Background: There is no consensus on the optimal type of antibiotic-loaded bone cement (ALBC) spacer for ue in the first stage of revision total hip arthroplasty (THA) as a method for treating/managing periprosthetic joint infection (PJI) following THA. The purpose of this study was to determine the influence of ALBC spacer type on a collection of outcome metrics for revision THA (rHA). We hypothesized that infectious complications would be comparable across spacer types, while mechanical complications would be more common with the use of hemiarthroplasty ALBC spacer designs in rHA. Methods: This was a multicenter retrospective review of 144 patients who underwent a planned two-stage revision for THA for PJI between 2011 and 2022. Patients were stratified into three groups: pre-molded articulating hemiarthroplasty ALBC (PHA) spacers, custom articulating hemiarthroplasty ALBC (CHA) spacers, and custom ALBC THA (CTHA) spacers. The types and incidence of complications that arose during the time that the spacer was in situ were obtained. In total, 29 (20.1%) PHA, 11 (7.6%) CHA, and 104 (72.2%) CTHA patients were included. Results: CHA patients were significantly younger (mean age: 54.1 years) than PHA (mean age: 63.9) and CTHA (mean age: 63.9) patients (p = 0.011). The proportion of patients discharged home was significantly higher in the CHA group (81.8%) compared to that in both the CTHA group (64.4%) and the PHA group (34.5%) (p = 0.02). The re-revision rate for hip PJI was higher for CHA (18.2%), followed by PHA (13.8%) and CTHA (5.8%), while hemiarthroplasty spacers had the highest dislocation rate (13.8% in PHA and 18.2% in CHA vs. 3.8% in CTHA, p = 0.055). The vast majority of the outcome metrics did not differ among the three spacer groups, with examples being the incidence of dislocations, the incidence of all types of unplanned procedures for treating/managing re-infection, the time to the second stage in the rHA, and the proportion of spacers that were not removed until the second stage in the rHA. Conclusions: For the vast majority of the outcome metrics determined, the difference among the three study groups was not significant. Thus, the present results suggest that antibiotic-loaded cement spacer type does not influence outcomes when a spacer is used in the first stage of a two-stage protocol for the revision of a THA.

Background: The timing of operative debridement for open upper extremity fractures has not been consistently shown to impact infection rates. Nevertheless, current treatment protocols continue to advocate for prompt surgical debridement in the operating room. We hypothesized that delaying the surgical treatment of low-grade open forearm fractures beyond 24 h from presentation does not increase the likelihood of infection. Methods: The medical charts of patients who presented to a level one trauma center with Gustilo type 1 or 2 open forearm fractures between 2017 and 2020 were retrospectively reviewed. Treatment protocols for these low-grade open fractures included prompt wound irrigation in the emergency department and intravenous antibiotic treatment for 72 h, without emphasizing the timing of surgical intervention. Outcome measures included time to surgery, infection rate, and union rate. Results: The mean ± standard deviation age of the 62-patient cohort was 57 ± 20 years, and 30 (48%) were males. There were 9 proximal third, 16 midshaft, and 37 distal third fractures, of which 41 involved both bones. Forty-eight fractures were classified as Gustilo type 1 and fourteen as Gustilo type 2. Surgery was performed at a median interval of 47 h following presentation, with 43 (69%) patients undergoing surgery later than 24 h following presentation. There was one case (1.6%) of infection and three cases (4.8%) of non-union. Conclusions: Subject to small numbers, our findings suggest that in patients without risk factors, surgical treatment for low-grade open forearm fractures can be safely deferred without an apparent increase in infection rates. Accordingly, treatment protocols for these fractures may prioritize prompt and adequate antibiotic administration over the urgency of surgical intervention.

Although studies have suggested a negative effect of positive ulnar variance on outcomes after adequate arthroscopic triangular fibrocartilage complex (TFCC) management, the exact clinical impact of ulnar positive variance remains inconclusive. The purpose of this study was to determine the rate of subsequent ulnar shortening osteotomy (USO) after arthroscopic management of TFCC pathology in ulnar-positive wrists and to identify factors associated with progression to USO. This retrospective cohort study included 150 wrists with positive ulnar variance that underwent arthroscopic TFCC debridement or repair by a single surgeon between 2005 and 2025 after application of the exclusion criteria. Patients were stratified based on whether secondary USO was performed during follow-up. Baseline demographics, radiographic ulnar variance, index arthroscopic procedure type, and adjunct procedures were compared between groups. Univariable logistic regression was performed to explore factors associated with subsequent USO. The mean preoperative ulnar variance was 1.74 ± 0.77 mm (range, 0.5–4.0 mm). Arthroscopic repair was performed in 90 wrists (60%) and debridement in 60 wrists (40%). During follow-up, 12 wrists (8%) underwent secondary USO at a median of 8.2 months after index arthroscopy. Baseline demographics, the degree of ulnar variance, and the index arthroscopic procedure type were not associated with progression to USO. In contrast, full-thickness lunate chondral defects requiring microfracture at the index arthroscopy were more common in wrists that later underwent USO than in those that did not (25% vs. 3.6%; p = 0.018). In univariable regression analysis, lunate microfracture was associated with subsequent USO, although this finding should be interpreted cautiously given the small number of events. Among ulnar-positive wrists treated arthroscopically for TFCC pathology, the observed proportion of subsequent USO was 8%. Baseline demographics and the degree of ulnar variance were not associated with progression to USO. Full-thickness lunate chondral defects requiring microfracture at the index arthroscopy were more frequently observed in wrists that later underwent USO. IV, therapeutic study.