Keisuke Oe

Aims: The aim of this multicentre retrospective study was to evaluate the efficacy of continuous local antibiotic perfusion in the management of patients with a fracture-related infection. Methods: The study included 170 patients with a fracture-related infection who were treated surgically at ten tertiary trauma centres between January 2019 and December 2022, with a minimum follow-up of one year. They were divided into continuous perfusion (n = 105) and non-continuous perfusion (n = 65) groups. The primary outcome was reoperation within one year. Secondary outcomes included recurrence of infection and acute renal failure. Univariate and multivariate logistic regression analyses were performed, followed by propensity score matching based on the classification of the elements of a fracture-related infection, to address baseline imbalances. Results: The rate of reoperation within one year was significantly lower in the continuous antibiotic perfusion group than in the non-continuous perfusion group (20.0% vs 43.1%; p = 0.002). The rate of recurrent infection was also significantly lower in the continuous perfusion group (12.4% vs 32.3%; p = 0.003). After multivariable adjustment, continuous perfusion remained independently associated with a reduced risk of reoperation (adjusted odds ratio (OR) 0.30 (95% CI 0.13 to 0.70)) and recurrence of infection (adjusted OR 0.28 (95% CI 0.11 to 0.73)). In the propensity score-matched cohort, continuous perfusion also remained significantly associated with a reduced risk of reoperation (18.6% vs 44.1%; p = 0.005) and recurrence of infection (8.5% vs 32.2%; p = 0.002). The incidence of acute renal failure did not differ significantly between the groups. Conclusion: Continuous local antibiotic perfusion was associated with a significantly lower rate of reoperation and recurrent infection in patients with a fracture-related infection, without an apparent increase in the rate of acute renal failure. Cite this article: Bone Joint J 2026;108-B(5):726–734.

Aim: Periprosthetic joint infection (PJI) is a serious complication that is difficult to treat and significantly affects patients’ functional prognosis and quality of life. I In Japan, continuous local antibiotic perfusion (CLAP) therapy, in which high-concentration antibiotics are administered directly to the infected area via a tube or needle, is widely used for musculoskeletal infections, and there have been many reports demonstrating its effectiveness. However, studies on its application in PJI remain limited. This study aims to compare treatment outcomes between PJI cases with and without CLAP intervention. Method: We analyzed 65 PJI cases (29 TKA, 36 THA) that underwent surgery at our institution between April 2016 and July 2024, with at least six months of follow-up. Treatment success was defined as cases that did not require additional surgery for infection. Patients were classified into the CLAP group (n=17) and the non-CLAP group (n=48) based on the introduction period of CLAP (before September 2022: non-CLAP, after October 2022: CLAP). We also investigated the implementation of Debridement, Antibiotics, and Implant Retention (DAIR) and implant retention. Statistical analysis was conducted using the chi-square test and t-test. Results: The CLAP group included 17 joints, while the non-CLAP group had 48 joints. There were no significant differences between groups regarding age, sex, BMI, timing from infection onset to surgery, timing from TJA surgery to infection onset, DAIR implementation, and implant retention. In terms of treatment success, the CLAP group had a significantly higher success rate in THA than the non-CLAP group (CLAP: 76.9%, non-CLAP: 34.8%, p=0.037). However, no significant difference was observed in TKA (CLAP: 75%, non-CLAP: 72%, p=1.0). Regarding case distribution, there was no significant difference in THA between primary (16 joints) and revision cases (20 joints) (p=0.614), whereas in TKA, primary cases (25 joints) were significantly more frequent than revision cases (4 joints) (p=0.002). Conclusions: These results suggest that CLAP intervention may improve treatment outcomes in THA-associated PJI. In contrast, the high proportion of primary cases in TKA may have influenced treatment outcomes. Further accumulation of cases and long-term prognosis evaluation are needed for a more comprehensive analysis.

Lower-limb fracture malunion can result in angular deformity that requires surgical correction. Chipping corrective osteotomy (CCO) is a novel method that involves a chipping technique at the center of rotation of angulation, followed by single-stage internal fixation. This case series describes 3 cases of correction of fracture malunion of the lower limb managed using combined CCO and intramedullary nail stabilization. A 47-year-old man with a 17° varus deformity of the left tibia from a past accident had left knee pain. CCO was performed, achieving bone union in 4 months. The Mikulicz line improved from −11% to 23%, and his knee became pain-free. A 59-year-old man with a 19° valgus deformity of the right tibia from a past accident had right knee pain. CCO was performed, achieving bone union in 11 months. The Mikulicz line improved from 119% to 72%, and he could perform daily activities pain-free. A 59-year-old man with a complex left distal femoral deformity (25° varus and 15° internal rotation) from a past accident had left knee pain. CCO was performed, achieving bone union in 8 months. The Mikulicz line improved from −52% to 4%, and he started enjoying jogging. We performed CCO combined with intramedullary nail stabilization in 3 cases of post-traumatic angular and rotational malunion, achieving good clinical outcomes. This single-stage surgery is advantageous for bone healing and is cost-effective, making it a viable option for correcting long-bone malunion.

Background/Objectives: The aim of this study was to evaluate changes in bone mineral density (BMD) around the stem in elderly patients with femoral neck fractures who underwent hemiarthroplasty using a collared and full hydroxyapatite coated cementless stem, as assessed using the Dorr classification and with anti-osteoporosis drug intervention. Methods: This study followed 85 older patients with femoral neck fractures classified by Dorr’s classification. We measured their BMD around the stem using dual-energy X-ray absorptiometry according to Gruen 7 zones classification and clinical scores. We compared the rate of BMD change based on Dorr’s classification and clinical scores. We also investigated the effect of osteoporosis treatment interventions on the rate of BMD change. The study followed up with the patients for one year after surgery. Results: After excluding patients with missing data, 40 patients were included in the analysis. The rate of change in BMD in zone 2 was significantly reduced in Dorr type C compared to Dorr type B. Clinical scores did not significantly differ between the three groups. Regarding the association between osteoporosis treatment and the rate of BMD change, the pre-injury intervention group had a significantly suppressed decline in the rate of BMD change in zones 1 and 7 compared to the post-injury intervention and no-intervention groups. Conclusions: Careful follow-up examination is crucial when performing hemiarthroplasty in patients with Dorr type C femoral neck fractures because the rate of BMD change may decline postoperatively. Pre-injury osteoporosis intervention therapy may suppress BMD loss around the stem.