Francois Loubignac

Periprosthetic joint infection (PJI) is a devastating complication in total hip and knee replacement. Its prevention is key to decrease the incidence and avoid some consequences that seriously impact patients and health systems. In view of the variety of recommendations and guidelines, we decided to conduct an expert, peer-reviewed European consensus analysis about the pre-, intra-, and postoperative prevention of PJI. A multinational group of practicing orthopedic experts developed a series of 47 consensus statements in 6 main groups of intervention, and a 2-stage Delphi approach was launched with a threshold for agreement at 75% and for very high agreement at more than 90%. A total of 306 orthopedic surgeon responses were gathered from 9 countries. Consensus was reached for 42/47 statements, 31/47 of which achieved a very high consensus. Many preoperative actions gathered strong consensus, although areas like the use of alcoholic chlorhexidine or the timing of hair removal did not attain strong consensus, despite available evidence. Intra- and postoperative actions showed more variability regarding incise drapes, skin suturing techniques, and wound follow-up. This study confirms an important consensus among orthopedic surgeons across Europe in many areas well known to contribute to the prevention of PJI; however, there are still grounds for improvement.

Intraprosthetic dislocation is a rare complication in dual mobility hip prostheses, which usually occurs after the third postoperative year due to wear of the polyethylene retentive rim. We report a rare and non-described case of a patient who presented disassembly of the polyethylene insert from his dual mobility socket at nine postoperative months, secondary to several reduction attempts of a posterior dislocation of his prosthesis.

Lipoma is by far the most common of all benign soft-tissue tumors which far outnumber malignant tumors. Soft-tissue sarcomas are malignant tumors and are usually named for the type of tissue in which they begin. Liposarcoma (LPS), which arises in the fatty tissue, is rather an uncommon soft-tissue tumor. Multiple histologic subtypes of liposarcoma are recognized, including myxoid liposarcoma, and correspond to tumors of very different prognosis. In two-third of the cases, this tumor occurs in the muscle while often demonstrating a misleading benign appearance as observed in the majority of soft-tissue sarcomas.