Septic arthritis of the hip caused by Campylobacter fetus subsp. fetusis very rare. The authoris isolated C. fetus subsp. fetus from a specimen of the left hip. The patient was a 53-year old man with a history of heavy drinking, diabetes, and chronic hepatitis, and had been suffering from avascular necrosis of both femoral heads. It was considered that the organism invaded already damaged tissue of the joint. The patient was treated with intravenous antibiotics and later received successful total hip replacement.
Arthritis, Infectious/*etiology ; *Campylobacter Infections ; Campylobacter fetus/*isolation & purification ; Case Report ; Femur Head Necrosis/etiology ; Hip/*microbiology ; Human ; Male ; Middle Age

INTRODUCTIONThe Singapore General Hospital Bone Bank, which exclusively stores femoral head allografts, relies on flash sterilisation to prevent allograft-related disease transmission and wound infection. However, intraosseous temperatures during autoclaving may be lower than required to eliminate human immunodeficiency virus, and hepatitis B and C viruses. The aim of this study is to determine the intraosseous temperatures of femoral head allografts during autoclaving and to assess the adequacy of autoclaving in preventing disease transmission.

METHODSSix femoral heads were acquired from patients who underwent hip arthroplasty. The specimens were divided into two groups. The first group underwent flash sterilisation with a sterilisation time of 4 min, while a longer sterilisation time of 22 min was used for the second group.

RESULTSThe highest core temperature in the first group was 130°C, while the core temperatures in the second group plateaued at 133°C for all allografts. In the first group, only smaller allografts maintained temperatures sufficient for the inactivation of the clinically relevant viral pathogens. In contrast, all allografts in the second group were terminally sterilised.

CONCLUSIONThere is an inverse correlation between the size of allografts and intraosseous temperatures achieved during autoclaving. Therefore, we recommend dividing large allografts into smaller pieces, in order to achieve intraosseous temperatures adequate for the elimination of transmissible pathogens during flash sterilisation. Allografts should not be terminally sterilised, as the resulting allografts will become unusable. Despite modern processing techniques, stringent donor selection remains vital in the effort to prevent allograft-related infections. Autoclaving is an economical and efficacious method of preventing allograft-related disease transmission.

Allografts ; Blood-Borne Pathogens ; Bone Transplantation ; instrumentation ; Disease Transmission, Infectious ; prevention & control ; Disinfection ; methods ; standards ; Equipment Contamination ; prevention & control ; Femur Head ; microbiology ; transplantation ; Humans ; Sterilization ; methods ; Temperature

We present four cases of concomitant early (modified Ficat-Arlet stage I) avascular necrosis of the femoral head and acute bacterial arthritis of the hip joint by Gram-negative enteric bacilli. This was found in immunosuppressed oncologic patients whose clinical presentations and radiological findings were not entirely specific for joint sepsis. It is important to recognise the coexistence of these two pathologies, so as to avoid a delay in diagnosis and prevent significant morbidity and mortality.
Acute Disease ; Adenocarcinoma ; complications ; microbiology ; Adult ; Arthritis, Infectious ; complications ; diagnosis ; Bacillus ; isolation & purification ; Contrast Media ; Female ; Femur Head Necrosis ; complications ; diagnosis ; Gram-Negative Bacteria ; isolation & purification ; Hodgkin Disease ; complications ; microbiology ; Humans ; Leukemia, Myeloid, Acute ; complications ; microbiology ; Lung Neoplasms ; complications ; microbiology ; Male ; Middle Aged ; Multiple Myeloma ; complications ; microbiology ; Neoplasms ; complications ; microbiology ; Risk Factors ; Young Adult

BACKGROUND: In primary total hip replacements (THRs), the dissected femoral heads (FHs) are commonly used to make the bone-chips for the reconstruction in the orthopaedic surgery. The donated FHs are routinely microbiologically cultured to identify and contaminated FHs are discarded. This study examines whether a positive FH culture predicts an infection and prosthetic failure after primary THR. METHODS: The study sampled 274 donated FHs from patients with osteonecrosis (ON), hip joint osteoarthritis (OA), and femoral neck fracture (FNF) in THR to culture the microbes. The FH contamination rates were analyzed for ON, OA, and FNF groups. Proportion of the postoperative infection or prosthetic failure in the group of donors with a positive FH culture were compared to the proportion in the group of donors with a negative FH culture. RESULTS: The rates of the positive culture in the ON, OA, and FNF groups were 7.1%, 3.8%, and 4.0%, respectively. The infection rate was found to be non-significantly greater in the ON group than in the OA and FNF groups. In the negative culture group, one patient (0.63%) had a postoperative superficial infection, and five patients (3.2%) experienced additional surgeries including a fixation for a periprosthetic fracture, within a minimum follow-up of two years. However, no postoperative infection was encountered, and no revision surgery was required in the positive culture group. CONCLUSIONS: A positive FH culture is not always associated with elevated risks of infection or prosthetic failure after THR. Therefore, such finding cannot be used as a prognostic factor of THR. The FHs that return a positive culture may not lead to the orthopaedic assessment of an infection or other postoperative complication risks in primary THR.
Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/adverse effects/*methods ; Female ; Femoral Neck Fractures/surgery ; Femur Head/*microbiology ; Humans ; Male ; Middle Aged ; Osteoarthritis, Hip/surgery ; Osteonecrosis/surgery ; Prognosis ; Prosthesis-Related Infections/*microbiology ; Staphylococcus/isolation & purification