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Orthopaedic prosthetic infections

Ben Parkinson, Drew Armit, Peter McEwen, Michelle Lorimer, Ian A Harris
BACKGROUND: Climate factors have been shown to be associated with spontaneous musculoskeletal and some surgical site infections with increased rates of infection during warmer periods. To date, little research has been performed to determine if this phenomenon is associated with differences in the risk of revision for prosthetic joint infection (PJI) in primary TKA. QUESTIONS/PURPOSES: (1) Does the rate of revision for early PJI within the first year after primary TKA differ between tropical and nontropical regions? (2) Is there a seasonal variation in the rate of revision for PJI? (3) Is the geographic and seasonal variation (if present) associated with the sex, age, and/or American Society of Anesthesiologists (ASA) grade of the patient? METHODS: All 219,983 primary TKAs performed for osteoarthritis over a 5-year period (2011-2015) in the Australian Orthopaedic Association National Joint Replacement Registry were examined based on the month of the primary procedure to determine the rate of revision for PJI within 12 months...
February 21, 2018: Clinical Orthopaedics and related Research
M Morgenstern, T F Moriarty, R Kuehl, R G Richards, M A McNally, M H J Verhofstad, O Borens, C Zalavras, M Raschke, S L Kates, W J Metsemakers
INTRODUCTION: Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI...
February 6, 2018: Injury
Sujeesh Sebastian, Rajesh Malhotra, Vishnubhatla Sreenivas, Arti Kapil, Rama Chaudhry, Benu Dhawan
INTRODUCTION: Accurate and prompt microbiological diagnosis of prosthetic joint infection (PJI) is crucial for successful antimicrobial treatment. Studies have shown the diagnostic utility of sonication of explanted implants in total joint arthroplasty but all did not use consensus statements for defining PJI. We evaluated the diagnostic utility of culture of samples obtained by sonication of explanted implants compared with periprosthetic tissue cultures (PTC) for the diagnosis of PJI using Musculoskeletal Infection Society (MSIS) consensus criteria...
January 31, 2018: Journal of Microbiological Methods
Chenglong Wang, Dong Yin, Weifa Shi, Wenwen Huang, Deling Zuo, Qiang Lu
BACKGROUND: Many orthopaedic surgeons worry about asymptomatic bacteriuria (ASB) as a possible risk factor for prosthetic joint infection (PJI). However, available evidence establishing a direct link between ASB and PJI is limited. This meta-analysis aimed to investigate whether ASB is a factor for PJI and whether pre-operative antibiotic treatment shows benefit. METHOD: We systematically searched major databases such as PubMed, Web of Science, the Cochrane Library and EMBASE for studies...
January 24, 2018: International Orthopaedics
Margarida Tavares, Ana Cláudia Carvalho, José Pedro Almeida, Paulo Andrade, Ricardo São Simão, Pedro Soares, Carlos Alves, Rui Pinto, Arnaud Fontanet, Laurence Watier
A prospective audit and feedback antimicrobial stewardship intervention conducted in the Orthopaedics Department of a University Hospital in Portugal was evaluated by comparing an interrupted time series in an intervention group and a non-intervention (control) group. Monthly antibiotic use (except cefazolin) was measured as World Health Organization- and Anatomical Therapeutic Chemical-defined daily doses (DDD) from January 2012 to September 2016, excluding the 6-month phase of intervention implementation starting on January 1, 2015...
January 12, 2018: International Journal of Antimicrobial Agents
J Dattilo, D Gittings, M Sloan, R Charette, E Hume, G-C Lee
AIMS: To evaluate the effectiveness of an institutionally developed algorithm for evaluation and diagnosis of prosthetic joint injection and to determine the impact of this protocol on overall hospital re-admissions.p PATIENTS AND METHODS: We retrospectively evaluated 2685 total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients prior to (1263) and following (1422) the introduction of an infection detection protocol. The protocol used conservative thresholds for C-reactive protein to direct the medical attendant to aspirate the joint...
December 2017: Bone & Joint Journal
Emily P Ernest, Anthony S Machi, Brock A Karolcik, Paul R LaSala, Matthew J Dietz
Adjuvant treatments including Betadine, Dakin's solution (sodium hypochlorite), or hydrogen peroxide (H2 O2 ) have been attempted to eradicate prosthetic joint infection caused by biofilm or intracellular bacteria. The purpose of this study was to evaluate the in vitro abilities of chemical adjuvants to decrease Staphylococcus aureus (S. aureus) biofilm presence on orthopaedic implant grade materials, including titanium, stainless steel, and cobalt chrome. S. aureus biofilms were grown for 48 h and evaluated for baseline colony forming units/centimeter squared (CFU/cm2 ) and compared to treatments with Betadine, Dakin's solution, H2 O2 , or 1% chlorine dioxide (ClO2 )...
November 15, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
D Makki, T Elgamal, P Evans, D Harvey, G Jackson, S Platt
AIMS: The aim of this paper was to present the clinical features of patients with musculoskeletal sources of methicillin-sensitive Staphylococcus aureus (MSSA) septicaemia. PATIENTS AND METHODS: A total of 137 patients presented with MSSA septicaemia between 2012 and 2015. The primary source of infection was musculoskeletal in 48 patients (35%). Musculoskeletal infection was considered the primary source of septicaemia when endocarditis and other obvious sources were excluded...
November 2017: Bone & Joint Journal
Feng Mingli, Shen Huiliang, Cao Guanglei, Li Zheng, Lu Shibao, Liu Limin, An Shuai
BACKGROUND & OBJECTIVE: Hip fracture is common osteoporotic fracture associated sometimes with failed internal fixation. Joint replacement is commonly used to salvage failed internal fixation of hip fractures (FIFHF). Our objective was to present the outcome of Arthroplasty after FIFHF in our patients. METHODS: A prospective analysis was made on consecutive patients who underwent prosthetic replacements for FIFHF in Orthopaedics Department of Xuanwu Hospital between June 2012 and January 2015...
July 2017: Pakistan Journal of Medical Sciences Quarterly
Jonatan Tillander, Kerstin Hagberg, Örjan Berlin, Lars Hagberg, Rickard Brånemark
BACKGROUND: Percutaneous anchoring of femoral amputation prostheses using osseointegrating titanium implants has been in use for more than 25 years. The method offers considerable advantages in daily life compared with conventional socket prostheses, however long-term success might be jeopardized by implant-associated infection, especially osteomyelitis, but the long-term risk of this complication is unknown. QUESTIONS/PURPOSES: (1) To quantify the risk of osteomyelitis, (2) to characterize the clinical effect of osteomyelitis (including risk of implant extraction and impairments to function), and (3) to determine whether common patient factors (age, sex, body weight, diabetes, and implant component replacements) are associated with osteomyelitis in patients with transfemoral amputations treated with osseointegrated titanium implants...
December 2017: Clinical Orthopaedics and related Research
Elizabeth R Kapasa, Peter V Giannoudis, Xiaodong Jia, Paul V Hatton, Xuebin B Yang
Despite the phenomenal success of implants particularly in the realms of dentistry and orthopaedics, there are still challenges to overcome. The failure of implants resulting from infection, prosthetic loosening, and non-union continue to be the most notorious examples. The cascade of fracture healing and bone repair, especially with the presence of an implant, is complex because it involves a multifaceted immune response alongside the intricate process of bone formation and remodelling. Bone loss is a serious clinical problem that is frequently accompanied by chronic inflammation, illustrating that there is a convoluted relationship between inflammation and bone erosion...
September 22, 2017: Journal of Functional Biomaterials
Isabel A C Baert, Enrique Lluch, Francis Van Glabbeek, Rudy Nuyts, Salim Rufai, Joanna Tuynman, Filip Struyf, Mira Meeus
Short stem uncemented femoral implants were developed with the aim of preserving proximal bone stock for future revisions, improving biomechanical reconstruction, aiding insertion through smaller incisions and potentially decreasing or limiting the incidence of thigh pain. Despite all the advantages of short stem designs, it remains unclear whether they are able to limit post-surgical thigh pain. In patients with short stem hip arthroplasty and persistent thigh pain, it is of the utmost importance to understand the potential etiologies of this chronic pain for selecting the appropriate treatment strategy...
September 2017: Medical Hypotheses
P Berger, M Van Cauter, R Driesen, J Neyt, O Cornu, J Bellemans
AIMS: The purpose of this current multicentre study is to analyse the presence of alpha-defensin proteins in synovial fluid using the Synovasure lateral flow device and to determine its diagnostic reliability and accuracy compared with the prosthetic joint infection (PJI) criteria produced by the Musculoskeletal Infection Society (MSIS). PATIENTS AND METHODS: A cohort of 121 patients comprising 85 total knee arthroplasties and 36 total hip arthroplasties was prospectively evaluated between May 2015 and June 2016 in three different orthopaedic centres...
September 2017: Bone & Joint Journal
D Musil, M Balejová, M Horníková, A Chrdle, N Mallátová, O Nyč, V Chmelík, J Gallo, D Jahoda, J Stehlík
PURPOSE OF THE STUDY This study aims to articulate regional guidelines for curative and suppressive antibiotic therapy of total joint replacement infections. MATERIAL AND METHODS When developing the standard, used as source materials were the published foreign guidelines for antibiotic therapy of prosthetic joint infections, the analysis of resistance of bacterial strains conducted in the Hospital in České Budějovice, a.s. and the assessment of strain resistance for the Czech Republic published by the European Antimicrobial Resistance Surveillance Network (EARS-Net)...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Alessandro Bidossi, Monica Bortolin, Marco Toscano, Elena De Vecchi, Carlo L Romanò, Roberto Mattina, Lorenzo Drago
Biofilm-related infections represent a recurrent problem in the orthopaedic setting. In recent years, great interest was directed towards the identification of novel molecules capable to interfere with pathogens adhesion and biofilm formation on implant surfaces. In this study, two stable forms of α-tocopherol, the hydrophobic acetate ester and the water-soluble phosphate ester, were tested in vitro as coating for titanium prosthesis. Antimicrobial activity against microorganisms responsible of prosthetic and joints infections was assessed by broth microdilution method...
2017: PloS One
Bingyun Li, Thomas J Webster
There has been a dramatic increase in the emergence of antibiotic-resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic-resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55-70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S...
July 19, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Leah S Spittle, Kathleen B Muzzin, Patricia R Campbell, Janice P DeWald, Francisco Rivera-Hidalgo
AIM: Antibiotic prophylaxis guidelines have been developed for health care and dentistry. The authors examined whether dentists were following the 2007 American Heart Association (AHA) and the 2012 American Association of Orthopaedic Surgeons (AAOS) recommendations for antibiotic prophylaxis. MATERIALS AND METHODS: A survey was sent to 600 dentists in the south-central region of the United States. The survey examined dentists' prescribing practices for patients with cardiac and prosthetic joint replacements, antibiotic regimen prescribed, confidence in their prescription decisions, and dentistry's contribution to antibiotic resistance...
July 1, 2017: Journal of Contemporary Dental Practice
Erik Lenguerrand, Michael R Whitehouse, Andrew D Beswick, Andrew D Toms, Martyn L Porter, Ashley W Blom
OBJECTIVES: To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. DESIGN: We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales...
July 10, 2017: BMJ Open
Katja Šuster, Aleš Podgornik, Andrej Cör
Staphylococcus spp. accounts for up to two thirds of all microorganisms causing prosthetic joint infections, with Staphylococcus aureus and Staphylococcus epidermidis being the major cause. The present study describes a diagnostic model to detect staphylococci using a specific bacteriophage and bioluminescence detection, exploring the possibility of its use on sonicate fluid of orthopaedic artificial joints. Intracellular adenosine-5'-triphosphate release by bacteriophage mediated lysis of staphylococci was assessed to determine optimal parameters for detection...
July 2017: New Microbiologica
Christoph H Lohmann, Sanjiv Rampal, Martin Lohrengel, Gurpal Singh
As imaging techniques are ever-evolving, this article aims to provide a brief overview of the various modalities including their limitations. The ability of imaging for evaluation of implant osseo-integration will be addressed and also the role of imaging in assessing septic and aseptic loosening, with a particular focus on adverse tissue reactions, will be discussed. Specific features when imaging the big joints such as shoulder, hip, knee and ankle joint will also be outlined.Overall, a lack of standardisation and validity was noted and despite the gross variety of imaging modalities, there is no technique covering all aspects required for evaluation of implant fixation and septic and aseptic loosening...
May 2017: EFORT open reviews
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