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Orthopedic infection control

David J Tennent, Stefanie M Shiels, Jessica A Jennings, Warren O Haggard, Joseph C Wenke
BACKGROUND: Contaminated traumatic open orthopedic wounds are frequently complicated by polymicrobial contamination and infection. In high-risk wounds, the standard of care comprises debridement and irrigation combined with antibiotics which can be applied directly or combined with systemic antibiotics. Recently, bioabsorbable chitosan sponges have been shown to be an effective single-agent delivery device for local antibiotics with and without negative pressure wound therapy (NPWT). Severely contaminated orthopedic wounds, however, are often complicated by polymicrobial infections, necessitating multiple antibiotic agents...
March 15, 2018: Journal of Orthopaedic Surgery and Research
Teng-Fei Zhu, Wen-Guo Zhao, Han-Lin Zheng, Jia-Xiang Wu
OBJECTIVE: To investigate the application effect of damage control orthopedics for the treatment of severe multiple fractures. METHODS: From January 2014 to December 2016, 23 patients with severe multiple fractures were treated with the damage control orthopedics (DCO), included 14 males and 9 females with an average age of (41.57±8.29) years old ranging from 28 to 60 years old; the NISS averaged(27.70±5.44) points ranging from 18 to 40 points. As the control group, 27 patients with severe multiple fractures were treated by the early total care(ETC) technology from Jan...
February 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Paweł Baranowski, Tadeusz Płusa, Alicja Baranowska
Perioperative infections after orthopedic surgery are complications that extend the process of treatment and rehabilitation of patients. The multifactor mechanism of their formation has already been defined, which allows effective control of the threat. In addition to the introduction of ever safer surgical techniques, strict epidemic surveillance and acceptable by the body implanted materials, widely prophylactic perioperative antibiotic therapy is applied. The effects of this action are demonstrated in available clinical analyzes, which indicate a reduction in the scale of the threat...
February 23, 2018: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Marco Laurenti, Valentina Cauda
Among metal oxides, zinc oxide (ZnO) is one of the most attractive materials thanks to its biocompatible and biodegradable properties along with the existence of various morphologies featuring piezoelectric, semiconducting and photocatalytic activities. All of these structures were successfully prepared and tested for numerous applications, including optoelectronics, sensors and biomedical ones. In the last case, biocompatible ZnO nanomaterials positively influenced cells growth and tissue regeneration as well, promoting wound healing and new bone formation...
February 22, 2018: Materials
Thijs H Oude Munnink, Anna Demmer, Roel H J Slenter, Kris L L Movig
The authors present a case of a 69-year-old man with arrhythmogenic right ventricular cardiomyopathy controlled with amiodarone and an infected orthopedic prosthesis requiring treatment with rifampicin. This combination involves a pharmacokinetic drug-drug interaction leading to subtherapeutic drug concentrations of amiodarone and its active metabolite. The long half-life of amiodarone and its active metabolite in combination with the late onset and offset of cytochrome P4503A (CYP3A4) induction by rifampicin makes this a challenging drug-drug interaction to cope with in clinical practice...
February 20, 2018: Therapeutic Drug Monitoring
Can-Hua Xu, Zeng-Hui Wu, Rong-Chun Chen, Hong-Fa Zhong, Qing-Shun Zhang, Ning Liu, Bi Zhang
OBJECTIVE: To evaluate the clinical outcomes between extreme lateral interbody fusion and conventional posterior operation in the treatment of upper lumbar disc herniation. METHODS: Among 60 patients with upper lumbar disc herniation were treated with extreme lateral interbody fusion(XLIF) or conventional posterior operation from June 2010 to December 2014, 30 patients(19 males and 11 females) were treated with XLIF (XLIF group); and the other 30 patients(17 males and 13 females) were treated with conventional posterior operation (conventional group)...
November 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
David C Evans, Bruce G Evans
Wound healing remains a concern in primary total joint arthroplasty, given the risk of deep infections arising from hematomas, wound separations, and superficial infections. If wound additives can prevent these early complications, their universal application would be cost-effective. This study examined whether 2 wound additives, platelet-rich plasma (PRP) and activated collagen, would improve postoperative wound healing and reduce complications in primary total joint arthroplasty. A prospective, randomized controlled study was conducted using 3 cohorts with 30 patients each (group 1: PRP; group 2: activated collagen; and group 3: control)...
February 16, 2018: Orthopedics
Mitchell R Klement, Brian T Nickel, Abiram Bala, Colin T Penrose, Cynthia L Green, Samuel S Wellman, Michael P Bolognesi, Thorsten M Seyler
The co-occurrence of a mental illness and a substance abuse disorder (SUD) is common and has been referred to as a "dual diagnosis" (DD). Although studies have independently investigated mental illness alone and SUD alone, few have examined the effects of these entities combined on complications. A search of the Medicare database from 2005 to 2012 identified 2000 DD patients who underwent total hip arthroplasty (THA). They were compared with 86,976 patients with mental illness only and 590,689 controls (no mental illness or SUD)...
February 16, 2018: Orthopedics
Zhong-You Zeng, Wei-Feng Yan, Yong-Xing Song, Ke-Ya Mao, Jian-Fei Ji, Jian-Qiao Zhang, Peng Wu, Fei Pei, Guo-Hao Song, Jian-Fu Han, Wei Yu
OBJECTIVE: To discuss the advantages and disadvantages of two different surgical approaches combined fixation with lumbar interbody fusion in treating single segmental lumbar vertebra diseases. METHODS: The clinical data of 86 patients with single segmental lumbar vertebra diseases treated from June 2011 to June 2013 was retrospectively analyzed. There were 33 males and 53 females, aged from 28 to 76 years old with an average of 53.0 years. Among them, there were 39 cases of lumbar disc degeneration, 22 cases of lumbar disc herniation complicated with spinal canal stenosis, 9 cases of huge lumbar disc herniation and 16 cases of lumbar degenerative spondylolisthesis (Meyerding degree I )...
May 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
M Tyrrell Burrus, Jourdan M Cancienne, Jeffrey D Boatright, Scott Yang, Stephen F Brockmeier, Brian C Werner
Background: Humeral head avascular necrosis (AVN) of differing etiologies may lead to shoulder arthroplasty due to subchondral bone collapse and deformity of the articular surface. There have been no large studies evaluating the complications for these patients after they undergo total shoulder arthroplasty (TSA). Questions/Purposes: The first objective of this study is to evaluate the complication rate after TSA in patients with humeral head AVN. The secondary objective is to compare the complication rates among the different etiologies of the AVN...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Mubashar Rehman, Asadullah Madni, Thomas J Webster
Titanium-based materials do not fulfill all the requirements of orthopedic implants due to a mismatch in mechanical properties with bone which are prone to change during the course of bone growth. Biofunctional biomaterials are a new class of materials that show bioactivity and adaptability at any stage of bone growth. Areas covered: Different biofunctional biomaterials have evolved over time that can enhance calcium phosphate (CaP) precipitation, stimulate osteogenic differentiation, and can control osteoblast gene expression...
January 18, 2018: Expert Review of Medical Devices
Manouk Backes, Siem A Dingemans, Marcel G W Dijkgraaf, H Rogier van den Berg, Bart van Dijkman, Jochem M Hoogendoorn, Pieter Joosse, Ewan D Ritchie, W Herbert Roerdink, Judith P M Schots, Nico L Sosef, Ingrid J B Spijkerman, Bas A Twigt, Alexander H van der Veen, Ruben N van Veen, Jefrey Vermeulen, Dagmar I Vos, Jasper Winkelhagen, J Carel Goslings, Tim Schepers
Importance: Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee. Objective: To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee...
December 26, 2017: JAMA: the Journal of the American Medical Association
Ning Wei, Peizhi Yuwen, Wei Liu, Yanbin Zhu, Wenli Chang, Chen Feng, Wei Chen
BACKGROUND: The relative efficacy of operative and nonoperative treatments for the displaced intra-articular calcaneal fractures (DIACF) remains uncertain. OBJECT: We conducted a meta-analysis to compare the effectiveness of operative and nonoperative treatments in treating patients with DIACF. METHODS: Databases including Cochrane Library, Medline, Embase, CBM, CNKI, and Google Scholar were searched. After independent study selection by 2 authors, data were extracted and collected independently...
December 2017: Medicine (Baltimore)
Laura Selan, Rosanna Papa, Angela Ermocida, Andrea Cellini, Evaristo Ettorre, Gianluca Vrenna, Davide Campoccia, Lucio Montanaro, Carla Renata Arciola, Marco Artini
Finding new strategies to counteract periprosthetic infection and implant failure is a main target in orthopedics. Staphylococcus aureus, the leading etiologic agent of orthopedic implant infections, is able to enter and kill osteoblasts, to stimulate pro-inflammatory chemokine secretion, to recruit osteoclasts, and to cause inflammatory osteolysis. Moreover, by entering eukaryotic cells, staphylococci hide from the host immune defenses and shelter from the extracellular antibiotics. Thus, infection persists, inflammation thrives, and a highly destructive osteomyelitis occurs around the implant...
December 2017: International Journal of Immunopathology and Pharmacology
M De Gori, A D’Arienzo, L Andreani, G Beltrami, D A Campanacci, P De Biase, F Frenos, S Giannotti, F Sacchetti, F Totti, P Parchi, R Capanna
Treatment of bone metastases is often palliative, aiming at pain control and stabilization or prevention of pathological fractures. However, a complete resection with healing purposes can be performed in selected cases. The aim of our work was to evaluate the survival of megaprostheses used for reconstruction after bone metastases. Between January 2001 and March 2015, we implanted 169 Megasystem-C® (Waldemar LINK® GmbH & Co. KG, Hamburg, Germany) after bone metastasis resection. Patients, 95 females and 74 males, were operated at an average age of 61 (12-87) years for proximal femoral resection in 135 (79...
October 2017: Journal of Biological Regulators and Homeostatic Agents
Maryam Seyedmajidi, Sina Haghanifar, Karimollah Hajian-Tilaki, Seyedali Seyedmajidi
Bone defects are common and persistent problems in clinical orthopedics and dentistry. The development of synthetic reconstruction materials is essential owing to the restricted access to natural bone grafts, disease transmission risks, surgical costs, donor-site morbidity, infections, and immune response-related complications. Accordingly, the aim of the present study was to evaluate the histopathological, histomorphometrical, and radiological characteristics of composite foams containing hydroxyapatite/bioactive glass (HA/BG) and fluorapatite/bioactive glass (FA/BG) as cell scaffolds in rat tibia reconstruction...
November 14, 2017: Biomedical Materials
Andrea Torroni, Chongchen Xiang, Lukasz Witek, Eduardo D Rodriguez, Paulo G Coelho, Nikhil Gupta
PURPOSE: Orthopedic and maxillofacial bone fractures are routinely treated by titanium internal fixation, which may be prone to exposure, infection or intolerance. Magnesium (Mg) and its alloys represent promising alternatives to produce biodegradable osteosynthesis devices, with biocompatibility and, specifically, hydrogen gas production during the degradation process, being the main drawback. Aim of this study is to test and compare biocompatibility, degradation rate and physiscochemical properties of two Mg-alloys to identify which one possesses the most suitable characteristics to be used as resorbable hardware in load-bearing fracture sites...
December 2017: Journal of Cranio-maxillo-facial Surgery
Fraence Gottschalk, Thomas Wilke, Sabrina Mueller, Kirstin Heinrich, Ulf Maywald, Andreas Fuchs, Holly Yu
BACKGROUND: This study assessed Staphylococcus aureus infection risk in patients with type 2 diabetes mellitus (T2DM) undergoing an orthopedic knee, hip, or spine surgery. PATIENTS AND METHODS: All patients with a diagnosis of T2DM in the period from 2010 to 2012 were identified from a German claims database. First inpatient knee, hip, or spine surgery was used as index date. Cumulative incidence of S. aureus infections was calculated for several time intervals...
October 12, 2017: Surgical Infections
Lijun Deng, Yi Deng, Kenan Xie
Polyetheretherketone (PEEK) is an ideal substitute material for bone tissue engineering, which can avoid the stress shielding phenomenon due to its similar mechanical properties to natural human bone. Complex bone defect and postoperative infection are still two enormous challenges in orthopedic clinics. It's well-known that additive manufacturing possesses the merits of high-precision and rapid prototyping, thus it easily meets the needs of mold processing. In the present study, we developed a novel Ag-decorated 3D printed PEEK via catecholamine chemistry...
December 1, 2017: Colloids and Surfaces. B, Biointerfaces
Lucas Castellani, Nick Daneman, Samira Mubareka, Richard Jenkinson
BACKGROUND: Prosthetic joint infections (PJI) of hip and knee arthroplasties are becoming increasingly common with an aging population and an increasing demand for these procedures. Despite attempts at standardization, medical and surgical approaches vary widely among practitioners. QUESTIONS/PURPOSES: We first sought to determine if there were specific factors associated with choice of one- versus two-stage revision. Then we investigated whether the type of revision approach influenced clinical treatment success...
October 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
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