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Periprosthetic joint infection

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https://www.readbyqxmd.com/read/28065627/revision-total-hip-and-knee-arthroplasties-after-solid-organ-transplant
#1
Cameron K Ledford, Joseph M Statz, Brian P Chalmers, Kevin I Perry, Arlen D Hanssen, Matthew P Abdel
BACKGROUND: As solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA. METHODS: A retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013...
December 11, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28053259/qualitative-%C3%AE-defensin-test-synovasure-for-the-diagnosis-of-periprosthetic-infection-in-revision-total-joint-arthroplasty
#2
I K Sigmund, J Holinka, J Gamper, K Staats, C Böhler, B Kubista, R Windhager
AIMS: The diagnosis of periprosthetic joint infection (PJI) remains demanding due to limitations of all the available diagnostic tests. The synovial fluid marker, α-defensin, is a promising adjunct for the assessment of potential PJI. The purpose of this study was to investigate the qualitative assessment of α-defensin, using Synovasure to detect or exclude periprosthetic infection in total joint arthroplasty. PATIENTS AND METHODS: We studied 50 patients (28 women, 22 men, mean age 65 years; 20 to 89) with a clinical indication for revision arthroplasty who met the inclusion criteria of this prospective diagnostic study...
January 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28053254/the-synergy-cementless-femoral-stem-in-primary-total-hip-arthroplasty-at-a-minimum-follow-up-of-15-years
#3
I De Martino, V De Santis, R D' Apolito, P K Sculco, M B Cross, G Gasparini
AIMS: We report on the outcome of the Synergy cementless femoral stem with a minimum follow-up of 15 years (15 to 17). PATIENTS AND METHODS: A retrospective review was undertaken of a consecutive series of 112 routine primary cementless total hip arthroplasties (THAs) in 102 patients (112 hips). There were 60 female and 42 male patients with a mean age of 61 years (18 to 82) at the time of surgery. A total of 78 hips in the 69 patients remain in situ; nine hips in eight patients died before 15 years, and 16 hips in 16 patients were revised...
January 2017: Bone & Joint Journal
https://www.readbyqxmd.com/read/28050817/phosphatidylcholine-coatings-deliver-local-antimicrobials-and-reduce-infection-in-a-murine-model-a-preliminary-study
#4
Michael A Harris, Karen E Beenken, Mark S Smeltzer, Warren O Haggard, J Amber Jennings
BACKGROUND: Phosphatidylcholine coatings have been shown to elute antibiotics for several days. A recently developed biofilm inhibitor, cis-2-decenoic acid (C2DA), has been shown to exhibit synergistic activity with several common antibiotics. This study aims to evaluate the effectiveness of C2DA and amikacin dual drug delivery from a phosphatidylcholine coating. QUESTIONS/PURPOSES: (1) What are the in vitro elution profiles of amikacin and C2DA from phosphatidylcholine-coated coupons in incubated phosphate-buffered saline? (2) Does the presence of C2DA in eluate samples lower the amount of amikacin needed for bacterial inhibition in overnight bacterial turbidity assays? (3) Does addition of amikacin and C2DA result in decreased colony-forming units (CFUs) on wire implants and bone when compared with phosphatidylcholine coatings alone in a mouse model of periprosthetic joint infection? METHODS: Effects of loading concentrations were assessed during 7-day in vitro elution studies for coatings containing all mixtures of 0%, 5%, 15%, and 25% wt of amikacin and C2DA (n = 4) through quantitative high-performance liquid chromatography concentration determination and plotting concentration eluted over time...
January 3, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28040397/should-preoperative-antibiotics-be-tailored-according-to-patient-s-comorbidities-and-susceptibility-to-organisms
#5
Timothy L Tan, Miguel M Gomez, Michael M Kheir, Mitchell G Maltenfort, Antonia F Chen
BACKGROUND: Preoperative antibiotic prophylaxis remains one of the most important strategies for preventing periprosthetic joint infection (PJI). Current guidelines recommend giving universal antibiotic prophylaxis to all total joint arthroplasty patients regardless of their medical conditions or immune status; however, no studies have evaluated the individualizing of antibiotics. The aims of this study were (1) to determine if comorbidities influence the organism profile of PJIs, and (2) to investigate if the efficacy of two different perioperative antibiotics (cefazolin or vancomycin) for preventing PJI is affected by patient's comorbidities...
November 23, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28027814/outcome-of-total-hip-and-total-knee-revision-arthroplasty-with-minor-infection-criteria-a-retrospective-matched-pair-analysis
#6
Kevin Staats, Paul Kolbitsch, Irene K Sigmund, Gerhard M Hobusch, Johannes Holinka, Reinhard Windhager
BACKGROUND: Although diagnostic modalities for the detection of periprosthetic joint infection have improved, some infectious revision cases may still be diagnosed as aseptic complications. We raised the question whether patients with positive Musculoskeletal Infection Society minor infection criteria differ in their outcome parameters (revision-free survival, revision rate) when compared to patients with "true" aseptic complications. Additionally, we asked whether the indication for revision surgery (eg, loosening) might have an influence on possible outcome discrepancies...
November 19, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28018092/prosthetic-hip-infection-with-edwardsiella-tarda-in-sickle-cell-beta-thalassemia-disease-a-case-report
#7
David B Frumberg, Samantha E Epstein, Julio J Jauregui, Robert Pivec, Aditya V Maheshwari
Periprosthetic infection following total hip arthroplasty is a devastating complication that has been reported to occur in up to 1.6% of all primary total hip arthroplasties. We report a previously unrecognized gram-negative bacillus as the infecting agent in a patient with bilateral total hip arthroplasties for stage IV osteonecrosis. A 22-year-old male with combined sickle cell disease and beta thalassemia with a prior history of unknown hip surgeries and treatment for distal tibial osteomyelitis in Africa developed a periprosthetic joint infection; intra-operative cultures confirmed the infecting organism to be Edwardsiella tarda which was sensitive to late-generation cephalosporins and vancomycin...
October 2016: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28002371/polymicrobial-periprosthetic-joint-infections-outcome-of-treatment-and-identification-of-risk-factors
#8
Timothy L Tan, Michael M Kheir, Dean D Tan, Javad Parvizi
BACKGROUND: The treatment outcomes of periprosthetic joint infection are frequently dependent on characteristics of the causative organism. The objective of this comparative study was to investigate the prevalence of and risk factors for development of polymicrobial periprosthetic joint infection, and the outcome of surgical treatment of these patients. METHODS: All patients with polymicrobial, monomicrobial, or culture-negative periprosthetic joint infection treated from 2000 to 2014 were identified at a single institution...
December 21, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27999506/preoperative-acute-inflammatory-markers-as-predictors-for-postoperative-complications-in-primary-total-knee-arthroplasty
#9
Gustavo Godoy, Gonzalo Sumarriva, J Lockwood Ochsner, George Chimento, Dana Schmucker, Vinod Dasa, Mark Meyer
BACKGROUND: C-reactive protein (CRP) has been suggested as an independent risk factor for cardiovascular pathology in the nonsurgical setting. While postoperative CRP and erythrocyte sedimentation rate (ESR) have an established role in aiding the diagnosis of periprosthetic joint infections, some authors suggest a link between preoperative CRP and postoperative complications in patients undergoing total joint arthroplasty. METHODS: We conducted a retrospective cohort study of 351 patients who underwent unilateral primary total knee arthroplasty by a single surgeon during a 28-month period (January 2013 through April 2015)...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27999071/in-vitro-activity-of-gentamicin-as-an-adjunct-to-penicillin-against-biofilm-group-b-streptococcus
#10
Corinne Ruppen, Andrew Hemphill, Parham Sendi
OBJECTIVES: Group B Streptococcus (GBS) increasingly causes invasive disease in non-pregnant adults, particularly in elderly persons and those with underlying diseases. Combination therapy with penicillin plus gentamicin has been suggested for periprosthetic joint infection. The postulated synergism of this combination is based on experiments with planktonic bacteria. We aimed to assess the efficacy of this combination against sessile bacteria. METHODS: Four different GBS strains were used...
December 20, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27993444/two-stage-revisions-for-culture-negative-infected-total-knee-arthroplasties-a-five-year-outcome-in-comparison-with-one-stage-and-two-stage-revisions-for-culture-positive-cases
#11
Heng Li, Ming Ni, Xiang Li, Qingmeng Zhang, Xin Li, Jiying Chen
BACKGROUND: Culture-negative periprosthetic joint infection (PJI) is very intractable when dealing with an infected total knee arthroplasty (TKA) patient. Two-stage revision has been proved to be a reliable solution for PJI patients. Whether it is still credible for culture-negative infected patients remains uncertain. METHODS: Our group retrospectively reviewed all total knee revision patients from January 2003 to January 2014, 145 PJI patients were diagnosed as infection with the PJI diagnostic criteria and 129 patients were successfully followed...
December 16, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/27986370/effects-of-ethyl-chloride-spray-on-early-recovery-after-total-knee-arthroplasty-a-prospective-study
#12
Wang Rui, Gong Long, Geng Li, Yu Yang, Li Hengjin, Wang Zhenhu
BACKGROUND: Ethyl chloride spray as a common cooling modality has been widely used in acute sports injuries and joint injection procedures. Several clinical studies reported that use of ethyl chloride has positive effects on swelling, pain reduction and recovery from sports injuries. The main aim of present study was to analyze whether postoperative use of ethyl chloride spray benefits results after primary total knee arthroplasty (TKA). METHODS: Between April 1, 2014 and October 21, 2015, 306 subjects undergoing primary TKA used ethyl chloride spray for improving recovery from the damage from surgery...
December 13, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/27984683/-etiological-agents-more-common-in-primary-hip-and-knee-joint-replacement-infections-in-older-adults
#13
O Argüelles-Martínez, A H Rivera-Villa, A Miguel-Pérez, R Torres-González, J M Pérez-Atanasio, A Mata-Hernández, J C De la Fuente-Zuno
BACKGROUND: The most common etiological agents in periprosthetic infections are Escherichia coli and Staphylococcus aureus. The frequency of these infections are found in knee replacement with 0.68 to 1.60% compared to the hip with 0.67 to 2.4%. OBJECTIVE: To identify what are the most common etiologic agents in periprosthetic infections in elderly patients with primary hip and knee surgery. MATERIAL AND METHODS: An observational study, transverse and retrospective case series was performed in a period from June 2011 to December 2014, patients over 60 years with a diagnosis of periprosthetic infection by two positive cultures with antibiograma...
May 2016: Acta Ortopédica Mexicana
https://www.readbyqxmd.com/read/27984342/strategies-to-prevent-periprosthetic-joint-infection-after-total-knee-arthroplasty-and-lessen-the-risk-of-readmission-for-the-patient
#14
Richard Iorio, Feroz Osmani
There is yet to be a standardized total knee arthroplasty (TKA) surgical protocol that has been studied to a sufficient degree to offer evidence-based practices regarding infection and readmission prevention. Although high-level evidence is often sought to provide guidance concerning protocol- and process-level decisions, the literature is often confusing and nondefinitive in its conclusions and recommendations regarding periprosthetic joint infection and readmission prevention. Areas of study that require further investigation include the following: the role of patient optimization and preoperative mitigation of risk; perioperative antibiotics; operating room environment; blood management; operative techniques, implants, and infection prevention measures; wound care management; and post acute care...
December 13, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27966180/-endoprostheses-in-the-elderly-biomaterials-implant-selection-and-fixation-technique
#15
M M Morlock, M Jäger
The replacement of hip and knee joints is one of the greatest success stories in orthopedics. Due to continuous improvement of biomaterials and implant design, patient-associated problems are now mostly multifactorial and only rarely caused by the implant. Abrasion was significantly reduced by the introduction of highly cross-linked polyethylene (PE), antioxidant stabilized PE, new ceramics and the development of ceramic and protective surfaces. It is assumed that further reduction of frictional resistance will not lead to a significantly better clinical result: however, the problem of periprosthetic infections and implant-related incompatibility is still unsolved and remains challenging for biomaterial research...
December 13, 2016: Der Orthopäde
https://www.readbyqxmd.com/read/27956126/a-bundle-protocol-to-reduce-the-incidence-of-periprosthetic-joint-infections-after-total-joint-arthroplasty-a-single-center-experience
#16
Matthew W Bullock, Matthew L Brown, Daniel N Bracey, Maxwell K Langfitt, John S Shields, Jason E Lang
BACKGROUND: Periprosthetic joint infection (PJI) represents a devastating complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Modifiable patient risk factors as well as various intraoperative and postoperative variables have been associated with risk of PJI. In 2011, our institution formulated a "bundle" to optimize patient outcomes after THA and TKA. The purpose of this report is to describe the "bundle" protocol we implemented for primary THA and TKA patients and to analyze its impact on rates of PJI and readmission...
November 22, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27925637/risk-factors-for-perimegaprosthetic-infections-after-tumor-resection
#17
Marco De Gori, Giorgio Gasparini, Rodolfo Capanna
Periprosthetic joint infection remains one of the most challenging and pervasive complications following megaprosthetic replacement after tumor resection. The authors conducted a systematic review of the literature for clinical studies that reported a risk factor analysis for perimegaprosthetic joint infections. The search included English-language studies published up to July 2015. Eight studies fulfilled the inclusion criteria. Identified factors mostly related to both surgical procedure and hospitalization...
December 7, 2016: Orthopedics
https://www.readbyqxmd.com/read/27925502/implementation-of-an-algorithm-for-prosthetic-joint-infection-deviations-and-problems
#18
Heinrich M L Mühlhofer, Karl-Georg Kanz, Florian Pohlig, Ulrich Lenze, Florian Lenze, Andreas Toepfer, Ruediger von Eisenhart-Rothe, Johannes Schauwecker
BACKGROUND: The outcome of revision surgery in arthroplasty is based on a precise diagnosis. In addition, the treatment varies based on whether the prosthetic failure is caused by aseptic or septic loosening. Algorithms can help to identify periprosthetic joint infections (PJI) and standardize diagnostic steps, however, algorithms tend to oversimplify the treatment of complex cases. We conducted a process analysis during the implementation of a PJI algorithm to determine problems and deviations associated with the implementation of this algorithm...
December 7, 2016: Surgical Infections
https://www.readbyqxmd.com/read/27922947/microbiology-and-antimicrobial-challenges-of-prosthetic-joint-infection
#19
Douglas R Osmon
Research that leads to better strategies to diagnose and treat prosthetic joint infection (PJI) is critical because PJI is a devastating complication of total knee arthroplasty. A key to the diagnosis and management of PJI is defining the microbiology of PJI and improving the medical management of PJI utilizing both systemic and local antimicrobial therapy. In this review, the author will present his opinions on future research needs as they relate to the microbiology of PJI, including antimicrobial resistance and the antimicrobial treatment of PJI...
December 5, 2016: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/27919578/is-the-commercial-antibiotic-loaded-bone-cement-useful-in-prophylactic-and-cost-saving-after-knee-and-hip-joint-arthroplasty-the-transatlantic-paradox
#20
Pablo Sanz-Ruiz, Jose Antonio Matas-Diez, Mar Sanchez-Somolinos, Manuel Villanueva-Martinez, Javier Vaquero-Martín
BACKGROUND: The use of antibiotic-loaded bone cement (ALBC) has proven to be effective in preventing periprosthetic infection (PPI) after total hip (THA) and knee arthroplasty (TKA). However, the economic benefit of using ALBC routinely remains controversial. METHODS: A total of 2518 patients subjected to THA, partial hip arthroplasty, and TKA between 2009 and 2012 were identified in our prospectively collected registry. Two groups were defined: before (2009-2010) and after the introduction of ALBC (2011-2012)...
November 15, 2016: Journal of Arthroplasty
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