Periprosthetic joint infection (PJI) due to Salmonella is rare. It frequently occurs patients receiving immunosuppressive medicine. We describe two periprosthetic Salmonella infection of two immunocompromised patients. Both of patients were receiving azathioprine and prednisolone therapy. First patient presented six years after total hip arthroplasty with a huge abscess on her right thigh that was reached to femoral component through the lytic area of lateral femur. Second patient presented with drainage from his hip and he had undergone two-step revision surgery for PJI 3 months ago. There is no consensus in the treatment of periprosthetic salmonella infections. We prefer two-step revision surgery for these infections as previously described in the literature.

Purpose: Routine preoperative urinalysis has been the standard of care for the orthopedic population for decades, regardless of symptoms. Studies have demonstrated antibiotic overuse and low concordance between bacteria cultured from the surgical wound and the urine. Testing and treatment of asymptomatic urinary tract colonization before total joint arthroplasty (TJA) is unnecessary and increases patient risk. We investigated reducing antibiotic use by (1) modifying testing algorithms to target patients at risk, (2) modifying reflex to culture criteria, and (3) providing treatment guidelines.
Materials and Methods: A pre-post study was conducted to determine identify the impact of eliminating universal urinalysis prior to TJA on surgical site infection (SSI) and catheter-associated urinary tract infection (CAUTI) rates and number of antibiotic prescriptions. Patients who underwent primary hip or knee TJA or spinal fusions from February 2016 to March 2018 were included. Patient data was collected for pre- and post-practice change period (February 2016-October 2016 and August 2017-March 2018). Patient demographics, urinalysis results, cultures, and prescriptions were analyzed retrospectively from every tenth chart in the pre-period and prospectively on all patients in the post-period.
Results: A total of 4,663 patients were studied. There was a 96% decrease in urinalyses performed (P<0.0001), and a 93% reduction rate in antibiotic utilization (P<0.001). No significant difference in SSI and CAUTI rates was observed (P>0.05).
Conclusion: The elimination of routine urinalysis before orthopedic surgery resulted in a reduction in antibiotic utilization with no significant change in the SSI or CAUTI rates. Cost savings resulted from reduced antibiotic usage.

Purpose: We conducted a retrospective case-control study to evaluate the factors predictive of hip fractures in elderly patients.
Materials and Methods: We studied 172 patients age 70 years or older who sustained hip fractures with minor injuries between January 2002 and January 2007. We analyzed bone mineral density, comorbidities, body mass index, and the activities of daily living (ADL) scale. One hundred eighty patients (control subjects) with no history of fracture were matched to the study subjects with respect to age and sex.
Results: Multivariate logistic regression showed that female sex, low bone mineral density, high ADL scale, cerebral vascular attack, and knee osteoarthritis were associated with an increased incidence of hip fracture.
Conclusion: Female sex, low bone mineral density, and high ADL scale were related to hip fractures in the elderly. Knee osteoarthritis should be regarded as an independent risk factor for fractures because of an increased risk of falling.