This Consensus Statement was organized by the European Network of Human Congenital Imprinting Disorders (EUCIDnet) with financial support from European Cooperation in Science and Technology (COST; BM1208) Newlife the Charity for Disabled Children, the European Society of Pediatric Endocrinology (ESPE) and the Societe Francaise de lutte contre les Cancers et leucemies de l'enfant et de l'adolescent (SFCE) provided funding for the consensus meeting The European Society of Pediatric Nephrology (ESPN) provided support for the meeting Individual authors would like to thank the following funders for research support: Alex's Lemonade Stand Foundation (JMK); Bundesministerium fur Bildung und Forschung (BMBF) (number 01GM1513C) (DP); Child Growth Foundation (KT-B); European Union FP7 Innovative Training Network (ITN) Ingenium N 290123 (YLeB, AR, IN, ERM); FIS (grant PI15/01481) (PL, JT); Fondation de Recherche Medicale (YLeB); Margaret Q Landenberger Foundation (JMK); MIUR PRIN 2015 JHLY35 (AR, GBF, SRu); MOH Grants to Istituto Auxologico Italiano (grant: RC 08C502_2015) (SRu); US National Institutes of Health (grant K08CA193915) (JMK); UK National Institute for Health Research (NIHR) Rare Diseases Translational Research Collaboration (ACF); St Baldrick's Scholar Award (JMK); The Estonian Research Council (grant PUT355) (KO); Universite P et M Curie, Institut National de la Sante Et de la Recherche Medicale (YLB); Telethon-Italia GGP15131 and AIRC IG18671 (AR); Wellcome Trust (MDK); European Research Council (ERM); and NIHR Senior Investigator Award (ERM) The University of Cambridge has received salary support in respect of ERM from the National Health Service (NHS) in the East of England through the Clinical Academic Reserve The views expressed are those of the authors and not necessarily those of the NHS or UK Department of Health No funding was received from pharmaceutical companies

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Expert consensus document: Clinical and molecular diagnosis, screening and management of Beckwith-Wiedemann syndrome: an international consensus statement.

It is expected that the projected increased usage of implantable devices in medicine will result in a natural rise in the number of infections related to these cases. Some patients are unable to autonomously prevent formation of biofilm on implant surfaces. Suppression of the local peri-implant immune response is an important contributory factor. Substantial avascular scar tissue encountered during revision joint replacement surgery places these cases at an especially high risk of periprosthetic joint infection. A critical pathogenic event in the process of biofilm formation is bacterial adhesion. Prevention of biomaterial-associated infections should be concurrently focused on at least two targets: inhibition of biofilm formation and minimizing local immune response suppression. Current knowledge of antimicrobial surface treatments suitable for prevention of prosthetic joint infection is reviewed. Several surface treatment modalities have been proposed. Minimizing bacterial adhesion, biofilm formation inhibition, and bactericidal approaches are discussed. The ultimate anti-infective surface should be “smart” and responsive to even the lowest bacterial load. While research in this field is promising, there appears to be a great discrepancy between proposed and clinically implemented strategies, and there is urgent need for translational science focusing on this topic.

https://www.mdpi.com/1422-0067/15/8/13849/pdf

Antibacterial Surface Treatment for Orthopaedic Implants

Implanted biomaterials play a key role in current success of orthopedic and trauma surgery. However, implant-related infections remain among the leading reasons for failure with high economical and social associated costs. According to the current knowledge, probably the most critical pathogenic event in the development of implant-related infection is biofilm formation, which starts immediately after bacterial adhesion on an implant and effectively protects the microorganisms from the immune system and systemic antibiotics. A rationale, modern prevention of biomaterial-associated infections should then specifically focus on inhibition of both bacterial adhesion and biofilm formation. Nonetheless, currently available prophylactic measures, although partially effective in reducing surgical site infections, are not based on the pathogenesis of biofilm-related infections and unacceptable high rates of septic complications, especially in high-risk patients and procedures, are still reported. In the last decade, several studies have investigated the ability of implant surface modifications to minimize bacterial adhesion, inhibit biofilm formation, and provide effective bacterial killing to protect implanted biomaterials, even if there still is a great discrepancy between proposed and clinically implemented strategies and a lack of a common language to evaluate them. To move a step forward towards a more systematic approach in this promising but complicated field, here we provide a detailed overview and an original classification of the various technologies under study or already in the market. We may distinguish the following: 1. Passive surface finishing/modification (PSM): passive coatings that do not release bactericidal agents to the surrounding tissues, but are aimed at preventing or reducing bacterial adhesion through surface chemistry and/or structure modifications; 2. Active surface finishing/modification (ASM): active coatings that feature pharmacologically active pre-incorporated bactericidal agents; and 3. Local carriers or coatings (LCC): local antibacterial carriers or coatings, biodegradable or not, applied at the time of the surgical procedure, immediately prior or at the same time of the implant and around it. Classifying different technologies may be useful in order to better compare different solutions, to improve the design of validation tests and, hopefully, to improve and speed up the regulatory process in this rapidly evolving field.

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Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama

https://www.naemt.org/Files/PHTLS/TraumaResources/May14JAA/An%20evidence-based%20prehospital%20guideline%20for%20external%20hemorrhage%20control.pdf

An Evidence-based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on Trauma

Bioinspired surface modification of orthopedic implants for bone tissue engineering.

Background: Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection. Methods: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety days, one year, two years, and five years after surgery was assessed. Multivariate analysis was used to assess periprosthetic joint infection as an independent predictor of mortality. In the periprosthetic joint infection population, variables investigated as potential risk factors for mortality were evaluated. Results: Mortality was significantly greater (p < 0.001) in patients with periprosthetic joint infection compared with those undergoing aseptic revision arthroplasty at ninety days (3.7% versus 0.8%), one year (10.6% versus 2.0%), two years (13.6% versus 3.9%), and five years (25.9% versus 12.9%). After controlling for age, sex, ethnicity, number of procedures, involvedjoint,bodymassindex,andCharlsonComorbidityIndex,revisionarthroplastyforperiprostheticjointinfectionwas associated with a fivefold increase in mortality compared with revision arthroplasty for aseptic failures. In the periprosthetic joint infection population, independent predictors of mortality included increasing age, higher Charlson Comorbidity Index, history of stroke, polymicrobial infections, and cardiac disease. Conclusions: Although it is well known that periprosthetic joint infection is a devastating complication that severely limits joint function and is consistently difficult to eradicate, surgeons must also be cognizant of the systemic impact of periprosthetic joint infection and its major influence on fatal outcome in patients. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

An effort to prevent PJI has led to the development of antimicrobial dressings that support wound healing. We sought to determine whether Aquacel Surgical dressing independently reduces the rate of acute PJI following TJA. A single institution retrospective chart review of 903 consecutive cases who received the Aquacel Surgical dressing and 875 consecutive cases who received standard gauze dressing was conducted to determine the incidence of acute PJI (within 3 months). The incidence of acute PJI is 0.44% in the Aquacel dressing group compared to 1.7% in the standard gauze dressing group (P = 0.005). Multivariate analysis revealed that use of Aquacel dressing was an independent risk factor for reduction of PJI (odds ratio of 0.165, 95% confidence interval: 0.051-0.533). Aquacel Surgical dressing significantly reduces the incidence of acute PJI.

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Aquacel Surgical Dressing Reduces the Rate of Acute PJI Following Total Joint Arthroplasty: A Case-Control Study

Purpose of review To present a summary of epiphysiodesis indications and to report most recent advances in the field, along with their clinical relevance. Recent findings Percutaneous epiphysiodesis using transphyseal screws (PETS) and guided growth using eight plates represent the most recent techniques used for hemiepiphysiodesis. Summary PETS and guided growth have yielded very good results and low rates of complications and are the current standard for the management of angular deformities of the lower extremities in children. Permanent percutaneous epiphysiodesis remains the preferred method for the treatment of limb length discrepancies.

Surgical epiphysiodesis indications and techniques: update.

Tranexamic acid (TA) has been reported to reduce blood loss after total joint arthroplasty; however, the literature is sparse in evaluating its efficacy in simultaneous bilateral total knee arthroplasty (TKA). In this retrospective study of consecutive patients, TA use in bilateral TKA was associated with a significant reduction in perioperative serum hemoglobin drop, as well as allogeneic blood transfusion needs from 50% to 11% of patients. No autologous blood donation or drains were used. There were no venous thromboembolic events reported. Implementation of a systematic intravenous TA protocol in simultaneous bilateral TKA appears highly effective in reducing transfusion requirements, potentially reducing healthcare resource utilization as well as the morbidity and complications associated with allogeneic blood transfusions.

Evaluation of the Efficacy and Safety of Tranexamic Acid for Reducing Blood Loss in Bilateral Total Knee Arthroplasty

Increasing numbers of total joint arthroplasty (TJA) patients have a history, or an active diagnosis, of cancer. We aimed to evaluate the risk of early postoperative complications in these patients. In our series, a history of malignancy was associated with an elevated risk of ischemic cardiac events and postoperative deep vein thrombosis (DVT), while active malignancy was associated with increased respiratory and renal complications, hematoma/seroma formation and early postoperative mortality. Both groups presented increased rates of overall in-hospital complications. Patients with bone metastasis to the hip demonstrated increased DVT and 90-day mortality rates. Cancer patients have increased morbidity and mortality after TJA and should undergo comprehensive medical optimization and adapted thromboprophylaxis.

Joseph A. Karam

Papers

Periprosthetic Joint Infection Increases the Risk of One-Year Mortality

Aquacel Surgical Dressing Reduces the Rate of Acute PJI Following Total Joint Arthroplasty: A Case-Control Study

Surgical epiphysiodesis indications and techniques: update.

Evaluation of the Efficacy and Safety of Tranexamic Acid for Reducing Blood Loss in Bilateral Total Knee Arthroplasty

Total joint arthroplasty in cancer patients