Diagnosing Periprosthetic Joint Infection: a Scoping Review

Purpose of ReviewThe goal of this review is to provide an up to date understanding of the utility and limitations of the current tests utilized in the diagnosis of periprosthetic joint infection (PJI) in total knee and hip arthroplasty.Recent FindingsDespite the growth in literature surrounding PJI diagnosis, there remains challenges in establishing a diagnosis of PJI. A combination of clinical, serum, and synovial tests and microbiologic and histologic examinations can yield a diagnosis in the majority of cases. Novel molecular and imaging studies may be beneficial for indeterminant cases. A number of emerging diagnostic tests have been proposed and may be incorporated into diagnostic algorithms in the future. Recently proposed stepwise diagnostic algorithms have shown high sensitivity and specificity.SummaryThe diagnosis of PJI remains challenging due to a lack of tests that can definitively rule out infection. Diagnosis and investigations should occur in a stepwise fashion. There has been a plethora of new diagnostic tests introduced in attempts to improve the accuracy of diagnostic algorithms. The definition and algorithms for the diagnoses of PJI will continue to evolve as new techniques and tests are introduced.     

Severe bone defects and reduced mineralization caused by massive metallosis after total knee arthroplasty: histopathologic and bone morphometric findings

Abstract

We encountered a patient who developed metallosis after total knee arthroplasty (TKA), resulting in loosening of the implant, bone resorption, reduced bone formation, and fracture. The implant was replaced with a NexGen modular revision TKA system after autologous bone and hydroxyapatite granule grafting. Histopathologic examination showed accumulation of metallic debris and tartrate-resistant acid phosphatase-positive cells around the trabecular and cortical bone. Examination of hard tissue specimens showed a reduced bone volume (determined by bone histomorphometry) and an increase of all osteoid parameters, indicating disturbance of mineralization in addition to increased bone resorption.     

ECONOMIC VALUATION OF ECOSYSTEM SERVICES: DISCUSSION AND APPLICATION

ABSTRACT

Ecosystems provide a wide range of services that improve human welfare. Changes in ecosystems imply potential changes in the generation of these ecosystem services and thus changes in welfare. In the lingo of economists, these welfare changes are measured as changes in economic values—increases in welfare being benefits and decreases in welfare being costs. For instance, individuals may benefit from, and thus value, reductions in risks to endangered species. Yet values for many changes in ecosystem services are not captured in market transactions, and thus measuring these values requires nonmarket valuation methods. This paper discusses ecosystem services and values from the viewpoint of an economist, explains what is meant by the valuation of ecosystems, and provides an overview of methods for valuation of ecosystem services. An example is presented from a recent natural resource damage assessment—the Green Bay total value equivalency study. Resources in the Lower Fox River and Green Bay in Wisconsin have been injured by polychlorinated biphenyl contamination from numerous paper mills along the river over several decades. The Green Bay study examines individuals' preferences and values for reducing ecosystem risks and improving ecosystem services and how these values are related to individuals' awareness of and use of ecosystem services in the area. The study uses methods from nonmarket valuation to scale potential restoration projects.     

Knee osteoarthritis in women

Osteoarthritis is a disease that progresses over time and culminates in the destruction of articular cartilage and joints. Thus, with an increasing elderly population the treatment of knee osteoarthritis has become a major healthcare issue. It has been shown that women are more severely impacted by knee osteoarthritis. Differences in knee anatomy, kinematics, previous knee injury, and hormonal influences may play a role. Sex difference with respect to osteoarthritis presentation, treatment, and the allocation of resources also exists. In general, women present for treatment in more advanced stages of osteoarthritis and have more debilitating pain than their male counterparts. In addition, healthcare providers are more likely to recommend total joint arthroplasty for their male patients. Understanding how and why these gender differences occur is instrumental in formulating an inclusive strategy for combating osteoarthritis in the future.     

38例完全性肺静脉异位引流的外科治疗

目的：总结３８例完全性肺静脉异位引流的外科治疗经验。资料和方法：３８例中男１７例,妇女１例。年龄２个月￣２２岁,３岁以内婴幼儿１２例。体重４．５￣３６．０ｋｇ。心上型２０例、心内型１５例、混合型３例。全组均在中度低温体外循环下将完全性异位引流的肺静脉直接或通过房间隔缺损隔入左房。结果：手术死亡３例（７．９％）,其中２例术后严重心律失常、１例多次缝合止血致吻合口狭小。术后并发心律失常１２例、呼吸道感     

胃肠外营养添加精氨酸对胃癌术后患者淋巴细胞免疫功能的作用

为探讨胃肠外营养（ＴＰＮ）添加精氨酸（Ａｒｇ）对胃癌术后患者淋巴细胞免疫功能的影响及意义,对３６例胃癌术后患者进行了ＴＰＮ支持的前瞻性研究,检测常规ＴＰＮ和ＴＰＮ添加Ａｒｇ支持前后患者的Ｔ淋巴细胞亚群、ＮＫ细胞活性、ＩＬ２和ＣＤ２５水平变化。结果：常规ＴＰＮ支持前后患者的Ｔ淋巴细胞亚群、ＮＫ细胞活性、ＩＬ２和ＣＤ２５水平变化无明显差异,而ＴＰＮ添加Ａｒｇ支持后患者的ＣＤ４、ＣＤ４／ＣＤ８比值、ＮＫ细胞活性和ＩＬ２水平均明显增加（Ｐ＜０．０５）。本研究结果显示：常规ＴＰＮ不能纠正胃癌术后患者的淋巴细胞免疫功能抑制,但ＴＰＮ添加Ａｒｇ则可促进ＩＬ２生成增加,ＮＫ细胞活性增强,改善了胃癌术后患者的淋巴细胞免疫功能,提示ＴＰＮ添加Ａｒｇ有免疫促进作用     

全结直肠切除并回肠储袋-肛管吻合术治疗溃疡性结肠炎

目的　探讨全结直肠切除、回肠储袋肛管吻合术治疗溃疡性结肠炎的疗效。方法　对１９８４ ～１９９８ 年间进行的９ 例全结直肠切除、回肠储袋肛管吻合的溃疡性结肠炎患者作回顾性总结。结果　“Ｓ”形储袋６ 例,“Ｊ”形储袋３ 例。９ 例均存活。手术后发生粘连性肠梗阻１ 例,经非手术治疗后缓解;１ 例发生储袋瘘导致盆腔感染,最终切除储袋,行回肠造瘘;伤口感染１ 例;切口疝１ 例。随访８ 例,随访时间１ ～１３ 年。排便次数中位数为５ 次／２４ 小时（４～１０ 次／２４ 小时） 。对排尿和性功能无影响。结论　全结直肠切除、回肠储袋肛管吻合手术治疗溃疡性结肠炎患者的初步结果基本满意。     

股骨假体周围骨密度定量测定

目的 通过双能X线骨密度仪测定不同情况下股骨假体周围的骨密度变化情况,了解骨丢失与股骨假体松动的关系。方法 分为骨水泥固定的股骨假体组、非骨水泥固定的股骨假体组、股骨假体松动组共3个组,采用LUNAR DPXL-L型双能X线骨密度仅(Lunar Corp Wisconsin,USA)及Orthopaedies软件,分析时用Gruen’s 7区法。结果 骨水泥固定的股骨假体组骨丢失为15．1%～29．3%,非骨水泥固定的股骨假体组骨丢失为13．2％～27．9%,股骨假体松动组骨丢失为25．4％～43．4%,3组均是股骨近端骨丢失明显．骨丢失主要发生在术后8年以内。结论 骨水泥固定的股骨假体和非骨水泥固定的股骨假体周周骨密度降低一样,假体松动者假体周围骨丢失明显增加。股骨近端2个以上区域骨丢失大于35％或术后8年以后突然出现明显的骨丢失,考虑有股骨假体松动存在的可能性。     

Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty

BACKGROUND: After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. METHODS: Thirty-seven patients, scheduled for total knee arthroplasty, were randomly assigned to three treatment groups: in group 1 (EPI) patients received bolus doses of morphine via an epidural catheter; in group 2 (IA) an intraarticular bolus of 1 mg of morphine was applied at the end of the operation with subsequent use of a patient-controlled analgesia (PCA) pump; group 3 (Control), in which only PCA was provided, served as control for both analgesic procedures. Main outcome measures included visual analogue pain scales, total morphine consumption, and stress hormones. RESULTS: No statistically significant differences in visual analogue pain scales could be detected between the three groups. Application of intraarticular morphine did not reduce the amount of analgesics required for postoperative analgesia as compared to intravenous analgesia alone. Application of epidural morphine significantly suppressed beta-endorphine release, but did not significantly influence other stress hormones as compared to the control group. CONCLUSION: Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.