Educational Workshops 2013 Bone and Joint Infections Ice Breaker Quiz

Question 1. What do these people have in common?

Question 1. Answer: All had a THR

Question 2. What do these people have in common?

Question 2. Answer: All had a TKR

Question 3. When was the first joint replacement performed?

Question 3: ANSWER: 1880S T GLUCK IN GERMANY Ivory used to replace femoral head Published paper in 1891. Performed at least 14 joint replacements in 1880s, all in tuberculous joints.

Question 4: How many prosthetic joints are put in per year in England and Wales?

Question 4: Answer: 2011-12: 182,631 (88,984 hip; 93,080 knee; 567 ankle)* *Data from National Joint Registry for England and Wales 9th Annual Report 2012

Question 5: How many are replaced because of infection?

Question 5: Answer: 2269 in 2011 (= 1. 24%) Question 5: Answer: 2269 in 2011 (= 1.24%)* *Data from National Joint Registry for England and Wales 9th Annual Report 2012

Question 6: How much does it cost to treat a typical prosthetic joint infection?

Question 6: Answer: From a paper currently ‘in-press’ from the Journal of Hospital Infection* $34,800 (Australian) £20,410 €24,160 *Peel TN, Cheng AC, Lorenzo YP, Kong DCM, Buising KL and Choong PFM. Factors influencing the cost of prosthetic joint infection treatment

Question 7: What is the average age of a patient receiving a primary joint replacement?

Question 7: Answer: 67. 31 years (2011) (67. 2 hip, 67. 41 knee) Question 7: Answer: 67.31 years (2011) (67.2 hip, 67.41 knee)* *Data from National Joint Registry for England and Wales 9th Annual Report 2012

Question 8: How many were placed in patients over the age of 90?

Question 8: Answer: 943 (2011) (580 hip, 363 knee) Question 8: Answer: 943 (2011) (580 hip, 363 knee)* *Data from National Joint Registry for England and Wales 9th Annual Report 2012

Question 9. 74 year old woman with severe neck pain and S Question 9. 74 year old woman with severe neck pain and S. aureus bacteraemia. What are the pathological signs in this MRI?

Question 9. Answer: High signal changes are seen in the C3/C4 disc associated with a prevertebral fluid collection, which extends from C2 to the C5/C6 disc. The appearance is consistent with spondylodiscitis in C3/C4.

Question 10. What is the most likely organism to grow in blood cultures, what changes seen on MRI of the spine and What treatment was used? History: 40yr old male, admitted with SOB ?LRTI. Pt gave few weeks history of lower back and leg pain. No evidence of LRTI on CXR - ?dyspnoea due to severe back pain. PMH: 1. IVDU - still injecting 2. Hep C (not viraemic)

Question 10. Answer: Blood cultures x 2 sets: Staph Question 10. Answer: Blood cultures x 2 sets: Staph. aureus (MSSA) MRI spine: L5/S1 discitis with epidural abscess and end-plate changes consistent with osteomyelitis. Further investigations: Epidural aspirate: Staph. aureus (MSSA); ECHO: Suspicious of TV vegetation on TTE, confirmed on TOE. Treated with flucloxacillin and rifampicin - Good response with improvement clinically and radiologically. After 6/52 iv still had small epidural collection, so had further 6/52 po flucloxacillin and rifampicin. Question supplied by Jo Seale and Craig Sullivan, Barts Health NHS Trust