Silver and copper as additives of various biomaterials have been reported as the potential solutions for biomedicine applications, mostly because of inducing bactericidal effects. The application of those admixtures in diamond-like carbon (DLC) coatings may be desirable for orthopedic implants. In the present manuscript, the biological effect of coatings with up to about 7 at.% and 14 at.% of, respectively, Cu and Ag is compared. The morphology, chemical structure, and composition of films deposited on AISI 316LVM and Ti6Al7Nb is characterized. The live/dead analysis conducted with Escherichia coli shows a higher bactericidal potential of silver than copper. Although the Cu-doped coatings can positively affect the proliferation of Saos-2 and EA.hy926 cell lines, the results of XTT test are on the verge of 70% of viability. Biological effect of silver on EA.hy926 cell lines is negative but that admixture ensures high proliferation of osteoblasts in contact with coatings deposited on titanium alloy (over 20% better than for substrate material). In that case, the viability is reaching about 85% for Ag-doped coatings on AISI 316LVM and 75% on Ti6Al7Nb. The results indicate that for the sake of bactericidal coatings that may promote osteointegration, the candidates are DLC with silver content no higher than 10 at.%.

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.

Suction drainage after primary total hip arthroplasties (THA) offers no benefits. Revision hip arthroplasties (RHA) are more demanding procedures and associated with greater blood loss compared to primary cases. There is still a lack of literature regarding the application of drainage in RHA. A total of 40 patients who underwent RHA were included in this prospective study. Simple randomization with an allocation ratio 1:1 was performed. Primary outcomes: total blood loss, hemoglobin drop, joint hematoma size in USG, infection. Secondary outcomes: blood transfusion rate, soft tissue hematomas, C-reactive protein levels, Visual Analogue Scale before and on 3rd day after surgery, Harris Hip Score before and 6 weeks after surgery. An intention to treat analysis was performed, with a 2-year follow up. Statistically significant differences between groups was in blood loss: drainage 1559.78 ml, non-drainage 1058.27 ml, (p = 0.029) and hemoglobin level on 1st day after surgery: drainage 10.58 g/dl, non-drainage 11.61 g/dl (p = 0.0496). In terms of the other analyzed parameters, statistical differences were not found. Our study revealed that the use of suction drainage may lead to higher blood loss in the early postoperative period. Further studies are needed to evaluate our results.

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.

Endoprotezoplastyka stawu biodrowego i kolanowego jest powszechnie stosowaną procedurą w zaawansowanej chorobie zwyrodnieniowej, która likwiduje ból i przywraca sprawność choremu. Z tego powodu liczba wykonywanych zabiegów alloplastyki systematycznie wzrasta. Zwiększenie liczby chorych z endoprotezami, skrócenie czasu pobytu w szpitalu po operacji, problem z dostępem do specjalistów oraz rosnąca rola lekarzy rodzinnych nakładają na tych ostatnich obowiązek bliższego zapoznania się z najpoważniejszym powikłaniem pooperacyjnym, jakim są zapalenia okołoprotezowe. Diagnostyka przewlekłego zapalenia okołoprotezowego jest złożonym i trudnym zagadnieniem, natomiast objawy zapalenia występujące w krótkim okresie po operacji lub też ostre krwiopochodne zapalenie stawu z endoprotezą powinny zostać rozpoznane jak najszybciej, ponieważ prawidłowe postępowanie daje szansę na pełne wyleczenie z uratowaniem implantu. Opóźnienie rozpoznania i zaniechanie leczenia operacyjnego skutkują zmianą algorytmu i często kilkuetapowym, długotrwałym leczeniem. Jeśli występują objawy sugerujące wczesne zapalenie okołoprotezowe, najlepszym postępowaniem jest ponowne pilne skierowanie chorego do szpitala, w którym była wykonana operacja. W przypadku podejrzenia zapalenia okołoprotezowego antybiotykoterapia ma ogromne znaczenie, ale rozpoczęta bez właściwych wskazań nie daje gwarancji wyleczenia i zaciemnia obraz choroby. Przed podaniem antybiotyku powinno się podjąć próbę potwierdzenia rozpoznania zapalenia i wyizolowania patogenu, tak aby można było zastosować antybiotykoterapię celowaną. Wczesne podanie antybiotyku znacznie osłabia możliwość wyizolowania patogenu i zwiększa liczbę szczepów wielolekoopornych. Podstawą leczenia infekcji okołoprotezowych zawsze jest leczenie operacyjne skojarzone z celowaną antybiotykoterapią. Szybka diagnoza i właściwe postępowanie operacyjne zapewniają choremu możliwość wyleczenia i dają szanse na normalne funkcjonowanie. Operacje ortopedyczne to zazwyczaj zaplanowane procedury. W zapobieganiu infekcji okołoprotezowej kluczowe znaczenie ma odpowiednie przygotowanie pacjenta, które polega na ustabilizowaniu chorób ogólnoustrojowych, prawidłowej ich kontroli i eliminacji wewnątrzustrojowych ognisk zapalnych.Słowa kluczowe: zapalenie okołoprotezowe stawu, rozpoznawanie, antybiotykoterapia, postępowanie pooperacyjne, lekarz rodzinny Hip and knee replacement is a common procedure in the treatment of advanced arthropathy. It relieves pain and restores joint function. That is why the number of arthroplasties is continuously increasing. In view of the growing number of patients with endoprostheses, shorter hospitalisation after the surgery, problems with availability of specialists and an increasing role of primary care physicians, family doctors need better knowledge of the most severe postoperative complication, i.e. periprosthetic joint infection. The diagnosis of chronic periprosthetic infection is a complex and challenging problem. The symptoms of early postoperative infection or acute haematogenous periprosthet...