Surgical strategies for management of infection following knee arthroplasty and arthroscopic procedures

Infection is one of the most feared complications following knee arthroplasty and soft tissue arthroscopic procedures. This article summarizes the current understanding on the management of this rare but devastating problem. The healthcare and economic burden of periprosthetic joint infection (PJI) is highlighted, together with how the classification of infection and host staging can aid decision-making. Surgical treatment options will be described. These consist of ‘debridement, antibiotics and implant retention’ (DAIR), revision arthroplasty (single- or two-stage), as well as salvage procedures (arthrodesis, permanent resection, and amputation). In selected cases, chronic antibiotic suppression may be the only viable option. All implant-related orthopaedic infections must be managed using a multidisciplinary team (MDT) approach, ideally within dedicated bone infection units, in order to optimize clinical outcomes.     

Comparison of survival rate and crestal bone loss of narrow diameter dental implants versus regular dental implants: A systematic review and meta‐analysis

The aim of the present study was to establish survival rates, as well as crestal bone loss (CBL) of narrow diameter implants (NDI), compared to regular diameter implants (RDI). The current review followed the Enhancing the QUAlity and Transparency Of health Research guidelines and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. We searched main databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register) for articles addressing the focused question up to and including May 2018. Meta‐analyses were conducted for CBL and survival rates. Qualitatively, three clinical studies showed comparable CBL and survival rates between NDI and RDI at follow up. Only one study showed increased CBL around NDI compared to RDI. The overall weighted mean difference (WMD) for CBL (WMD = .06, 95% confidence interval [CI] = ‐.38‐.51, P=.76) and risk difference for survival rate (risk difference = .88, 95% CI = .22‐3.50, P=.85) were not significant between the NDI and RDI groups at follow up. NDI and RDI showed comparable CBL and survival rates. However, the findings of the present study should be interpreted with caution due to significant heterogeneity and the low number of included studies. Further randomized, controlled trials should be performed in order to obtain strong conclusions.     

种植基台背景色及粘接剂颜色对不同厚度高透氧化锆修复体颜色的影响研究

 目的　研究种植基台背景色及粘接剂颜色对3种不同厚度高透氧化锆修复体颜色的影响，为粘接剂的选择提供指导方案。方法　制备不同厚度（1.5、2.0、2.5 mm）的高透氧化锆修复体各20个。将3种厚度修复体分别使用3种颜色粘接剂粘接于喷砂后的种植基台上，记为1.5 mm透明、有色、白色研究组，2.0 mm透明、有色、白色研究组，2.5 mm透明、有色、白色研究组；将未粘接于种植基台上的3种厚度修复体记为1.5 、2.0 和2.5 mm对照组；每组修复体各5个。应用VITA Easyshade Ⅴ比色仪测量各组修复体的色彩参数（CIE L*a*b*），并计算粘接前后修复体的色差值（ΔE），对比肉眼可察觉阈值和临床可接受阈值，以评价种植基台背景色及粘接剂颜色对不同厚度修复体颜色的影响程度。结果　（1）种植基台背景色对不同厚度修复体颜色的影响分析：1.5 mm透明研究组ΔE（8.51）高于临床可接受阈值；2.0 mm透明研究组ΔE（2.03）低于临床可接受阈值，但高于肉眼可察觉阈值；2.5 mm透明研究组ΔE（1.26）低于肉眼可察觉阈值。（2）粘接剂颜色对不同厚度修复体颜色的影响分析：当修复体厚度为1.5 mm时，仅有色研究组ΔE低于临床可接受阈值，但仍高于肉眼可察觉阈值，且不同粘接剂组间ΔE比较，差异有统计学意义（F = 21.941，P < 0.05）；当修复体厚度为2.0 mm时，不同粘接剂组间ΔE比较，差异有统计学意义（F = 13.683，P < 0.05），且均低于临床可接受阈值，仅有色研究组ΔE低于肉眼可察觉阈值，但有色研究组ΔE与透明研究组ΔE比较，差异无统计学意义（P > 0.05）；当修复体厚度为2.5 mm时，不同粘接剂组间ΔE比较，差异无统计学意义（F = 0.683，P > 0.05），且均低于肉眼可察觉阈值。结论　种植基台背景色及粘接剂颜色均会对较薄高透氧化锆修复体的颜色造成影响。在种植义齿修复过程中，当设计的修复体厚度< 2.5 mm时，推荐使用与修复体颜色一致的有色粘接剂；当修复体厚度≥ 2.5 mm时，种植基台背景色和粘接剂颜色对修复体颜色的影响较小，3种粘接剂均可使用。     

意向性牙再植的临床考量

当根管治疗和根尖手术难以治疗患牙根尖周病损时，意向性牙再植作为一项有着较久历史的临床技术，可作为保存天然牙的治疗手段之一。与牙种植术相比，有着更好的美学性能、经济效益，并保存了患牙的本体感受是意向性再植特有的优势。文章就意向性再植的适应证与非适应证、与牙种植术的比较及临床治疗程序做一综述。     

Bioactivity of PEEK GRF30 and Ti6Al4V SLM in Simulated Body Fluid and Hank’s Balanced Salt Solution

In recent years, scientists have defined two main paths for orthopedic implant fabrication: searching for new materials with properties closest to natural bone in order to reduce the stress-shielding effect or creating individually adapted geometry of the implant with the use and Rapid Prototyping methods. Therefore, materials such as PEEK GRF30 and Ti6Al4V selective laser melting (SLM) are of interest. They are defined as materials suitable for implants, however, the knowledge of their bioactivity, a feature which is one of the most desirable properties of biomaterials, is still insufficient. Using Simulated Body Fluid and Hank’s Balanced Salt Solution, the bioactivity of PEEK GRF30 and Ti6Al4V SLM was assessed, as well as commercial Ti6Al4V as a reference material. Ten cylindrical samples of each material were prepared and immersed in solutions per period from 2 to 28 days at 37 °C. Optical analysis of the changes on the examined surfaces suggested that right after 2-day crystals with different morphologies were formed on each material. Further analysis of the chemical composition of the altered surfaces confirmed the formation of a calcium phosphate layer on them, however, the Ca/P ratio was slightly different from 1.67. On the basis of the obtained results, it can be concluded that both PEEK GRF30 and Ti6Al4V SLM are characterized by appropriate—comparable to Ti6Al4V—bioactivity.     

Economic Burden of Patient-Reported Penicillin Allergy on Total Hip and Total Knee Arthroplasty

IntroductionSelf-reported penicillin allergies in patients undergoing total joint arthroplasty often results in the use of second-line prophylactic antibiotics. A higher risk of prosthetic joint infection (PJI) is associated with suboptimal antibiotics vs first generation cephalosporins, which have historically been grouped with other beta-lactam antibiotics such as penicillin for potential allergic reactions. This study evaluates the economic burden of self-reported penicillin allergies in total joint arthroplasty (TJA).MethodsData from studies reporting true incidence of IgE-mediated penicillin allergies, infection-free survivorship of TJA, and cost of PJI attributed to use of second-line antibiotics were obtained. Projected cost of preoperative penicillin allergy testing and potentially avoidable PJI associated with second-line antibiotic usage were calculated. This was compared with projected cost of PJI in the current state to estimate cost savings.ResultsImplementation of preoperative penicillin allergy testing leads to a potential savings of nearly $37 million to payors in the first year based on 1-year survivorship. This savings increases to $411.6 million over a 10-year span and $1.18 billion over a 20-year span.ConclusionPreoperative penicillin allergy testing or risk stratification via thorough history should be implemented as standard of care for patients with self-reported penicillin allergies before TJA and would result in decreased cost of PJI.