Periprosthetic fractures of the proximal femur are one of the most frequent causes of revision after total hip arthroplasty. Internal fixation may be chosen if the hip implant is stable or if a stable fixation may be obtained. Preservation of bone perfusion and adequate stability are essential for successful fracture healing. As presented in this report, a patient developed both osteonecrosis and atrophy of the cortical bone due to use of a specific plate to treat a periprosthetic fracture of the femur. An 82-year-old female sustained a periprosthetic fracture of the proximal femur two years after cemented hemiarthroplasty. The fracture was treated by plate fixation. Along the proximal femoral diaphysis, cerclages were applied to avoid interference of screws with the femoral stem. Due to postoperative restrictions and finally due to pain, the patient never could be mobilized out of a wheelchair. After 4 years, pain persisted while the fracture had healed without loosening of the joint replacement components. However, pronounced atrophy of the whole femur was present, with devitalized areas of the bone underlying the plate. When not strictly applied as an internal fixator at a distance from the bone, the plate model used in this case may disturb periosteal blood flow, causing osteonecrosis. Furthermore, high bending rigidity of the plate-bone construct may lead to stress shielding and atrophy. The case illustrates that design and mechanical properties of a plate are relevant in bone biology and healing.conclusions. Clinical trial abstracts should include items that the CONSORT group has identified as essential.

Background: due to increase in total hip arthroplasties (THAs), the incidence of periprosthetic hip fractures (PPHFs) is forecast to raise considerably in the next decades, with Vancouver B1 fractures (VB1) accounting for one third of total cases. Femur fixation with cerclages (with or without screws) is considered the current treatment option for intraoperative VB1. Methods: the study retrospectively includes data from patients who developed VB1 PPHFs during THAs from December 3rd 2020 to November 30th 2022. The primary outcome of this study was to identify the reintervention-free survival rate. The secondary aim was to determine clinical and radiographic assessment at follow-up, based on Harris hip score (HHS) and limb length discrepancy (LLD). Results: 37 patients with mean age 60.03 ± 15.49 (22 to 77) years old were included. Overall, the Kaplan-Meier estimated a re-operation free survival rate of 99% (CI 95%) at 6 months. The mean limb length discrepancy (LLD) improved from -3.69±6.07 (range -27.9 to 2.08) mm to 0.10±0.67 (range -1.07 to 1.20) mm. The mean HHS improved from 42.72±14.37 (range 21.00-96.00) to 94.40±10.32 (range 56.00-100.00).

Culture-positive (CP) and culture-negative (CN) periprosthetic joint infections (PJI) remain a crucial area of research; however, current studies comparing these infections rely on unstandardized outcome reporting tools. Our study aimed to compare the outcomes of CP and CN PJI using the standardized Musculoskeletal Infection Society (MSIS) outcome reporting tool. We retrospectively reviewed 138 patients who were diagnosed with PJI and indicated for two-stage revision total knee arthroplasty (rTKA). The majority of patients in both CP and CN cohorts achieved infection control without the need for reoperation (54.1% and 62.5%, respectively). There was a significant difference in the overall distribution of MSIS outcomes (p=0.043), with a significantly greater rate of CN patients falling into Tier 1 (infection control without the use of suppressive antibiotics) (52.5% versus 29.6%, p=0.011). There was also a significant difference in the distribution of septic versus aseptic reoperations after 2nd stage (p=0.013), with more CP reoperations being septic and more CN reoperations being aseptic. The duration from 1st to 2nd stage was significantly shorter in the CN cohort (p=0.002). While overall infection control was similar between cohorts, these data suggest that the outcomes of two-stage rTKA are favorable in cases of CN PJI.

Background: Periprosthetic joint infection (PJI) following total hip and knee arthroplasty remains an extremely challenging and relatively high complication. This study aims to develop, validate and evaluate the use of machine learning (ML) algorithm to predict PJI in patients undergoing revision arthroplasties. Methods: A comprehensive review of patients undergoing hip or knee revision arthroplasty from 1 January 2015 to 31 March 2021 was conducted. Clinical data coming from preoperative patients history, laboratory analysis and demographic characteristics of patients were screened. Final data have been used to train a Logistic Regression model with the aim of predicting PJI preoperatively. Results: 1360 patients were enrolled, 1141 in the aseptic cohort and 219 in the infected cohort were included. ML demonstrated good discriminatory performance in predicting PJI in the selected patients (area under the curve 0.770 ± 0.006 in the training set and 0.720 ± 0.057 in the test set), and identified 3 significant predictors of PJI. Conclusion: ML algorithm trained using preoperative clinical data accurately predicted PJI. The incorporation of ML models into preoperative assessment of patients undergoing prosthetic revision procedures are useful in providing specific risk assessment to aid individualised counselling, shared decision making and presurgical optimization.

The increasing prevalence of periprosthetic femoral fractures, specifically in the vicinity of the hip, has emerged as a significant issue in recent times. Consequently, there is a need for a thorough examination to enhance the effectiveness of management and treatment approaches. The findings emphasized a significant disparity in the occurrence and characteristics of these fractures, as multiple studies have highlighted the efficacy of various treatment strategies, such as open reduction and internal fixation, as well as the utilization of cortical strut allografts. Furthermore, the research has identified potential risk factors that have an impact on the characteristics of fractures, providing valuable insights that could be crucial in the development of preventive strategies. This research provides a thorough examination of periprosthetic femoral fractures, highlighting the importance of a cohesive treatment algorithm to improve the handling of such fractures. Moreover, it promotes the need for a collaborative endeavor in conducting research in this field, cultivating a more profound comprehension that has the potential to drive progress in therapeutic approaches, ultimately enhancing patient results over an extended period of time. It is crucial that forthcoming research endeavors persist in expanding upon these discoveries, striving towards a unified methodology in tackling this substantial clinical obstacle.

An elderly male, with recent COVID-19 and cardiovascular comorbidities, had a prolonged hospitalisation due to periprosthetic joint infection and bacteraemia, post hip hemiarthroplasty. Despite the initial clinical improvement while under targeted antimicrobial therapy, low-grade fever and signs of myelosuppression later occurred. In the May-Grünwald-Giemsa stain of peripheral blood smear (PBS), pseudohyphae among RBCs and phagocytosed blastospores in neutrophils and monocytes were detected, indicating candidaemia and not contamination of the stain. Echinocandin treatment was immediately initiated, and Candida albicans was identified, using multiplex PCR, from the obtained blood cultures. Despite the early initiation of antifungal therapy and the removal of the CVL (central venus line), the patient passed away within the next twenty-four hours. Candidaemia is a leading cause of nosocomial bloodstream infections with very high morbidity and mortality and is associated with multiple risk factors (surgery, CVLs, prolonged hospitalization, concomitant bacterial infection, broad-spectrum antibiotics, immunosuppression). The isolation from blood cultures is the gold standard for candidaemia diagnosis. Detection of candidaemia by PBS is extremely rare, requires an experienced microscopist, and is considered to be an emergency. Clinical suspicion, early laboratory identification, and immediate clinician notification can lead to prompt antifungal treatment.