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Mohamed Zubair Farook, Moji Awogbade, Karthik Somasundaram, Ines L H Reichert, Patrick L S Li
BACKGROUND: Sickle cell disease (SCD) is a multisystem disease, and the predominant articular manifestation is osteonecrosis (ON). Total hip arthroplasty (THA) is technically challenging, and the complication rates are high. In this retrospective study, we have analysed the outcome of THA in a cohort of patients with SCD at our institution. MATERIALS AND METHODS: We identified 34 THAs between 1999 and 2016 in 30 patients (mean age 37 years) from our SCD database...
June 15, 2018: International Orthopaedics
Xinggui Song, Xin Li, Junlei Song, Chi Xu, Rui Li, Heng Li, Jiying Chen
Objective: To investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness. Methods: A clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed...
June 1, 2018: Chinese Journal of Reparative and Reconstructive Surgery
Matthew W Tetreault, Kenneth A Estrera, Erdan Kayupov, Caroline Brander, Craig J Della Valle
Background: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines. Methods: One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014...
June 2018: Arthroplasty Today
S M Klim, F Amerstorfer, G Gruber, G A Bernhardt, R Radl, L Leitner, A Leithner, M Glehr
The early and accurate diagnosis of periprosthetic joint infection (PJI) can be challenging. Fibrinogen plays an important role in mediating inflammation of bacterial infections and therefore could be a valuable biomarker for PJI. The purpose of this study was to investigate the sensitivity and specificity of serum levels of fibrinogen in detecting PJI, and to compare the results with the established PJI biomarkers C-reactive protein (CRP) and leukocyte count. Eighty-four patients (124 surgeries) were prospectively included...
June 11, 2018: Scientific Reports
Akos Zahar, Christian Lausmann, Camila Cavalheiro, Anoop C Dhamangaonkar, Tommaso Bonanzinga, Thorsten Gehrke, Mustafa Citak
BACKGROUND: Synovial analysis of joint aspirates is a key diagnostic tool; all major diagnostic algorithms include cell count (CC) and polymorphonuclear percentage (PMN%) as important criteria to make the diagnosis. In this context, we conducted this study to analyze the overall accuracy of CC and PMN%. METHODS: A single-center retrospective analysis was performed with clinical data of included patients, with a total of 524 preoperative joint aspirations (255 hips, 269 knees)...
May 17, 2018: Journal of Arthroplasty
Michael M Kheir, Timothy L Tan, Jaiben George, Carlos A Higuera, Mitchell G Maltenfort, Javad Parvizi
BACKGROUND: Preoperative identification of patients at risk of failing surgical treatment for periprosthetic joint infection (PJI) is imperative to allow medical optimization and targeted prevention. The purpose of this study was to create a preoperative prognostic calculator for PJI treatment by assessing a patient's individual risk for treatment failure based on many preoperative variables. METHODS: A retrospective review was performed of 1438 PJIs, treated at 2 institutions from 2000 to 2014...
April 30, 2018: Journal of Arthroplasty
Ruben Scholten, Borg Leijtens, Keetie Kremers, Marc Snoeck, Sander Koëter
Hypothermia is associated with a higher risk of perioperative complications and occurs frequently after total joint arthroplasty (TJA). The incidence of hypothermia following total joint arthroplasty was assessed with its risk factors and its correlation with PJI. Correlation of hypothermia with age, gender, BMI, type of arthroplasty surgery, type of anesthesia, operation time, blood loss, date of surgery and PJI was evaluated in 2600 patients. Female gender and spinal anesthesia increased the risk for hypothermia whereas an increased BMI and surgery duration correlated decreased the risk of hypothermia...
June 2018: Journal of Orthopaedics
Asep Santoso, Kyung-Soon Park, Young-Rok Shin, Hong-Yeol Yang, Ik-Sun Choi, Taek-Rim Yoon
Introduction: Negative culture findings are common in periprosthetic joint infection (PJI) of the hip. Methods: Retrospective study was performed to total 84 patients which devided into two groups: culture-negative (n: 27) and culture-positive (n: 57). Results: The reimplantation rate was 96.3% and 91.2% in the culture-negative and culture-positive groups, respectively. The overall infection control rate was 92.6% and 82.4% in the culture-negative and culture-positive groups, respectively...
June 2018: Journal of Orthopaedics
Alberto V Carli, Samrath Bhimani, Xu Yang, Karen L de Mesy Bentley, F Patrick Ross, Mathias P G Bostrom
BACKGROUND: Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty. Current animal models of PJI do not effectively recreate the clinical condition and thus provide limited help in understanding why treatments fail. We developed a mouse model of the first-stage surgery of a 2-stage revision for PJI involving a 3-dimensionally printed Ti-6Al-4V implant and a mouse-sized cement spacer that elutes vancomycin. METHODS: Vancomycin was mixed with polymethylmethacrylate (PMMA) cement and inserted into custom-made mouse-sized spacer molds...
June 6, 2018: Journal of Bone and Joint Surgery. American Volume
Vignesh K Alamanda, Bryan D Springer
PURPOSE OF REVIEW: Periprosthetic joint infection (PJI) remains a complication that is associated with high morbidity as well as high healthcare expenses. The purpose of this review is to examine patient and perioperative modifiable risk factors that can be altered to help improve rates of PJI. RECENT FINDINGS: Evidence-based review of literature shows that improved control of post-operative glycemia, appropriate management of obesity, malnutrition, metabolic syndrome, preoperative anemia, and smoking cessation can help minimize risk of PJI...
June 4, 2018: Current Reviews in Musculoskeletal Medicine
Timothy L Tan, Michael M Kheir, Alexander J Rondon, Javad Parvizi, Jaiben George, Carlos A Higuera, Noam Shohat, Antonia F Chen
BACKGROUND: Two-stage exchange arthroplasty involves resection and reimplantation of new implants at a later stage. An antibiotic-free period is often advocated by surgeons before reimplantation. However, there is no conclusive evidence supporting the utility or duration of this practice. This study evaluated the utility and optimal duration of the antibiotic-free period before reimplantation. METHODS: Electronic infection databases of 2 institutions were retrospectively reviewed from 2000 to 2014 to identify 785 patients who underwent 2-stage exchange arthroplasty, of which 409 were reimplanted without any surgeries between the first and second stage...
April 26, 2018: Journal of Arthroplasty
Morgan I Ivy, Matthew J Thoendel, Patricio R Jeraldo, Kerryl E Greenwood-Quaintance, Arlen D Hanssen, Matthew P Abdel, Nicholas Chia, Janet Z Yao, Aaron J Tande, Jayawant N Mandrekar, Robin Patel
Background: Metagenomic shotgun sequencing has the potential to transform how serious infections are diagnosed by offering universal, culture-free pathogen detection. This may be especially advantageous for microbial diagnosis of prosthetic joint infection (PJI) by synovial fluid analysis, since synovial fluid cultures are not universally positive, and synovial fluid is easily obtained pre-operatively. We applied a metagenomics-based approach to synovial fluid in an attempt to detect microorganisms in 168 failed total knee arthroplasties...
May 30, 2018: Journal of Clinical Microbiology
Andrea Zanirato, Luca Cavagnaro, Marco Basso, Stefano Divano, Lamberto Felli, Matteo Formica
INTRODUCTION: Total knee arthroplasty revision (TKAr) is increasing of relevance in orthopaedic surgeon daily practice and will become more and more relevant in the future. The aim of this study is to summarize indications, complications, clinical and radiological mid-term results of metaphyseal sleeves in management of bone defects in TKAr. METHODS: A systematic review of English literature was performed on Medline. Retrospective or prospective studies with 2 years of follow-up (FU) were included...
May 29, 2018: Archives of Orthopaedic and Trauma Surgery
Piotr Kasina, Anders Enocson, Viktor Lindgren, Lasse J Lapidus
Background and purpose - Patients in Sweden are insured against avoidable patient injuries. Prosthetic joint infections (PJIs) resulting from intraoperative contamination are regarded as compensable by the Swedish public insurance system. According to the Patient Injury Act, healthcare personnel must inform patients about any injury resulting from treatment and the possibility of filing a claim. To analyze any under-reporting of claims and their outcome, we investigated patients' claims of PJI in a nationwide setting Patients and methods - The national cohort of PJI after primary total hip replacement, initially operated between 2005 and 2008, was established through cross-matching of registers and review of individual medical records...
May 29, 2018: Acta Orthopaedica
Joshua S Bingham, Christopher G Salib, Kade McQuivey, M'Hamed Temkit, Mark J Spangehl
BACKGROUND: The diagnosis of a periprosthetic joint infection (PJI) remains a clinical challenge, as there is no uniformly accepted gold standard. In 2011, the Musculoskeletal Infection Society (MSIS) convened a work group to create a standardized definition for a PJI that could be universally adopted. Based on the MSIS criteria, the diagnosis of a PJI can be made with 1 of the 2 major criteria, or 3 of the 5 minor criteria. The purpose of this study was to determine the likelihood of having a PJI based on the number of positive minor criteria and thereby develop a prediction algorithm for differentiating between a chronic PJI and a non-PJI based on the number of positive MSIS minor criteria...
May 9, 2018: Journal of Arthroplasty
Claire C Triffault-Fillit, Tristan T Ferry, Frédéric F Laurent, Pierre P Pradat, Céline C Dupieux, Anne A Conrad, Agathe A Becker, Sébastien S Lustig, Michel-Henry Mh Fessy, Christian C Chidiac, Florent F Valour
OBJECTIVES: The high microbiological diversity encountered in prosthetic joint infection (PJI) makes the choice of empirical antimicrobial therapies challenging, especially in case of implant retention or one-stage exchange. Despite the risk of dysbiosis and toxicity, the combination of vancomycin with a broad-spectrum beta-lactam is currently recommended in all cases, even if Gram-negative bacilli (GNB) might be less represented in late PJI. In this context, this study aimed to describe the microbiological epidemiology of PJI according to the chronology of infection...
May 24, 2018: Clinical Microbiology and Infection
Amar Rangan
No abstract text is available yet for this article.
July 2018: Shoulder & Elbow
C L Abad, A Haleem
PURPOSE OF REVIEW: Prosthetic joint infection (PJI) is a rare but serious complication that is frequently misdiagnosed. We aimed to highlight the nuances of PJI diagnosis and antimicrobial therapies and provide clarity in key areas of management. RECENT FINDINGS: Current research in PJI centers on a potential role for diagnostic biomarkers, molecular techniques, and implant sonication to reduce culture-negativity rates. The optimal duration of antimicrobial therapy remains controversial...
May 22, 2018: Current Infectious Disease Reports
Jong-Keun Kim, Do-Yoon Lee, Dong-Wan Kang, Du-Hyun Ro, Myung Chul Lee, Hyuk-Soo Han
BACKGROUND: Although two-stage exchange arthroplasty is considered a treatment of choice for chronic features of fungal PJI (periprosthetic joint infection), there is no consensus for local use of antifungal agent. The purpose of this study was to evaluate the efficacy of antifungal-impregnated cement spacer (AICS). METHODS: Nine patients who were diagnosed and treated for chronic fungal PJI after TKA in a single center from January 2001 to December 2016 were enrolled...
May 16, 2018: Knee
Kier Blevins, Arash Aalirezaie, Noam Shohat, Javad Parvizi
BACKGROUND: Although an abundance of literature exists linking malnutrition with infectious complications in surgical patients, there is little specifically examining the link between malnutrition and periprosthetic joint infection (PJI). This study evaluated the relationship between abnormal nutritional parameters and development of PJI in patients undergoing primary total joint arthroplasty (TJA). METHODS: We retrospectively reviewed TJA patients from 2000 to 2016 with preoperative nutritional screening at a single institution...
April 23, 2018: Journal of Arthroplasty
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