The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

Background The use of drains reportedly does not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drain placement after primary hip replacement. This study aimed to assess the safety of not using suction drainage after primary hip replacement in a population of patients undergoing extended thromboprophylaxis. Methods In this prospective randomized study, all patients were qualified for primary hip replacement and were divided into two groups: with and without drainage. The inclusion criterion was idiopathic hip osteoarthritis. The exclusion criteria were secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. We performed an intention-to-treat analysis. Clinical, laboratory, and radiographic parameters were measured for the first three days after surgery. Hematoma collection, due to extended thromboprophylaxis, in the joint and soft tissues was evaluated precisely. The patients underwent follow-up for 30 days. Results The final analysis included a total of 100 patients. We did not find any significant statistical differences between groups in terms of hip fluid collection (9.76 vs. 10.33 mm, with and without drainage, respectively; mean difference, 0.6 mm; 95 % confidence interval [CI] -2.8 to 3.9; p = 0.653), estimated blood loss (1126 vs. 1224 ml; mean difference, 97.1 ml; 95 % CI -84.1 to 278.2; p = 0.59), and hemoglobin levels on postoperative day 3 (11.05 vs. 10.85 g/dl; mean difference, 0.2; 95 % CI -2.1 to 2.5; p = 0.53). In addition, the other parameters did not show significant differences between groups. Notably, two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. Conclusions We conclude that the use of closed suction drainage after primary hip replacement is a safe procedure in patients undergoing extended thromboprophylaxis. Further research is warranted to validate these findings. Trial registration The study was successfully registered retrospectively at Clinicaltrial.gov with the identification number NCT04333264 03 April 2020.

Background: Several studies have suggested that the use of drains did not improve surgical outcomes after hip replacement. There is still a lack of strict recommendations for drainage use.Methods: Prospective, randomised study was performed. The analysis included 100 patients. Inclusion criteria: idiopathic hip osteoarthritis. Exclusion criteria: secondary coxarthrosis, autoimmune disease, coagulopathy, venous/arterial thrombosis, hepatic/renal insufficiency, cement, or hybrid endoprostheses. Results: We found smaller haematomas in the no-drainage group (9.76 mm vs. 10.33 mm, p = 0.653). The visual analogue scale score was lower in the no-drainage group (5 vs. 6). Less bloodloss in the no-drainage group (1,124 ml vs 1,224 ml, p = 0.59). Two patients had a deep joint infection in the no-drainage group, none in the drainage group.Conclusion: It is noteworthy that two cases of early infections were observed in the no-drainage group, whereas there were no such complications in the drainage group. Further research is warranted to validate our findings.Trial registration: The study was successfully retrospectively registered in Clinicaltrial.gov with identification number: NCT04333264 (03/04/2020). https://clinicaltrials.gov/ct2/show/NCT04333264?term=NCT04333264&draw=2&rank=1

Introduction. Complications after arthroplasty often result in irreversible disability. In some cases, for the extremity to be salvaged, permanent knee joint arthrodesis is a last-chance procedure. Modular implant design simplifies surgical technique and knee arthrodesis without bone-on-bone contact, immediately provides full weight bearing and restores limb length and alignment. Puropose. The aim of this article was to perform a clinical evaluation of patients after knee arthrodesis with a dedicated modular intramedullary nail without bone-on-bone contact after a failed infected total knee arthroplasty. Methods. Between 2017 and 2021, 17 patients were treated with knee arthrodesis with a modular nail after a septic complication of total knee arthroplasty. Clinical evaluation of 15 patients was obtained during a follow-up visit, including: the pain severity using the Visual Analog Scale (VAS), physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score, gait independence, and the shortening of the affected limb in relation to the other one. Results. The mean follow-up duration was 1.4 years. The group included 11 women and 4 men with an average of 69.3 (57–84) years. All nails were cemented. There was one recurrence of infection. The mean VAS pain score was 2.73, also 4 patients felt no pain at all. The average functional score on the WOMAC scale was 36.4 (14–60) and for the Oxford Knee Score was 26.5 (15–41). Each patient achieved an independent gait. All patients reported the necessity of use of crutches outside home. The average limb shortening was 2.05 cm (0.5–3.0). In addition, 14 of the 15 patients positively evaluated the procedure results and if they had to, they would again decide on this form of treatment. During follow-up, no complication or problems with implants used were observed. Conclusions. Knee arthrodesis with modular nail offers an acceptable functional result and gives a chance of salvaging a limb in complex septic complications of TKA.

Background Complications after arthroplasty often result in irreversible disability. In some cases for the extremity to be salvaged, the permanent knee joint arthrodesis is the last-chance procedure. Modular implant design simplifies surgical technique but modularity may potentially compromise mechanical strength of an implant. Mechanical properties of the implant are particularly important in case of knee arthrodesis without bone-on-bone contact where forces during gait and weight bearing are transmitted directly through the nail. The aim of this article was to perform comparative analysis of the mechanical properties of modular nail CHARFIX2 FN, when compared to the femoral nail, used for knee arthrodesis; and to analyze the effectiveness of treatment with use of this nail based on the observations of clinical cases. Methods Comparative analysis of: the static 4-point bending test, dynamic 4-point bending test and static torsion test. All tests were performed in accordance with requirements of ASTM F 1264. A clinical analysis of 5 cases, in which CHARFIX2 FN nails were used, was also performed. Results Based on the results of mechanical tests, the strength characteristics of CHARFIX2 FN nail have been found superior and more advantageous than corresponding features of the standard femoral nail. For CHARFIX2 FN nail, the median for flexural stiffness was almost 4 times higher and for maximum torque value was almost 2 times higher when compared to the femoral nail. Observations of the clinical cases gave satisfactory results. Conclusions The obtained mechanical tests present significant differences between CHARFIX2 FN and the femoral nail in mechanical strength and, therefore, its improved stability and safety for patients during walking. It can be used for permanent knee immobilization with satisfactory clinical results. The functional outcomes and subjective measurements of pain in patients treated with CHARFIX2 FN group are satisfying.