Introduction: Surgical site infection is one of the most challenging complications for spinal surgeons and can lead to a poor clinical outcome. The aim of this study was to compare the rate of infection with and without the use of Betadine Irrigation with Intrawound Vancomycin Powder to decrease surgical site infections (SSIs) following posterior lumbar spine instrumentation. Methods: This a single-institution Prospective study from June 2016 to May 2018. All patients undergoing posterior lumbar spine decompression and instrumentation for spondylolysis, spondylolisthesis and multilevel lumbar canal stenosis. Patients were randomized into the following groups: Group A- Betadine irrigation and intrawound vancomycin powder (BIVP) and Group B-patients receiving no prophylaxis (NONE). Outcome of SSI/wound complication were recorded and analysed. Results: Total 224 patients included in this study as per inclusion and exclusion criteria. The BIVP group had 80 patients and 144 in NONE group. Both groups were statistically similar with regard to age, gender, body mass index and comorbidities. There was significant decrease in infection rate in the BIVP group-A (1.25%) compared with the NONE group-B (4.16%). No adverse events were noted in the intervention group associated with the use of betadine and vancomycin powder. Conclusion: Betadine Irrigation and Intrawound Vancomycin Powder led to a significant decrease in SSI rates following lumbar spine surgery. Administration of BIVP is not time consuming and decreased SSI rates.

Introduction: Human Immunodeficiency Virus (HIV) infection and highly active antiretroviral therapy (HAART) have both documented associations with osteonecrosis and postoperative complications. Yet, the majority of the current literature focus on comparative outcomes between HIV-positive and HIV-negative patients. The aim of this study was to evaluate complication rates and further osteonecrosis among HIV-positive hip arthroplasty patients stratified by HAART use. Methods: Between 2010 and 2018, a retrospective review of the Mariner database was performed using PearlDiver to identify HIV hip arthroplasty patients. Groups were 1:1 matched based on age, gender, Charlson Comorbidity Index, obesity, tobacco, and alcohol status. One-year costs, readmission, revision, and complication rates were assessed. Continuous and categorical outcomes were measured via Student T-tests and Chi-square analyses, respectively. Results: Of the 5,453 HIV patients identified, 2,965 and 2,488 patients had documentation of HAART and no-HAART use, respectively. Following 1:1 match, each cohort consisted of 1,364 patients, of whom 1,035 males and 329 females, with no intergroup demographical differences. Among complications analyzed, HAART patients reported 1.21 increased odds of osteonecrosis diagnosis at any location following THA (p<0.001). HAART negative patients reported 1.5 and 1.2 increased odds of pneumonia (p=0.004) and UTI (p=0.03), respectively. No significant difference was noted in terms of length of stay (p=0.57), readmission (p=0.42), reoperation (p=0.42), or PJI rates (p=0.67). Conclusion: When treating HIV hip arthroplasty patients, it is critical to assess HAART therapy status. Appropriate follow-up and coordinated care are required to monitor HIV treated and non-treated patients for future osteonecrosis as well as respiratory/urinary complications.

Background: Septic arthritis an orthopedic emergency. Delay in its diagnosis and treatment can lead to disastrous complications like destruction of articular cartilage, epiphysis , and dislocation of joints. Changing trends in microbiological spectrum and emerging drug resistance poses big challenge.Although Staphylococcus aureus is implicated as the most common causative agent, changes in resistance and the increasing other pathogens have been reported. We present Microbiological profile in children with Septic Arthritis treated at our institute. Materials and Methods: Records of children treated during 2011–2019 were analysed .All Children with a clinical diagnosis of septic arthritis were included in this study. Arthrotomy was performed and the fluid was sent for Microbiological Evaluation. The Data was analyzed to map the microbiological profile. Results: 580 children were included in the final study. 257 (44.3%) No growth, 105 (18.1%) Klebseilla, 84 (14.4%) MSSA, 33 (6.6%) MRSA, 33 (6.6%) Enterobacter Species, 23 (3.9%) Candida, 18 (3.1%) E.coli, 15 (2.5%) Mycobacterium , 9 (1.5%) Coagulase negative staphylococcus, 3 (0.5%) Citrobacter. 55.6% of our patients had a microbiological growth out of which 50% had a gram negative organism isolated and 10% had MRSA which shows a significant change in microbiological profile from Gram positive to negative and MRSA as a community acquired infection. Fungal growth was significant at 7% of all growth hence a suspicion and subcultures are necessary. Conclusion: There is a changing microbiological pattern towards gram negative organisms, community acquired MRSA and Fungi. We need to revisit our antibiotic protocols in septic arthritis in children.

Introduction: Osteonecrosis (ON) of the femoral head has been correlated with specific risk factors including corticosteroid use, excessive alcohol consumption, congenital deformities, as well as Human Immunodeficiency Virus (HIV) and associated antiretroviral therapy (HAART) therapy. This study aimed to examine perioperative complications among hip osteonecrosis patients with and without HIV. Methods: A retrospective review utilizing the Mariner database was performed with the PearlDiver Supercomputer for patients diagnosed with osteonecrosis of the hip from 2010-2018. Patients were grouped into those with no history of HIV versus those diagnosed with HIV within 1 year of ON presentation. Cohorts were matched for age, Charlson Comorbidity Index (CCI), and gender. Complications included pneumonia, venous thromboembolism (VTE), blood transfusion, urinary tract Infection (UTI), dislocation, periprosthetic joint infection (PJI) and aseptic complications. One-year comparative cost of care was performed. Results: From 2010-2018, 904 (15.5%) HIV patients with ON were identified. Following the match criteria, 805 ON patients with or without HIV were identified. No significant differences in complications were noted for pneumonia (10.8% vs 11.1%; p=0.94), VTE (5.6% vs 5.6%; p=0.99), blood transfusion (4.8% vs 5.5%; p=0.65), UTI (9.3% vs 10.2%; p=0.61), dislocation (4.7% vs 4.4%; p=0.91), PJI (3.6% vs 3.9%; p=0.90), and aseptic complication (2.6% vs 2.2%; p=0.75) between HIV positive and negative subjects, respectively. Furthermore, one-year cost of treatment did not vary between cohorts ($26,507.48 vs. $27,112.18; p=0.78). Conclusion: HIV patients diagnosed with ON were at no increased risk for perioperative complications compared to HIV-negative patients.

Introduction: Periprosthetic knee infection is a challenging complication of arthroplasty. The diagnosis starts with history and clinical presentation, radiographical and laboratorial findings, all of which are of little diagnostic value. Knee arthrocentesis and the respective culture are the most reliable tests for establishing a diagnosis. In our institution we have several years of experience of the Alpha-defensin test (a-defensin). The treatment is complex and revisions under a septic context tend to fail more often and are associated with higher costs. Materials and Methods: The authors report a retrospective study of all cases of periprosthetic knee infection from an orthopedic department during a period of 7 years. We have collected the epidemiological data, microbiological findings, treatment performed and mortality rate. Results: We have analyzed 69 cases of periprosthetic knee infection, with an incidence of 3.36% of the knee arthroplasties performed. Treatments provided were: drainage of the purulent contents and intravenous antibiotic therapy - initially empirical and posteriorly culture oriented; 2-stage revision (revision performed after confirmation of infection treatment by the alpha-defensin test). The complications described are: knee arthrodesis, resection arthroplasty or supracondylar amputation. In most cases, no microorganism was isolated; however, the most frequently isolated microorganism was Staphylococcus aureus. Conclusion: Considering the literature, the overall incidence of periprosthetic infections vary mostly from 1.5 to 2.5% in primary arthroplasty and higher in revision arthroplasty. Recurrent infection is the most fearful complication, sometimes requiring salvage techniques such as knee arthrodesis or amputation of the lower limb.

Introduction:Surgical reconstruction of the lumbosacral spine in advanced lumbosacral tuberculosis is technically demanding due to the complex local anatomy,unique biomechanics and difficult fixation in the surrounding diseased bone.We have analysed the difficulties encountered in surgical reconstruction of the lumbosacral junction, in order to describe an effective strategy for tuberculosis with extensive destruction of lumbosacral spine. Methods:We reviewed a prospective cohort of 47 patients with advanced lumbosacral tuberculosis(L3 to S1) who underwent surgical reconstruction according to the following protocol.Patients with L5 tuberculous spondylitis(Type-1)were treated with posterior stabilization involving L3,L4,S1(with supplemental iliac screws, if anchorage in S1 was inadequate).In L5-S1 spondylodiscitis with extensive destruction of sacral promontory with disease free sacral ala(Type-2),lumbosacral spine was reconstructed by spinopelvic stabilization using alar screws with supplemental iliac screws.In extensive L5-S1 spondylodiscitis with destruction of both sacral promontory and sacral ala(Type-3),stability was achieved with spinopelvic stabilization using iliac screws alone as distal anchors.Additional anterior reconstruction was performed in cases where there was a significant anterior column deficiency and additional restoration of lordosis within physiological limits was needed. Results:Average follow-up was 42.5+/-6.9(37-118)months.All patients showed good bone healing at a mean of 9.5+/-1.6 months,significant improvement in neurology,VAS scores,ODI scores,ESR and CRP, p<0.05. Conclusion: The proposed classification and the corresponding treatment strategies have proved to be effective in addressing various scenarios of lumbosacral tuberculosis with extensive destruction of lumbosacral spine, in a systematic way.It helps reconstruct the lumbosacral spine,restore stability and physiological lumbar lordosis as evidenced by good radiological and functional outcomes at a mean follow-up of 42.5+/-6.9 months.

Background: Though two-stage revision arthroplasty remains the gold standard for treating periprosthetic joint infection (PJI) of the knee, this approach involves substantial morbidity and mortality for patients. An alternative involves implanting a functional prosthetic spacer using a primary total knee arthroplasty (TKA) femoral component and an all-polyethylene tibial component secured with antibiotic-laden cement. Some patients may choose to retain spacers indefinitely, even though their long-term longevity is unknown.
Methods: A retrospective chart review was undertaken of functional spacers for chronic PJI of the knee between January 2014 and October 2019 with minimum 1 year follow-up. The primary outcome was infection treatment success defined by the Delphi criteria. Secondary outcomes were reinfections, complications, reoperations, radiographic signs of failure, range of motion (ROM) and KOOS outcomes. Kaplan-Meir analysis estimated implant survival free from revision and reinfection.
Results: 33 patients met criteria with average follow-up of 45.1 months(±21). 78.8% (N=26) had treatment success, and 36.4% (N=12) underwent revision arthroplasty. Kaplan-Meier survival analysis predicted 61.8% of patients to be free from revision at 4 years. Causes of revision included reinfection (N=6), instability (N=5), and tibial loosening (N=1). 33.3% of retained functional spacers showed radiographic signs of failure. ROM and KOOS outcomes were similar between knees which underwent revision vs no revision.
Conclusion: A high rate of treatment success and spacer retention was seen at 4 years. Single-stage functional spacers are a valuable option for treating chronic PJI after primary TKA and may be acceptable for patients preferring to avoid a second operation.