Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Risk Factors for Venous Thromboembolism (VTE) Following Anterior Cruciate Ligament (ACL) reconstruction: A systematic review and meta-analysis","authors":"Yao-Tung Tsai,&nbsp;Chia-Chun Wu,&nbsp;Ru-Yu Pan,&nbsp;Pei-Hung Shen","doi":"10.1016/j.otsr.2025.104184","DOIUrl":"10.1016/j.otsr.2025.104184","url":null,"abstract":"<div><h3>Background</h3><div>Thromboembolism (VTE) is an uncommon, but potentially serious complication in patients who undergo anterior cruciate ligament (ACL) reconstruction.</div></div><div><h3>Patients and methods</h3><div><span>PubMed, EMBASE, and Cochrane databases were searched for relevant studies published until July 16, 2023. Eligible studies were those investigating patients who were undergoing ACL reconstruction, with the primary focus on factors associated with VTE including age, sex, </span>body mass index (BMI), hypertension, smoking, type of surgical setting (outpatient vs. inpatient), and tourniquet time.</div></div><div><h3>Results</h3><div><span>Six studies consisted of a total of 47,886 patients underwent ACL reconstruction were included. The VTE rate ranged between 0.4% and 11.0%, and the mean patient age ranged from 26.8 to 33.25 years. The meta-analysis revealed no significant association between VTE risk and sex (pooled adjusted odds ratio [aOR] = 1.28, 95% confidence interval [CI]: 0.88–1.85). Furthermore, the meta-analysis showed a significantly higher risk of VTE in smokers compared to non-smokers, favoring non-smokers (pooled aOR = 1.71, 95% CI: 1.16–2.54). The </span>systematic review identified several other potential factors, including older age, BMI, hypertension, smoking, surgical setting, and tourniquet time, which were documented in at least 2 included studies. However, while some of these factors showed reported significance, the number of studies was insufficient to generate a pooled result.</div></div><div><h3>Discussion</h3><div>According to our meta-analysis, sex does not appear to be a significant risk factor for VTE in patients undergoing ACL reconstruction. However, more evidence is needed to determine whether factors such as older age, BMI, hypertension, outpatient vs. inpatient surgery, and tourniquet time are associated with increased VTE risk. Caution is still advised when managing patients with these risk factors in the context of ACL reconstruction. A future meta-analysis is warranted once a sufficient number of studies are available to draw more definitive conclusions.</div></div><div><h3>Level of evidence</h3><div>IV</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104184"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a cardiovascular risk associated with the use of fluoroquinolones for the treatment of osteoarticular infections? Analysis of a retrospective cohort of 817 patients from a surgical and infectious disease referral center (CRIOAC)","authors":"Malo Buisson ,&nbsp;Philippe-Alexandre Faure ,&nbsp;Barthelemy Lafon Desmurs ,&nbsp;Caroline Loiez ,&nbsp;Benjamin Valentin ,&nbsp;Henri Migaud ,&nbsp;Eric Senneville","doi":"10.1016/j.otsr.2025.104242","DOIUrl":"10.1016/j.otsr.2025.104242","url":null,"abstract":"<div><h3>Introduction</h3><div>Bone joint infection is a rare but serious complication, the treatment of which most often requires intervention combined with prolonged high-dose antibiotic therapy. Fluoroquinolones are among the standard antibiotics for the treatment of these infections, particularly in combination with rifampicin for staphylococcal infections and as monotherapy for Gram-negative bacilli infections. However, recent studies, confirmed by several meta-analyses, have highlighted an increased cardiovascular risk such as aortic aneurysm and mitro-aortic regurgitation occurring early following fluoroquinolone use, leading to recommendations for caution from health agencies. These meta-analyses are often based on limited series with numerous indication biases (variable treatment durations) and low doses. We therefore conducted a single-center, single-prescriber, real-life study of a continuous series of osteo-articular infections. The objectives were to determine the rate of cardiovascular events (aortic aneurysm, mitro-aortic regurgitation) at 60 days, the mortality rate at 60 days, and at the final follow-up.</div></div><div><h3>Hypothesis</h3><div>Our hypothesis was that despite long-term, high-dose treatments, there was no increased cardiovascular risk in patients treated for osteo-articular infections with fluoroquinolones.</div></div><div><h3>Materials and methods</h3><div>Between 2017 and 2019, 817 patients were treated at the CRIOAC (Referral Center for Complex Osteo-Articular Infections) Lille-Tourcoing (332/817 patients received treatment with fluoroquinolones). This retrospective cohort study assessed the onset or worsening of cardiovascular events (such as aortic aneurysms and mitro-aortic regurgitation) and death at 2 months using a propensity score.</div></div><div><h3>Results</h3><div>After propensity score weighting, there was no significant difference in the risk of aortic aneurysm and mitro-aortic regurgitation at 60 days (Odds ratio (OR) 0.921 [0.317; 2.673], p = 0.879) or in the risk of death at 60 days (OR 1.252 [0.502; 3.118]; p = 0.630). There was also no significant difference in the risk of death at last follow-up after propensity score weighting (OR 1.011 [0.646; 1.582], p = 0.962).</div></div><div><h3>Discussion</h3><div>The results of this study suggest that the use of fluoroquinolones in patients treated for osteoarticular infections does not pose a significant increased risk of aortic aneurysm, mitro-aortic regurgitation, or death within two months. We believe it is reasonable to continue prescribing fluoroquinolones for osteoarticular infections while maintaining surveillance for these events.</div></div><div><h3>Level of evidence</h3><div>III; case-control study with propensity score.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104242"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professor Alain LORTAT-JACOB","authors":"Thomas Bauer","doi":"10.1016/j.otsr.2025.104381","DOIUrl":"10.1016/j.otsr.2025.104381","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104381"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professor Rémy Nizard: Surgical excellence and human commitment","authors":"Pierre-Alban Bouché ,&nbsp;Flore Devriese ,&nbsp;Valérie Rozier ,&nbsp;Jules Descamps","doi":"10.1016/j.otsr.2025.104380","DOIUrl":"10.1016/j.otsr.2025.104380","url":null,"abstract":"","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104380"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of the Girdlestone Procedure for the Treatment of Refractory Hip Prosthesis Infections","authors":"Aimery Sabelle ,&nbsp;Julien Berhouet ,&nbsp;Adrien Lemaignen ,&nbsp;Louis-Romée Le Nail ,&nbsp;Ramy Samargandi","doi":"10.1016/j.otsr.2025.104313","DOIUrl":"10.1016/j.otsr.2025.104313","url":null,"abstract":"<div><h3>Introduction</h3><div>Refractory prosthetic joint infections (PJI) of the hip remain a major challenge in orthopedic surgery. The Girdlestone procedure, also known as resection arthroplasty, was originally described for native hips but has since been adopted as a salvage option for complex and recurrent prosthetic infections. The main objective of this study was to evaluate the effectiveness of this procedure in treating prosthetic hip infections in this context.</div></div><div><h3>Materials and methods</h3><div>Eighty-eight patients (91 hips) who underwent femoral resection arthroplasty for refractory hip prosthesis infection between March 2004 and August 2019 were retrospectively included and analyzed as part of a single-center study with a minimum follow-up of two years. The primary outcome was infection eradication. Secondary outcomes included the incidence of treatment failure and the nature of postoperative complications. Risk factors for failure were identified using a Cox proportional hazards model. Bacteriological data and functional outcomes were also reported.</div></div><div><h3>Results</h3><div>Out of 91 hips, infection eradication was achieved in 65 cases (71%) following Girdlestone procedure. Six postoperative deaths related to infection occurred (6/88, 7%). In 20 out of 91 hips (22%), one or more revision surgeries were performed for persistent infection after implant removal. Among these, infection control was achieved in 10/20 (50%). Multivariate analysis identified corticosteroid use (HR = 6; p &lt; 0.01), preoperative fever (HR = 4.12; p &lt; 0.01), and polymicrobial infection (HR = 2.5; p &lt; 0.05) as independent risk factors for failure. The mean limb shortening was 5.7 (±1.7) cm, and the average walking distance was 175 (±350) meters. The mean Merle d’Aubigné and Postel score at final follow-up was 9.3 (±2.2) out of 18.</div></div><div><h3>Conclusion</h3><div>Definitive removal of the hip prosthesis remains a viable therapeutic option in refractory infections, despite a substantial complication rate. It should be considered, particularly when the prosthesis is no longer functional.</div></div><div><h3>Level of evidence</h3><div>IV; Retrospective case series.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104313"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of the C-reactive protein to albumin ratio in the treatment of septic arthritis in young children: a retrospective study","authors":"Xingguang Chen ,&nbsp;Yao Liu ,&nbsp;Chengda Zou ,&nbsp;Yuhan Sun ,&nbsp;Ting Zhuang ,&nbsp;Chaochen Zhao ,&nbsp;Qian Sun ,&nbsp;Mengxia Li ,&nbsp;Wen Zheng ,&nbsp;Xiaodong Wang","doi":"10.1016/j.otsr.2024.103948","DOIUrl":"10.1016/j.otsr.2024.103948","url":null,"abstract":"<div><h3>Introduction</h3><div>Septic arthritis<span> (SA) can cause lifelong disability in children due to joint dysfunction but there is controversy regarding the timing of surgery in SA. The C-reactive protein to albumin ratio (CAR) has emerged as a novel marker of inflammation and has been extensively used in predicting inflammatory bowel disease, arthritis, and systemic inflammation. Despite advancements, few studies have evaluated the role of CAR in SA. Therefore, the present study was aimed to investigate whether CAR could serve as predictive indicators for determining whether patients under four years old with SA should be managed conservatively or require surgical intervention, and to analyze its predictive accuracy.</span></div></div><div><h3>Hypothesis</h3><div>An increase in CAR values among patients under four years old with SA indicates the requirement of surgical intervention.</div></div><div><h3>Materials and methods</h3><div>This retrospective study enrolled SA children under four years old and divided them into two groups, the surgery and conservative groups. The clinical data between the two groups were compared and multivariate logistic regression was performed to assess the independent predictors of SA requiring surgery. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to determine the predictive ability of CAR in SA requiring surgery.</div></div><div><h3>Results</h3><div>A total of 82 SA children were included, with 42 children (51.3%) in the surgery group and 40 children (48.7%) in the conservative group. CAR ≥ 1.165 [OR = 12.641, 95% CI (4.264–37.479), <em>p</em> &lt; 0.001] was an independent predictive indicator for surgery in SA children under four years old, with a predicted sensitivity of 0.714, specificity of 0.850, and AUC of 0.793 [95% (0.694−0.893)] indicating good predictive accuracy.</div></div><div><h3>Discussion</h3><div>CAR to be an independent predictive indicator patients under four years old with SA. And a CAR value ≥ 1.165 upon admission in these patients suggests the necessity for surgical intervention.</div></div><div><h3>Level of evidence</h3><div>IV, Retrospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 103948"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141728239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meniscal tear analysis in anterior cruciate ligament rupture: A retrospective comparison of early versus delayed intervention","authors":"Yazeed Alshoaibi ,&nbsp;Julien Erard ,&nbsp;Assala Abumukh ,&nbsp;Léopold Joseph ,&nbsp;Nicolas Cance ,&nbsp;Sébastien Lustig ,&nbsp;Elvire Servien","doi":"10.1016/j.otsr.2024.104120","DOIUrl":"10.1016/j.otsr.2024.104120","url":null,"abstract":"<div><h3>Introduction</h3><div>Combined anterior cruciate ligament (ACL) and meniscal tear patterns and their effect on knee stability have been widely researched, however, their evolution and repairability from time of injury have been scarcely addressed. When addressed with delay, meniscal lesions associated with ACL tears may increase in severity and irreparability.</div><div>This study aims to investigate the incidence, rate and pattern of meniscus tears in the context of ACL deficient knees and to assess the meniscal condition in early versus late ACL reconstruction (ACLR).</div><div>The hypothesis was that an increased time between trauma and ACLR was associated with different meniscal tear patterns.</div></div><div><h3>Material and Methods</h3><div>Between 2012 and 2022, ACL reconstruction was performed in 1,840 cases. Out of the reviewed 1,317 ACLR’s 726 exhibited concomitant meniscal lesions. The mean age was 32 years ±10. Meniscal tear status was evaluated during arthroscopy according to the ISAKOS classification. Patients were divided into 2 groups according to injury-to-surgery time: &lt;2 months (116; 16%) and &gt;2 months (610; 84%).</div></div><div><h3>Results</h3><div>Vertical meniscal lesion was the prevalent pattern regardless of the meniscus involved and the time from injury to ACLR, accounting for 50 to 76% of the patients. No significant difference was found comparing patterns rates between early and delayed treatment groups for both compartments.</div><div>There was a significant difference in the distribution of circumferential areas of meniscal tears when comparing the medial with the lateral compartment. However, no significant difference in circumferential distribution of medial or lateral meniscus tears are present when performing surgery within or beyond 2 months.</div></div><div><h3>Conclusion</h3><div>There was no difference in meniscal tear patterns between early and delayed ACLR. The most frequent meniscal tear pattern was the vertical tear. No difference was found in circumferential distribution of meniscal tears between early and delayed ACLR. However, the circumferential distribution of meniscal tears was different comparing medial and lateral meniscus.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104120"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Muscle composition is not a prognostic factor for muscle strength recovery after anterior cruciate ligament surgery by hamstring tendon autograft","authors":"Maxime Pingon ,&nbsp;Gaspard Fournier ,&nbsp;Jobe Shatrov ,&nbsp;Ando Radafy ,&nbsp;Clara Bernard ,&nbsp;Julien Gondin ,&nbsp;Sébastien Lustig ,&nbsp;Elvire Servien","doi":"10.1016/j.otsr.2024.104111","DOIUrl":"10.1016/j.otsr.2024.104111","url":null,"abstract":"<div><h3>Purpose</h3><div>For the athlete, anterior Cruciate Ligament (ACL) rupture and its surgical management are often a turning point in their career. Success and time to return to sport are essential parameters for athletes and their support staff, so it is critical to understand the prognostic factors influencing return to sport after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to determine the influence of hamstring muscle composition on muscle power following ACLR with autogenous hamstring grafts.</div></div><div><h3>Methods</h3><div>24 patients with chronic torn ACL were included at a single-center over a period of 17 months. They underwent surgical repair and during this procedure grafts were harvested from the gracilis and the semitendinosus. Muscle composition was assessed on the remaining proximal part of the <em>semitendinosus</em> muscle, which is usually discarded, by immunostaining. Muscle power was defined by comparing the strength of the operated leg and the healthy leg on an isokinetic dynamometer at 6 months according a standardized protocol after 6 months of outpatient rehabilitation. Various other intrinsic and extrinsic factors were also studied, such as body mass index (BMI), age, sex, smoking, or sport practiced, to determine factors influencing isokinetic strength test after ACLR.</div></div><div><h3>Results</h3><div>No statistical relationship was identified between muscle composition and the muscle power between the operated and healthy leg. Smoking and female gender were associated with worse muscle recovery. Age and BMI had no influence on isokinetic performance at 6 months.</div></div><div><h3>Conclusion</h3><div>Following ACLR muscle composition is not associated with difference in strength between the two legs at 6 months. Determining muscle fiber composition of the patient does not inform the rehabilitation protocol or predict muscle strength recovery. Larger series data is required to understand the influence of gender or tobacco on muscle fiber characteristic.</div></div><div><h3>Level of Evidence</h3><div>: I; Prospective prognostic study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104111"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Detection of Chondral Damage in Suprapatellar Tibia Nailing: Incidence, Extent, and Clinical Relevance. A prospective study","authors":"Mehmet Salih Söylemez ,&nbsp;Serdar Kamil Çepni ,&nbsp;Bahattin Kemah ,&nbsp;Çağrı Özcan","doi":"10.1016/j.otsr.2025.104320","DOIUrl":"10.1016/j.otsr.2025.104320","url":null,"abstract":"<div><h3>Background</h3><div><span>Suprapatellar intramedullary nailing (SP-IMN) is widely used for </span>tibial shaft fractures due to its biomechanical and clinical advantages over infrapatellar approaches. However, concerns remain regarding potential chondral damage, with limited evidence from prospective studies. This study aims to address these gaps by evaluating the incidence of chondral damage, the presence of debris, and their effects on clinical outcomes. Specifically, we sought to answer the following questions: (1) Do clinical outcomes differ with different locations or grades of chondral damage? (2) What is the incidence of chondral damage following SP-IMN? (3) What are the characteristics of chondral damage?</div></div><div><h3>Hypothesis</h3><div>We hypothesize that extent and anatomical location of chondral damage may influence clinical outcomes, with more severe or widely distributed injuries potentially leading to poorer clinical results.</div></div><div><h3>Patients and methods</h3><div><span>This prospective study included 51 patients treated with SP-IMN for tibial shaft fractures. Arthroscopic evaluations were performed pre- and post nailing to assess chondral damage. The Outerbridge classification was used to grade chondral injuries. Clinical outcomes were assessed at 3, 6, and 12 months postoperatively using </span>Lysholm scores<span>, Visual Analog Scale (VAS) scores, anterior weight-bearing test (AWT-K) ratio, and range of motion (ROM).</span></div></div><div><h3>Results</h3><div>Chondral damage was observed in 70% of cases, with Outerbridge Grade 1 injuries being the most common (35%). Metallic debris was identified in 57% of cases, predominantly localized in Hoffa’s fat pad. Neither chondral damage nor metallic debris significantly affected clinical outcomes, including Lysholm scores, VAS scores, AWT-K ratio, or ROM. Significant improvements in these clinical measures were observed over time for all patients, irrespective of intra-articular findings.</div></div><div><h3>Conclusion</h3><div>SP-IMN is an effective technique for tibial shaft fractures, with a high incidence of chondral damage and metallic debris but no significant adverse impact on clinical outcomes. Further studies are warranted to explore the long-term effects of metallic debris and refine surgical techniques to minimize intra-articular injuries.</div></div><div><h3>Level of evidence III</h3><div>Single cohort prospective study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104320"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nine-year retrospective study of bacterial epidemiology and culture optimization in four orthopaedic surgery departments","authors":"Sylvain Robinet ,&nbsp;François Parisot ,&nbsp;Arnaud Clavé","doi":"10.1016/j.otsr.2025.104193","DOIUrl":"10.1016/j.otsr.2025.104193","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Management of device-associated bone and joint infections&lt;span&gt;&lt;span&gt; combines surgical treatment and antibiotic&lt;span&gt; therapy. Immediate postoperative broad-spectrum empiric treatment is often recommended pending complete microbiology results. The probabilistic antibiotics often used are not harmless, and expose the patient to the selection of resistant bacteria and changes in bacterial ecology within the healthcare units. The aim of this study was to answer the following questions: (1) Have the pathogenic bacteria isolated in osteoarticular infections and/or their &lt;/span&gt;&lt;/span&gt;antibiotic susceptibility profile changed over a 9-year period at our center, with possible implications for antibiotic therapy protocols? (2) Is there a way to optimize the &lt;/span&gt;&lt;/span&gt;incubation time&lt;span&gt; for microbiological cultures while still being acceptable for slow growing pathogens?&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Hypothesis&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Our hypothesis was that no difference in microbial epidemiology and &lt;/span&gt;antibiotic resistance rates would be found over this 9-year period, confirming antibiotic protocols.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;We conducted a retrospective study describing a nine-year bacterial epidemiology in four traumatology&lt;span&gt; and orthopedic surgery departments. Bacteria identified, site of infection, and antibiotic resistance were evaluated. Antibiotics for use in probabilistic protocols and after documentation of infection were selected for follow-up. Bacterial species were isolated after a maximum incubation period of 15 days up to 2020, and 10 days from 2021 with the addition of a solid culture medium that promotes anaerobic bacterial growth.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 648 clinical situations, 824 bacteria were identified. Gram-positive cocci accounted for 61.4% (506/824) of the strains, including 291/824 (35.3%) &lt;span&gt;&lt;span&gt;Staphylococcus aureus&lt;/span&gt;&lt;/span&gt;&lt;span&gt; and 136/824 (16.5%) coagulase-negative staphylococci. For the latter, fluoroquinolone&lt;span&gt; resistance remained stable at 7.3% (18/291 (p = 0.086)) and 22.8% (34/136 (p = 0.432)), respectively. Resistance to rifampicin was also stable for &lt;/span&gt;&lt;/span&gt;&lt;span&gt;&lt;em&gt;Staphylococcus aureus&lt;/em&gt;&lt;/span&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt; (1.2%,4/291 (p = 0.486)) and for coagulase-negative staphylococci (10.7%, 15/136 (p = 0.596)). Enterobacteriaceae accounted for 148/824 (18.0%) of identifications and were more resistant to piperacillin/tazobactam (15.1%, 24/148) than to &lt;/span&gt;cefepime&lt;span&gt; (5.6%,9/148 (p = 0.006)). There was no significant difference between the 15-day and 10-day culture protocols in the proportion of anaerobic bacteria&lt;span&gt; isolated from shoulder (p = 0.721), hip and knee (p = 0.530) &lt;/span&gt;&lt;/span&gt;&lt;/span&gt;prosthesis infections and spinal device-associated infections (p = 0.373). A microbiological diagnosis was made within five days using the 10-day culture protocol in 333/344 (96.8%) cases.&lt;/span&gt;&lt;/div&gt;","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"111 6","pages":"Article 104193"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}