Current Issue : April-June Volume : 2026 Issue Number : 2 Articles : 5 Articles
Total knee arthroplasty is an increasingly common surgical intervention for degenerative knee disease, yet it carries a risk of prosthetic joint infection (PJI). While bacterial infections dominate the landscape of PJIs, fungal infections represent a rare but significant concern, especially in immunocompromised patients. This case report describes a 71-year-old patient who presented in October 2024 with left knee pain and swelling 7 months after total knee arthroplasty. A prosthetic joint infection due to Candida parapsilosis was diagnosed preoperatively by repetitive microbiological examination of synovial fluid and intraoperatively by tissue samples and sonication of prosthetic material. A two-stage revision surgery with a short 4-week interval was performed using an antifungal-impregnated spacer, followed by 6 months of systemic antifungal treatment with fluconazole and continued by fluconazole suppressive treatment for another 6 months. A favorable clinical and functional outcome was achieved after 11 months of follow-up. This is a rare case of fungal PJI treatment with a two-stage revision with a shorter interval, using an antifungal impregnated spacer combined with a prolonged antifungal therapy....
Background/Objectives: Childhood is marked by frequent musculoskeletal injuries, with fractures representing a major cause of pediatric trauma admissions. Unstable long-bone fractures often require surgical stabilization, commonly achieved using elastic stable intramedullary nailing (ESIN). Although this method ensures effective fixation and early mobilization, concerns remain regarding potential metal ion release in growing children. This study aimed to assess changes in calcium, magnesium, copper, zinc, titanium, and aluminum concentrations in blood and material from the medullary cavity of forearm fractures following intramedullary fixation. Methods: A prospective study was conducted on 40 patients aged 4–15 years treated with ESIN at the University Children’s Hospital in Lublin. Peripheral blood and material from the medullary cavity were collected before implantation and at implant removal. Elemental concentrations were determined using high-resolution ICP-OES, and statistical analyses included paired comparisons, delta values, and multivariate methods. Results: No significant systemic changes were found for calcium, magnesium, copper, zinc, or aluminum. A modest but significant increase in blood titanium levels was observed after treatment (p = 0.0075), especially in patients with two rods. Multivariate analysis confirmed overall stability of elemental profiles, with titanium contributing most strongly to post-treatment variation. Conclusions: Intramedullary titanium fixation in children does not significantly disrupt systemic mineral homeostasis. The slight increase in circulating titanium reflects implant exposure rather than toxicity, supporting the safety of ESIN, although continued monitoring of metallic elements may be warranted....
Introduction: Post-traumatic and post-surgical ulnar nerve neuropathies at the elbow and wrist remain challenging conditions often associated with significant sensory and motor impairment. Traditional approaches such as neurolysis alone may be insufficient, especially in complex or recurrent cases. Adipofascial flaps have shown promising outcomes in peripheral nerve surgery. The aim of this study was to evaluate the outcomes of 13 patients with severe ulnar neuropathies who were treated with a size- and shape-personalized adipofascial flap for nerve coverage. Materials and Methods: We retrospectively analyzed 13 patients treated between May 2020 and May 2024 for severe post-traumatic or postsurgical ulnar neuropathies. All underwent surgical decompression, external neurolysis, and adipofascial flap coverage. Pre- and postoperative outcomes were assessed with clinical and neurological evaluations and using the QuickDASH and NRS pain scores. Discussion: All patients showed improvement in pain and sensory-motor function, including those with complications, supporting the role of flap coverage in neuroprotection. This is the first study to describe the use of adipofascial flaps for pseudo-palsy and painful neuroma-incontinuity of the ulnar nerve at the elbow and wrist level. Conclusions: Adipofascial flaps represent a safe, technically feasible, and effective option in complex ulnar nerve injuries, providing both mechanical and biological support. Despite the small cohort, the results suggest strong clinical potential across varied injury patterns....
Introduction: Surgical site infections (SSIs) and prosthetic joint infections remain among the most serious complications in orthopedic surgery, and chemical debridement is recommended for all septic revisions. The combination of polyhexanide (PHMB) and poloxamer (PLX), with in vitro antimicrobial and antibiofilm activity, represents a promising antiseptic solution. An Italian Delphi consensus was conducted to define the indications and clinical applications of PHMB/PLX as an antiseptic solution. Materials and Methods: A steering committee convened a panel of orthopedic surgeons, infectious disease specialists, and wound care specialists with expertise in musculoskeletal infections. A modified three-phase Delphi process was conducted. Twelve clinical questions and four outcome measures were developed through literature review and iterative discussion. Two Delphi rounds were conducted using a 9-point Likert scale, and statements were rated according to the GRADE method. Results: Twelve statements were developed, and all achieved strong consensus after two Delphi rounds. The panel identified key patient-related risk factors (smoking, diabetes, obesity, immunosuppression) and procedure-related risks (open fractures, primary/revision arthroplasty, prolonged operative time). Antiseptic irrigation was considered superior to saline, and PHMB-PLX was considered potentially useful based on expert opinion as an addition to mechanical debridement given its antibiofilm activity and good cytocompatibility. Low-pressure irrigation and short exposure times are the preferred application methods, while avoiding use on cartilage or neural tissues. Conclusions: The Delphi panel reached strong consensus supporting the intraoperative use of PHMB-PLX due to its potential as an antiseptic adjunct, supported by expert consensus and translational evidence for preventing and treating SSIs in orthopedic surgery. The panel recommended conducting high-quality clinical research to verify these findings and improve standardized irrigation protocols....
Total knee arthroplasty (TKA) remains a cornerstone of orthopedic surgery, with optimal coronal alignment playing a pivotal role in determining both clinical outcomes and implant longevity. Traditionally, mechanical alignment has been regarded as the gold standard. However, the emergence of alternative philosophies—such as kinematic alignment and hybrid techniques—has shifted the focus toward individualized approaches. Recent advancements in robotic and computer-assisted systems have significantly enhanced the precision of implant positioning, allowing surgeons to better replicate native knee biomechanics and improve patient satisfaction. This narrative review examines current alignment philosophies in TKA, including mechanical, kinematic, and hybrid methods. It analyzes each technique’s principles, functionalities, benefits, and limitations while highlighting ongoing debates regarding their clinical application. Special attention is given to the role of technology in enabling more accurate, patient-specific surgical execution. Despite promising developments, challenges remain in standardizing these techniques and validating their long-term efficacy. To ensure a comprehensive evaluation relevant literature was reviewed, focusing on studies that explore alignment strategies, biomechanical outcomes, and the integration of technology in TKA. This review aims to synthesize current evidence, identify gaps in knowledge, and outline directions for future research needed to optimize alignment strategies in modern knee arthroplasty....
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