HIP International最新文献

{"title":"Early surgery within 48 hours of admission for hip fracture did not improve 1-year mortality in Japan: a single-institution cohort study.","authors":"Hiroki Iida, Yasuhiko Takegami, Yoshihito Sakai, Tsuyoshi Watanabe, Yusuke Osawa, Shiro Imagama","doi":"10.1177/11207000241248836","DOIUrl":"10.1177/11207000241248836","url":null,"abstract":"<p><strong>Introduction: </strong>Early surgery for hip fracture, within 48 hours of hospital admission, is effective in reducing mortality. However, the average preoperative waiting time for hip fractures in Japan is 4.5 days and the 1-year mortality rate after a hip fracture is 10% in Japan. This study aimed to investigate whether early surgery, within 48 hours, could reduce the 1-year mortality rate in patients with hip fractures in Japan.</p><p><strong>Methods: </strong>This cohort study involved 402 consecutive patients with hip fractures who underwent surgical treatment between January 2013 and September 2019. The exclusion criteria were an age of <60 years and in-hospital injury. A total of 389 patients were included in this study. The patients were divided into two groups: those who underwent early surgery within 48 hours of admission (early group) and those who di not undergo early surgery (delayed group). We compared patient characteristics and treatment outcomes between the 2 groups.</p><p><strong>Results: </strong>A comparison of patient characteristics revealed that the early group had lower hemoglobin levels (P=0.046), lower C-reactive protein levels (<i>P</i> = 0.031), lower numbers of patients with weekend hospitalization, lower numbers of patients with a history of using medications that may cause bleeding (<i>P</i> < 0.01), and who received general anaesthesia (<i>P</i> < 0.01). However, there were no significant differences with regard to the other variables between the 2 groups. A treatment outcome analysis showed that the early group had shorter waiting times for surgery (<i>P</i> < 0.01) and shorter stays in acute-care wards (<i>P</i> < 0.01). However there were no differences in the total hospital stay, Barthel index at discharge, home discharge rates, in-hospital mortality rates, and 1-year mortality.</p><p><strong>Conclusion: </strong>Our findings indicate that early surgery did not reduce the 1-year mortality rate in older patients with hip fractures in Japan.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"660-667"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141070920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases.","authors":"Gaetano Caruso, Edoardo Gambuti, Elisa Spadoni, Sara Filipponi, Achille Saracco, Francesca Artioli, Ambra Galla, Leo Massari","doi":"10.1177/11207000241248416","DOIUrl":"10.1177/11207000241248416","url":null,"abstract":"<p><strong>Background: </strong>DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH.</p><p><strong>Aim: </strong>To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4).</p><p><strong>Results: </strong>18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (<i>n</i> = 10,629) were females and 44% (<i>n</i> = 8325) were males. According to Graf classification, 34.9% (<i>n</i> = 6621) were 1A, 52.7% (<i>n</i> = 9999) were 1B, 4.0% (<i>n</i> = 753) were 2A+, 2.5% (<i>n</i> = 478) were 2A-, 1.5% (<i>n</i> = 284) were 2B, 1% (<i>n</i> = 196) were 2C, 1.3% (<i>n</i> = 243) were 2D, 1% (<i>n</i> = 193) were 3 and 1.0% (<i>n</i> = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60).</p><p><strong>Conclusions: </strong>Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"628-632"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The anterior femoral cortical window as an alternative to an extended trochanteric osteotomy in revision hip arthroplasty surgery: the evolution of the surgical technique and outcomes in 22 consecutive cases.","authors":"David Morley, Michael C Wyatt, John van Dalen","doi":"10.1177/11207000241267704","DOIUrl":"https://doi.org/10.1177/11207000241267704","url":null,"abstract":"<p><strong>Background: </strong>The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.</p><p><strong>Results: </strong>The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.</p><p><strong>Conclusions: </strong>This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"11207000241267704"},"PeriodicalIF":1.3,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal retractor insertion point for nerve safety during total hip arthroplasty: an anatomical study on the femoral and sciatic nerves in relation to hip motion.","authors":"Masakazu Okamoto, Yoshinobu Uchihara, Kenichiro Saito, Yusuke Inagaki, Pasuk Mahakkanukrauh, Yasuhito Tanaka","doi":"10.1177/11207000241227399","DOIUrl":"10.1177/11207000241227399","url":null,"abstract":"<p><strong>Background: </strong>Nerve injury is one of the most serious complications of total hip arthroplasty (THA). It is suspected to be a result from nerve compression or direct injury caused by an acetabular retractor. The anatomical relationship between the acetabular rim and the femoral and sciatic nerves, including hip motion, has not been investigated. This study aimed to identify the optimal position for retractor insertion during THA to prevent nerve damage.</p><p><strong>Methods: </strong>A total of 28 hip joints from 14 freshly frozen cadavers were used. Using an anterolateral approach, each cadaver was immobilised in the lateral decubitus position and deployed to measure the distance between the nerves and the acetabular rim, while the hip joint was changed to the extension, neutral, and flexion positions.</p><p><strong>Results: </strong>Three femoral nerves were closest to the anterior margin of the acetabulum at 90° and 120° of extension and farthest away at 30° of flexion. The sciatic nerve was closest to the posterior margin of the acetabulum at 90° and 120° of flexion and farthest away at 30° and 150° of extension compared with the other points.</p><p><strong>Conclusions: </strong>To prevent nerve damage during THA, we suggest that the retractor be inserted at the points where the nerves are the farthest away, such as at 30° and 150°. The femoral and sciatic nerves vary in their movements depending on the hip position. Therefore, the safe insertion of a retractor is recommended for hip flexion of the femoral nerve and extension of the sciatic nerve. Additionally, it is important to carefully insert the retractor along the acetabular margin without penetrating the joint capsule. Overall, this study provides valuable insights into the anatomical location and movement of the femoral and sciatic nerves in relation to hip motion and can help inform surgical techniques for safer THA.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"459-466"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision rate following unipolar versus bipolar hemiarthroplasty.","authors":"David Kugelman, Joseph X Robin, Benjamin C Schaffler, Roy Davidovitch, Kenneth Egol, Ran Schwarzkopf","doi":"10.1177/11207000241235394","DOIUrl":"10.1177/11207000241235394","url":null,"abstract":"<p><strong>Introduction: </strong>There has been much debate on use of bipolar or unipolar femoral heads in hemiarthroplasty for the treatment of femoral neck fractures. The outcome of these implants should be studied in the America Joint Replacement Registry (AJRR).</p><p><strong>Methods: </strong>All primary femoral neck fractures treated with hemiarthroplasty between January 2012 and June 2020 were searched in the AJRR. All cause-revision of unipolar and bipolar hemiarthroplasty and reasons for revision were assessed for these patients until June of 2023.</p><p><strong>Results: </strong>There were no differences in number and reason for all cause revisions between unipolar and bipolar hemiarthroplasty (<i>p</i> <i>=</i> 0.41). Bipolar hemiarthroplasty had more revisons at 6 months postoperatively (<i>p</i> <i>=</i> 0.0281), but unipolar hemiarthroplasty had more revisions between 2 and 3 years (<i>p</i> <i>=</i> 0.0003), and after 3-years (<i>p</i> <i>=</i> 0.0085), as analysed with a Cox model. Patients with older age (HR = 0.999; 95% CI, 0.998-0.999; <i>p</i> <i>=</i> 0.0006) and higher Charlson Comorbidity Index (HR = 0.996; 95% CI, 0.992- 0.999; <i>p</i> <i>=</i> 0.0192) had a significant increase in revision risk.</p><p><strong>Conclusions: </strong>We suggest that surgeons should consider using bipolar prosthesis when performing hemiarthroplasty for femoral neck fracture in patients expected to live >2 years post injury.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"553-558"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Stuck in the middle\": the missing lumbosacral link in total hip arthroplasty.","authors":"Christopher M Scanlon, Thomas Christensen, Thomas Bieganowski, Weston Buehring, Morteza Meftah, Matthew S Hepinstall","doi":"10.1177/11207000231223706","DOIUrl":"10.1177/11207000231223706","url":null,"abstract":"<p><strong>Introduction: </strong>Spinopelvic mobility drives functional acetabular position, influencing dislocation risk after total hip arthroplasty (THA). Patients have been described as \"stuck sitting\" or \"stuck standing\" based on pelvic tilt (PT). We hypothesised that some patients are \"stuck in the middle,\" meaning their PT changes minimally from sitting to standing - increasing their risk of dislocation.</p><p><strong>Methods: </strong>We reviewed 195 patients with standing and sitting whole body radiographs prior to THA. Standing anterior pelvic plane tilt (APPT) and standing and sitting sacral slope (SS) were measured and used to calculate sitting APPT. Normal standing and sitting were defined as APPT >-10° and <-20°, respectively. Spinal stiffness was classified as <10° change in sacral slope between sitting and standing. Patients were categorised as: (A) able to fully sit and stand; (B) \"stuck sitting\" - able to fully sit; unable to fully stand; (C) \"stuck standing\" - able to fully stand; unable to fully sit; or (D) \"stuck in the middle\" - unable to sit or stand fully.</p><p><strong>Results: </strong>84 patients could sit and stand normally (A), 22 patients were stuck sitting (B), 76 patients were stuck standing (C), and 13 patients were stuck in the middle (D). While 111 patients (56.9%) were considered stuck, only 58 patients (29.7%) met criteria for spinal stiffness.</p><p><strong>Discussion: </strong>We identified a subset of patients with stiff spines and abnormal PT in both sitting and standing, including 37.1% of patients who would be classified as \"stuck sitting\" based only on standing radiographs. Placing acetabular components in less than anatomic anteversion in these patients may increase posterior dislocation risk.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"482-486"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does-dual mobility still offer improved stability in smaller cup sizes? A computer modelling comparison of stability with 22-mm versus 28-mm inner heads in dual-mobility versus single-bearing constructs.","authors":"Amit Atrey, Alessandro Navacchia, Sarah E Ward, David Rister, Jacqueline Brillantes, Alexandra Stavrakis, Amir Khoshbin","doi":"10.1177/11207000231220031","DOIUrl":"10.1177/11207000231220031","url":null,"abstract":"<p><strong>Purpose: </strong>Dislocation remains 1 of the leading causes of revision after primary total hip arthroplasty (THA) and there is clear evidence the dual-mobility (DM) is used more frequently to minimise this. But in smaller cups, whether the use of DM with smaller 22-mm heads imparts any increased stability compared to standard bearing is unknown; especially when those smaller cups now allow for large single-bearing (SB) heads.</p><p><strong>Methods: </strong>3 primary cup sizes (48 mm, 50 mm, 52 mm) were chosen <i>a priori</i> for modelling. Head sizes trialled for the standard bearing (SB) constructs group were 28-0 mm, 32-0 mm and 36-0 mm against neutral polyethylene liners. In the modular sub-hemispheric DM constructs the inner head sizes for the DM constructs were altered where appropriate (22-0 mm vs. 28-0 mm). Cup position, stem offset, and stem size were standardised.</p><p><strong>Results: </strong>Both DM constructs outperformed all SB constructs because of a statistically significant jump distance increase (<i>p</i> < 0.001). However, there was no difference in range of motion (ROM) or jump distances between the 22-mm and 28-mm DM inner heads.The ROM angle before impingement between the DM (with 22-mm or 28-mm heads) and SB (with different head sizes where appropriate) showed no statistically significant difference. However, DM constructs presented significantly larger jump distances than SB constructs for both provocative dislocation tests across all 3 cup sizes.Of interest, for 50-mm and 52-mm cup sizes (for which this particular DM construct design can accommodate both 22-mm and 28-mm inner heads), there were no differences in ROM or jump distance between 22-mm versus 28-mm inner heads.</p><p><strong>Conclusions: </strong>In this computer-modelling study, DM constructs are advantageous over SB constructs for improving jump distances in clinically provocative positions, but not range of motion angles. Inner head diameter of DM has no effect on stability.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"476-481"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extra-articular hip resection with maintenance of pelvic continuity in malignant tumours of the proximal femur with articular invasion.","authors":"Guillaume-Anthony Odri, Cédric Yatim, Diane Ji Yun Yoon, Pierre-Alban Bouche, Mathieu Severyns, Pascal Bizot","doi":"10.1177/11207000241249135","DOIUrl":"10.1177/11207000241249135","url":null,"abstract":"<p><strong>Introduction: </strong>Extra-articular hip resection may be necessary in cases of malignant tumour of the pelvic bone or of the proximal femur invading the hip joint. When the tumour is in the proximal femur, it is possible to resect the acetabulum en bloc by performing a periacetabular osteotomy, but this creates a discontinuity in the pelvic ring with difficult reconstruction and diminished function. Several techniques described recently seek to be as sparing as possible on the pelvic bone by preserving the posterior column or both columns in order to facilitate reconstruction and improve function. However, these still require complex reconstructions and can necessitate intra-pelvic dissection.</p><p><strong>Technique: </strong>We describe here an extra-articular hip resection technique for tumours of the proximal femur invading the joint, with maintenance of pelvic continuity by preserving both columns and the quadrilateral plate of the acetabulum, without intra-pelvic dissection, that can be performed on patients in whom the medial wall of the acetabulum is thick enough. Our preliminary assessments have included studies on dry bone and imaging analyses. The technique was first tested on a single cadaver pelvis (encompassing 2 hips) and subsequently performed on a patient with a pathological fracture of the femoral neck due to osteosarcoma secondary to Paget's disease.</p><p><strong>Conclusions: </strong>Further clinical applications are essential to evaluate the overall effectiveness, safety and impact on patient functionality of this experimental technique.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"537-545"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140876313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammatory bowel disease patients undergoing total hip arthroplasty have higher odds of implant-related complications.","authors":"Matthew L Magruder, Shabnam Parsa, Adam M Gordon, Mitchell Ng, Che Hang J Wong","doi":"10.1177/11207000231214768","DOIUrl":"10.1177/11207000231214768","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates whether IBD patients are at increased risk of implant-related complications after THA.</p><p><strong>Materials and methods: </strong>A retrospective study from 01 January 2010 to 31 October 31 2020 using an administrative claims database was performed. IBD patients undergoing THA (<i>n</i> = 11,025), without corticosteroid treatment, were propensity score matched to controls in a 1:5 ratio (<i>n</i> = 55,121) based on age, sex, and the Charlson Comorbidity Index (CCI). Outcomes evaluated included periprosthetic fracture, aseptic loosening, prosthetic joint infection, and THA revision within 2 years of index procedure. Chi-square analyses were used to compare the matched cohorts. The association of IBD and implant-related complications was evaluated using logistical regression to calculate odds ratios (ORs), 95% confidence intervals (95% CIs), and <i>p</i>-values. A <i>p-</i>value < 0.001 was used as the significance threshold.</p><p><strong>Results: </strong>Patients with IBD had a greater incidence and odds of total implant complications (7.03% vs. 3.98%; OR 1.76; <i>p</i> < 0.001) compared with matched controls. IBD patients had significantly higher incidence and odds of developing periprosthetic fracture (0.50% vs. 0.20%; OR 2.46; <i>p</i> < 0.001), THA revisions (2.21% vs. 1.17%; OR 1.91; <i>p</i> < 0.001), aseptic loosening (1.45% vs. 0.84%; OR 1.75; <i>p</i> < 0.001), and prosthetic joint infection (2.87% vs. 1.77%; OR 1.64; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Patients with IBD who underwent primary THA had a significantly higher risk of implant-related complications compared to matched controls. Providers should use this study to appropriately assess post-complication risk factors for their patients with IBD.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"498-502"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The accuracy and diagnostic value of gram staining joint aspirates in suspected joint infections.","authors":"James Zhang, Anna Stevenson, Andrew Kailin Zhou, Faris Khan, Rahul Geetala, Matija Krkovic","doi":"10.1177/11207000241230927","DOIUrl":"10.1177/11207000241230927","url":null,"abstract":"<p><strong>Background: </strong>Septic arthritis is a debilitating condition with prolonged treatment and adverse outcomes. A gram stain is often performed from the joint aspirate sample, followed by a definitive culture. In our study, we assessed the accuracy of gram staining for suspected septic arthritis and explored factors associated with positive culture growth and false negatives in the gram stain.</p><p><strong>Methods: </strong>We retrospectively reviewed joint aspirates performed from 2015-2021 at a major trauma centre. Aspirates not cultured for septic arthritis were excluded. Data collected included aspirate site, gram stain and culture result delay, patient demographics, orthopaedic/rheumatological history, and comorbidities. Outcomes measured were gram stain sensitivity and specificity. Factors influencing positive cultures and false negative gram stain results were analysed using logistic regression.</p><p><strong>Results: </strong>Of 408 joint aspirates meeting the criteria, 37 did not undergo initial gram staining. Gram stain sensitivity was 30.4%, specificity was 97.6%. The delay from aspirate to definitive gram stain and culture results was 1.1 and 5.4 days, respectively Logistic regression identified that prosthetic joint(<i>p</i> = 0.007), past joint infections(<i>p</i> = 0.006), arthritis(<i>p</i> < 0.001), hypertension(<i>p</i> = 0.007), diabetes(<i>p</i> = 0.019) were positively associated with positive cultures. Past joint infections(<i>p</i> = 0.004) were positively associated with false negative gram stain results. Patients on antibiotics during the aspirate had a higher risk of false negative gram stain results (OR = 5.538, 95%CI, 2.802-10.948; <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>In conclusion, the initial gram stain has limited sensitivity and caution should be exercised when interpreting negative results. Vigilance is crucial when the highlighted comorbidities or antibiotic use are present, to assess patients with potential joint infections.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"546-552"},"PeriodicalIF":1.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11264559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}