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Periprosthetic AND Infection

Michael M Kheir, Timothy L Tan, Noam Shohat, Carol Foltz, Javad Parvizi
BACKGROUND: Current guidelines recommend serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as the first-line testing for evaluation of suspected periprosthetic joint infection, in addition to synovial white blood-cell (WBC) count and polymorphonuclear percentage. However, the sensitivity and other diagnostic measures of these tests using a standardized definition of periprosthetic joint infection and the influence of organisms on these inflammatory markers remain inadequately investigated...
December 5, 2018: Journal of Bone and Joint Surgery. American Volume
Christopher J Vertullo, Richard N de Steiger, Peter L Lewis, Michelle Lorimer, Yi Peng, Stephen E Graves
BACKGROUND: Periprosthetic infection following total knee replacement remains alarmingly frequent, is devastating for patients, and is an increasingly substantial public health burden. While both the prosthetic design elements and type of polyethylene used in total knee replacement can independently affect survivorship of the prosthesis, their influence on the risk of revision for infection is unknown. Therefore, we examined the effects of total knee prosthetic design and type of polyethylene bearing on the long-term revision risk for nonacute infection following total knee replacement by comparing 4 different cohorts: patients who had minimally stabilized total knee prostheses with crosslinked polyethylene (XLPE) bearing surfaces, minimally stabilized total knee prostheses with noncrosslinked polyethylene (NXLPE), posterior stabilized total knee prostheses with XLPE, and posterior stabilized total knee prostheses with NXLPE...
December 5, 2018: Journal of Bone and Joint Surgery. American Volume
Paul Bonnevialle, Pierre-Sylvain Marcheix, Xavier Nicolau, Marine Arboucalot, Marie Lebaron, Christophe Chantelot, Didier Mainard, Matthieu Ehlinger
INTRODUCTION: Interprosthetic femoral fractures (IFF) are becoming more frequent; however they have not been the subject of many publications and the largest study on this topic includes only 30 cases. The complication rate and clinical outcomes have only been evaluated in small case series. This led us to conduct a retrospective, multicenter, observational study in IFF patients with at least 12 months' follow-up to (1) determine the mortality and morbidity (2) determine the clinical and radiological outcomes and (3) identify elements of the treatment indications...
December 1, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Zhen Tan, Pengde Kang, FuXing Pei, Bin Shen, ZongKe Zhou, Jing Yang
BACKGROUND: The aim of this study was to compare the analgesic effect on the lateral and overall knee and early rehabilitation between adductor canal block (ACB) and femoral nerve block (FNB) after total-knee arthroplasty. METHOD: Two hundred patients randomly participated in the study and were divided into the ACB group and FNB group in a randomized manner. All patients received standardized anesthesia and analgesia upon hospitalization. Outcome evaluations included visual analog scale (VAS) scores at rest and during activity, quadriceps strength, range of motion (ROM), total opioid consumption and complication occurrence, sleep interruptions caused by pain, postoperative nausea and vomiting (PONV), and postoperative length of stay (PLOS) before discharge in all groups...
November 2018: Medicine (Baltimore)
David R Maldonado
No abstract text is available yet for this article.
November 30, 2018: Clinical Orthopaedics and related Research
David Novikov, Afshin A Anoushiravani, Kevin K Chen, Theodore S Wolfson, Nimrod Snir, Ran Schwarzkopf
BACKGROUND: Advancements in the management of human immunodeficiency virus (HIV) now permit HIV-positive patients to have longer life spans, increasing their cumulative risk of developing an advanced degenerative joint disease, necessitating total hip arthroplasty (THA). The purpose of this study was to provide an extended follow-up on a previously published study on a cohort of HIV-positive THA recipients in an effort to confirm the safety and longevity of THA in this population. METHODS: This study is a follow-up on a previous study comprised of 41 hips in 31 HIV-positive THA recipients...
November 8, 2018: Journal of Arthroplasty
Antonio Pellegrini, Claudio Legnani, Vittorio Macchi, Enzo Meani
INTRODUCTION: Periprosthetic shoulder infections (PSIs) represent a serious complication following shoulder arthroplasty. No consensus exists regarding the optimal option. We conducted a retrospective case-control study to compare the outcomes of 2-stage revision shoulder arthroplasty and those of definitive articulating antibiotic spacer implantation with regards to eradication of the infection, improvement of pain and shoulder function. MATERIALS AND METHODS: Thirty patients treated for an infected shoulder arthroplasty were retrospectively reviewed after a mean follow-up of 8 years (range, 2-10 years)...
November 26, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Wesley Frevert, Thomas W Wright, Kevin W Farmer, Qingping Yang, Aimee M Struk, Greg Schultz
Successfully treating shoulder arthroplasty infection requires diagnosis and bacterial identification. Higher incidence of infection with low-virulence bacteria makes this challenging. This study evaluates shoulder prostheses for infection using sonication and a functional biofilm assay. Nineteen patients undergoing revision shoulder arthroplasty were followed prospectively. Periprosthetic tissue and prosthetic components were obtained during the revision and evaluated with a functional biofilm assay. Results were compared with conventional cultures and laboratory results...
2018: Journal of Surgical Orthopaedic Advances
Elsa A Spaans, Koen L M Koenraadt, Robert Wagenmakers, Leon H G J Elmans, Joost A A M van den Hout, D Eygendaal, Stefan B T Bolder
INTRODUCTION: Surgeon volume of hip arthroplasties is of importance with regard to complication and revision rates in total hip arthroplasty. For hip hemiarthroplasty, the effect of surgeon volume on outcome is far less studied. We analyzed the outcome of hip hemiarthroplasties performed by orthopedic surgeons in a retrospective cohort in different volume categories, focusing on early survival of the prosthesis and complications. METHODS: Between March 2009 and January 2014, 752 hemiarthroplasties were performed for intracapsular femoral neck fracture by 27 orthopedic surgeons in a large Dutch teaching hospital...
November 27, 2018: Archives of Orthopaedic and Trauma Surgery
Matthew R Boylan, Joseph A Bosco, James D Slover
BACKGROUND: Smoking is associated with adverse outcomes after total joint arthroplasty (TJA), including periprosthetic joint infection (PJI). Although preoperative smoking cessation interventions may help reduce the risk PJI, the short-term cost-effectiveness of these programs remains unclear. METHODS: Decision analysis was used to evaluate the cost-effectiveness of a preoperative smoking cessation intervention over a 90-day TJA episode of care. Costs and probabilities were derived from literature review and published Medicare data...
September 28, 2018: Journal of Arthroplasty
Mitchell R Klement, Andrew J Luzzi, Ahmed Siddiqi, Kerrianne Valichka, Peter F Sharkey
BACKGROUND: Total knee arthroplasty (TKA) for the majority of patients with severe knee osteoarthritis provides relief of symptoms and improved function. However, there remains a subset of dissatisfied patients despite an unremarkable workup. A corticosteroid injection (CSI) is a commonly used nonsurgical treatment for painful knee osteoarthritis but its efficacy in a replaced knee remains unknown. METHODS: A retrospective chart review identified primary TKA patients who subsequently received a CSI into a replaced knee from 2015 to 2016 by a single surgeon...
November 3, 2018: Journal of Arthroplasty
Ameer M Elbuluk, David Novikov, Matthew Gotlin, Ran Schwarzkopf, Richard Iorio, Jonathan Vigdorchik
Despite the development of newer preventative measures, the rate of infection continues to be approximately 1% for patients undergoing total joint arthroplasty (TJA). The extent of the infection can range from a mild superficial infection to a more serious periprosthetic joint infection (PJI). PJIs not only play a significant role in the clinical well-being of the TJA patient population, but also have substantial economic implications on the health care system. Several approaches are currently being used to mitigate the risk of PJI after TJA...
January 2019: Orthopedic Clinics of North America
E Ekman, H Nurmi, A Reito, J Paloneva
BACKGROUND AND AIMS: Hemiarthroplasty is a common method of treating displaced femoral neck fractures, especially among elderly non-active patients with frailty syndrome. Complications arising from the use of a modern, modular hemiendoprosthesis via a posterior approach have been poorly reported in this population. The aim of this study was to evaluate complications and mortality associated with the use of Lubinus sp II cemented, unipolar hemiarthroplasty prosthesis and posterior approach during a 9-year follow-up...
November 25, 2018: Scandinavian Journal of Surgery: SJS
Takashi Imagama, Atsunori Tokushige, Kazushige Seki, Toshihiro Seki, Daisuke Nakashima, Hiroyoshi Ogasa, Takashi Sakai, Toshihiko Taguchi
Therapeutic outcomes for septic arthritis vary greatly depending on the span of time between disease-onset and surgery. The most important factor is making an early and definitive diagnosis; however, some cases may be difficult to diagnose. We investigated presepsin, a biomarker of sepsis, to determine whether or not presepsin in synovial fluid would be useful for the diagnosis of septic arthritis. We selected 18 patients with septic arthritis including periprosthetic joint infections (SA group) and 28 patients with osteoarthritis (OA group)...
November 23, 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
Ataollah Moshirabadi, Mohammad Razi, Peyman Arasteh, Mohammad Mahdi Sarzaeem, Saman Ghaffari, Saied Aminiafshar, Kami Hosseinian Khosroshahy, Fatemeh Maryam Sheikholeslami
BACKGROUND: PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) techniques have been used for the diagnosis of bacteria in some infections. In this study, we aimed to evaluate the diagnostic accuracy of PCR for the diagnosis of prosthetic joint infections (PJI) and to identify isolated microorganisms, using the RFLP method. METHODS: During January 2015 to January 2018, patients who were suspected of having PJI after arthroplasty surgery or were candidates for revision surgery due to loosening of implant entered the study...
October 25, 2018: Journal of Arthroplasty
Bart Lambert, Daniëlle Neut, Hugo C van der Veen, Sjoerd K Bulstra
Highly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections...
November 23, 2018: International Orthopaedics
Aydın Arslan, Ali Utkan, Bulent Ozkurt
The purpose is to evaluate feasibility of simultaneous TKA in comparison with staged and unilateral procedures. Number of patients included: 72 simultaneous bilateral, 61 staged bilateral and 222 unilateral TKAs were included. The mean age in the simultaneous group was lower than the other groups. Heart failure as comorbidity was observed less in the simultaneous TKA group than the other two groups. There was no significant difference between simultaneous and staged groups with respect to postoperative WOMAC and SF36 scores...
June 2018: Acta Orthopaedica Belgica
Werner Zimmerli, Parham Sendi
Rifampin has been used as an agent in combination therapy in orthopedic device-related infections (ODRI) for almost three decades. The aim of this review is to provide data regarding the role of rifampin against biofilm infection in vitro , in animal models, and in clinical ODRI. Available data are gathered in order to present the rational use of rifampin combinations in patients with periprosthetic joint infection (PJI). In-vitro data, animal data and available clinical data in the field of staphylococcal PJI will be reviewed...
November 19, 2018: Antimicrobial Agents and Chemotherapy
Ioanna K Bolia, Sotirios Tsiodras, George D Chloros, Angelos Kaspiris, Thomas Sarlikiotis, Olga D Savvidou, Panayiotis J Papagelopoulos
As a result of the increasing numbers of joint replacement surgeries and other implant-associated procedures performed, the incidences of periprosthetic joint infections and osteomyelitis are on the rise. Antibiotic resistance to gram-positive species, which are mostly isolated from such infections, is a significant obstacle in clinical practice. Promising clinical outcomes have been reported with the use of novel antibiotics for patients with periprosthetic joint infections and osteomyelitis. Further research is necessary for the establishment of these novel antibiotic therapies in routine clinical practice...
November 1, 2018: Orthopedics
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