Periprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single “gold standard” test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities for the identification of infections in this setting.

Mehmet Kursat Yilmaz, MD , Nursanem Celik, MD , Saad Tarabichi, MD , Ahmad Abbaszadeh, MD , Javad Parvizi, MD, FRCS. Hip Pelvis 2024;36:161-7. https://doi.org/10.5371/hp.2024.36.3.161

Introduction Femoral shaft nonunion can be extremely vexing and result in significant morbidity. We aimed to evaluate the outcomes of patients with nonunion of the femoral shaft fracture undergoing double plating and bone grafts from the iliac crest and femoral canal. Methods This retrospective study included 44 patients with femoral shaft nonunion between March 2020 to March 2022. Patients underwent dual plating, bone grafting from the iliac crest, and the utilization of the femoral canal. Age, sex, body mass index (BMI), the two surgical interventions interval, union time after the second surgery, hip range of motion (ROM), limb length discrepancy (LLD), infections, and deep vein thrombosis (DVT) were evaluated. Results Patients comprised 21 males (47.7%) and 23 females (52.3%), with a mean age of 42.3 ± 15.2 years. The mean BMI was 26.7 ± 3.77 kg/m2. The mean duration between the two surgical interventions for the patients was 17.07 ± 6.6 months. The patients were followed for ≥ 12 months. All patients achieved successful union and fracture healing, with an average time of 5 months. The mean hip flexion and extension were 112.84 ± 7.7˚ and 14.8 ± 5.2˚ degrees, respectively. Thirteen patients showed LLD after the first surgery, with a mean LLD of 7.15 ± 5.04 millimeters. LLDs were successfully rectified in all patients following the surgical intervention. No patients experienced postoperative infections or DVT. Conclusion According to our findings, the utilization of double-plate fixation in combination with iliac crest and femoral canal bone graft has proven to be a secure, productive, and straightforward surgical alternative for the management of femoral nonunion.

Total hip arthroplasty (THA) is a cornerstone intervention for Crowe Type 4 developmental dysplasia of the hip (DDH), a severe form characterized by complete hip dislocation and acetabular deficiency. This study aimed to evaluate the incidence of nerve injury in patients undergoing THA via trochanteric osteotomy and proximal femoral shortening, with a secondary focus on the impact of prosthesis type (cemented vs. cementless). A prospective cohort study was conducted in Iran on 62 patients (81 hips) with Crowe Type 4 developmental dysplasia of the hip between 2020 and 2022. All procedures utilized a standardized direct lateral approach with trochanteric osteotomy and femoral shortening (3-4 cm). Nerve injury was assessed postoperatively via electromyography/nerve conduction velocity (EMG/NCV). Continuous variables were analyzed using independent t-tests, categorical variables with chi-square tests, and significance set at P < 0.05. In this study, ultimately, 46 patients (62 hips) completed the study according to the protocol. Among the participants, 54 cases (87.1%) were female and 8 cases (12.9%) were male. The mean age and BMI of patients were 40.35 years and 25.19 Kg/m², respectively. Finally,59 cases (95.2%) were without any neurological deficit and 3 cases (4.8%) developed neurological problem during 12 months after surgery. The frequency of neurological deficit had a statistically significant correlation with the type of prosthesis (P = 0.01). Trochanteric osteotomy with proximal femoral shortening achieves substantial leg lengthening in Crowe Type 4 developmental dysplasia of the hip, with minimal nerve injury risk. Cementless prostheses demonstrated superior neurological safety, advocating for their preferential use.