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Background The bacterial persistence, responsible for therapeutic failures, can arise from the biofilm formation, which possesses a high tolerance to antibiotics. This threat often occurs when a bone and joint infection is diagnosed after a prosthesis implantation. Understanding the biofilm mechanism is pivotal to enhance prosthesis joint infection (PJI) treatment and prevention. However, little is known on the characteristics of Cutibacterium acnes biofilm formation, whereas this species is frequently involved in prosthesis infections. Methods In this study, we compared the biofilm formation of C. acnes PJI-related strains and non-PJI-related strains on plastic support and textured titanium alloy by (i) counting adherent and viable bacteria, (ii) confocal scanning electronic microscopy observations after biofilm matrix labeling and (iii) RT-qPCR experiments. Results We highlighted material- and strain-dependent modifications of C. acnes biofilm. Non-PJI-related strains formed aggregates on both types of support but with different matrix compositions. While the proportion of polysaccharides signal was higher on plastic, the proportions of polysaccharides and proteins signals were more similar on titanium. The changes in biofilm composition for PJI-related strains was less noticeable. For all tested strains, biofilm formation-related genes were more expressed in biofilm formed on plastic that one formed on titanium. Moreover, the impact of C. acnes internalization in osteoblasts prior to biofilm development was also investigated. After internalization, one of the non-PJI-related strains biofilm characteristics were affected: (i) a lower quantity of adhered bacteria (80.3-fold decrease), (ii) an increase of polysaccharides signal in biofilm and (iii) an activation of biofilm gene expressions on textured titanium disk. Conclusion Taken together, these results evidenced the versatility of C. acnes biofilm, depending on the support used, the bone environment and the strain.

Background: Open Latarjet (Lt) and arthroscopic Bankart associated with Hill-Sachs remplissage (BHSR) have been commonly proposed to treat anterior shoulder instability. Hypothesis: Patients undergoing either Latarjet or arthroscopic Bankart repair with remplissage, when matched according to relevant demographic and injury-specific variables, would have equivalent clinical and radiographic outcomes at a minimum 5-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: In a retrospective multicentric study, including 325 patients treated operatively for primary chronic anterior shoulder instability, 220 patients were reviewed with a minimum follow-up of 5 years. In this database, patients in the Lt and BSHR groups were matched 1 to 1 based on age at surgery, sex, amount of glenoid bone loss, and length and width of the Hill-Sachs lesion. Clinical outcomes were assessed using active range of motion, subjective shoulder value (SSV), Rowe scores, and Walch-Duplay scores. Recurrent instability, postoperative complications, and return to sports (RTS) were compared. Arthritis was evaluated according to the Samilson and Prieto classification. Results: A total of 68 patients (34 patients in the Lt group matched to 34 patients in the BHSR group) were analyzed at a mean follow-up of 90 ± 25 months. Preoperatively, the mean age was 25 ± 6.5 years, the glenoid bone loss was <6% (mean, 5.58% ± 5.52%), and the width and depth of the Hill-Sachs lesion were <27 mm (mean, 15.7 ± 6.91 mm) and 5 mm (mean, 4.8 ± 2.41 mm), respectively, in the 2 groups. Postoperatively, 1 hematoma required a revision in the Lt group. The recurrence rate was 6% (n = 2) in the Lt versus 14% (n = 5) in the BHSR group (P = .2) at the final follow-up. RTS at 1 year was higher in the Lt group (82% vs 62%; P < .01). There was no difference in active range of motion, Rowe scores, and Walch-Duplay scores at the last follow-up. However, the SSV was higher in the Lt group (92% vs 81%; P = .003). The arthritis rate was 20% (grade 1: n = 6; grade 2: n = 1) in the LT group versus 3% (grade 1: n = 1) in the BHSR group (P = .054), with no clinical effect on functional scores. Conclusion: At >7 years of follow-up, there was no statistical difference in the recurrence rate between patients in the Lt and BHSR groups. However, RTS was greater at 1 year after the Lt procedure. The possibility of degenerative arthritis developing in the Lt group is worrisome and requires a longer follow-up to assess potential clinical impairment.

is an anaerobic bacterium isolated from prosthetic joint infections (PJI), an infection which does not induce clinically relevant symptoms for patients without fever, serum inflammatory markers and has a very indolent course. species participates in the balance of skin microbiota but is also responsible for infections; this species is regarded as an opportunistic pathogen or pathobiont. The aim of this study was to determine the existence of a correlation between clinical infectious characteristics of patients and clinical strains behaviors. They were evaluated through the determination of bacterial internalization, persistence rate into osteoblast-like cells, and biofilm formation capacity before interaction and for internalized bacteria. This phenomenon could play a role in infections without having yet been observed . A total of 28 clinical strains were isolated and analyzed from patients with PJI. Similar infectious clinical characteristics were observed among the PJI patients, whereas the associated clinical strains have various and heterogeneous behaviors in the assay of this study. Most of the tested strains (75%) were internalized into osteoblast-like cells with a higher rate of strains with phylotype IA1 than other phylotypes (IB and II). High internalization rates of in osteoblast-like cells seemed to be associated with strains isolated from patients with no local inflammatory symptoms, especially articular stiffness profile. All the strains were able to form biofilm, and internalization into osteoblast-like cells modified the capacity of clinical strains to form biofilm significantly for seven clinical strains (25%), associated with the presence of a high level of polymorphonuclear leukocytes-patient blood with PJI from whom these strains were isolated. In our cohort, the persistence rate of strains in osteoblast cells is less important for strains isolated from patients with tobacco use. This study raises the hypothesis that the interaction between bone environment, host, and strain modulates ability to stimulate inflammatory symptoms in patients with PJI. ClinicalTrials.gov identifier: NCT03950063.

The objective of this study was to evaluate antimicrobial therapy outcomes of bone and joint infections (BJI) caused by Clostridium perfringens. We investigated remission of symptoms and the absence of relapse or reinfection during follow-up. Among the 8 patients with C. perfringens BJI, the type of infection was early prosthesis infection (n = 2), osteosynthetic device infection (n = 4), and chronic osteomyeletis (n = 2). Clindamycin-rifampicin combination was given in 4 cases and metronidazole in 4 cases. The overall success rate was 87.5%. Among the 7 patients who completed antibiotic treatment, the success rate was 100%. The clindamycin-rifampicin combination appeared to be effective in patients with C. perfringens BJI.

PurposeIn the case of reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFs) with tuberosity reconstruction, it is unclear whether the supraspinatus tendon continues to play a role. The aim of this study was to evaluate the clinical and radiological outcomes of RSA for PHFs in a large cohort of elderly patients and compare the results in the case of supraspinatus excision or preservation.MethodsIn this retrospective multicentre study, 150 patients (mean age 77 years, 93% female) were reviewed and radiographed with a minimum follow-up of 24 months. The same Grammont prosthetic design was used in all cases (inclination angle 155°, non-lateralised glenosphere). Patients were divided into two groups: Group A (n = 117) underwent supraspinatus excision and Group B supraspinatus preservation (n = 33). Complications were recorded, and shoulder function, active mobility and subjective results were assessed.ResultsAt a mean follow-up of 59 months, there was no statistical difference in the complication rate (6% vs. 6.8%, p = 1), mean Constant score (61 points vs. 59 points, p = 0.52), simple shoulder value (74% vs. 73.9%, p = 0.9), active anterior elevation (125° vs. 128°, p = 0.45) and internal rotation (4.9 points vs. 4.1 points, p = 0.2). However, mean active external rotation was better in Group A (22° vs. 13°, p = 0.01). The greater tuberosity healing rate in satisfactory position did not differ statistically between the groups (68% vs. 55%, p = 0.14).ConclusionIn the case of RSA with tuberosity reconstruction for acute PHFs, there is no clear evidence that supraspinatus preservation is advantageous.

Cutibacterium acnes is an opportunistic pathogen involved in Bone and Prosthesis Infections (BPIs). In this study, we observed the behavior of commensal and BPI C. acnes strains in the bone environment through bacterial internalization by osteoblast-like cells and biofilm formation. For the commensal strains, less than 1% of the bacteria were internalized; among them, about 32.7 ± 3.9% persisted intracellularly for up to 48 h. C. acnes infection seems to have no cytotoxic effect on bone cells as detected by LDH assay. Interestingly, commensal C. acnes showed a significant increase in biofilm formation after osteoblast-like internalization for 50% of the strains (2.8-fold increase). This phenomenon is exacerbated on a titanium support, a material used for medical devices. For the BPI clinical strains, we did not notice any increase in biofilm formation after internalization despite a similar internalization rate by the osteoblast-like cells. Furthermore, fluorescent staining revealed more live bacteria within the biofilm after osteoblast-like cell interaction, for all strains (BPIs and commensal). The genomic study did not reveal any link between their clinical origin and phylotype. In conclusion, we have shown for the first time the possible influence of internalization by osteoblast-like cells on commensal C. acnes.

Background Arthroscopic Bankart repair alone cannot restore shoulder stability in patients with glenoid bone loss involving more than 20% of the glenoid surface. Coracoid transposition to prevent recurrent shoulder dislocation according to Bristow-Latarjet is an efficient but controversial procedure. Questions/purposes We determined whether an arthroscopic Bristow-Latarjet procedure with concomitant Bankart repair (1) restored shoulder stability in this selected subgroup of patients, (2) without decreasing mobility, and (3) allowed patients to return to sports at preinjury level. We also evaluated (4) bone block positioning, healing, and arthritis and (5) risk factors for nonunion and coracoid screw pullout. Methods Between July 2007 and August 2010, 79 patients with recurrent anterior instability and bone loss of more than 20% of the glenoid underwent arthroscopic Bristow-Latarjet-Bankart repair; nine patients (11%) were either lost before 2-year followup or had incomplete data, leaving 70 patients available at a mean of 35 months. Postoperative radiographs and CT scans were evaluated for bone block positioning, healing, and arthritis. Any postoperative dislocation or any subjective complaint of occasional to frequent subluxation was considered a failure. Physical examination included ROM in both shoulders to enable comparison and instability signs (apprehension and relocation tests). Rowe and Walch-Duplay scores were obtained at each review. Patients were asked whether they were able to return to sports at the same level and practice forced overhead sports. Potential risk factors for nonhealing were assessed. Results At latest followup, 69 of 70 (98%) patients had a stable shoulder, external rotation with arm at the side was 9° less than the nonoperated side, and 58 (83%) returned to sports at preinjury level. On latest radiographs, 64 (91%) had no osteoarthritis, and bone block positioning was accurate, with 63 (90%) being below the equator and 65 (93%) flush to the glenoid surface. The coracoid graft healed in 51 (73%), it failed to unite in 14 (20%), and graft osteolysis was seen in five (7%). Bone block nonunion/migration did not compromise shoulder stability but was associated with persistent apprehension and less return to sports. Use of screws that were too short or overangulated, smoking, and age higher than 35 years were risk factors for nonunion. Conclusions The arthroscopic Bristow-Latarjet procedure combined with Bankart repair for anterior instability with severe glenoid bone loss restored shoulder stability, maintained ROM, allowed return to sports at preinjury level, and had a low likelihood of arthritis. Adequate healing of the transferred coracoid process to the glenoid neck is an important factor for avoiding persistent anterior apprehension. Level of Evidence Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Background: The induced membrane (IM) preclinical models have been described in small animals, but few studies have looked at bone regeneration achievement. The optimisation and validation of such a preclinical model, considering the results obtained after the use of biomaterials as a substitute for bone grafting, could lead to simplifying the surgical procedure and enhance the clinical results. Methods: An in vivo model of the IM technique was developed on the femur of Lewis rats after a 4‐mm critical bone defect stabilised with an osteosynthesis plate. A first optimisation phase was performed by evaluating different osteotomy methods and two different osteosynthesis plate sizes. The efficiency of the model was evaluated by the failure rate obtained 6 weeks after the first operative time. Thereafter, bone regeneration was evaluated histologically and radiologically at 24 weeks to confirm the critical nature of the bone defect (negative control), the effectiveness of the IM with a syngeneic bone graft (positive control) and the possibility of using a biomaterial (GlassBone Noraker) in this model. Results: Sixty‐three rats were included and underwent the first surgical step. Nineteen rats subsequently underwent the second surgical step. The results obtained led to select piezotomy as the best osteotomy technique and 1‐mm‐thick plates with 2.0‐mm‐diameter screws as osteosynthesis material. Twenty‐four weeks after the second surgical step, solely the group with both surgical steps and a syngeneic bone graft showed complete ossification of the bone defect. In contrast, the group without a graft did not present a suitable ossification, which confirms the critical nature of the defect. IM produced an incomplete bone regeneration using GlassBone alone. Conclusions: A piezotome osteotomy with an osteosynthesis plate of sufficient stiffness is required for this two‐stage bone regeneration model in rats. The 4‐mm bone defect is critical for this model and suitable for biomaterial evaluation.

ObjectiveMedication reconciliation (MR) is recognised as an important tool in preventing medication errors such as unintentional discrepancies (UDs). The aim of this study was to identify independent predictive factors of UDs during MR at patient admission to an orthopaedic and trauma department. The secondary objective was to build and validate a ready-to-use score to prioritise patients.MethodA retrospective study was performed on 3.5 years of pharmacist-led MR in the orthopaedic and trauma department of a large university teaching hospital. Independent predictors of UD were identified by multivariable logistic regression. A priority score to identify patients at risk of at least one UD was constructed from the odds ratios of the risk factors, and validated in a separate cohort. Performance was assessed with sensitivity, specificity, C-statistic and Hosmer-Lemeshow goodness-of-fit.ResultsIn total, 888 patients were included and 387 UDs were identified, mainly drug omissions (65.1%). Five independent predictors of UD were identified: age >75 years (OR 2.05, 95% CI 1.41 to 3.00; p<0.001), admission during school holidays (OR 1.69, 95% CI 1.17 to 2.44; p=0.005), female gender (OR 2.20, 95% CI 1.53 to 3.16; p<0.001), emergency hospitalisation (OR 2.05, 95% CI 1.45 to 2.92; p<0.001), and ≥5 medications on the best possible medication history (BPMH) (OR 3.29, 95% CI 2.20 to 4.94; p<0.001). Based on these predictors, a priority score ranging from 0 to 10 was built and internally and externally validated (C statistic 0.72, 95% CI 0.67 to 0.76).ConclusionsThis study confirms the high prevalence of UD in patients admitted to orthopaedic and trauma surgery departments. Five independent predictive factors of UD during MR were identified (female gender, emergency hospitalisation, hospitalisation during school holidays, age ≥75 years, and ≥5 medicines on the BPMH). The developed risk score will help to prioritise MR among patients at risk of medication error and is ready-to-use in other orthopaedic and trauma departments.