environmental aerobic actinomycetes that are increasingly recognized as opportunistic human pathogens, particularly among immunocompromised patients and those with indwelling medical devices. This review aims to summarize the clinical spectrum, diagnostic methodologies, patterns of antimicrobial resistance, and treatment outcomes associated with human Tsukamurellainfections. A narrative review of published case reports, case series, and microbiological studies was conducted, emphasizing clinical manifestations, laboratory identification, antimicrobial susceptibility, and therapeutic interventions. The available evidence indicates that catheter-related bloodstream infections are the most frequently reported presentations; however, pulmonary, ocular, cutaneous, endocardial, central nervous system, peritoneal, and prosthetic joint infections have also been documented. Diagnosis remains challenging, as Tsukamurellacan be misidentified by conventional methods; precise identification often necessitates advanced techniques such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S ribosomal ribonucleic acid (16S rRNA) gene sequencing. Successful management typically involves prolonged targeted antimicrobial therapy and the removal of infected devices. In conclusion, Tsukamurellais an under-recognized pathogen, and standardized diagnostic and susceptibility-testing protocols, along with larger clinical studies, are essential to enhance patient management.

Microbes are increasingly used as living therapeutics, yet their uncontrolled dissemination in the body has remained a clinical roadblock. Physical containment remains largely unattainable owing to eventual bacteria escape. In this work, we present an implantable material that encapsulates and confines bacteria, wherein synthetically engineered microbes produce therapeutic payloads from within. We developed a hydrogel scaffold with dual mechanical features: high stiffness to regulate bacterial proliferation and high toughness to resist material fracture under physiological stress. This design achieved complete bacterial containment for 6 months and withstood multiple forms of mechanical loading that otherwise caused catastrophic material failure. By genetically engineering embedded bacteria, we endowed the material with environmental sensing and on-demand therapeutic release capabilities and demonstrated autonomous treatment in a murine prosthetic joint infection model.

Incidence of Early Periprosthetic Hip Fractures in Patients Over Age 70 Years Following Primary Total Hip Arthroplasty Using a Novel Triple-Tapered Collared Femoral Stem.

Orthopedic infections, including osteomyelitis and prosthetic joint infection (PJI), are complicated clinical problems that urgently need to be paid attention to and solved. Clinically, antibacterial drug-loaded bone cement (ALBC) has been frequently used to treat localized orthopedic infections because of its strong local antimicrobial activity. While, ALBC faces the problem of poor therapeutic effect in clinical applications due to the development of bacterial resistance to antimicrobial drugs, as well as the limitations in the bone cement's mechanical properties and drug release properties. Numerous research efforts are currently underway to create new composite bone cement by combining the use of a wide range of antimicrobial drugs, optimizing the preparation process of bone cement, introducing new antimicrobial agents and innovative materials to overcome the shortcomings of the conventional ALBC, expanding its potential for clinical use. However, the majority of related studies are performed on the in vitro level, and additional in vivo experimental data are required to confirm their efficacy and safety. This review summarizes the development of ALBC, with a focus on the research progress and innovative breakthroughs in drug selections, drug release mechanisms, and clinical applications, which is expected to provide a reference for the in-depth investigation of multifunctional bone cement and multidisciplinary cross-collaboration, as well as to expand the potential of bone cement for clinical applications.

Do Wound Protectors Reduce Contamination in Total Shoulder Arthroplasty? A Randomized Controlled Trial.

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) and its management with two-stage exchange arthroplasty can lead to notable femoral and tibial bone loss, further complicating subsequent reconstruction. This study aims to characterize the extent of bone loss in two-stage TKA revision for infection and assess the effect of reimplantation timing on bone loss progression. We conducted a retrospective cohort study of patients who underwent a two-stage TKA revision for PJI between 2007 and 2022. The primary outcome was the degree of bone loss between the index and reimplantation procedures, and whether it was influenced by the rate of timing of reimplantation. Patients undergoing single-stage revisions were excluded. A total of 160 patients met the inclusion criteria. Bone loss was characterized using the Anderson Orthopaedic Research Institute (AORI) classification (1/2A/2B/3) before the index procedure and after reimplantation, with progression defined as an increase in AORI classification. Among the 160 patients, 100 (62.5%) experienced bone loss progression. This included 19 patients (11.9%) with a progression score of 1, 75 patients (46.9%) with a progression score of 2, and six patients (3.75%) with a progression score of 3. A higher AORI score at the index procedure showed a statistically significant association with bone loss progression (P < 0.001). Time to reimplantation was statistically significant (P = 0.034), with patients progressing from AORI 1 to AORI 3 experiencing the longest reimplantation interval (mean: 147 days). No notable differences were observed in revision surgery rates, time to revision surgery, infection eradication rates, or baseline medical comorbidities across progression groups. This study demonstrates that two-stage revision TKA for PJI is associated with a notable degree of bone loss, particularly in cases of delayed reimplantation. These findings emphasize the importance of timely reimplantation, or other strategies, to mitigate bone loss and surgical complexity.

Arthroscopic Treatment Shows Noninferior Outcomes to Open Treatment for Native Glenohumeral Septic Arthritis: A Systematic Review.

Abstract Introduction Daptomycin is a lipopeptide antibiotic commonly used to treat infections caused by Gram-positive bacteria resistant to other antibiotics, including prosthetic joint infections. Pulmonary toxicity is a rare but recognized complication, most often manifesting as eosinophilic pneumonia. However, daptomycin-induced lung injury can also occur without eosinophilia, which may complicate diagnosis. We present a case of daptomycin-induced lung injury presenting with hypoxemic respiratory failure and radiographic infiltrates, but without peripheral or bronchoalveolar lavage (BAL) eosinophilia. Case Description A 64-year-old male with hypertension, obesity, polymyalgia rheumatica, and multiple prior left knee surgeries was treated for prosthetic joint infection with intravenous daptomycin and rifampin, intended for a 42-day course. Three weeks into therapy, he developed fever, cough, dyspnea, and hypoxemia requiring hospitalization. Chest CT revealed bilateral upper-lobe predominant ground-glass and reticular opacities. Empiric antibiotics (cefepime and vancomycin) were initiated, and daptomycin was discontinued due to suspected drug-induced lung injury. Bronchoscopy showed thick secretions; cultures were negative, and BAL analysis demonstrated monocyte predominance without eosinophils. The patient was discharged on home oxygen and a tapering course of prednisone (starting at 50 mg, tapered to 5 mg). At two-month outpatient follow-up, he reported gradual improvement in dyspnea and dry cough, with near-complete radiologic resolution of infiltrates. His staphylococcal prosthetic joint infection was managed with intravenous vancomycin, which was subsequently discontinued. Discussion This case underscores that daptomycin-induced lung injury can occur in the absence of eosinophilia. While eosinophilic pneumonia is the most commonly recognized pulmonary toxicity associated with daptomycin, there is increasing evidence that lung injury may present without peripheral or BAL eosinophilia. Diagnosis in this patient was based on the temporal association with daptomycin exposure, characteristic radiographic findings, exclusion of infectious etiologies, and clinical improvement following drug discontinuation and corticosteroid therapy. The monocyte-predominant BAL pattern in this case suggests that daptomycin-induced lung injury may involve other immune pathways or direct cytotoxic effects, rather than eosinophilic infiltration alone. This case adds to the growing body of literature indicating that the absence of eosinophilia does not exclude the diagnosis of daptomycin-induced lung injury. Conclusion Daptomycin-induced lung injury should be considered in patients presenting with new pulmonary infiltrates and hypoxemic respiratory failure during therapy, even when eosinophilia is absent. Diagnosis relies on clinical suspicion, temporal relationship to daptomycin exposure, and exclusion of other causes. Prompt discontinuation of daptomycin and initiation of corticosteroid therapy are essential for recovery. This abstract is funded by: None

Biomimetic pore-throat engineered ultrahigh molecular weight polyethylene with sustained tea polyphenol release for infection-resistant joint implant material.

Bone and joint infections (BJIs) are complex and difficult to eradicate, and have high relapse rates and limited oral treatment options. Tetracyclines combine favorable bone penetration, oral bioavailability, and activity against multidrug-resistant (MDR) pathogens, but their clinical role in BJIs remains unclear. This study aimed to summarize experimental and clinical evidence on tetracyclines in the management of BJIs, including pharmacology, antimicrobial activity, clinical efficacy, and guideline recommendations. We performed a literature review of PubMed® (1960-2024) for animal, pharmacokinetic, and clinical studies evaluating tetracyclines in BJIs. Data on bone distribution, anti-biofilm activity, clinical outcomes, tolerability, and recommendations were extracted and synthesized. Tetracyclines display strong bone affinity but inconsistent tissue concentrations in experimental models. In vitro and in vivo studies suggest anti-biofilm activity, particularly in combination with rifampicin, although monotherapy is insufficient. Two randomized controlled trials reported inferior outcomes compared with standard regimens. Observational studies of minocycline and tigecycline demonstrated variable efficacy (40-80%), with better outcomes in salvage therapy for MDR infections, but frequent gastrointestinal intolerance. Data on omadacycline remain limited to a single small cohort. Tetracyclines are recommended in guidelines for zoonotic infections (e.g., Brucella) and as long-term suppressive therapy in selected prosthetic joint infections, but evidence is weak compared with other agents, especially fluoroquinolones. Tetracyclines may provide therapeutic options for refractory or MDR-related BJIs, and for suppressive therapy when surgical or antibiotic alternatives are limited. However, available data are heterogeneous and largely observational. Robust prospective studies are needed to clarify their role, particularly for newer agents such as omadacycline and eravacycline.

In PJI revision surgery, prolonged wound drainage (PWD) is a common concern associated with increased periprosthetic joint infection (PJI), yet no clinical guidelines exist, guiding when intervention should occur. This study aimed to quantify the association between PWD and treatment failure following hip PJI surgery, and which factors were associated with those results. A retrospective cohort study of hip PJI patients was conducted from March 2019 to January 2023. Univariate and multivariate logistic regression was performed to identify risk factors associated with PWD and failure of treatment (per modified Delphi criteria) Statistical significance was considered for p<0.05. 164 patients were identified: 98 women (59.8%) and 66 men (40.2%), with a mean age of 69.3±13.9 years, Univariate analysis demonstrated that wound leakage duration was associated with treatment failure (OR:1.1, 95% CI 1.0-1.1, p=0.0024). Multivariate analysis demonstrated that leakage >14 days was the strongest predictor of treatment failure (OR 2.8, 95% CI 1.3-6.0, p=0.0064) Factors associated with leakage >14 days included malnutrition (p=0.0042), number of previous PJI surgeries (p=0.0214), and McPherson host grade 2 (p=0.0230). Gram-negative (p= 0.0266) and polymicrobial hip cultures (p=0.0128) were also associated with prolonged leakage. Univariate associations remained significant with multivariate analysis. Wound drainage >14 days is associated with an elevated risk of failure after PJI surgery. Surgeons should consider early repeat surgery on patients with PWD by twoweeks following PJI revision surgery. Previous PJI surgery and malnutrition are risk factors for PWD and should prompt early consultation with nutritional services.

Unicompartmental knee arthroplasty (UKA) is an option for unicompartmental osteoarthritis. With medial or multicompartment joint wear being the most common clinical scenarios, lateral UKA (L-UKA) is less commonly considered than other knee joint arthroplasty procedures. As such, the postoperative outcomes of L-UKA relative to medial UKA (M-UKA) and total knee arthroplasty (TKA) remain poorly characterized at a national level in the United States. Patients undergoing L-UKA were identified from the PearlDiver M170Ortho Database and separately matched 1:4 with M-UKA and TKA patients by age, sex, and Elixhauser Comorbidity Index. Multivariable logistic regression compared 90-day adverse events, emergency department visits, readmissions, and 5-year implant-related issues. First, 343 L-UKAs were assessed relative to 1,295 M-UKAs. L-UKA demonstrated higher odds of 90-day severe adverse events (odds ratio [OR], 1.83; P = 0.037), infection (OR, 1.41; P = 0.022), wound dehiscence (OR, 3.60; P = 0.008), readmission (OR, 1.67; P = 0.047), and 5-year prosthetic joint infection (OR, 2.57; P = 0.001). Second, 425 L-UKAs were assessed relative to 1,700 TKAs. L-UKA demonstrated higher odds of 90-day wound dehiscence (OR, 2.13; P = 0.025), 5-year prosthetic joint infection (OR, 1.64; P = 0.028), and revision (OR, 2.00; P = 0.007), but lower odds of 5-year stiffness (OR, 0.45; P < 0.001). In the first study of L-UKA using national-level US data, L-UKA demonstrated mixed outcomes compared with both M-UKA and TKA. While L-UKA demonstrated lower stiffness rates than TKA, the elevated risk of 90-day postoperative complications and inferior 5-year revision-free survival suggest the need for careful consideration of L-UKA and future prospective analysis to further elucidate whether these associations can be generalized across surgeons with differing case volumes.

BackgroundConflicting evidence exists regarding the ability of surgical helmet systems (SHSs) to reduce rates of infection after joint replacement. The purpose of this study was to investigate the use of SHS in total ankle arthroplasty (TAA) and their effect on postoperative infection rates.MethodsA retrospective cohort study was conducted on patients who underwent elective primary TAA between January 2013 and June 2023 in a US private academic setting to compare rates of surgical site infection with and without the use of an SHS. Demographic characteristics, revision rates, superficial and deep infection, and their respective operative or nonoperative treatment, patient-reported outcome measures (12-Item Short Form Health Survey physical component summary [PCS], Foot and Ankle Ability Measure [FAAM], visual analog scale [VAS]), and implant survivorship were collected and compared between groups.ResultsA total of 938 patients who underwent primary TAA at our institution were included in this study, with 496 (52.9%) in the hood group and 442 (47.1%) in the conventional gown group at a mean follow-up of 6.8 (range: 2-12.5) years. There were no significant differences found between the use of a surgical hood vs conventional gowning with regard to overall surgical site infection (5.24% vs 4.98%, P = .972) and deep prosthetic joint infection (2.62% vs 2.71%, P = 1.000). A multivariable logistic regression model controlling for age, body mass index, tobacco use, and diabetes found no association between the use of surgical hoods and surgical site infections after TAA (OR = 1.12, P = .710). Furthermore, no differences in FAAM, VAS, PCS, or implant survivorship were found between groups.ConclusionAlthough SHS may provide additional protection for the surgeon from being contaminated during the surgery, the use of surgical hoods was not associated with a protective effect against surgical site infection. Considering the disadvantages and added costs of SHS, the decision to wear hoods during TAA is therefore left to the individual surgeon's discretion and personal preference.

Aim: Prosthetic joint infections (PJIs) are severe complications of joint arthroplasty, and their management has become increasingly complex in the era of antimicrobial resistance. This study aimed to evaluate the microbiological characteristics and clinical outcomes of PJIs in a high-resistance clinical setting. Material and Methods: This retrospective study included 74 patients diagnosed with PJI between January 2019 and June 2022 at a tertiary care hospital. Microbiological findings, antimicrobial resistance patterns, treatment outcomes, recurrence, and mortality were analyzed. Results: Microbiological growth was detected in 75.0% (n=54) of cases; 25.0% (n=18) were culture-negative. Among the 84 isolated pathogens, gram-negative bacteria accounted for 55.9% (n=47) and predominated particularly in early-onset infections. Staphylococcus aureus was the most frequently identified pathogen; however, carbapenem-resistant gram-negative organisms were common and were significantly associated with treatment failure (p=0.004) and mortality (p=0.011). Polymicrobial infections (35.2%, n=19) were independently associated with recurrence (p=0.001) and increased the odds of mortality (OR=7.91, 95% CI=1.42-52.61, p=0.017). Treatment success was significantly higher in patients with primary knee prostheses compared with hip or revision prostheses (p=0.029). Conclusion: PJIs in this study were characterized by a high burden of gram-negative and multidrug-resistant pathogens. Carbapenem resistance and polymicrobial etiology were key determinants of adverse outcomes, emphasizing the critical role of local antimicrobial resistance surveillance in guiding empirical treatment decisions.

Abstract Background Managing Gram-positive infections that require prolonged intravenous (IV) antibiotic therapy poses a significant challenge for healthcare sustainability. Long-acting lipoglycopeptides (LALs) have shifted this paradigm by enabling potential outpatient management. However, further real-world evidence is needed to confirm their efficacy in complex non-Acute Bacterial Skin and Skin-Structure Infection (ABSSSI) indications and to quantify their total pharmacoeconomic impact-including indirect costs-within a structured Day Hospital (DH) setting. Methods This retrospective multicenter study was conducted across several Italian specialized centers, including adults treated with dalbavancin or oritavancin. The primary endpoint was clinical cure, defined as infection resolution without requiring additional IV therapy. The pharmacoeconomic analysis compared the observed DH model against a counterfactual inpatient Standard of Care (SoC) scenario. Direct costs (drug acquisition, bed-day costs, and DRG tariffs) and indirect costs (productivity loss and healthcare-associated infections [HAIs]) were analyzed for the clinically cured cohort. Results 108 patients were enrolled (62% male; median age 66.5 years; median Charlson Comorbidity Index of 3). Indications included ABSSSI (47.2%) and complex off-label infections (52.8%), such as osteomyelitis/spondylodiscitis (24%), prosthetic joint infections (18.5%), and endocarditis (7.4%). The overall clinical success rate was 86.9%, with no significant difference between registered and off-label indications (P = 0.57). Failure was not associated with age, comorbidity, diabetes, or pathogen (MRSA versus MSSA; P= 0.93). Adverse events were rare (4%) and mild; renal function remained stable, and TDM was avoided in 94%. This model replaced 1652 inpatient bed-days with 167 outpatient visits, generating a net direct healthcare saving &amp;gt;€629 000. By avoiding hospitalization for the working-age cohort (n = 45), the model prevented an estimated 502 lost workdays, equivalent to €119 647 in retained productivity. The protocol prevented an estimated 7.2 healthcare-associated infections, avoiding an additional €36 000-€76 000 in direct management costs (Table 1). Conclusions A LAL-based Day Hospital model is clinically non-inferior to inpatient care while being significantly superior in terms of operational and economic efficiency. This strategy optimizes critical hospital bed occupancy, drastically reduces direct expenditures, and mitigates the socioeconomic burden of chronic infections, serving as a fundamental pillar for modern Antimicrobial Stewardship programs. Table 1.Pharmacoeconomic analysis comparing resource utilization, direct medical costs, and estimated secondary outcomes between the observed Long-Acting Lipoglycopeptide (LAL) Day Hospital pathway and a counterfactual Standard of Care (SoC) inpatient pathway for the cohort of 88 clinically cured patients.CategoryParameterStandard of Care (SoC)LAL Day Hospital (DH)Difference/SavingsResource UtilizationInpatient bed-days1, 6520−1, 485 bed-daysDay Hospital visits0167Direct CostsHospitalization cost (€600/day)€99 1,20€0LAL Drug acquisition cost€0€33 6,86DH Administration visits (€150/visit)€0€2 5,05Total Direct Costs€99 1,20€36 1,91€62 9,29Indirect Secondary CostsProductivity loss (502 workdays)€11 9,65€0€11 9,65HAI Management costs (estimated)€36,000—€76,000€0€36,000—€76,000Resource Utilization: Inpatient bed-days for the SoC arm were estimated based on literature-derived mean Length of Stay (LoS) specific to each infection type (e.g., 10 days for ABSSSI, 21–28 days for osteoarticular infections).Costs: Direct costs were calculated using conservative national estimates: €600 per inpatient bed-day, €3 828 per LAL treatment course (drug acquisition), and €150 per DH administration visit.Secondary Outcomes: The number of avoided HAIs was estimated by applying the national prevalence rate of 8.2% (ECDC data) to the 88 patients who avoided hospitalization. The cost per HAI was conservatively estimated at €50 000. ‘Workdays Lost’ refers to the estimated productivity loss for the subgroup of 45 patients of working age (&amp;lt;65 years), assuming the duration of lost work would equal the estimated length of inpatient stay.

Abstract Background Osteoarticular tuberculosis (TB) is a rare but serious manifestation of extrapulmonary TB. Despite improvements in imaging and microbiological diagnostics, bone TB remains challenging to identify because its clinical presentation is often nonspecific. While the spine and knee are the most frequently affected sites, involvement of less typical skeletal locations can occur, further complicating timely diagnosis. Methods We retrospectively reviewed all cases of bone TB diagnosed at the ‘Malattie Infettive e Ortopedia Settica’ Department—ATS Liguria, Savona area, from 2022 to 2025. Diagnostic confirmation relied on imaging, histopathology, culture, and polymerase chain reaction (PCR) testing for Mycobacterium tuberculosis. Results Eight patients (6 males, 2 females; mean age 50 years) were identified. Three were Italian, and five were foreign-born. Two patients had vertebral TB: an 80-year-old Ukrainian woman and a 25-year-old Gambian man. Both developed paraparesis requiring surgical stabilization; intraoperative cultures confirmed the diagnosis. Two patients (aged 19 and 23) presented with chronic knee arthritis. Initial arthrocentesis cultures and PCR were negative. Diagnosis was achieved through surgical biopsy; in one case, culture remained negative, but histopathology revealed necrotizing granulomas with Langhans giant cells, and PCR on the histological piece identified M. tuberculosis. A 75-year-old Italian woman with diabetes developed a tuberculous prosthetic joint infection, confirmed by synovial fluid culture. An 86-year-old Italian man with squamous cell carcinoma had mandibular TB diagnosed by bone biopsy, along with concurrent pulmonary TB. A 74-year-old Italian man presented with wrist pain and a draining fistula; bone culture was positive for M. tuberculosis. A 14-year-old boy had ankle inflammation and cervical lymphadenopathy; bone biopsy confirmed TB. All patients tested positive on the QuantiFERON-TB Gold assay. Only one had pulmonary involvement, and one had lymph node disease. All isolates were susceptible to first-line drugs. Treatment typically lasted 12 months, although one patient discontinued therapy after eight months due to hepatotoxicity. Conclusions Bone TB should be considered in cases of chronic osteoarticular infection, even in non-endemic settings and when atypical anatomical sites are involved. Diagnostic accuracy improves when culture, histopathology, and molecular testing are combined. Early recognition and multidisciplinary management are essential to optimize outcomes.