Background: PJIs following total hip and knee arthroplasty represent severe complications with broad implications, and with significant disability, morbidity, and mortality. To be able to provide correct and effective management of these cases, an accurate diagnosis is needed. Classically, acute PJIs are characterized by a preponderance of virulent microorganisms, and chronic PJIs are characterized by a preponderance of less-virulent pathogens like coagulase-negative staphylococci or Cutibacterium species. This paper aims to analyze if there are any changes in the causative microorganisms isolated in the last years, as well as to provide a subanalysis of the types of PJIs. Methods: In this single-center study, we prospectively included all retrospectively consecutive collected data from patients aged over 18 years that were hospitalized from 2016 through 2022, and patients that underwent a joint arthroplasty revision surgery. A standardized diagnostic protocol was used in all cases, and the 2021 EBJIS definition criteria for PJIs was used. Results: 114 patients were included in our analysis; of them, 67 were diagnosed with PJIs, 12 were acute/acute hematogenous, and 55 were chronic PJIs. 49 strains of gram-positive aerobic or microaerophilic cocci and 35 gram-negative aerobic bacilli were isolated. Overall, Staphylococcus aureus was the most common isolated pathogen, followed by coagulase-negative staphylococci (CoNS). All cases of acute/acute hematogenous PJIs were caused by gram-positive aerobic or microaerophilic cocci pathogens. Both Staphylococcus epidermidis and methicillin-resistant S. aureus were involved in 91.66% of the acute/acute hematogenous PJIs cases. 21.8% of the chronic PJIs cases were caused by pathogens belonging to the Enterobacterales group of bacteria, followed by the gram-negative nonfermenting bacilli group of bacteria, which were involved in 18.4% of the cases. 12 chronic cases were polymicrobial. Conclusion: Based on our findings, empiric broad-spectrum antibiotic therapy in acute PJIs could be focused on the bacteria belonging to the gram-positive aerobic or microaerophilic cocci, but the results should be analyzed carefully, and the local resistance of the pathogens should be taken into consideration.

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.

Polysplenia syndrome represents a type of left atrial isomerism characterized by multiple small spleens, often associated with cardiac malformations and with situs ambiguus of the abdominal organs. The case presented is of a one-month-old male infant, weighing approximately 3000 g, born at the County Clinical Emergency Hospital of Sibiu, who was hospitalized from birth until death. The patient suffered cardio-respiratory arrest due to severe hypoxia and septicemia on the background of a series of complex cardiac malformations associated with congenital abdominal organ anomalies. Examination of the body revealed a common atrium with complete atrioventricular canal defect, left ventricular hypertrophy, right ventricle hypoplasia, truncus arteriosus, superior vena cava duplication, bilobation of the lungs, situs ambiguous of the abdominal organs with right-sided stomach, a midline liver, gall bladder agenesis, multiple right-sided spleens and complete inversion of the intestines and pancreas. Histopathology concluded that the patient suffered cardiac lesions consistent with infantile lactic acidosis, as well as pulmonary modifications suggesting congenital alveolar dysplasia and altered hepatic architecture compatible with fibrosis.

Purpose: The presence of pathogen microorganisms in the operating room remains a significant concern. This study aims to explore the factors influencing the presence of pathogens in the operating room. Methods: We analysed the presence of microorganisms in the operation theatre during total knee and hip replacement procedures for 33 patients performed in the same operation room (OR) over a period of 2 months. Three hundred and ninety‐six samples were taken from several areas belonging to the sterile field. We have also analysed behavioural aspects in the OR that could influenced the potential contamination of the sterile field, such as the number of touches of the lamps, the temperature in the OR, the height of the operating table, the number of door openings. Results: Out of the total of 396 samples, 74 were positive. Most contaminations were with Staphylococcus epidermidis (45.45%). Most pathogens were found on the instrument table at the end of the intervention (27.27%). There is a correlation regarding the fact that at lower heights, the risk of contamination higher than if the table is raised more. We also find correlations between the number of operating room doors opened and the presence of field contamination, as well as between the number of touches of the lamps and the presence of pathogens on sterile fields. Conclusion: The presence of pathogens in the OR is influenced by the number of lamp touches, the frequency of door openings, and the increased number of people in the room. However, temperature and the height of the operating table do not have a significant impact on the occurrence of pathogens. The most commonly found pathogen in the OR was S. epidermidis . At the end of the surgery, the instrument table showed the highest percentage of pathogen presence. Level of Evidence: Level IV, case series.