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

BACKGROUND: The authors conducted the present study to identify clinical and radiological prognostic factors in infants and neonates with septic arthritis of the hip. METHODS: The authors retrospectively reviewed the records of 31 patients with septic arthritis of the hip. All of the patients were younger than 18 months old. Follow-up periods ranged from 5 to 17 years. The following potential variables for predicting the prognosis were included in the assessment: gender, age, underlying diseases, duration of symptoms, changes of hip joint in X-ray, concomitant osteomyelitis, elevation of erythrocyte sedimentation rate and C-reactive protein, sepsis, pus drainage, synovial fluid culture, and infecting organisms. Clinical and radiological prognoses were analyzed at the final follow-up. RESULTS: Univariate analysis demonstrated that radiological prognoses were poorer in patients who had underlying diseases, a longer duration of symptoms, and pus drainage. However, on multivariate analysis, only the variable-duration of symptoms-was found to be statistically related with a poor radiological prognosis. CONCLUSIONS: Although poor prognosis for patients with several underlying diseases and radiological changes has already been established, a favorable outcome might be expected with prompt surgical drainage and appropriate antibiotics.
Arthritis, Infectious/*diagnosis/microbiology/therapy ; Female ; Follow-Up Studies ; *Hip Joint ; Humans ; Infant ; Infant, Newborn ; Male ; Prognosis ; Retrospective Studies

OBJECTIVETo study the therapeutic effects and clinical experiences of second-stage revision in postoperative infection after total hip replacement and to explore its security and validity.

METHODSFrom January 2006 to March 2009, 17 hips in 17 patients (7 males and 10 females, ranging in age from 43 to 75 years, with an average of 58.5 years) were treated with second-stage revision. All the patients suffered from different degrees of hip pain. In bacilliculture of Synovial fluid or peritonsillar tissue, 11 patients showed positive results and 6 patient negative. The intraoperative periprosthetic histopathological examination showed that all the patients had acute inflammation. Eight patients had sinus communicating with prosthesis; 15 patients had increased ESR, and 15 patients had C reactive protein increased. All the patients had osteolysis, prosthesis loosening, and the performance of periosteal reaction in X-ray. All the patients were treated with second stage revision. In the first operation, thorough debridement was perfumed and the prosthesis was removed. Then the prosthesis of antibiotic--loaded acrylic cement was implanted. After giving antibiotics intravenously for 4 weeks, the antibiotics were taken orally for another six weeks. The ESR and C response protein were examined at regular time, and the second-stage revision surgery was perfumed when the ESR and C response protein were normal. The Harris score was used to evaluate therapeutic effects of second-stage revision surgery before and after treatment.

RESULTSAll the patients were followed up with an average of 19.5 months, ranged from 12 to 35 months. No complications occurred. Postoperative X-ray showed prosthesis in the correct position. The Harris score increased from preoperative (39.3 +/- 5.6) to postoperative (84.4 +/- 10.3) (t = 15.86, P < 0.01).

CONCLUSIONThe second-stage revision in postoperative infection after total hip replacement has a good efficacy, safety and reliability advantages. This technology provides an alternative in postoperative infection after total hip replacement.

Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications ; drug therapy ; microbiology ; surgery ; Prosthesis-Related Infections ; drug therapy ; microbiology ; surgery

OBJECTIVETo explore the value of detecting bacterial 16S rRNA with 23S rRNA in the diagnosis of periprosthetic joint infection (PJI).

METHODSA prospective study was conducted among 67 patients with previous total hip arthroplasty (THA) undergoing a reoperation for infection (23 patients) or aseptic loosening (44 patients). Bacterial 16S rRNA and 23S rRNA in the interface membrane were detected by real-time PCR and their value in diagnosis of PJI was assessed.

RESULTSThe 16S rRNA and 23S rRNA showed no significant difference in their power in the diagnosis of PJI. The detection of 16S rRNA/23S rRNA showed a higher sensitivity and a greater negative predictive value in PJI diagnosis than the detection of 16S rRNA+23S rRNA (95.7% vs 52.2%, P<0.01; 97.6% vs 79.6%, P=0.01). The specificity, positive predictive value, and accuracy of the 4 diagnostic strategies were not significantly different.

CONCLUSIONSThe diagnostic power of 16S rRNA and 23S rRNA was similar in detecting PJI. Compared with the diagnostic strategy with 16S rRNA+23S rRNA, 16S rRNA/23S rRNA is more sensitive in detecting PJI.

Arthritis, Infectious ; diagnosis ; microbiology ; Arthroplasty, Replacement, Hip ; Humans ; Prospective Studies ; Prosthesis-Related Infections ; diagnosis ; microbiology ; RNA, Bacterial ; isolation & purification ; RNA, Ribosomal, 16S ; isolation & purification ; RNA, Ribosomal, 23S ; isolation & purification ; Real-Time Polymerase Chain Reaction ; Reoperation ; Sensitivity and Specificity

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

The authors report a case of Campylobacter fetus subsp. fetus gastro-intestinal infection and bacteremia with poly-arthritis, mainly of the hip, in a French patient simultaneously suffering from cirrhosis of the liver. The outcome was eventually favorable, however only after a trial of ineffective pefloxacin-gentamicin therapy. The authors suggest: (i) gentamicin should not be given alone in C. fetus subsp. fetus infections, and (ii) pefloxacin should not be given if antibiotic sensitivities data are not available. The inconclusive reliability of disk diffusion tests for C. fetus subsp. fetus should be recognized.
Antibiotics, Combined/*administration & dosage ; Arthritis, Infectious/*drug therapy/microbiology ; Bacteremia/*drug therapy/microbiology ; Campylobacter Infections/*drug therapy/microbiology ; Campylobacter fetus/*drug effects ; Case Report ; Drug Resistance, Microbial ; Gastrointestinal Diseases/*drug therapy/microbiology ; Gentamicins/administration & dosage ; *Hip Joint ; Human ; Male ; Middle Age ; Pefloxacin/*administration & dosage