Background: Recent studies increasingly highlight the efficacy of tranexamic acid administration in total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, the optimal dosage of tranexamic acid is still controversial. Methods: The current study analyzes the efficiency of tranexamic acid dosage and the number of administrations in THA and TKA. The objective of this study is to compare the incidence of deep vein thrombosis (DVT) based on the number of dosages. We divided the patients into two groups; one group received a single dosage, and the other group received two dosages. Doppler ultrasound examinations were conducted on the lower limbs of all patients at both six and thirty days postoperatively. The second objective is to compare the decrease in hemoglobin (Hb) in the two groups. Results: The results show that there is no difference in DVT incidence between the patients with different TXA numbers of dosages. There is no statistically significant decrease in Hb between the two groups at day one and day five postoperatively. Day one shows a statistically higher average in the two-dose group, approximately 0.06 g/dL, and day five shows a slightly elevated average in the single-dose group, approximately 0.06 g/dL. Blood transfusion requirements show no significant differences in the groups; one patient in the single-dose tranexamic acid group needed transfusion at day five postoperatively, while two patients in each group required immediate postoperative transfusion. Conclusion: There was no increase in the incidence of deep vein thrombosis among patients receiving two dosages of tranexamic acid.

One of the complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). Numerous studies have been performed to explore the value of biological parameters in the early identification of infection rates after THA and TKA. This study investigates alterations in inflammatory markers associated with PJI. This retrospective study focused on a cohort of patients with hip and knee arthroplasty treated between 2016 and 2022. CRP, ESR, and fibrinogen were observed preoperatively, on days one, three, six, and twenty-one postoperatively. From a total of 4076 THA and TKA performed during this period, 62 patients were identified with periprosthetic infections. We also identified the pathogens responsible for infections in order to assess if asymptomatic preoperative infections were involved in PJI. In patients with acute infections following TKA, days one and three postoperative recorded a CRP value below the expected range. The value of CRP in patients with early infection after THA was significantly increased on day six postoperative. ESR and fibrinogen values were not statistically significantly correlated with early PJI. The CRP level in acute PJI shows different patterns than those shown in the literature.

Background/Objectives: Total knee arthroplasty (TKA) is the gold-standard treatment for advanced knee arthritis, offering pain relief and improved joint function. However, tibial component malalignment, malrotation, and improper biomechanical loading remain critical factors contributing to implant failure, instability, and revision surgeries. This review systematically examines the impact of biomechanical loading on the tibial insert following primary TKA, with a focus on alignment, posterior tibial slope (PTS), and load distribution. Methods: A systematic literature search was conducted across the PubMed, Google Scholar, and Web of Science databases following the PRISMA guidelines. Studies investigating the effects of tibial component alignment, varus/valgus deviations, PTS, and load distribution on tibial inserts post-TKA were included. Seven studies meeting the inclusion criteria were analyzed and described narratively. Results: The reviewed studies highlighted that varus and valgus malalignment significantly alter tibiofemoral contact pressures and ligament strains, increasing the risk of aseptic loosening and implant failure. Excessive PTS was associated with posterior femoral translation, altered ligament tension, and increased contact stresses on polyethylene (PE) inserts. Kinematically aligned TKA demonstrated reduced tibial force imbalances and improved functional outcomes compared to mechanically aligned TKA. Computational and cadaveric studies revealed that even minor malalignments (e.g., 3° varus or valgus) can cause significant biomechanical changes. Conclusions: Biomechanical loading on tibial inserts after primary TKA is highly sensitive to the alignment and PTS. Optimal alignment and controlled biomechanical forces are essential. Kinematically aligned TKA has shown promising effects, preventing aseptic loosening and ensuring long-term implant survival. Further in vivo studies are needed to validate these findings and optimize surgical techniques.

Breakage of tibial interlocking nails is a rare complication and is associated with tibial nonunion. The distal part of a broken tibial nail is difficult to extract and can be a real challenge. Preoperative planning is important, as the retrieval techniques of broken implants are not routine operations. There are various techniques and instruments described by different authors with none being uniformly successful. Therefore, surgeons should know as many methods as possible to choose the most suitable one. Minimally invasive retrieval techniques should be favored because of their reduced morbidity, while fenestration extraction methods should be used as the second intention. Cannulated intramedullary nails are more prone to benefitting from minimally invasive retrieval techniques than solid ones. This paper reviews and describes the present techniques used to extract the distal part of broken tibial nails, to serve as a quick guide for surgeons who need it.

Introduction: Periprosthetic joint infections (PJI) are among the most serious and costly complications in orthopedic surgery, significantly affecting patient prognosis and healthcare systems. Despite rigorous aseptic measures, intraoperative contamination of sterile fields, instruments, and air remains a persistent source of potential infection. This study investigates the relationship between the microbial contamination of sterile fields during arthroplasty and postoperative inflammatory markers, with the objective of determining whether the contamination of sterile fields correlates with the presence of periprosthetic joint infection (PJI). Material and Methods: This prospective observational study included 33 patients undergoing total hip or knee arthroplasty in a university-affiliated orthopedic center. Intraoperative samples were collected from sterile fields and equipment to detect microbial contamination, while postoperative monitoring involved the C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); leukocyte count; temperature; and wound assessment on days 1, 3 and 7. All patients received 48 h of prophylactic cefuroxime. Statistical analysis was conducted using the International Business Machines (IBM) Statistical Product and Service Solutions (SPSS) software for Windows, version 30.0 (IBM Corporation, Armonk, New York, United States of America) with significance set at p ≤ 0.05. Results: Postoperative inflammatory markers showed distinct patterns depending on the isolated microorganism, with Proteus vulgaris and Staphylococcus hominis ssp. consistently associated with higher CRP and leukocyte values, indicating a more intense systemic response. Staphylococcus epidermidis was the most frequently isolated species but showed moderate inflammatory profiles, suggesting its potential role in subclinical colonization. A strong correlation between CRP on day 3 and leukocyte count (r = 0.81) confirms their combined utility in the early detection of infectious complications, while ESR appeared less dynamic and more complementary in nature. Discussion: This study highlights the significant role of intraoperative contamination and microbial virulence in shaping the postoperative inflammatory response after arthroplasty. Elevated CRP and leukocyte levels, particularly on day 3, were closely associated with pathogens known for biofilm formation and chronic infections. Despite prophylactic antibiotic use, confirmed infections still occurred, suggesting the need to reassess current protocols and enhance intraoperative contamination control. Conclusions: Pathogen presence in sterile fields during arthroplasty increases the risk of periprosthetic joint infections, often without early clinical symptoms. CRP on day 3 and leukocyte count were the most reliable early indicators of persistent inflammation.

Introduction: Periprosthetic joint infection (PJI) remains one of the most challenging complications following total hip arthroplasty (THA). Antibiotic-loaded bone cement (ALBC) provides high local antibiotic concentrations and is widely used in patients at increased risk of infection. Although several dual-antibiotic formulations have been investigated, their influence on the early postoperative inflammatory response has not been directly compared. Methods: In this prospective observational cohort study, 35 patients undergoing primary cemented THA between January 2025 and January 2026 were allocated to one of five ALBC regimens according to routine clinical practice: gentamicin alone, gentamicin–vancomycin, gentamicin–clindamycin, gentamicin–meropenem, or gentamicin–tobramycin (n = 7 per group). Serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and leukocyte count were measured preoperatively and on postoperative Days 1, 3, and 7. Longitudinal analyses accounting for within-patient correlations were performed to assess the effects of treatment group, postoperative time, and the group × time interaction. Day-specific between-group comparisons using one-way analysis of variance (ANOVA), with eta-squared (η²) as an effect-size measure, were performed as secondary analyses, with Bonferroni adjustment applied to post-hoc pairwise comparisons. Results: All treatment groups demonstrated progressive reductions in postoperative inflammatory markers. Longitudinal analysis demonstrated significant effects of treatment group, postoperative time, and the group × time interaction for CRP and ESR (all p < 0.001). For leukocyte count, significant effects of time and the group × time interaction were observed (both p < 0.001), whereas the overall group effect was not statistically significant (p = 0.071). Secondary day-specific analyses showed significant between-group differences in CRP, with comparatively lower values observed in the gentamicin–meropenem group. Several pairwise differences in CRP and ESR remained statistically significant after Bonferroni adjustment, whereas no pairwise differences in leukocyte counts remained significant after correction. Conclusions: Different antibiotic-loaded PMMA formulations were associated with distinct early postoperative inflammatory profiles. Gentamicin–meropenem was associated with comparatively lower CRP and ESR values; however, these exploratory findings do not establish superior infection-preventive efficacy and require confirmation in larger studies.