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Periprosthetic AND Infection

Dimitrios S Evangelopoulos, Sufian S Ahmad, Anna M Krismer, Christoph E Albers, Sven Hoppe, Barbara Kleer, Sandro Kohl, Atesch Ateschrang
Revision total knee arthroplasty (RTKA) represents an effective treatment for failed TKA, but with less favorable outcomes. Considering the technical complexity and economic burden of RTKA procedures, it is mandatory to investigate current mechanisms and predictors for RTKA failure. The objective of this study is to evaluate the survivorship and determine the predominant causes of failure of RTKA. A total of 146 patients undergoing RTKA between 2003 and 2013 were identified from the institutional database. Revision was defined as surgery in which the whole prostheses (inlay and both femoral and tibial components) required exchange...
October 18, 2018: Journal of Knee Surgery
Stefan J Gelderman, Paul C Jutte, Ronald Boellaard, Joris J W Ploegmakers, David Vállez García, Greetje A Kampinga, Andor W J M Glaudemans, Marjan Wouthuyzen-Bakker
Background and purpose - 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used in the diagnostic work-up of a patient with suspected periprosthetic joint infection (PJI) but, due to a lack of accurate interpretation criteria, this technique is not routinely applied. Since the physiological uptake pattern of FDG around a joint prosthesis is not fully elucidated, we determined the physiological FDG uptake in non-infected total hip prostheses. Patients and methods - Patients treated with primary total hip arthroplasty (1995-2016) who underwent a FDG-PET/CT for an indication other than a suspected PJI were retrospectively evaluated...
October 18, 2018: Acta Orthopaedica
Shawn Vasoo
With the increasing number of prosthetic joints replaced annually worldwide, orthopedic implant-associated infections (OIAIs) present a considerable burden. Accurate diagnostics are required to optimize surgical and antimicrobial therapy. Sonication fluid cultures have been shown in multiple studies to improve the microbiologic yield OIAIs, but uptake of sonication has not been widespread in many routine clinical microbiology laboratories. In this issue M. Dudareva and colleagues (J Clin Microbiol 56:e00688-18, 2018, https://doi...
October 17, 2018: Journal of Clinical Microbiology
T L Masters, C A Hilker, P R Jeraldo, A V Bhagwate, K E Greenwood-Quaintance, B W Eckloff, N Chia, A D Hanssen, M P Abdel, J Z Yao, J Jen, R Patel
With the emergence of RNA sequencing technologies, metatranscriptomic studies are rapidly gaining attention as they simultaneously provide insight into gene expression profiles and therefore disease association pathways of microbial pathogens and their hosts. This approach, therefore, holds promise for applicability in infectious disease diagnostics. A challenge of this approach in the clinical setting is the low amount and quality of RNA, especially microbial RNA in most clinically-infected specimens. Here, we compared two commercially available stranded cDNA library preparation kits, the NuGEN Ovation SoLo RNA-Seq System and the Illumina TruSeq Stranded Total RNA, using RNA extracted from synovial and sonicate fluids from a subject with periprosthetic joint infection...
October 14, 2018: Journal of Microbiological Methods
L Bause
The introduction of biologics has led to a great improvement in the treatment options for inflammatory rheumatic diseases. Nevertheless, surgical interventions are still necessary in many patients but a change in surgical indications could be observed. The previously predominant synovectomy of inflamed rheumatic joints is now reduced to a few so-called rebellious joints with persistent inflammation. Joint-preservation and tenoplasty are standard surgical procedures requiring a specific approach including potential complications...
October 16, 2018: Der Orthopäde
Shahryar Ahmadi, Thomas M Lawrence, Shawn Sahota, Cathy D Schleck, William S Harmsen, Robert H Cofield, John W Sperling
Background: The purpose of this study was to evaluate the value of perioperative tests for the diagnosis of infection in revision shoulder arthroplasty. Methods: A retrospective analysis was performed on 537 shoulder arthroplasties (429 patients) that underwent revision shoulder arthroplasty at our institution. Periprosthetic tissue cultures were positive in 169/537 surgeries. Results: White-blood cell count (WBC) was elevated in 3.8% revision arthroplasties...
September 2018: Archives of Bone and Joint Surgery
E Carlos Rodriguez-Merchan
Background: Periprosthetic infection is the most serious joint replacement complication, occurring in 0.8-1.9% of total knee arthroplasties (TKAs).This review aims to define the role of preoperative aspiration culture (PAC) for diagnosis of TKA infection. Methods: A PubMed (MEDLINE) search related to TKA infection and PAC was analyzed. The main criteria for selection were that the articles were focused in the aforementioned question. Results: Twenty articles were found, but only fourteen were selected and reviewed because they were deeply focused on the topic...
September 2018: Archives of Bone and Joint Surgery
Andrea Vergara, Mariana J Fernández-Pittol, Ernesto Muñoz-Mahamud, Laura Morata, Jordi Bosch, Jordi Vila, Alex Soriano, Climent Casals-Pascual
BACKGROUND: Periprosthetic joint infection (PJI) remains a major clinical challenge. In this study, we evaluated the diagnostic performance of lipocalin-2 (LCN2), a well-characterized neutrophil protein, in synovial fluid to discriminate PJI and aseptic implant failure. METHODS: Synovial fluid from patients with acute or chronic PJI, aseptic failure, or controls was obtained during surgery. LCN2 was quantified using a modified enzyme immunoassay coupled with chemiluminescence (Architect Urine NGAL; Abbott Laboratories)...
September 22, 2018: Journal of Arthroplasty
Annett Klinder, Sarah Zaatreh, Martin Ellenrieder, Sylvio Redanz, Andreas Podbielski, Tobias Reichel, Hans Bösebeck, Wolfram Mittelmeier, Rainer Bader
Two-stage revision arthroplasty is the treatment of choice for periprosthetic infection, a serious complication after knee or hip arthroplasty. Our prospective clinical trial aimed to investigate the concentrations of gentamicin and vancomycin in wound exudate and tissue in two-stage revision arthroplasty. Wound exudate and periprosthetic membrane samples were collected from 18 patients (10 hip and eight knee patients), who were due for two-stage treatment after a periprosthetic joint infection. Samples were taken during insertion of antibiotic-impregnated spacers and after their removal...
October 12, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Brian T Grisez, Andrew E Hanselman, Karim W Boukhemis, Trapper A J Lalli, Brock A Lindsey
Traditional above-the-knee amputation prosthetics utilize a stump-socket interface that is well-known for skin/socket problems, sitting difficulty, disuse osteopenia, and increased work of ambulation. As a result, we evaluated a novel osseointegrated transcutaneous implant in a large animal. The implant was designed to promote osseointegration at the bone-implant interface and minimize complications. As proof of concept, four Dorset sheep underwent a two-stage surgery for forelimb placement of an osseointegrated transcutaneous implant utilizing Compress® technology (Biomet, Inc...
2018: Advances in Orthopedics
Giovanni Balato, Maria Rizzo, Tiziana Ascione, Francesco Smeraglia, Massimo Mariconda
BACKGROUND: Knee arthrodesis with intramedullary (IM) nail or external fixator (EF) is the most reliable therapeutic option to achieve definitive infection control in patients with septic failure of total knee arthroplasty (TKA). The first aim of this study was to compare re-infection rates following knee arthrodesis for periprosthetic joint infection (PJI) with IM nail or EF. The second aim was to compare rates of radiographic union, complication, and re-operation as well as clinical outcomes...
October 10, 2018: BMC Musculoskeletal Disorders
George Grammatopoulos, Wade Gofton, Zaid Jibri, Matthew Coyle, Johanna Dobransky, Cheryl Kreviazuk, Paul R Kim, Paul E Beaulé
BACKGROUND: Many patients undergo both THA and spinal arthrodesis, and those patients may not fare as well as those who undergo one procedure but not the other. The mechanisms of how spinal arthrodesis affects patient function after THA remain unclear. QUESTIONS/PURPOSES: The aims of our study were to (1) determine how patient-reported outcome measures (PROMs), including the Oxford hip score as well as dislocations and complications compare after THA between patients with and without spinal arthrodesis; (2) characterize sagittal pelvic changes in these patients that occur when moving between different functional positions and test for differences between patients with and without spinal arthrodesis; and (3) assess whether differences in sagittal pelvic dynamics are associated with PROMs, complications, and dislocations after THA...
May 30, 2018: Clinical Orthopaedics and related Research
Jonathon M Spanyer, Scott Foster, Jasmine A Thum-DiCesare, Young-Min M Kwon, Dennis W Burke, Sandra B Nelson
A 61-year-old woman with a periprosthetic knee joint infection caused by Mycobacterium abscessus was successfully treated with surgical débridement, multidrug antimicrobial therapy, and staged reimplantation. To the authors' knowledge, this represents the first report of successfully treating this organism after knee arthroplasty. M. abscessus knee infections are rare, and there are no specific guidelines to inform treatment or successful treatment regimens for periprosthetic knee infections. Medical management alone was not successful in this case and hence cannot be recommended...
September 2018: American Journal of Orthopedics
Wo-Jan Tseng, Drew A Lansdown, Trevor Grace, Alan L Zhang, Brian T Feeley, Li-Wei Hung, C Benjamin Ma
BACKGROUND: This study evaluated outcomes after treatment of shoulder periprosthetic joint infection (PJI) with a 3-stage revision protocol consisting of (1) débridement, explantation, and cement spacer placement, followed by parenteral antibiotics; (2) open biopsy and débridement; and (3) reimplantation if cultures were negative. We hypothesized this protocol would eradicate persistent infection while producing excellent functional and subjective outcomes, and there would be no difference in these parameters for patients with shoulder PJI compared with patients with revision for aseptic indications...
October 4, 2018: Journal of Shoulder and Elbow Surgery
Jeffrey D Hassebrock, Michael G Fox, Mark J Spangehl, Matthew R Neville, Adam J Schwartz
BACKGROUND: The American Academy of Orthopedic Surgeons clinical practice guideline currently recommends repeat joint aspiration when workup of periprosthetic joint infection (PJI) reveals conflicting data. This guideline is based on a single study of 31 patients published 25 years ago. We sought to determine the correlation between first and second aspirations and factors that may play a role in variability between them. METHODS: Sixty patients with less than 90 days between aspirations and no intervening surgery were identified at our institution and classified by Musculoskeletal Infection Society (MSIS) criteria as infected, not infected, or not able to determine after both aspirations...
September 11, 2018: Journal of Arthroplasty
Min Lu, Dayna Phillips
Posttraumatic arthritis accounts for a notable share of secondary osteoarthritis about the hip joint. Compared with total hip arthroplasty for primary osteoarthritis or inflammatory arthritis, total hip arthroplasty for posttraumatic arthritis offers greater technical challenges because of bone deformities and retained implants. Careful preoperative evaluation is necessary to prepare the approach, hardware removal strategy, and implants necessary to address bone deficiencies. Although arthroplasty is a highly successful procedure for posttraumatic arthritis, the results are less favorable than surgery for primary osteoarthritis...
October 4, 2018: Journal of the American Academy of Orthopaedic Surgeons
Charlotte M Mallon, Rachael Gooberman-Hill, Andrew J Moore
BACKGROUND: Approximately 340,000 knee replacements are performed each year in the USA and UK. Around 1% of patients who have had knee replacement develop deep infection around the prosthesis: periprosthetic knee infection. Treatment often requires a combination of one or more major operations and antibiotic therapy. This study aimed to understand and characterise patients' experiences of periprosthetic knee infection. METHODS: Qualitative semi-structured interviews were conducted with 16 patients (9 men, 7 women; 59-80 years, mean age 72) who experienced periprosthetic knee infection and subsequent revision treatment in six National Health Service orthopaedic departments...
October 2, 2018: BMC Musculoskeletal Disorders
Nicholas M Brown, Gerard Engh, Kevin Fricka
Partial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed...
October 3, 2018: Journal of Knee Surgery
Marjan Wouthuyzen-Bakker, Michael M Kheir, Ignacio Moya, Alexander J Rondon, Matthew Kheir, Luis Lozano, Javad Parvizi, Alex Soriano
Introduction: Failure after a two-stage exchange surgery for periprosthetic joint infections (PJI) is high. Previous studies demonstrated that positive cultures at reimplantation are associated with failure afterwards. The aim of this multicenter study was to define the role of antibiotics in the cement spacer in relation to reimplantation cultures and subsequent failure. Methods: We retrospectively evaluated two-stage exchange procedures between 2000 and 2015. Culture-negative PJIs, cases in whom no cultures were obtained during reimplantation and cases without data on cement spacers were excluded...
October 3, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Yannick Herry, Anthony Viste, Hugo Bothorel, Romain Desmarchelier, Michel-Henri Fessy
PURPOSE: The purpose of this study was to assess the clinical outcomes, complications, and survival of a long cementless titanium femoral stem in revision total hip arthroplasty (THA) at a minimum five year follow-up. METHODS: Between 2000 and 2010, 114 patients (116 hips), with a mean age of 68 ± 12 years, underwent revision THA using a KAR® stem (DePuy, Leeds, UK). The main reasons for revision were aseptic loosening (82%), periprosthetic joint infections (PJI) (11%), and periprosthetic fractures (6%)...
October 1, 2018: International Orthopaedics
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