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< Back Dr. Alper DUNKI Chondroblastoma Chondroblastoma is a rare, epiphyseal, benign bone tumor that exhibits locally aggressive behavior. It primarily affects skeletally immature individuals, most commonly males in their second decade of life. Most frequent locations include the distal femur, proximal tibia, proximal humerus, and less commonly the hip or calcaneus. Clinical Presentation Patients typically present with: Persistent joint-related pain Restricted range of motion Swelling or localized tenderness Due to its proximity to the joint, the symptoms often mimic inflammatory or mechanical arthropathy. Imaging Features Chondroblastomas typically present as well-circumscribed, lobulated lytic lesions located in the epiphysis or apophysis of long bones, most often around the knee or proximal humerus. On radiographs, they demonstrate geographic bone destruction with a thin sclerotic margin and may contain subtle internal calcifications reflecting a chondroid matrix. CT better delineates these calcifications and cortical integrity. On MRI, chondroblastomas usually appear heterogeneous, with intermediate signal intensity on T1-weighted and variable high signal on T2-weighted or fat-suppressed sequences, often surrounded by bone marrow and soft-tissue edema. A thin hypointense rim corresponding to reactive sclerosis is frequently seen. Post-contrast images show heterogeneous enhancement of the solid components and reactive tissues. Joint effusion or mild synovitis is common due to the subarticular location. Overall, the imaging appearance of chondroblastoma reflects a benign but locally active epiphyseal lesion in skeletally immature patients. X-Ray: Well-defined lytic lesion within the epiphysis; may show stippled or punctate calcification within the matrix. MRI: Demonstrates surrounding bone marrow and soft tissue edema. Lesion appears hypointense on T1 and heterogeneously hyperintense on T2 sequences. CT Scan: Can better define the mineralized matrix and thin sclerotic rim. Bone Scan: Typically shows increased uptake due to hypermetabolic activity. Histopathology Composed of round to polygonal chondroblasts with occasional multinucleated giant cells . The hallmark finding is “chicken wire” calcification , which refers to thin pericellular calcification encircling individual tumor cells. A "cobblestone " or lobulated architectural pattern may be observed. Differential Diagnosis Giant Cell Tumor (GCT): Usually affects skeletally mature individuals; tends to lack the calcified matrix. Clear Cell Chondrosarcoma: Typically occurs in the femoral head; may mimic chondroblastoma radiologically but differs in age group and clinical behavior. Chondromyxoid Fibroma (CMF): May resemble CB histologically but is more often metaphyseal and lacks typical pericellular calcification. Treatment and Prognosis The primary treatment is intralesional curettage . The resulting cavity may be filled with bone graft or bone cement . Radiofrequency ablation (RFA) has been explored in selected cases. The recurrence rate varies between 5% and 20%, depending on surgical technique and completeness of removal. Care must be taken to avoid damage to the physis and articular cartilage , particularly in younger patients. WHO Classification According to the 2020 WHO Classification of Bone Tumors, chondroblastoma is categorized as a benign chondrogenic tumor (ICD-O: 9230/0). References Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F (eds). WHO Classification of Soft Tissue and Bone Tumours, 5th Edition. Lyon: IARC Press; 2020. Oliveira AM, Hsi BL, Weremowicz S, Rosenberg AE, Dal Cin P, Joseph N, et al. Aneurysmal bone cysts are clonal and characterized by specific chromosomal rearrangements. Am J Pathol. 2004;164(5):1639–1646. Lucas DR, Bridge JA. Chondroblastoma. In: Bone and Soft Tissue Pathology , 2nd ed. Elsevier; 2019. p. 275–283. Xu H, Nugent D, Monforte HL, Binitie O, Ahmed S, Letson GD, et al. Chondroblastoma of bone in the extremities: a clinical review of 177 cases. J Bone Joint Surg Am. 2015;97(11):925–931. Amanatullah DF, Clark TR, Lopez MJ, Borys D, Tamurian RM. Chondroblastoma of bone in the pediatric population. J Pediatr Orthop. 2014;34(4):421–425. Wu RT, O’Donnell RJ, Horvai AE. Histologic spectrum and molecular pathogenesis of chondroblastoma and related tumors. Arch Pathol Lab Med. 2020;144(1):26–35. Yoshida A, Ushiku T, Motoi T, et al. Recurrent IDH2 mutations in chondroblastoma and chondromyxoid fibroma: differential diagnostic and therapeutic implications. Mod Pathol. 2022;35(6):775–784. Bohman SL, et al. Treatment of chondroblastoma with extended curettage and adjuvants: long-term local control and functional outcomes. Clin Orthop Relat Res. 2019;477(5):1074–1082. Axial and coronal fat-suppressed proton-density MRI images of the distal femur demonstrate a well-defined lobulated lesion in the epiphyseal region, showing heterogeneous high signal with a thin hypointense rim and surrounding bone marrow and soft-tissue edema. The lesion abuts the subchondral bone without cortical destruction. Findings are consistent with a chondroblastoma in a skeletally immature patient. Previous Next

< Back Dr. Fevzi SAGLAM Limb Salvage vs Amputation Limb salvage surgery has replaced amputation as the preferred approach for most malignant bone and soft tissue tumors, provided that oncologic safety can be maintained. Advances in imaging, chemotherapy, and reconstructive techniques have enabled wide resection with functional preservation in appropriately selected patients. Absolute indications for limb salvage include the ability to achieve negative margins without compromising major neurovascular structures, whereas amputation remains essential for cases with extensive involvement, infection, or unresectable disease. Long-term survival is comparable between limb salvage and amputation when clear margins are achieved, but limb salvage offers superior functional and cosmetic outcomes at the cost of higher complication rates. Future developments such as 3D-printed implants and biologic reconstructions are expected to further improve results, yet oncologic safety must always remain the primary goal. Limb Salvage and Amputation Orthopedic oncology is a multidisciplinary specialty concerned with the diagnosis and management of bone and soft tissue tumors. A pivotal decision in this field is whether the affected limb can be preserved or requires amputation. Historically, amputation was the standard treatment for malignant bone tumors. However, advances in imaging modalities, chemotherapy, radiotherapy, and surgical techniques have allowed limb salvage surgery to become a safe and effective alternative in many cases. The primary objective is to achieve oncologically safe resection margins while preserving limb function and appearance. Development and Indications of Limb Salvage Surgery Limb salvage surgery involves complete tumor excision with negative margins, followed by reconstruction of the resulting defect. The success of this procedure depends on tumor location, proximity to neurovascular structures, and patient-specific factors such as overall health and rehabilitation potential. Absolute Indications: • Tumor can be resected with safe margins without compromising major vessels or nerves. • Tumor reduction after neoadjuvant chemotherapy allows safe surgical margins. • Localized disease with no distant metastasis. Relative Indications: • Limited soft tissue involvement. • Absence of active infection or impaired wound healing. • Patient’s physical and psychological capacity for rehabilitation. Reconstruction techniques include modular tumor prostheses, autografts or allografts, rotationplasty, and vascularized fibular grafts. These strategies aim to restore limb length and maximize post-operative function. Indications and Role of Amputation Despite the advantages of limb salvage, amputation remains necessary in selected patients to ensure oncologic safety and optimal quality of life. Absolute indications include encasement of major neurovascular structures, uncontrolled infection, extensive soft tissue necrosis, or inability to achieve negative margins. Absolute Indications: • Tumor involving major arteries or nerves. • Widespread infection or chronic osteomyelitis. • Recurrent tumors where reconstruction is not feasible. • Inability to achieve oncologically safe margins. Relative Indications: • Patients with comorbidities precluding long or complex surgery. • Technical limitations preventing reconstruction. • Patient preference or anticipated noncompliance with rehabilitation. Modern prosthetic technology has significantly improved post-amputation functional outcomes and mobility. Oncologic and Functional Outcome Comparison Several studies have demonstrated no significant difference in long-term survival between limb salvage and amputation, provided negative surgical margins are achieved. Local recurrence risk remains primarily dependent on margin status. Functionally, limb salvage generally yields superior outcomes. Functional scores such as the Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS) are typically higher in limb salvage patients (%70–80) compared to amputees (%50–60). However, limb salvage procedures are associated with higher rates of early complications including infection, prosthesis loosening, and mechanical failures. Amputation, conversely, presents fewer surgical complications but poses greater psychosocial adaptation challenges. Complications and Rehabilitation The most common complications after limb salvage surgery include wound healing problems, deep infections, implant loosening, and fractures. In pediatric patients, expandable prostheses are often employed to accommodate ongoing growth. After amputation, patients frequently encounter phantom limb pain, skin irritation, and challenges with prosthesis fitting. Rehabilitation requires a multidisciplinary approach involving physiotherapy, psychological support, and prosthetic training to optimize functional independence. Conclusion and Future Perspectives Limb salvage surgery in orthopedic oncology offers superior functional and aesthetic outcomes in appropriately selected patients. Individual patient assessment remains critical. Future advances, including 3D printing, biologic reconstruction, and improved understanding of chemoresistance mechanisms, are expected to enhance limb salvage success. Nonetheless, the fundamental principle remains unchanged: oncologic safety must always take precedence over functional preservation. References: 1. Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am. 1986;68(9):1331–1337. 2. Gonzalez, M. R., Mendez-Guerra, C., Goh, M. H., & Pretell-Mazzini, J. (2025). Principles of Surgical Treatment of Soft Tissue Sarcomas. Cancers , 17 (3), 401. 3. Grimer, R. J., Taminiau, A. M., & Cannon, S. R. (2002). Surgical outcomes in osteosarcoma. The Journal of Bone & Joint Surgery British Volume , 84 (3), 395-400. 4. Aksnes LH, Bauer HC, Jebsen NL, et al. Limb-sparing surgery preserves more function than amputation: a Scandinavian Sarcoma Group study of 118 patients. J Bone Joint Surg Br. 2008;90(6):786–794. 5. Chandrasekar CR, Grimer RJ, Carter SR, et al. Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br. 2009;91(1):108–112. 6. Malawer, M. M., & Sugarbaker, P. H. (Eds.). (2006). Musculoskeletal cancer surgery: treatment of sarcomas and allied diseases . Springer Science & Business Media. 7. Davis AM, Bell RS, Badley EM, et al. Evaluating functional outcome in patients with lower extremity sarcoma. Clin Orthop Relat Res. 1999;(358):90–100. 8. Cirstoiu, C., Cretu, B., Serban, B., Panti, Z., & Nica, M. (2019). Current review of surgical management options for extremity bone sarcomas. EFORT open reviews , 4 (5), 174-182. Previous Next

< Back Supracondylar (Peds) Supracondylar fractures are the most common elbow fractures in children and require careful assessment due to the risk of neurovascular compromise. These injuries typically occur from a fall on an outstretched hand. Gartland classification (Type I–III) guides management. Type I fractures are treated with immobilization, while Type II and III generally require closed reduction and percutaneous pinning. Complications include brachial artery injury, median nerve or anterior interosseous nerve injury, and cubitus varus (gunstock deformity). Prompt assessment and treatment are critical to avoid long-term dysfunction. supracondylar-fractures-peds Previous Next

< Back Dr. Kayahan KARAYTUG Robotic Assisted THA Previous Next

< Back Myths and Misconceptions in Arthroplasty Despite rapid advances in implant design, navigation, and perioperative protocols, arthroplasty surgery remains surrounded by persistent misconceptions — many of which influence both surgeon behavior and patient expectations. Understanding and debunking these myths is essential for evidence-based orthopaedic care. Common Myths and the Truth Behind Them 1. “Cementless fixation is always superior in modern arthroplasty.” Myth: Uncemented implants provide better long-term outcomes in all patients. Reality: Cementless fixation requires good bone quality and metaphyseal support. In osteoporotic or elderly patients, cemented stems show lower periprosthetic fracture and early revision rates . 💡 Fixation method should match bone biology, not surgeon preference. 2. “Dual-mobility cups eliminate all risk of dislocation.” Myth: Dual-mobility (DM) constructs are fully protective against instability. Reality: DM cups reduce, but do not eliminate, dislocation risk. Malpositioned components, poor soft-tissue tension, or abductor deficiency can still cause failure. 💡 Stability begins with biomechanics, not implant geometry. 3. “Robotic and navigation-assisted arthroplasty always improves outcomes.” Myth: Technology guarantees precision and better function. Reality: Robotic and navigated systems improve accuracy of alignment , but functional and survival benefits remain unproven in large-scale data. They add cost and time without necessarily improving satisfaction. 💡 Precision ≠ Perfection. 4. “You should always restore the ‘anatomic’ joint line and alignment.” Myth: Mechanical restoration equals clinical success. Reality: Functional alignment — respecting soft-tissue balance and native kinematics — often yields superior outcomes. Over-correction may increase wear or instability. 💡 The goal is a stable, functional envelope — not a textbook angle. 5. “All painful arthroplasties are infected until proven otherwise.” Myth: Any postoperative pain should trigger a full infection workup. Reality: While infection must be excluded, pain can also result from component malrotation, metal hypersensitivity, referred spine pain, or iliopsoas impingement . 💡 Use a structured diagnostic algorithm (MSIS criteria) before reoperating. 6. “Periprosthetic joint infection (PJI) is mainly a surgical complication.” Myth: PJI reflects poor surgical technique. Reality: Most PJIs arise from hematogenous seeding or host-related factors (diabetes, immunosuppression, poor skin integrity). 💡 PJI prevention is multidisciplinary — perioperative glucose control, nutrition, and skin optimization matter. 7. “Early postoperative physiotherapy always improves implant longevity.” Myth: Aggressive rehabilitation speeds recovery. Reality: Excessive early load or forced motion can jeopardize soft-tissue healing, especially after revision or constrained implants. 💡 Rehab should be guided by fixation type and intraoperative stability. 8. “Metal allergy is a common cause of painful arthroplasty.” Myth: Nickel or cobalt allergy frequently causes chronic pain or implant loosening. Reality: True hypersensitivity reactions are rare (<1%) and diagnosis remains one of exclusion. Routine allergy testing before THA/TKA is not recommended . 💡 Rule out mechanical causes before immunologic speculation. 9. “Revision surgery always provides worse outcomes than primary arthroplasty.” Myth: All revisions result in inferior function and satisfaction. Reality: While complex, outcomes depend on indication, soft-tissue envelope, and implant choice . Early, well-planned revisions (e.g., aseptic loosening, instability) can yield excellent function. 💡 Timely, principle-based revision can restore function nearly to primary levels. 10. “All arthroplasty patients should receive the same thromboprophylaxis.” Myth: One size fits all for VTE prevention. Reality: Risk-stratified approaches are safer. Low-risk patients benefit from aspirin-based regimens, while high-risk cases (revision, obesity, cancer, immobility) require LMWH or DOACs. 💡 Balance thrombosis prevention with bleeding risk. Key Takeaways Cemented stems remain essential in fragile bone. Dual-mobility and robotics are tools, not cures. Alignment and soft-tissue balance outweigh mechanical angles. Holistic infection prevention > intraoperative sterility alone. Tailored rehabilitation and patient-specific care drive success. References : Abdel MP et al. J Bone Joint Surg Am. 2023;105(7):612–22. Lewis PL et al. J Arthroplasty. 2024;39(1):45–53. Gonzalez-Martin D et al. Eur J Trauma Emerg Surg. 2023. Haddad FS, et al. Bone Joint J. 2024;106-B(5):543–58. Parvizi J, et al. Clin Orthop Relat Res. 2021;479:985–99. Previous Next

< Back Patellofemoral Arthroplasty Patellofemoral arthroplasty is a type of partial knee replacement in which surgical option for isolated patellofemoral arthritis. Two different designs include; • İnlay-style designed (previous generation) o Positioning Inset flush with native trochlea o Rotation Determine by native trochlea o Narrower o No further proximal extension than native trochlear surface • Onlay-style designed (newer generation) o Replaces entire trochlea, perpendicular to AP axis o Set by surgeon, perpendicular to AP axis o Wider o Extends further proximal than native trochlea CLINICAL PRESENTATION · Anterior knee pain arise from patellofemoral joint o aggravated by activities such as squatting, ascending or especially descending stairs , getting up from a chair · Patellar crepitus and reproduce pain during retro-patellar palpation RADIOLOGIC ASSESMENT · Standing AP/lateral knee radiographs · Rosenberg view · Patellar skyline (axial or merchant) view · Standing full-leg radiographs o To evaluate; - Femorotibial compartments - Femorotibial malalignment - Stage of PF-OA (Iwano classification) - Trochlear dysplasia - Patellar height - Patellar subluxation · MRI - Meniscal pathology, ligament injury · CT - To evaluate rotational malalignment INDICATIONS · Indications o Isolated symptomatic PF o PF-OA Iwano stage 3–4 o Posttraumatic PF-OA o Trochlear dysplasia with or without instability o Failed prior conservative procedure o Good patellar tracking o Age>40 years · Absolute contraindications o Systemic inflammatory arthropathy o Tibiofemoral OA o Severe uncorrected tibiofemoral malalignment (Valgus deformity > 8 degrees or varus deformity > 5 degrees) o Uncorrected patellofemoral instability or maltracking o Stiffness o Ligamentous tibiofemoral instability o Acute infection or CRPS · Relative contraindications o Quadriceps atrophy o Patella baja o BMI > 30 COMPLICATIONS Showing that the 5-year cumulative revision rate was greater than 20% for inlay prostheses and less than 10% for onlay designs Early complications · Patellar instability · Maltracking (inlay-style implants %17-36, onlay-style implants less than %1) · Arthrofibrosis · Persistant pain · Extensor mechanism failure Late complications · Progression of tibiofemoral arthritis (most common reason for long-term failure, ̴25% of the revision at 15 years of follow-up) · Aseptic loosening (more frequent in cementless PFA) REFERENCES · Batailler C, Libert T, Oussedik S, Zaffagnini S, Lustig S. Patello-femoral arthroplasty- indications and contraindications. J ISAKOS. 2024 Aug;9(4):822-828. doi: 10.1016/j.jisako.2024.01.003. Epub 2024 Jan 5. PMID: 38185247. · Lonner JH, Bloomfield MR. The clinical outcome of patellofemoral arthroplasty. Orthop Clin North Am. 2013 Jul;44(3):271-80, vii. doi: 10.1016/j.ocl.2013.03.002. Epub 2013 May 4. PMID: 23827831. Pisanu G, Rosso F, Bertolo C, Dettoni F, Blonna D, Bonasia DE, Rossi R. Patellofemoral Arthroplasty: Current Concepts and Review of the Literature. Joints. 2017 Oct 4;5(4):237-245. doi: 10.1055/s-0037-1606618. PMID: 29270562; PMCID Previous Next

< Back Dr. Abdullah IYIGUN Neurologic Assessment Concise clinical guide covering motor, sensory, and reflex examination of spinal segments, with key diagnostic patterns, special tests, and upper vs. lower motor neuron distinctions. Spinal Neurological Assessment (Spot Knowledge) General Principles Includes motor, sensory, and reflex exam of all extremities Use Manual Muscle Testing (0–5 scale) for consistency Reflexes graded as: 0 = absent, 1+ = diminished, 2+ = normal, 3+ = brisk, 4+ = clonus Upper Extremity Motor C5 – Shoulder abduction (deltoid), elbow flexion (biceps) C6 – Elbow flexion, wrist extension C7 – Elbow extension (triceps), wrist flexion C8 – Finger flexion T1 – Finger abduction (intrinsic muscles) 💡 Grip (C8) and finger abduction (T1) often early affected in cervical radiculopathy Sensory C5 – Lateral shoulder C6 – Radial forearm, thumb C7 – Middle finger C8 – Little finger, ulnar hand T1 – Medial forearm Reflexes C5–C6: Biceps → elbow flexion C6: Brachioradialis → elbow flexion, forearm supination C7: Triceps → elbow extension Special Tests Spurling : axial load with neck extension/lat. flexion → radicular pain = positive Lhermitte : electric-shock sensation with neck flexion → cervical myelopathy Hoffman : flicking distal phalanx of middle finger → thumb flexion/adduction = UMN sign Lower Extremity Motor L2 – Hip flexion L3 – Knee extension L4 – Ankle dorsiflexion L5 – Great toe extension (EHL) S1 – Plantar flexion, eversion S2 – Knee flexion 💡 L5 weakness → cannot heel walk; S1 weakness → cannot toe walk Sensory L2 – Anterior thigh L3 – Knee region L4 – Medial leg/ankle L5 – Dorsum of foot, great toe S1 – Lateral foot, little toe S2 – Posterior thigh Reflexes L4: Patellar (quadriceps) S1: Achilles (gastrosoleus) Pathological: Babinski – great toe dorsiflexion = UMN sign Clonus – rhythmic ankle beats with forced dorsiflexion = UMN sign Chaddock/Oppenheim – Babinski equivalents Special Tests SLR (Lasègue) : 30–70° → radicular pain = L4–S1 compression Bragard : pain reappears with ankle dorsiflexion after SLR Cross Lasègue : contralateral leg raising provokes pain → severe root compression Femoral Nerve Stretch : prone, knee flexion → anterior thigh pain = L2–L4 compression Clinical Pearls Always check sacral segments (S4–S5) → anal tone, perianal sensation, bulbocavernosus reflex Document systematically (ASIA/ISCoS standards if possible) Radiculopathy → loss of reflex in affected root Myelopathy → hyperreflexia + pathological reflexes References American Spinal Injury Association (ASIA). International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). 2022. Hoppenfeld S, DeBoer P. Examination of the Spine and Extremities. Appleton & Lange, 1976. Fehlings MG, Tetreault LA, et al. Assessment of spinal cord injury and myelopathy. Lancet Neurol. 2017;16(6):482–492. Dumitru D, Amato AA, Zwarts MJ. Electrodiagnostic Medicine. 2nd ed. Hanley & Belfus, 2002. Kendall FP, et al. Muscles: Testing and Function with Posture and Pain. 6th ed. Lippincott Williams & Wilkins, 2020. Previous Next

< Back Cemented vs Cementless Fixation Previous Next

< Back Joint Preservation vs Replacement Previous Next

< Back Growth Arrest & Bar Formation growth-arrest-bar-formation Previous Next

< Back Dr. Kayahan KARAYTUG Periprosthetic Joint Infection (PJI) Periprosthetic Joint Infection (PJI) is one of the most devastating complications of arthroplasty. Although uncommon (≈1–2%), it is a leading cause of revision surgery and implant failure. Biofilm formation on implant surfaces makes eradication difficult and often necessitates complex surgical management. Periprosthetic Joint Infection (PJI) Pathophysiology & Risk Factors Biofilm formation protects bacteria from antibiotics and immune response. Common organisms: Staphylococcus aureus , S. epidermidis , and Gram-negatives. Risk factors: prior surgery, obesity, diabetes, immunosuppression, long operative time, wound complications. 💡 Host factors often outweigh surgical technique in determining infection risk. Diagnosis 1.Clinical Persistent pain, drainage, erythema, or early implant loosening. Chronic PJI may lack systemic signs (fever often absent). 2. Laboratory ESR >30 mm/h , CRP >10 mg/L → highly suggestive. Normal ESR + CRP → infection unlikely. 3. Synovial Fluid Aspiration before antibiotics. Evaluate WBC count, %PMN, culture, and novel biomarkers (α-defensin, leukocyte esterase, synovial CRP). ≥2 positive cultures → diagnostic. 4. Imaging X-ray: loosening or osteolysis (nonspecific). MRI (metal-artifact reduction) → soft-tissue assessment. PET-CT / Indium-labeled WBC scan for uncertain cases. 5. Intra-operative ≥5 tissue samples; >5 PMNs/HPF = infection. Ultrasonication of explanted implants enhances microbial yield. Treatment Strategies 1. Antibiotic Suppression Reserved for unfit patients or non-surgical candidates. Combination therapy (e.g., rifampicin + fluoroquinolone) may control low-grade infection. 2. DAIR (Debridement, Antibiotics, and Implant Retention) Indication: acute infection (<3 weeks), stable implant, sensitive organism. Success: 30–70%. 💡 Early (<48 h) intervention improves eradication. 3. Resection Arthroplasty Salvage in non-ambulatory or medically fragile patients. High infection-control rate but poor function. 4. Single-Stage Exchange Removal and reimplantation in one operation. Indicated for known organism, healthy host, good bone stock. Control rate: 80–90% . 5. Two-Stage Exchange (Gold Standard) Step 1: remove all components, debridement, antibiotic spacer + 6 weeks IV therapy. Step 2: reimplant after infection markers normalize. Success: >90–95% . 💡 Most reliable approach for chronic PJI. Antibiotic-Loaded Cement & Spacers Deliver high local antibiotic concentration. Articulating spacers (e.g., PROSTALAC) maintain limb length and mobility while treating infection. Recurrent or Resistant Infections Options: repeat two-stage revision, chronic suppressive therapy, or salvage resection. MRSA/VRE infections → rifampicin-based protocols remain effective. Outcomes & Prognosis Infection eradication: >90% achievable with early multidisciplinary care. Function depends on timing, host status, and bone/soft-tissue preservation. Key Pearls Always rule out infection before any revision. Combine serologic + synovial + intra-operative data for accurate diagnosis. Early, coordinated management (orthopaedics + ID + microbiology) is vital. Prevention: meticulous wound care, peri-op glucose control, skin optimization. References Parvizi J, et al. Clin Orthop Relat Res. 2021; 479: 985-99. Tande AJ, Patel R. N Engl J Med. 2014; 370: 2451-62. Zimmerli W, et al. Lancet. 2004; 364: 1539-54. Osmon DR, et al. Infect Dis Clin North Am. 2020; 34: 57-75. Previous Next