BackgroundIn the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate technique.Questions/PurposesTo perform a meta-analysis to compare the accuracy of various applied imaging modalities in the assessment of periprosthetic knee infection.MethodsA systematic review and meta-analysis was conducted with a comprehensive search of MEDLINE and Embase® in accordance with the PRISMA and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) recommendations to identify clinical studies in which periprosthetic knee infection was investigated with different imaging modalities. The sensitivity and specificity of each imaging technique were determined and compared with the results of microbiologic and histologic analyses, intraoperative findings, and clinical followup of more than 6 months. A total of 23 studies, published between 1990 and 2015, were included for meta-analysis, representing 1027 diagnostic images of symptomatic knee prostheses. Quality of the included studies showed low concerns regarding external validity, whereas internal validity indicated more concerns regarding the risk of bias. The most important concerns were found in the lack of uniform criteria for the diagnosis of a periprosthetic infection and the flow and timing of the included studies. Differences among techniques were tested at a probability less than 0.05 level. Where there was slight overlap of confidence intervals for two means, it is possible for the point estimates to be statistically different from one another at a probability less than 0.05. The z-test was used to statistically analyze differences in these situations.ResultsBone scintigraphy was less specific than all other modalities tested (56%; 95% CI, 0.47–0.64; p < 0.001), and leukocyte scintigraphy (77%; 95% CI, 0.69–0.85) was less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88–0.98; p < 0.001) or combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86–0.97; p < 0.001). Fluorodeoxyglucose positron emission tomography (FDG-PET) (84%; 95% CI, 0.76–0.90) was more specific than bone scintigraphy (56%; 95% CI, 0.47–0.64; p < 0.001), and less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88–0.98; p = 0.02) and combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86–0.97; p < 0.001). Leukocyte scintigraphy (88%; 95% CI, 0.81–0.93; p = 0.01) and antigranulocyte scintigraphy (90%; 95% CI, 0.78–0.96; p = 0.02) were more sensitive than FGD-PET (70%; 95% CI, 0.56–0.81). However, because of broad overlapping of confidence intervals, no differences in sensitivity were observed among the other modalities, including combined bone scintigraphy (93%; 95% CI, 0.85–0.98) or combined leukocyte and bone marrow scintigraphy (80%; 95% CI, 0.66–0.91; p > 0.05 for all paired comparisons).ConclusionsBased on current evidence, antigranulocyte scintigraphy and combined leukocyte and bone marrow scintigraphy appear to be highly specific imaging modalities in confirming peripr...

AimTo determine current practice recommendations for the treatment of slipped capital femoral epiphysis (SCFE) among members of the European Paediatric Orthopaedic Society (EPOS).Materials and methodsA questionnaire with 4 case vignettes of a 12-year-old boy presenting with a stable and unstable SCFE. Each, stable and unstable slips, was of mild (20° epiphyseal-shaft angle) and of severe (60° epiphyseal-shaft angle) degree was sent to all members of EPOS in 2009 in order to ascertain their views on the best management of SCFE. Specifically, respondents were asked about the role of reduction, methods of fixation, prophylactic fixation of the non-affected hip, postoperative management and their view on the anticipated need for secondary surgery.ResultsThe response rate was 25% (72/287). The participating surgeons’ average workload was 76% in paediatric orthopaedics, with mean 16 years of experience. Surgeons were most consistent in their advice for stable slips, where around 90% of the respondents did not recommend a reduction of the slip regardless of severity of slip. Seventy per cent of the respondents recommended the use of only one screw for fixation of a stable slip and for mild unstable slips. For severe unstable slips, 46% of surgeons recommended reduction only by positioning of the hip on the fracture table, 35% by manipulation and 11% advised open reduction. Responders were less consistent in their advice on the anticipated need for secondary osteotomies (in mild slips about 40% and about 60% in severe slips would advise an osteotomy) and on treatment of the contralateral hip (with 32% of surgeons recommending prophylactic fixation of the contralateral hip).ConclusionWithin members of EPOS, there is controversy on several aspects of the management of SCFE particularly on aspects of the treatment of unstable SCFE.SignificanceMembers of EPOS predominantly use traditional means of treatment for patients with SCFE. In contrast, the more modern treatment concepts, such as open reduction via surgical dislocation, are rarely used.

We present a case of a 45-year-old woman with a right proximal tibiofibular dislocation she sustained after a fall during roller skating. Anteroposterior and lateral radiographs confirmed the diagnosis; there were no other injuries. The dislocation was reduced by direct manipulation after intra-articular infiltration, in our emergency department. The patient was treated with a long, non-weight bearing leg cast for 1 week. After 4 weeks, she had no pain and a full range of motion of the knee.

Osteochondritis dissecans of the hip is a rare condition with limited treatment options. For patients who have undergone arthroscopic microfracture and chondroplasty, long-term results showing clinical improvement are scarce. Although open osteochondral grafting is a demanding and invasive procedure, promising results are reported after short-term follow-up. We present a technique for an arthroscopic autologous osteochondral transplantation with a graft from the ipsilateral knee to the femoral head.

No abstract