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Journal of Bone and Joint Infection

Jolien Onsea, Melissa Depypere, Geertje Govaert, Richard Kuehl, Thomas Vandendriessche, Mario Morgenstern, Martin McNally, Andrej Trampuz, Willem-Jan Metsemakers
Introduction: Intraoperatively obtained peri-implant tissue cultures remain the standard for diagnosis of fracture-related infection (FRI), although culture-negative cases may complicate treatment decisions. This paper reviews the evidence on sonication fluid and tissue sampling for the diagnosis of FRI. Methods: A comprehensive search in Pubmed, Embase and Web-of-Science was carried out on April 5, 2018, to identify diagnostic validation studies regarding sonication fluid and tissue sampling for FRI. Results: Out of 2624 studies, nine fulfilled the predefined inclusion criteria...
2018: Journal of Bone and Joint Infection
James X Liu, Jordan Werner, Thorsten Kirsch, Joseph D Zuckerman, Mandeep S Virk
Introduction: Chlorhexidine gluconate (CHX) is widely used as a preoperative surgical skin-preparation solution and intra-wound irrigation agent, with excellent efficacy against wide variety of bacteria. The cytotoxic effect of CHX on local proliferating cells following orthopaedic procedures is largely undescribed. Our aim was to investigate the in vitro effects of CHX on primary fibroblasts, myoblasts, and osteoblasts. Methods: Cells were exposed to CHX dilutions (0%, 0.002%, 0.02%, 0.2%, and 2%) for either a 1, 2, or 3-minute duration...
2018: Journal of Bone and Joint Infection
Giovanni Riccio, Luca Cavagnaro, Wassim Akkouche, Giuliana Carrega, Lamberto Felli, Giorgio Burastero
Introduction: Biomarkers such as α-defensin demonstrated to be a potentially useful option in periprosthetic joint infection (PJI) diagnosis. Recently, a new point-of-care test for α-defensin level detection in synovial fluid has been commercialized in Europe. The aim of this study is to compare the α-defensin test (SynovasureTM ) diagnostic ability with the main available clinical tests for periprosthetic joint infection diagnosis in a practical clinical setting of a Bone Infection Unit. Methods: Between 2015 and 2017, 146 patients with suspected chronic PJI were screened with SynovasureTM ...
2018: Journal of Bone and Joint Infection
Sean Dx Duffy, Nathanael Ahearn, Elizabeth Sr Darley, Andrew J Porteous, James R Murray, Nicholas R Howells
Background: Debridement, antibiotics and implant retention (DAIR) forms the primary treatment modality for early prosthetic joint infection (PJI). The KLIC score has been proposed as a risk stratification tool for use in predicting outcome of prosthetic knee infections. Our aim was to determine the accuracy of this scoring system at an independent tertiary PJI centre in a typical DAIR population. Methods: Between 2008 and 2015, patients with infected knee prostheses treated with DAIR were identified. The patient notes and blood tests were reviewed retrospectively and the 'KLIC-score' was calculated and correlated with outcome...
2018: Journal of Bone and Joint Infection
Jesse W P Kuiper, Christine M E Rustenburg, Jore H Willems, Steven J Verberne, Edgar J G Peters, Rachid Saouti
Background : Little is known about functional outcome and quality of life (QoL) after one-stage revision for periprosthetic joint infection (PJI) of the hip. Methods : a cohort of 30 subjects treated with one-stage revision between 2011 and 2015 was identified, and questionnaires on functional outcome and QoL were distributed. Results : 28 subjects were successfully treated (93%). Most subjects were referred from other hospitals. Coagulase-negative Staphylococcus was found in 50% of the cases, and 40% of all cultured bacteria were multidrug-resistant...
2018: Journal of Bone and Joint Infection
Viktor Janz, Georgi I Wassilew, Carsten F Perka, Michael Müller
Aims: In cases of a two-stage septic total hip arthroplasty (THA) exchange a femoral osteotomy with subsequent cerclage stabilization may be necessary to remove a well-fixed stem. This study aims to investigate the rate of bacterial colonization and risk of infection persistence associated with in situ cerclage hardware in two-stage septic THA exchange. Patients and Methods: Twenty-three patients undergoing two-stage THA exchange between 2011 and 2016 were included in this retrospective cohort study. During the re-implantation procedure synovial fluid, periprosthetic tissue samples and sonicate fluid cultures (SFC) of the cerclage hardware were acquired...
2018: Journal of Bone and Joint Infection
Paul Bosch, Janna van den Kieboom, Joost D J Plate, Frank F A IJpma, R Marijn Houwert, Albert Huisman, Falco Hietbrink, Luke P H Leenen, Geertje A M Govaert
Introduction : Diagnosing Fracture-Related Infections (FRI) based on clinical symptoms alone can be challenging and additional diagnostic tools such as serum inflammatory markers are often utilized. The aims of this study were 1) to determine the individual diagnostic performance of three commonly used serum inflammatory markers: C-Reactive Protein (CRP), Leukocyte Count (LC) and Erythrocyte Sedimentation Rate (ESR), and 2) to determine the diagnostic performance of a combination of these markers, and the additional value of including clinical parameters predictive of FRI...
2018: Journal of Bone and Joint Infection
Ben Tyas, Martin Marsh, Tamsin Oswald, Ramsay Refaie, Catherine Molyneux, Mike Reed
Objectives: The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of antibiotic resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile...
2018: Journal of Bone and Joint Infection
Lieke M A de Vries, William C Neve, Jeroen Steens
Background : A prosthetic joint infection (PJI) is a serious complication and specifically a burden for patients after hip fracture surgery, as they are mostly frail elderly patients with multiple comorbidities. Since treatment protocols are lacking there is a need to evaluate current practice. Aim: To evaluate the difference in prosthesis retention after an infected primary total hip replacement (THR) compared to PJI after hip prosthesis surgery performed for a hip fracture. Methods: We retrospectively collected data of patients who developed PJI after primary THR or after hip fracture surgery (THR or hemiarthroplasty) in the Westfriesgasthuis Hospital between 1998 and 2015...
2018: Journal of Bone and Joint Infection
Ricardo Sousa, Miguel Araújo Abreu
Prosthetic joint infection usually requires combined medical and surgical therapy. While revision surgery is widely considered to be the gold standard surgical procedure, debridement, antibiotics and irrigation with implant retention is a very appealing alternative. There is however great controversy regarding its real worth with success rates ranging from 0% to over 90%. A number of different patient and host related variables as well as specific aspects of surgical and medical management have been described as relevant for the final outcome...
2018: Journal of Bone and Joint Infection
Syed Mannan, Mohammed Ali, Lukasz Mazur, Mei Chin, Ahmed Fadulelmola
Background: Incidence of infection following total elbow replacement (TER) is recognised to be higher compared to hip or knee arthroplasty. Extensive swelling following TER can complicate the wound healing which might lead to infection. Tranexamic Acid (TXA) is proven to reduce blood loss peri-operatively which might contribute to better healing outcomes. Our aim is to assess the effect of TXA in wound healing following TER. Methods: A retrospective review of a single surgeon case series. 10 patients had TER mainly for complicated elbow fractures, four of them were relatively immune-supressed...
2018: Journal of Bone and Joint Infection
Daniël M C Janssen, Maud Kramer, Jan Geurts, Lodewijk V Rhijn, Geert H I M Walenkamp, Paul C Willems
Background: There is no generally established treatment algorithm for the management of surgical site infection (SSI) and non-union after instrumented spinal surgery. In contrast to infected hip- and knee- arthroplasties, the use of a local gentamicin impregnated carrier in spinal surgery has not been widely reported in literature. Patients and methods: We studied 48 deep SSI and non-union patients after instrumented spine surgery, treated between 1999 and 2016. The minimum follow-up was 1.5 years. All infections were treated with a treatment-regimen consisting of systemic antibiotics and repetitive surgical debridement, supplemented with local gentamicin releasing carriers...
2018: Journal of Bone and Joint Infection
Aditya Menon, Rajeev Soman, Camilla Rodrigues, Sanjay Phadke, Vikas M Agashe
Introduction: The use of antibiotic impregnated biodegradable synthetic high purity calcium sulfate (SHPCS) beads is frequently reported as they offer increased concentration of antibiotics locally, without need for removal. However some wound discharge following their use has been noted. The purpose of this study was to determine any correlation between wound discharge and infection remission. Methodology: Retrospective study of 39 cases of Osteoarticular infections from April 2013 to November 2016 in whom SHPCS beads were used...
2018: Journal of Bone and Joint Infection
Bahattin Kemah, Gökçer Uzer, Yalçın Turhan, Burak Özturan, Bülent Kılıç, Bilge Sümbül Gültepe, Ayşe Bahar Ceyran, Selim Ertürk, Burak Aksoylu, Özlem Şenaydın, Korhan Özkan
Purpose : Bone and soft tissue infections are among the least desired complications after orthopaedic surgery. This study analysed the in vivo effects of the local application of nano-silver particles (AgNPs) [1nm = 1 billionth of a meter] in soft tissue infections. Materials-Method : An experimental osteomyelitis model was formed by inoculating both tibias of 24 rats with methicillin-resistant Staphylococcus aureus . The rats were followed without treatment for 21 days. Blood samples and tibial x-rays at day 21 confirmed the development of infection...
2018: Journal of Bone and Joint Infection
Jacomien Aleman, Dirk Jan F Moojen, Marc L van Ogtrop, Rudolf W Poolman, Eric J F Franssen
Objectives : Antimicrobial therapy is one of the cornerstones of orthopaedic implant-related infections (OIRI) treatment. Infections with Gram-positive bacteria are often treated with vancomycin, penicillin or clindamycin. A recent IDSA guideline suggests increasing the dose of vancomycin to increase the trough vancomycin target serum concentrations. This is deemed necessary because of an observed decrease in vancomycin susceptibility among Gram-positive bacteria. However, elevated vancomycin concentrations are correlated with the risk of nephrotoxicity, especially with prolonged therapy...
2018: Journal of Bone and Joint Infection
Martin McNally
No abstract text is available yet for this article.
2018: Journal of Bone and Joint Infection
Geert H I M Walenkamp
The European Bone and Joint Infection Society (EBJIS) was founded by a French initiative as a Study Group in 1982. The group of 26 founding members increased to around 60 members in 1992, and membership was limited to surgeons from Europe, experienced in orthopedic infections. In 1993, a transformation to a Society was performed with a more open structure for all kind of doctors and scientists. Annual meetings, a Travelling Fellowship, research projects and instructional courses were organized. Professional support and improved publicity has resulted in an increase to more than 400 members, from worldwide...
2018: Journal of Bone and Joint Infection
Mindaugas Stravinskas, Malin Nilsson, Peter Horstmann, Michael Mørk Petersen, Sarunas Tarasevicius, Lars Lidgren
Objectives: The objective is to present the antibiotic elution from a locally implanted gentamicin containing hydroxyapatite and calcium sulphate bone substitute with an extended follow up of 30 days. We also compare the pharmacokinetics of the ceramic bone substitute with a published study on gentamicin containing poly (methyl methacrylate) (PMMA) bone cement used in primary total hip arthroplasty. Methods: Gentamicin release was measured in the urine for a month and the serum for 4 days in 10 patients operated for trochanteric hip fractures and 10 patients in uncemented hip revisions...
2018: Journal of Bone and Joint Infection
Krystle A Blanchette, Joseph C Wenke
Traumatic orthopedic injuries, particularly extremity wounds, are a significant cause of morbidity. Despite prophylactic antibiotic treatment and surgical intervention, persistent infectious complications can and do occur. Persistent bacterial infections are often caused by biofilms, communities of antibiotic tolerant bacteria encased within a matrix. The structural and metabolic differences in this mode of growth make treatment difficult. Herein, we describe both established and novel, experimental treatments targeted at various stages of wound healing that are specifically aimed at reducing and eliminating biofilm bacteria...
2018: Journal of Bone and Joint Infection
Sandrine Mariaux, Ulrika Furustrand Tafin, Olivier Borens
Introduction : When treating periprosthetic joint infection with a two-stage procedure, antibiotic-impregnated spacers can be used in the interval between prosthetic removal and reimplantation. In our experience, cultures of sonicated spacers are most often negative. The objective of the study was to assess whether that sonication causes an elution of antibiotics, leading to elevated antibiotic concentrations in the sonication fluid inhibiting bacterial growth and thus causing false-negative cultures. Methods : A prospective monocentric study was performed from September 2014 to March 2016...
2018: Journal of Bone and Joint Infection
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