The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients' Mental Health: A Narrative Review of the Literature

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.

Augmented Articulating Spacers in Infected Total Knee Arthroplasty: Surgical Technique

Periprosthetic joint infections (PJIs) are a prominent subject of discussion in orthopedics and are frequently debated at conferences and congresses. In the context of PJIs affecting the knee, the decision between following a one-stage or two-stage treatment approach has historically been a pivotal consideration. The first option is limited by indications and potentially devastating complications in case of failure, whereas the second is widely accepted as the gold standard. Initially, the spacer was conceived solely to restore and maintain knee space after removal of the implant. An articulating spacer was introduced to mitigate patient limitations and improve knee function and quality of life. Two main types of articulating spacers are utilized in knee PJI treatment: the mold spacer and the metal-on-poly spacer. This text outlines a technique for metal-on-poly spacer implants. Based on our experience and the existing literature, this approach facilitates early full weight bearing and faster recovery of the knee's range of motion, ultimately improving the quality of life after surgery, thus allowing the spacer retention for an extended period, as suggested by the 1.5-stage revision.

Comparison of unilateral and bilateral spinal anesthesia with 2% hyperbaric prilocaine in day-case inguinal herniorrhaphy: a randomized controlled trial

BACKGROUND

Hyperbaric 2% prilocaine produces a faster onset and shorter duration of spinal anesthesia than a plain solution. The anesthetic profile could be improved by restricting the block to the operative side. We compared unilateral versus conventional bilateral spinal anesthesia with hyperbaric 2% prilocaine in day-case patients undergoing unilateral inguinal herniorrhaphy.

METHODS

Eighty patients were randomly assigned to receive either conventional bilateral (N.=40) or unilateral (N.=40) spinal anesthesia with 50 mg hyperbaric prilocaine 2%. In the unilateral group, lateral decubitus was maintained for 10 minutes. Sensory and motor block courses, time to first micturition, and side effects were recorded.

RESULTS

On the operated side, the highest sensory block was T8 (T12-T2) in the unilateral and T9 (T11-T4) in the bilateral group (P=0.0328); the time to motor (115 ± 26 min in the unilateral and 108 ± 24 min in the bilateral groups, P=0.2350) and sensory (156 ± 30 min in the unilateral and 158 ± 26 min in the bilateral groups, P=0.7550) block resolution was similar in both groups. On the non-operated side, the unilateral group had a faster motor (64 ± 48, P<0.001) and sensory (120 ± 47, P<0.001) time to block resolution than the conventional group. Restricted unilateral motor and sensory block was achieved in 30% and 12.5% of patients, respectively. Time to voiding was shorter in the unilateral than in the conventional group (220 ± 47 vs. 249 ± 51 min, respectively, P=0.0104). There were no significant differences in adequacy for surgery and side effects between the groups.

CONCLUSION

In day-case inguinal herniorrhaphy, attempting unilateral spinal anesthesia with 50 mg hyperbaric 2% prilocaine produced faster time to voiding.

[Tracheal intubation with fiberscope in traumatology of the cervical spine. Our clinical experience]

Cervical spine lesions require early stabilisation. The fibroscope was used in order to avoid irreversible damage to the medulla during intubation. Twenty-five patients aged between 18 and 70 years old were treated. Pre-medication and local anesthesia of the nostril, rhinopharynx and oropharynx was performed. Local anesthesia of the hypopharynx was omitted to avoid the tussigenic reflex which is dangerous in this pathology. The patient was then deeply sedated maintaining respiratory activity. The tracheal tube was then introduced into the nostril and the fibroscope was then positioned using this as a guide. Following the insertion of the fibroscope in the trachea, the latter was then used to slide the tracheal tube down. The authors consider this technique to be useful in this pathology since it is risk free if used as described above.

[Axonal polyneuropathy caused by acute multiple organ disease]

Complications involving the peripheral nervous system known as CIP have been reported during the course of prolonged sepsis and MOFS. These may be differentiated from Guillain-Barré's syndrome by their electrophysiological characteristics of axonal neuronal damage and the normality of spinal fluid tests. The Authors report and discuss a case which was brought to their attention.

[Pseudotumor of the breast during a course of acute leukemia]

A case of breast infiltration with neoplasm-like clinical and radiological findings, occurring during acute leukaemia treated with polychemiosteroid therapy is described. Although at histopathological investigation this neoplasm is considered a reticulolymphoblastosarcoma, a personal suggestion that this breast infiltration is a blastic localization is put forward. This observation is a starting point for suggesting that antiblastic polichemio-therapy can change the clinical aspects of acute leukaemia.