Case: A 41-year-old man with Klippel-Trenaunay syndrome presented with pain and limited range of motion in his left hip due to secondary hip osteoarthritis. After preoperative assessment, which also included tomography and conventional arteriography, total hip arthroplasty by direct anterior approach was attempted, but rapid blood loss occurred during surgery and the procedure had to be stopped. Conclusions: Total hip arthroplasty should be undertaken with great caution in a patient with Klippel-Trenaunay syndrome. Preoperative conventional arteriography alone may not reveal the true extent of vascular malformations, which may lead to catastrophic results.

Periprosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery that is difficult to both diagnose and treat. Misdiagnosing a prosthetic infection has terrible consequences for both the patient and healthcare system. No currently used diagnostic test fulfills the requirements to be considered a gold standard. This shortcoming has been overcome through the implementation of multi-criteria diagnostic protocols elaborated by societies including the Infectious Diseases Society of America, International Consensus Meeting and European Bone and Joint Infection Society, using a combination of clinical, paraclinical and molecular findings in order to achieve the best accuracy in diagnosing PJI. This review aims to survey the current state of the techniques and technologies used for the diagnosis of PJI, investigating the accuracies of serum biomarkers (e.g., C-reactive protein, Interleukin-6, procalcitonin, D-dimers, Serum Intercellular Adhesion Molecule-1), synovial biomarkers (e.g., Antimicrobial peptides, lipocalin-2, leukocyte esterase, calprotectin), tissue biomarkers (e.g., Toll-like receptors, CD15) and advanced molecular techniques (e.g., Polymerase chain reaction, Metagenomic next-generation sequencing), as well as describing their ongoing limitations. In the search for an accurate, inexpensive and fast diagnostic test for PJI, we conclude that the accuracies of the currently studied biomarkers could be further enhanced through the development of novel detection technologies.

Periprosthetic joint infection (PJI) is a reputable complication of arthroplasty surgery. Septic loosening is an implant biofilm-related infection with different characteristics and treatment than aseptic loosening. Misdiagnosing PJI results in choosing an inappropriate treatment and, in most cases, failure to achieve asepsis. The worldwide increase of arthroplasty surgeries forces us to research more accurate ways to detect PJIs earlier, cheaper, and faster. In the current study, we investigated 52 arthroplasty revision surgeries (septic and aseptic) and, using immunohistochemistry staining of periprosthetic tissue, successfully demonstrated an important increase in antimicrobial peptides human β defensin-3 (HBD-3) and cathelicidin (LL-37) in the PJI group. Furthermore, we observed that patients with a positive LL-37 stain were associated with a more reserved prognosis at one-year follow-up. These promising results suggest that antimicrobial peptides HBD-3 and LL-37 could be used as future biomarkers for PJI detection.