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Orthopaedic prosthetic infections

Chahine Assi, Elie El-Najjar, Camille Samaha, Kaissar Yammine
Dual mobility cups (DMC) in total hip arthroplasty (THA) are becoming popular among orthopaedic surgeons. Substantial benefit of their use has been reported among high risk patients, particularly in reducing post-operative hip instability (dislocation). Many reports stated some concern when implanted in young and active people where complications such as polyethylene wear and mechanical loosening could potentially be higher. This Middle Eastern study analyses a retrospective series of THA for any aetiology other than infection, using DMC for the acetabular component in 75 patients (85 implants) less than 70 years old...
January 10, 2017: International Orthopaedics
Jason M Jennings, Douglas A Dennis, Raymond H Kim, Todd M Miner, Charlie C Yang, David C McNabb
BACKGROUND: Synovial fluid aspiration is a routine practice used by most orthopaedic surgeons to aid in the diagnosis of joint infection. In patients for whom there is a low pretest probability of infection, a positive culture-particularly if it is a broth-only culture-may be considered a contaminant, especially if the bacterial species are skin pathogens. To our knowledge no study has evaluated the incidence of contamination of aspirations from the native knee. QUESTIONS/PURPOSES: What is the frequency of false-positive cultures among knee aspirations of the native knee? METHODS: Two hundred patients, with a total of 200 knees, with the diagnosis of degenerative osteoarthritis undergoing a total knee arthroplasty (TKA) were identified for this study...
December 9, 2016: Clinical Orthopaedics and related Research
Yu Wang, John M Thompson, Alyssa G Ashbaugh, Pavlo Khodakivskyi, Ghyslain Budin, Riccardo Sinisi, Andrew Heinmiller, Marleen van Oosten, Jan Maarten van Dijl, Gooitzen M van Dam, Kevin P Francis, Nicholas M Bernthal, Elena A Dubikovskaya, Lloyd S Miller
INTRODUCTION: Diagnosing prosthetic joint infection (PJI) poses significant challenges, and current modalities are fraught with low sensitivity and/or potential morbidity. Photoacoustic imaging (PAI) is a novel ultrasound-based modality with potential for diagnosing PJI safely and noninvasively. MATERIALS: In an established preclinical mouse model of bioluminescent Staphylococcus aureus PJI, fluorescent indocyanine green (ICG) was conjugated to β-cyclodextrin (CDX-ICG) or teicoplanin (Teic-ICG) and injected intravenously for 1 week postoperatively...
February 2017: Journal of the American Academy of Orthopaedic Surgeons
H F Li, K J Qiu, F Y Zhou, L Li, Y F Zheng
In the case of medical implants, foreign materials are preferential sites for bacterial adhesion and microbial contamination, which can lead to the development of prosthetic infections. Commercially biomedical TiNi shape memory alloys are the most commonly used materials for permanent implants in contact with bone and dental, and the prevention of infections of TiNi biomedical shape memory alloys in clinical cases is therefore a crucial challenge for orthopaedic and dental surgeons. In the present study, copper has been chosen as the alloying element for design and development novel ternary biomedical Ti‒Ni‒Cu shape memory alloys with antibacterial properties...
November 29, 2016: Scientific Reports
P Stather, M Salji, S-U Hassan, M Abbas, A Ahmed, H Mills, T Elston, C Backhouse, A Howard, S Choksy
INTRODUCTION The objective of the study was to compare bacterial fallout during vascular prosthesis insertion and orthopaedic major joint replacement performed in conventional and laminar flow ventilation, respectively. MATERIALS AND METHODS A prospective single-centre case control study of 21 consecutive elective vascular procedures involving prosthetic graft insertion and 24 consecutive elective orthopaedic major joint replacements were tested for degree of bacterial fallout using agar settle plates. Preparation time, waiting time and total procedure duration were collected at the time of surgery, and bacterial colony counts on the agar settle plates from airborne bacterial fallout were counted after an incubation period...
November 21, 2016: Annals of the Royal College of Surgeons of England
Lorenzo Drago, Elena De Vecchi
Prosthetic joint infection is one of the most severe complication following joint arthroplasty, producing a significant worsening of patient's quality of life. Management of PJIs requires extended courses of antimicrobial therapy, multiple surgical interventions and prolonged hospital stay, with a consequent economic burden, which is thought to markedly increase in the next years due to the expected burden in total joint arthroplasties. The present review summarizes the present knowledge on microbiological diagnosis of prosthetic joint infections, focusing on aethiological agents and discussing pros and cons of the available strategies for their diagnosis...
November 5, 2016: Advances in Experimental Medicine and Biology
S Tevell, B Hellmark, Å Nilsdotter-Augustinsson, B Söderquist
Further knowledge about the clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different coagulase-negative staphylococci (CoNS) may facilitate interpretation of microbiological findings and improve treatment algorithms. Staphylococcus capitis is a CoNS with documented potential for both human disease and nosocomial spread. As data on orthopaedic infections are scarce, our aim was to describe the clinical and microbiological characteristics of PJIs caused by S. capitis...
January 2017: European Journal of Clinical Microbiology & Infectious Diseases
James P Lisik, Michelle M Dowsey, Joshua Petterwood, Peter F M Choong
BACKGROUND: Arthroscopic knee surgery has been a topic of significant controversy in recent orthopaedic literature. Multiple studies have used administrative (Victorian Admitted Episodes Dataset and Centre for Health Record Linkage) data to identify trends in practice. This study explored the usage and reporting of arthroscopic knee surgery by conducting a detailed audit at a major Victorian public hospital. METHODS: A database of orthopaedic procedures at St Vincent's Hospital Melbourne was used to retrospectively identify cases of knee arthroscopy from 1 December 2011 to 1 April 2014...
September 27, 2016: ANZ Journal of Surgery
Heather C Yun, Clinton K Murray, Kenneth J Nelson, Michael J Bosse
Trauma to the extremities is disproportionately represented in casualties of recent conflicts, accounting for >50% of injuries sustained during operations in Iraq and Afghanistan. Infectious complications have been reported in >25% of those evacuated for trauma, and 50% of such patients were treated in the intensive care unit (ICU). Osteomyelitis has been reported in 9% (14% of intensive care unit patients), and deep-wound infection in 27% of type III open-tibia fractures. Infections complicating extremity trauma are frequently caused by multidrug-resistant bacteria and have been demonstrated to lead to failure of limb salvage, unplanned operative take-backs, late amputations, and decreased likelihood of returning to duty...
October 2016: Journal of Orthopaedic Trauma
Dan Lebowitz, Benjamin Kressmann, Shpresa Gjoni, Besa Zenelaj, Olivier Grosgurin, Christophe Marti, Matthieu Zingg, Ilker Uçkay
Some patient populations and types of orthopaedic surgery could be at particular risk for anaerobic infections. In this retrospective cohort study of operated adult patients with infections from 2004 to 2014, we assessed obligate anaerobes and considered first clinical infection episodes. Anaerobes, isolated from intra-operative samples, were identified in 2.4% of 2740 surgical procedures, of which half (33/65; 51%) were anaerobic monomicrobial infections. Propionibacterium acnes, a penicillin and vancomycin susceptible pathogen, was the predominantly isolated anaerobe...
February 2017: Infectious Diseases
Menachem M Meller, Nader Toossi, Mark H Gonzalez, Min-Sun Son, Edmund C Lau, Norman Johanson
BACKGROUND: Patients with morbid obesity, defined as a BMI greater than 40 kg/m(2), and super obesity, defined as a BMI greater than 50 kg/m(2), increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care...
November 2016: Clinical Orthopaedics and related Research
Giorgio Maria Calori, Massimiliano Colombo, Paola Navone, Marta Nobile, Francesco Auxilia, Marco Toscano, Lorenzo Drago
The evolution of new prosthetic and osteosynthetic devices has led to more surgical indications, and this is accompanied by an increased incidence of septic complications in orthopaedic and trauma surgery in the general population. The strategy for choosing surgical or therapeutic (conservative) treatment is based on the identification of the pathogen: knowledge of the aetiological agents is an essential element in the decision-making process to ensure the most effective treatment is administered. The pathogen also needs to be considered in the challenging case of doubtful infection, where perhaps the only sign is inflammation, for a more accurate prediction of progression to either sepsis or healing...
August 1, 2016: Injury
Elena De Vecchi, Marta Bottagisio, Monica Bortolin, Marco Toscano, Arianna Barbara Lovati, Lorenzo Drago
Biofilm-related infections are serious complications in the orthopaedic prosthetic field and an accurate, quick microbiological diagnosis is required to set up a specific antimicrobial therapy. It is well known that the diagnosis of these infections remains difficult due to the bacterial embedding within the biofilm matrix on the implant surfaces. Recently, the use of DL-dithiothreitol (DTT) has been proved effective in biofilm detachment from orthopaedic devices.The purpose of the study is to evaluate the efficacy of two DTT solutions enriched with specific broths for aerobic or anaerobic bacteria to dislodge pathogens from the biofilm, while supporting the bacterial recovery and viability...
July 12, 2016: Advances in Experimental Medicine and Biology
Sandeep Kaur, Kusum Harjai, Sanjay Chhibber
Staphylococcus comprises up to two-thirds of all pathogens in orthopaedic implant infections with two species respectively Staphylococcus aureus and Staphylococcus epidermidis, being the predominate etiological agents isolated. Further, with the emergence of methicillin-resistant S. aureus (MRSA), treatment of S. aureus implant infections has become more difficult, thus representing a devastating complication. Use of local delivery system consisting of S.aureus specific phage along with linezolid (incorporated in biopolymer) allowing gradual release of the two agents at the implant site represents a new, still unexplored treatment option (against orthopaedic implant infections) that has been studied in an animal model of prosthetic joint infection...
2016: PloS One
Ian G Woodgate, John Rooney, Johnathan S Mulford, R Mark Gillies
INTRODUCTION: This is a report of a mechanical failure of an S-ROM revision total knee prosthesis. The prosthesis was used as a revision implant following deep peri-prosthetic infection in a morbidly obese male. The prosthesis failed on both the femoral and tibial sides at the modular metaphyseal stem junctions and required a further revision using the same type of implant after infection was excluded. CASE PRESENTATION: A 57 year old male had previously undergone a left total knee arthroplasty in 1999 for osteoarthritis...
January 2016: Journal of Orthopaedic Case Reports
P Seng, M Vernier, A Gay, P-O Pinelli, R Legré, A Stein
Streptococcal bone and joint infections are less common than staphylococcal cases. Few studies have reported the cases with well-identified Streptococcus species. Their clinical features and prognosis are not clearly known to date. Moreover, no treatment regimen has yet been clarified. We reviewed the streptococcal bone and joint infection cases managed in our centres from January 2009 to December 2013. We described the epidemiology, clinical and microbiologic characteristics, treatment approach and outcome...
July 2016: New Microbes and New Infections
Lorenzo Drago, Lars Lidgren, Elena Bottinelli, Jorge Hugo Villafañe, Pedro Berjano, Giuseppe Banfi, Carlo Luca Romanò, Thomas P Sculco
No abstract text is available yet for this article.
May 2016: Journal of Clinical Microbiology
Simon Strange, Michael R Whitehouse, Andrew D Beswick, Tim Board, Amanda Burston, Ben Burston, Fran E Carroll, Paul Dieppe, Kirsty Garfield, Rachael Gooberman-Hill, Stephen Jones, Setor Kunutsor, Athene Lane, Erik Lenguerrand, Alasdair MacGowan, Andrew Moore, Sian Noble, Joanne Simon, Ian Stockley, Adrian H Taylor, Andrew Toms, Jason Webb, John-Paul Whittaker, Matthew Wilson, Vikki Wylde, Ashley W Blom
BACKGROUND: Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective...
February 17, 2016: Trials
S Ferraris, S Spriano
Bacterial contamination is a critical problem in different fields (ranging from everyday life to space missions, and from medicine to biosensing). Specifically, in the case of medical implants, foreign materials are preferential sites for bacterial adhesion and microbial contamination, which can lead to the development of prosthetic infections. These problems can in turn lead to the necessity of a prolonged antibiotic therapy (which can last for years) and eventually to the removal of the device, with a consequent significant increase in the hospitalization times and costs, together with a stressful, painful and critical situation for the patient...
April 1, 2016: Materials Science & Engineering. C, Materials for Biological Applications
Andrew Jerome Hughes, Sven O'hEireamhoin, Eric Heffernan, Coner Hurson
Malrotation is a cause of persistent pain and poor functioning postoperatively in those who undergo a total knee replacement (TKR). The accurate measurement of malrotation is not routinely available in most hospital settings due to an absence of three-dimensional computed tomography (CT) software. An accessible, uncomplicated technique to demonstrate TKR prosthesis malrotation would be of benefit to orthopaedic surgeons worldwide. A patient was reviewed with persistent postoperative pain, having undergone a right TKR 3 years previously for progressive osteoarthritis...
November 2015: Orthopaedic Surgery
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