Yun Yang
Yun Yang
Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, PR China
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Yin-xiao Peng
Yin-xiao Peng
Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, PR China
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Bin Yu
Bin Yu
Department of Orthopaedics, The Third People’s Hospital of Chengdu, Sichuan, PR China
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results: 16 cases Müller et al. ( 3 ) ORIF: 40; amputation: 1; non-surgery: 1 ORIF: 17; non-surgery: 13 ORIF: 10; non-surgery: 5 32.4 months; two PST deaths, five patients lost to follow-up Work without limitations: 20 cases; change of
Mario Herrera-Pérez
Mario Herrera-Pérez
Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
School of Medicine, Universidad de La Laguna, Tenerife, Spain
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School of Medicine, Universidad de La Laguna, Tenerife, Spain
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Pablo Martín-Vélez
Pablo Martín-Vélez
Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
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David González-Martín
David González-Martín
Foot and Ankle Unit, Orthopaedic Department, Hospital Universitario de Canarias, Tenerife, Spain
School of Medicine, Universidad de La Laguna, Tenerife, Spain
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School of Medicine, Universidad de La Laguna, Tenerife, Spain
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Miguel Domínguez-Meléndez
Miguel Domínguez-Meléndez
Foot and Ankle Unit, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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Ahmed E Galhoum
Ahmed E Galhoum
Specialty Doctor Trauma and Orthopaedics, George Eliot Hospital NHS Trust, Nuneaton, UK
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Victor Valderrabano
Victor Valderrabano
Schmerzklinik, Basel, Switzerland
University of Basel, Basel, Switzerland
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University of Basel, Basel, Switzerland
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Sergio Tejero
Sergio Tejero
Foot and Ankle Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain
School of Medicine, Universidad de Sevilla, Sevilla, Spain
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School of Medicine, Universidad de Sevilla, Sevilla, Spain
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preference. AKA, above-knee amputation; ASA, Functional score from the American Society of Anaesthesiology; BKA, below-knee amputation; DVT, deep vein thrombosis; FU, follow-up; LOE, level of evidence; Nr, non reported; NWB, Non-weight-bearing; ORIF
Olga Savvidou
Olga Savvidou
First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Greece
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These authors contributed equally to this manuscript
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Olympia Papakonstantinou
Olympia Papakonstantinou
Second Department of Radiology, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Athens, Greece
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These authors contributed equally to this manuscript
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Eleftheria Lakiotaki
Eleftheria Lakiotaki
First Department of Pathology, National and Kapodistrian University of Athens, LAIKON General Hospital, Athens, Greece
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These authors contributed equally to this manuscript
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Dimitra Melissaridou
Dimitra Melissaridou
First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Greece
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Pinelopi Korkolopoulou
Pinelopi Korkolopoulou
First Department of Pathology, National and Kapodistrian University of Athens, LAIKON General Hospital, Athens, Greece
Co-senior authors
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Co-senior authors
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Panayiotis J. Papagelopoulos
Panayiotis J. Papagelopoulos
First Department of Orthopedics, National and Kapodistrian University of Athens, Medical School, ATTIKON University General Hospital, Greece
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Co-senior authors
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opposite of the zonation pattern typical of MO. 21 , 22 Due to the rarity of EO, there is no universally accepted treatment algorithm. Amputation or wide surgical resection are common treatment practices with no difference in overall survival between
Elizabeth K Tissingh
Elizabeth K Tissingh
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
King’s Global Health Partnerships, School of Life Course and Population Sciences, King’s College London, London, UK
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King’s Global Health Partnerships, School of Life Course and Population Sciences, King’s College London, London, UK
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Leonard Marais
Leonard Marais
Department of Orthopaedic Surgery, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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Antonio Loro
Antonio Loro
Comprehensive Rehabilitation Services for People with Disability in Uganda (CoRSU) Hospital, Kisubi, Uganda
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Deepa Bose
Deepa Bose
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Nilo T Paner
Nilo T Paner
Department of Orthopaedics, University of the Philippines, Philippine General Hospital Manila, The Phillipines
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Jamie Ferguson
Jamie Ferguson
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
Department of Orthopaedics, University of the Philippines, Philippine General Hospital Manila, The Phillipines
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Department of Orthopaedics, University of the Philippines, Philippine General Hospital Manila, The Phillipines
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Mario Morgensten
Mario Morgensten
Centre for Musculoskeletal Infections, Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland
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Martin McNally
Martin McNally
The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
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include internal and external fixation for fractures (open or closed) and amputation ( 8 ). Injuries cause more than 5 million deaths per year ( 9 ) and it is estimated that 88% of injury-related deaths occur in LMICs ( 10 ). For every death, between 10
Ismail Remzi Tözün
Ismail Remzi Tözün
Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
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Vahit Emre Ozden
Vahit Emre Ozden
Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
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Goksel Dikmen
Goksel Dikmen
Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
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Kayahan Karaytuğ
Kayahan Karaytuğ
Department of Orthopaedic Surgery and Traumatology, Acibadem Mehmet Ali Aydınlar University, School of Medicine, Acibadem Maslak Hospital, Sarıyer/Istanbul, Turkey
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resection arthroplasty, arthrodesis, and above-knee amputation. 1 Fig. 2 Overview of the surgical strategies with possible scenarios. Source : Reprinted Pocket Guide to Diagnosis & Treatment of PJI (version 9, October 2019) with permission of
Heinz Winkler
Heinz Winkler
Osteitis Centre, Privatklinik Döbling Wien, Heiligenstaedter Strasse 57-63, A-1190 Wien, Austria
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pressure on the patient, both physically and psychologically, as is illustrated by the voluntary amputation rate of 1.6%. 12 Bone grafting has been used in COM for decades. 13 Autologous bone (i.e. bone from the patient) is considered preferable
Nicolas Bonnevialle
Nicolas Bonnevialle
Orthopaedic Department and Biomechanics Department, IMFT CNRS URM 5502, Riquet Hospital, University Centre, Place Baylac, 31059 Toulouse, France
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Florence Dauzères
Florence Dauzères
Orthopaedic Department, Riquet Hospital, University Centre, Place Baylac, 31059 Toulouse, France
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Julien Toulemonde
Julien Toulemonde
Orthopaedic Department, Riquet Hospital, University Centre, Place Baylac, 31059 Toulouse, France
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Fanny Elia
Fanny Elia
Orthopaedic Department, Riquet Hospital, University Centre, Place Baylac, 31059 Toulouse, France
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Jean-Michel Laffosse
Jean-Michel Laffosse
Orthopaedic Department, CRIOAC and Biomechanics Department, IMFT CNRS, Riquet Hospital, University Centre, Place Baylac, 31059 Toulouse, France
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Pierre Mansat
Pierre Mansat
Orthopaedic Department and Biomechanics Department, IMFT CNRS URM 5502, Riquet Hospital, University Centre, Place Baylac, 31059 Toulouse, France
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weeks after an uneventful procedure. 25 As proposed by a workgroup from the Musculoskeletal Infection Society focused on lower limb arthroplasty infections, the diagnosis should be based on a combination of biological and clinical criteria ( Table
Hagen Schmal
Hagen Schmal
Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.
Department of Orthopaedics and Traumatology, Freiburg University Hospital, Freiburg, Germany.
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Department of Orthopaedics and Traumatology, Freiburg University Hospital, Freiburg, Germany.
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Michael Brix
Michael Brix
Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark.
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Mats Bue
Mats Bue
Department of Orthopaedic Surgery, Horsens Regional Hospital, Horsens, Denmark
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Anna Ekman
Anna Ekman
Orthopaedic Department, Södersjukhuset, Stockholm, Sweden
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Nando Ferreira
Nando Ferreira
Division of Orthopaedics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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Hans Gottlieb
Hans Gottlieb
Department of Orthopaedic Surgery, Herlev Hospital, Herlev, Denmark
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Søren Kold
Søren Kold
Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
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Andrew Taylor
Andrew Taylor
Department of Orthopaedic Surgery, Nottingham University Hospitals, UK
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Peter Toft Tengberg
Peter Toft Tengberg
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Ilija Ban
Ilija Ban
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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Danish Orthopaedic Trauma Society
Danish Orthopaedic Trauma Society
Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
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swelling, and improvement of function. For a minority of patients this might mean that an amputation or a ‘stable’ nonunion with acceptable pain level might be an option. For most patients an operative revision is indicated and required when progress in
Stefano Zaffagnini
Stefano Zaffagnini
Istituto Ortopedico Rizzoli, Dipartimento Rizzoli Sicilia, Bagheria (PA), Italy
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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Alberto Grassi
Alberto Grassi
Istituto Ortopedico Rizzoli, Dipartimento Rizzoli Sicilia, Bagheria (PA), Italy
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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Gianluca Zocco
Gianluca Zocco
Dipartimento di Ortopedia e Traumatologia, Department of Biomedical Sciences and Morphological and Functional Images, Scuola Ortopedia e Traumatologia, Università di Messina, Italy
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Michele Attilo Rosa
Michele Attilo Rosa
Dipartimento di Ortopedia e Traumatologia, Department of Biomedical Sciences and Morphological and Functional Images, Scuola Ortopedia e Traumatologia, Università di Messina, Italy
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Cecilia Signorelli
Cecilia Signorelli
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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Giulio Maria Marcheggiani Muccioli
Giulio Maria Marcheggiani Muccioli
Istituto Ortopedico Rizzoli, Dipartimento Rizzoli Sicilia, Bagheria (PA), Italy
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica, Bologna (BO), Italy
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patellar tracking in the final stage of pregnancy as a vital condition to ensure normal anatomy. In fact, a foetus with space to kick and flex the lower limbs is believed to have a good prospect of developing an adequately deep femoral trochlea. Conversely
Yangqi Xu
Yangqi Xu
Department of Surgery, Melbourne Medical School, University of Melbourne, Victoria, Melbourne, Australia
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Tony B Huang
Tony B Huang
Department of Surgery, Melbourne Medical School, University of Melbourne, Victoria, Melbourne, Australia
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Michael A Schuetz
Michael A Schuetz
Jamieson Trauma Institute, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Department of Orthopaedic Surgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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Peter F M Choong
Peter F M Choong
Department of Surgery, Melbourne Medical School, University of Melbourne, Victoria, Melbourne, Australia
Department of Orthopaedics, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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Department of Orthopaedics, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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the ICARAUS group
the ICARAUS group
the ICARAUS group
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loosening, tissue necrosis, and eventual loss of limb function, often leading to physical and emotional distress in patients ( 1 ). Patients with PJI often have prolonged hospital stays and require multiple reoperations ( 2 ). PJI can have long-term negative
