Background: The septic arthritis of the hip is a complex condition characterized by a variety of clinical presentations, a challenging diagnosis and different surgical treatment options, including arthroscopy, resection arthroplasty and one and two-stage total hip replacement. Each technique reports variable results in terms of infection eradication rate. The aim of this systematic review is to compare the most relevant studies available in current literature and to assess if a better treatment outcome can be predicted based on the microbiology, history, and type of infection (active vs quiescent) of each case. Methods: A systematic review of the literature was performed in accordance with the PRISMA guidelines, including the studies dealing with the treatment of hip septic arthritis in adult patients. Electronic databases, namely the MEDLINE, Scopus, and Web of Science, were reviewed using a combination of following keywords “septic arthritis” AND “hip joint” OR “hip” AND “adult”. Results: The total number of patients included in this review was 1236 (45% of which females), for 1238 hips. The most common pathogen isolated was Staphylococcus aureus in its Methicillin-sensitive variant ranging from 2 to 37% of cases. Negative cultures were the second most common finding. It was also differentiated the type of infection of the hip, 809 and 417 patients with active and quiescent hip infection, respectively, were analyzed. Eradication rates for two-stage revision arthroplasty ranged between 85 and 100%, for one-stage approach between 94 and 100%, while for arthroscopic debridement/lavage between 89 and 100%. Conclusion: Staphylococcus aureus is the most common microorganism isolated followed by culture negative infections. Arthroscopic, one and two stage procedures can be effective in the treatment of hip septic arthritis when the indication is consistent with the type of infection retrieved. Level of evidence: IV, therapeutic study.

Postoperative rehabilitation after extensor mechanism reconstruction (EMR) with allograft following total knee arthroplasty (TKA) is not standardized. This meta-analysis aimed to evaluate the effectiveness of early and late knee mobilization after EMR. The range of motion (ROM) and extensor lag in both groups were also assessed as the secondary endpoint. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed, including studies dealing with the use of allograft for EMR following TKA. Failure was defined as the persistence of extensor lag > 20°. Coleman Methodology Score and Methodological Index for Non-Randomized Studies (MINORS) score were used to assess the quality of studies included. The failure rate was set as the primary outcome in early (4 weeks) and late (8 weeks) mobilization groups after EMR with allograft. Secondary outcomes were postoperative extensor lag and ROM. Twelve articles (129 knees) were finally selected for this meta-analysis. Late and early knee mobilization was described in five and seven studies, respectively. No difference was noted between both groups' failure rates (11/84 vs. 4/38, respectively; p = 0.69). The mean extensor lag at last follow-up was 9.1° ± 8.6 in the early mobilization group, and 6.5° ± 6.1 in the late mobilization group is not significantly different (p > 0.05). The mean postoperative knee flexion was 107.6° ± 6.5 and 104.8° ± 7 in the early and late mobilization group, respectively. While immobilization after EMR in TKA is mandatory to allow tissue healing, early knee mobilization after four weeks can be recommended with no additional risk of failure and increased extensor lag compared to a late mobilization protocol. IV, therapeutic study. Registration PROSPERO (International Prospective Register of Systematic Reviews): CRD42019141574.

Background: Single-stage hardware removal and total hip arthroplasty is a complex surgical procedure, comparable to revision surgery. The purpose of the current study is to evaluate single-stage hardware removal and THA outcomes, compare this technique with a matched control group that has undergone primary THA and assess the risk of periprosthetic joint infection with a 24-month minimum follow-up. Methods: This study included all those cases treated with THA and concomitant hardware removal from 2008 to 2018. The control group was selected on a 1:1 ratio among patients who underwent THA for primary OA. The Harris Hip (HHS) and University of California at Los Angeles Activity (UCLA) scores, infection rate and early and delayed surgical complications were recorded. Results: One hundred and twenty-three consecutive patients (127 hips) were included, and the same number of patients was assigned to the control group. The final functional scores were comparable between the two groups; a longer operative time and transfusion rate were recorded in the study group. Finally, an increased incidence of overall complications was reported (13.8% versus 2.4%), but no cases of early or delayed infection were found. Conclusions: Single-stage hardware removal and THA is a safe and effective but technically demanding technique, with a higher incidence of overall complications, making it more similar to revision THA than to primary THA.

Joint Diseases and Related Surgery (JDRS), the official journal of the Turkish Joint Diseases Foundation, is an international, peer-reviewed, immediate open access journal. All published articles in JDRS has been free for everyone, without embargo, since 1990.

The management of periprosthetic joint infection (PJI) after total ankle replacement (TAR) may be challenging. Our aim was to define the eradication rate and limits of some of the surgical procedures commonly performed to treat acute and chronic PJI after TAR. For this PRISMA-compliant systematic review multiple databases were searched including clinical studies in which acute or chronic PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria adopted and the surgical treatment for PJI. The methodological index for nonrandomized studies (MINORS) was used to assess the methodological quality of studies. Three groups were built based on the surgical procedure performed in the studies: Group 1 for debridement, antibiotics, and implant retention (DAIR), Group 2 for 1.5-stage revision (1.5-stage) and Group 3 for 2-stage revision procedures (2-stage). Thirteen cohorts from seven studies (138 infected TARs; 40 % females, mean age 61.3 years) published between 2012 and 2023 were included. The definition of eradication of the infection was heterogenous among studies (reported as 'no more surgery' in 3 studies, normal clinical and serological markers in 2 studies and negative intraoperative cultures in 2 studies). The pooled eradication rate in DAIR, 1.5-stage and 2-stage revision groups was 89 % (95 %CI, 79-100), 95 % (95 %CI, 70-100) and 92 % (95 %CI, 80-99), respectively. The proportion of below-knee amputation was 7.2 % (10/138) at a mean 39.3-month follow-up. MINORS score (7.6/16 and 14.6/24 for noncomparative and comparative studies, respectively) revealed a poor quality of studies. In this review, the estimated effectiveness of DAIR, 1.5 and 2-stage exchange procedures to eradicate PJI after TAR was 89 %, 95 % and 92 %, respectively. Decision-making in this setting is based on small-sample retrospective studies of poor quality. Below-knee amputation rate after a diagnosis of PJI was 7.2 %. Level IV, systematic review of Level IV studies.