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Background: Two-stage revision in infected total knee arthroplasty increases the risk of blood loss and the need for transfusion. The present study aimed to test the hemostatic efficacy of a bipolar sealer to reduce blood loss and transfusion requirements after the first stage in patients affected by peri-prosthetic knee infections. Methods: Twenty-four patients undergoing 2-stage arthroplasty for infected TKA using a bipolar sealer (Haemodiss, Kylix, Naples, IT) were compared with 24 patients of a historical control group in which conventional electrocautery was used. Transfusion data, clinical information, and operative data were evaluated. The primary outcome measure was estimated blood loss at the time of the lowest hemoglobin level (nadir). The secondary outcome measures were the transfusion requirement and the number of units transfused. Results: The total blood loss was significantly lower in the prospective bipolar sealer group than the control group (1.19 (IQR 1.03–1.93) vs. 1.75 (IQR 1.13–2.07) L; p = 0.022). The transfusion rate was 8% in the bipolar sealer group, whereas 33% in the control group (p = 0.036). Furthermore, the mean number of blood units transfused was higher in the control group (0.4 ± 0.7 vs. 0.08 ± 0.3; p < 0.01). The Baseline Hematocrit and Operative time were directly associated with blood loss, whereas the bipolar use represented inverse predictor using multiple linear regression analysis. Conclusion: After the first stage of a two-stage exchange for periprosthetic knee infection, several factors influence postoperative blood loss, including preoperative HCT level and operative time. The bipolar sealer effectively supports hemostasis, thus reducing blood loss and the need for transfusions. [ABSTRACT FROM AUTHOR]

Background: Several arthroscopic glenoid bone augmentation techniques have been introduced to treat patients affected by anterior shoulder instability associated with critical bone loss. The efficacy of the different arthroscopic bony procedures has not been compared yet. Purpose: To compare the recurrence, complication, and reoperation rates of the arthroscopic Latarjet (AL) and arthroscopic free bone block (ABB) procedures for anterior shoulder instability. Study Design: Meta-analysis and systematic review; Level of evidence, 4. Methods: A systematic search was conducted in MEDLINE/PubMed, Web of Science, and Embase to identify clinical studies reporting the outcomes of the AL and ABB procedures. The following search phrases were used: "Arthroscopic" AND "Bone Block" OR "Bone Graft," and "Arthroscopic" AND "Glenoid Augmentation" OR "Glenoid Reconstruction," and "Arthroscopic" AND "Latarjet" OR "Coracoid Graft" OR "Coracoid Transfer." Exclusion criteria were <24 months of minimum follow-up, sample size <10 cases, revision after previous glenoid bone grafting, epilepsy, and multidirectional instability. Data regarding the study design, patient characteristics, surgical technique, and outcomes were extracted and analyzed. A proportional meta-analysis was conducted to compare the complication, recurrence, and reoperation rates between the 2 groups. Multiple subgroup analyses were performed to analyze the incidence of each complication and assess the weight of different fixation methods (in the whole cohort) or different graft types (in the ABB group). The modified Coleman Methodology Score was used to assess the risk of bias. Results: Of 5010 potentially relevant studies, 18 studies regarding the AL procedure (908 cases) and 15 studies regarding the ABB procedure (469 cases) were included. The 2 groups were comparable in age (P =.07), sex (P =.14), glenoid bone loss (P =.14), number of preoperative dislocations (P =.62), proportion of primary and revision procedures (P =.95), length of follow-up (P =.81), modified Coleman Methodology Score (P =.21), and level of evidence (P =.49). There was no difference in the recurrence (P =.88), reoperation (P =.79), and complication (P =.08) rates. The subgroup analyses showed a higher rate of hardware-related complications for screw fixation compared with flexible fixation (P =.01). Conclusion: The AL and ABB procedures had similar recurrence, reoperation, and complication rates. Screw fixation of the bone graft was related to an increased risk of complications compared with flexible fixation. Registration: CRD42022368153 (PROSPERO). [ABSTRACT FROM AUTHOR]

Background: The gold standard treatment for periprosthetic joint infections is the two-stage revision that includes the spacer placement before definitive reimplantation. The management of PJI affects patients' joint function and, subsequently, their mental health. Even though significant advances have been achieved, little to no attention has been paid to the psychological implications. So, based on standardized patient-reported outcome measures (PROMs), this study aimed to clarify the effect of spacer treatment of infected hip and knee arthroplasties on patients' mental health. Methods: We performed research on the literature on PJIs in the English language using the MEDLINE database with the search strings "spacer" OR "spacers" AND "hip" OR "knee" AND "SF-12" OR "SF-36" OR "EQ-5" OR "mental" OR "depression" OR "anxiety." The reference lists of selected articles were also hand-searched for any additional articles. Results: A total of 973 published papers were extracted, and 9 papers were finally included. A total of 384 patients who underwent spacer placement for PJI were identified. Of these 384 patients, 54% were female. The mean age ranged from 62 to 78.2 years. Of the11 papers identified for this review, 4 analyzed only hip spacers, including 119 patients; 4 only knee spacers, evaluating 153 patients; while a single study included 112 patients for both joints. Conclusions: Patients with the spacer are living in a state of mental upset, albeit better than the preoperative state. Clinical improvement with the review is not assured. The alteration of mental state turns out not to be transient for all the patients. [ABSTRACT FROM AUTHOR]

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is an effective treatment for end-stage osteoarthritis. The aim of this systematic review was to assess the age of patients undergoing TAR in prospective comparative studies. Our hypothesis is that the age reported in most recent papers might be lower than those reported in older papers. Methods: This systematic review was performed using Pubmed, Scopus, EMBASE and Cochrane databases. Only Level I and II studies dealing with TAR were included. Data regarding demographics, study design, year of publication and year/years in which surgery was performed were extracted. A two-fold analysis was conducted building groups of patients based on the year of publication and creating 1) two groups (before and after the median year) and 2) three groups (using tertiles) in order to compare age of patients operated in different period of times. A comparison was also performed considering the median year of surgery for patients undergoing TAR. Results: Overall 59 cohorts (42 studies, published between 1999 and 2023; median year of publication: 2017) were included (6364 ankles, 6284 patients, median age 63 years). The difference between the median age for 27 cohorts published until 2016 (weighted median 63 years; IQR, 62.5-64) and the median age for 33 cohorts published after 2017 (weighted median 63.2 years; IQR, 63-67.8) was not statistically significant (p=0.09). The division in tertiles did not reveal any significant change in the weighted median age at surgery (T1 (1999-2014; 63.2 years; IQR, 62.8-64.1), T2 (2015-2018; 63 years; IQR,63-63.5) and T3 (2019-2023; 63.2 years; IQR, 62.6-67.8)) over time (p=0.65). The median age of patients operated between 1999 and 2008 vs 2009 and 2023 (data from 48 cohorts) was not different either (p=0.12). Conclusion: According to this review of prospective studies published between 1999 and 2023, the median age for patients undergoing TAR over the last two decades has been 63 years, remaining steady with no significant changes over time. [ABSTRACT FROM AUTHOR]

Category: Ankle Arthritis; Ankle Introduction/Purpose: Total ankle replacement (TAR) is gaining momentum as surgical option in end-stage ankle osteoarthritis. Periprosthetic joint infection (PJI) is one of the most common complications and its management may be challenging. Our aim was to define the eradication rate and limits of the surgical procedures performed to treat PJI after TAR. Methods: This systematic review followed the PRISMA checklist and was registered in the Open Science Framework platform. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria and the surgical treatment for PJI. The methodological index for nonrandomized studies (MINORS) was used to assess the methodological quality of studies. Three groups were built based on the surgical procedure performed by authors: Group 1 for debridement, antibiotics, and implant retention (DAIR), Group 2 for 1.5-stage revision (1.5-stage) and Group 3 for 2-stage revision procedures (2-stage). Results: Fourteen cohorts (eight studies,152 infected TARs, 152 patients; 44% females, mean age: 61.4 years) were included. All studies had a retrospective design. Ankle pain with swelling and increased local temperature usually led to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis with positive blood tests. Microorganisms were identified in 92% (range,64%-100%) of cases. The definition of eradication of the infection was heterogenous ('no more surgery' (4 studies)), normal clinical-serological markers (2 studies), negative intraoperative cultures (2 studies). The eradication rate in DAIR, 1.5-stage and 2-stage groups was 64% (39/58 patients) 91% (11/12) and 89% (47/54),respectively. The incidence of below-knee amputation was 6.5% at 38.6-month follow-up. MINORS score was 8/16 for noncomparative studies and 14.6/24 for comparative ones (moderate quality). Conclusion: Decision-making in PJI after TAR is based on small-sample retrospective studies of moderate quality. In this review, the estimated effectiveness of DAIR and exchange procedures to eradicate the infection was two-thirds and nine-tenths, respectively. In case of failure, below-knee amputation is not uncommon. [ABSTRACT FROM AUTHOR]