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OBJECTIVE: To compare a series of monomicrobial Propionibacterium acnes (P. acnes) knee and hip periprosthetic joint infection (PJI) cases with cases of polymicrobial PJI which included P. acnes. We hypothesized that the presence of a polymicrobial P. acnes infection would lead to worse outcomes than those in cases of monomicrobial P. acnes PJI. METHODS: Retrospective multicentre study. All patients with hip or knee PJIs including P. acnes diagnosed from August-2002 to July-2013 in two university hospitals were included. We collected demographic data, McPherson classification, local signs of infection (swelling or wound drainage), laboratory and histological data, surgical management, antibiotic treatment and outcomes. Data were compared between two groups: cases of monomicrobial P. acnes PJI, and cases of polymicrobial PJI involving P. acnes. RESULTS: Thirty-eight patients who presented with 38 PJIs were included; median age was 71 (IQR:62.5-79); 21 were men (55%); median follow-up was 42 months (IQR:17.5-58). Local signs of infection were present in 14 patients (36.8%); ESR>30 mm/h in 14 patients (36.8%); CRP>1 mg/dl in 15 patients (39.5%); 11 out of 25 patients (44%) had positive preoperative cultures from joint aspiration. Positive histologic studies (Feldman's criteria) were found in 5 out of 28 patients (17.8%). Twenty-four patients (63%) had monomicrobial PJIs; 14 patients (37%) had polymicrobial PJIs. There were no significant outcome differences between monomicrobial and polymicrobial PJIs cases; overall, the success rates were 79.2% and 85.7% respectively (P > 0.05). CONCLUSIONS: We did not find any significant differences between monomicrobial and polymicrobial P. acnes PJI outcomes. ESR, CRP and histologic study are established parameters for diagnosing PJI which did not prove useful in P. acnes PJI.

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BACKGROUND: Hindfoot deformity has been described as a risk factor for poor hallux valgus (HV) surgery outcomes. However, there has been no study that demonstrates it. The purpose of this investigation was to evaluate the influence of hindfoot misalignment in HV surgery results. METHODS: All patients operated on for HV during 2010 and 2011 at 3 university hospitals were included. The preoperative and 2-year postoperative radiologic data included the HV and the intermetatarsal (IM) angles, the naviculocuboid overlap (NC), the talonavicular coverage (TN) angle, the talus-first metatarsal (T-1MT) angle, as well as the calcaneal pitch (CP) angle. Additionally, the Short Form-36 questionnaire version 2.0 (SF-36) and the American Orthopaedic Foot & Ankle Society (AOFAS) score, satisfaction and recurrence were also analyzed. A total of 207 met the inclusion criteria. There were 26 patients (12.6%) who could not be assessed at the 2-year follow-up. Patients were allocated to a varus, normal, or a valgus hindfoot tertile using the values for the CP, NC, TN, and T-1MT angles. RESULTS: No significant differences (P > .05) were found between the groups when the HV or IM angles, AOFAS, SF-36 Mental Composite Scale, SF-36 Physical Composite Scale, or satisfaction were compared. Similarly, no significant and strong correlations were observed (P > .05, ρ < 0.3) between any of the mentioned hindfoot measures and the outcomes scales. CONCLUSION: No influence of hindfoot misalignment on HV surgery outcomes was found in the present study in terms of correction, pain, function, satisfaction, or quality of life. Patients with hindfoot misalignment did not obtain worse outcomes in HV surgery. LEVEL OF EVIDENCE: Level II, prognostic, comparative study.

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Objetivo: Describir la severidad, el patrón de estudio, prescripción y la frecuencia de seguimiento de las guías de manejo de NAC en cuatro hospitales universitarios en Colombia. Tipo de Estudio: Cohorte bidireccional. Lugar de Estudio: Cuatro hospitales universitarios en tres ciudades de Colombia. Pacientes y Métodos: Mayores de 15 años hospitalizados entre enero de 2001 y diciembre de 2002 por NAC. Recolección de información sobre estado clínico, estudios paraclínicos y manejo en las primeras 24 horas. Clasificación en grupos de severidad. Evaluación de frecuencia de toma de exámenes, prescripción de antimicrobianos y proporción de seguimiento de las guías en cada grupo de severidad y cada hospital. Resultados: Se incluyeron 734 pacientes, edad promedio 56 años, 50.5/100 género masculino, promedio de estancia hospitalaria 8.6 días, 39/100 en clases IV y V de Fine y mortalidad total de 6.1/100. La frecuencia de toma de muestra de esputo [valor total de la cohorte (rango entre hospitales)] fue 46/100 (10 - 67/100), radiografía de tórax 95/100 (57/100-100/100), hemocultivos 34/100 (0–63/100) y gases arteriales 71/100 (10-88/100), que muestra entre grupos de severidad y hospitales amplia variación. Al menos 45 esquemas diferentes de antimicrobianos se utilizaron en el manejo de estos pacientes. Hubo gran variabilidad en el seguimiento de las guías de tratamiento (total 44/100, rango 22 a 72/100) entre grupos de severidad y hospitales, sin que este factor afectara la mortalidad.Conclusión: Existen diferencias entre el manejo de la NAC en la práctica clínica y las recomendaciones de las guías y amplia variabilidad entre instituciones, pero un efecto de la falta de la adherencia sobre la mortalidad no puede excluirse.

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