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Periprosthetic infection

Yosuke Takahashi, Yasuyuki Sasaki, Yasuyuki Bito, Manabu Motoki, Takashi Murakami, Toshihiko Shibata
We herein report two cases of perigraft effusion mimicking graft infection after debranching thoracic endovascular repair for an anastomotic pseudoaneurysm of the distal ascending aorta. Both patients presented with a bulging tumor on the sternum. Enhanced computed tomography showed no endoleak, but extension of periprosthetic graft fluid to a subcutaneous sternal wound was present. We suspected a deep sternal wound infection; however, cultures of débrided tissues were negative. After drainage of the subcutaneous fluid or negative pressure wound therapy, both patients were doing well without recurrence of effusion...
October 14, 2016: Journal of Vascular Surgery
Ayman M Ebied, Adel I Elseedy, Osama Gamal
BACKGROUND: Staged revision for periprosthetic infection of the hip is an accepted and widely used technique by many surgeons. However, single-stage exchange of the hip prosthesis remains an attractive option to others because of the advantages of reduced morbidity, shorter treatment time and hospital stay in addition to the reduced cost of treatment. HYPOTHESIS: Single-stage revision for periprosthetic hip infection can achieve excellent results if a specific protocol for patients' selection and management is followed...
October 10, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Leif Claassen, Sarah Ettinger, Marc-Frederic Pastor, Stefan Budde, Henning Windhagen, Thilo Floerkemeier
INTRODUCTION: The diagnostic algorithm in cases of assumed low-grade infection after total knee arthroplasty is discussed controversial. The aim of this study was to evaluate the reliability of neosynovium biopsies via knee arthroscopies in predicting a periprosthetic knee joint infection (PJI). METHODS: From 2010 to 2015, 56 consecutive patients received a diagnostic arthroscopy of the knee joint by reason of an assumed PJI. In 34 cases, a revision arthroplasty was performed after the diagnostic arthroscopy...
October 12, 2016: Archives of Orthopaedic and Trauma Surgery
Hamed Ebrahimzadeh Leylabadlo, Elham Zeinalzadeh, Najibeh Asl Rahnemaii Akbari, Hossein Samadi Kafil
Infection is a serious complication after implantation of total knee-prostheses. However, fungal infection is rarely found in periprosthetic joints, and in most reports, the infecting organism is a Candida species. This is a case report of infection after left knee total arthroplasty caused by Malassezia species. The patient is still undergoing antifungal therapy with voriconazole and is still being followed-up. To the authors' knowledge, the present case is the first report of Malassezia species in a patient after total knee arthroplasty...
2016: GMS Hygiene and Infection Control
M Daniel Hatch, Stephen D Daniels, Kimberly M Glerum, Laurence D Higgins
BACKGROUND: Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement. METHODS: Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis...
October 7, 2016: Journal of Shoulder and Elbow Surgery
D A George, N Logoluso, G Castellini, S Gianola, S Scarponi, F S Haddad, L Drago, C L Romano
BACKGROUND: The best surgical modality for treating chronic periprosthetic hip infections remains controversial, with a lack of randomised controlled studies. The aim of this systematic review is to compare the infection recurrence rate after a single-stage versus a two-stage exchange arthroplasty, and the rate of cemented versus cementless single-stage exchange arthroplasty for chronic periprosthetic hip infections. METHODS: We searched for eligible studies published up to December 2015...
October 10, 2016: BMC Infectious Diseases
Salvatore J Frangiamore, Anas Saleh, Matthew J Grosso, Mario Farias Kovac, Xiaochun Zhang, Thomas M Daly, Thomas W Bauer, Kathleen A Derwin, Joseph P Iannotti, Eric T Ricchetti
BACKGROUND: Periprosthetic joint infection (PJI) after shoulder arthroplasty can present a diagnostic and therapeutic challenge. This study evaluated the diagnostic utility of broader synovial fluid cytokine analysis for identifying PJI in patients undergoing revision shoulder arthroplasty. METHODS: Synovial fluid levels of 9 cytokines (interleukin [IL] 6, granulocyte-macrophage colony-stimulating factor, IL-1β, IL-12, IL-2, IL-8, interferon-γ, IL-10, and tumor necrosis factor-α) were measured in 75 cases of revision shoulder arthroplasty with a multiplex immunoassay...
October 5, 2016: Journal of Shoulder and Elbow Surgery
Jakrapun Pupaibool, Eric J Fulnecky, Robert L Swords, William W Sistrunk, Alastair D Haddow
PURPOSE: Periprosthetic joint infection (PJI) continues to be a significant complication after total joint arthroplasty. Diagnosis of PJI can be challenging and elusive in the absence of a gold standard. This purpose of this article is to review the current evidence on the utility of serum and synovial fluid biomarkers to help aid in the diagnosis of PJI with focusing on synovial fluid alpha-defensin. METHODS: Articles and data for this review were identified by searches of PubMed and Ovid MEDLINE up to June 1, 2016...
October 7, 2016: International Orthopaedics
Friedrich Boettner, Gabriele Koehler, Alexander Wegner, Tom Schmidt-Braekling, Georg Gosheger, Christian Goetze
OBJECTIVE: The current study investigates the diagnostic accuracy of the criteria described for frozen sections and whether modern leukocyte specific staining techniques including leukocyte peroxidase and Naphtol-AS-D-chloroacetate-esterase will improve the accuracy of the intra-operative histology. METHOD: 77 patients undergoing revision total hip and knee arthroplasty were included in this retrospective study. Patients were grouped into septic and aseptic based on intraoperative cultures...
2016: Open Orthopaedics Journal
Alberto V Carli, F Patrick Ross, Samrath J Bhimani, Scott R Nodzo, Mathias P G Bostrom
➤The poor treatment outcomes for periprosthetic joint infection (PJI) reflect the limited understanding that currently exists regarding the pathogenesis of this devastating clinical problem.➤Current animal models of PJI are limited in their translational nature primarily because of their inability to recreate the periprosthetic environment.➤A greater mechanistic understanding of the musculoskeletal and immune systems of small animals, such as mice and rats, provides a more robust platform for modeling and examining the pathogenesis of PJI...
October 5, 2016: Journal of Bone and Joint Surgery. American Volume
S J Verberne, P G Raijmakers, O P P Temmerman
BACKGROUND: Various imaging techniques are used for excluding or confirming periprosthetic hip infection, but there is no consensus regarding the most accurate technique. The objective of this study was to determine the accuracy of current imaging modalities in diagnosing periprosthetic hip infection. METHODS: A systematic review and meta-analysis of the literature was conducted with a comprehensive search of MEDLINE and Embase to identify clinical studies in which periprosthetic hip infection was investigated with different imaging modalities...
October 5, 2016: Journal of Bone and Joint Surgery. American Volume
H-R Choi, K Agrawal, H Bedair
AIMS: We hypothesised that the synovial white blood cell (WBC) count in patients with a late periprosthetic joint infection (PJI) of the hip would depend on the duration of a patient's symptoms, and that the optimal diagnostic threshold would also depend on this period of time. PATIENTS AND METHODS: The synovial WBC count and percentage of polymorphonuclear cells (%PMN), and the serum CRP and ESR levels obtained > six weeks after primary THA were compared between 50 infected and 88 non-infected THAs, and in patients with symptoms for more than or less than two weeks...
October 2016: Bone & Joint Journal
José Cordero, Alfonso Maldonado, Sergio Iborra
PURPOSE: Analysis of significant risk factors for mortality and for medical and orthopaedic complications. PATIENTS AND METHODS: Observational study of a prospective consecutive cohort of 697 patients diagnosed of hip fracture from December 2012 to December 2014. Average age was 85±9years and 520 were female (75%). Intracapsular fractures (308, 44%) were treated non-operatively, (19 patients), with cannulated screws (58) or with hip arthroplasty (228 bipolar, 3 total hip atrhoplasty)...
September 2016: Injury
Viktor Janz, Georgi I Wassilew, Carsten F Perka, Benjamin Bartek
BACKGROUND: It is currently unclear if an isolated exchange of the mobile components, in cases of periprosthetic joint infection (PJI), leads to a complete eradication of all bacteria or if residual bacteria remain attached to the retained components? OBJECTIVE: The purpose of this study was to investigate if bacteria only adhere to certain components or materials, or if they are ubiquitously distributed throughout the joint. METHODS: Twenty hundred and eighty four patients undergoing revision total hip or total knee arthroplasty surgery were included in this retrospective cohort study...
September 23, 2016: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
J W P Kuiper, S Vos, T J Burger, S Colen
Recently, guidelines regarding diagnosis and treatment of periprosthetic joint infection (PJI) have been published, but it is unknown how well these are -followed in the Netherlands and Belgium. Therefore, a survey study was performed in the Netherlands and Belgium. 81 orthopedic departments responded (54% in the Netherlands, 52% in Belgium). The majority used protocols for antibiotic and surgical treatment. To discriminate between early and late infection, differences in periods used were seen between respondents, and between countries...
August 2016: Acta Orthopaedica Belgica
Marcelo B P Siqueira, Paul Jacob, John McLaughlin, Alison K Klika, Robert Molloy, Carlos A Higuera, Wael K Barsoum
The purpose of this study was to estimate the survivorship of the varus-valgus constrained (VVC) knee implants in primary, aseptic, and septic revision total knee arthroplasty (TKA); determine functional outcomes; main modes of failure; and variables associated with increased mechanical failures. In this study, 685 consecutive cases of primary (n = 247), aseptic (n = 315), and septic revision (n = 123) TKAs with VVC implants were performed between 1999 and 2008; 533 knees (78%) had a mean follow-up of 8...
September 28, 2016: Journal of Knee Surgery
Daniel A Osei, Kelsey A Rebehn, Martin I Boyer
Wound healing complications associated with total knee arthroplasty present a considerable challenge to the orthopaedic surgeon. To ensure preservation of a functional joint, the management of periprosthetic soft-tissue defects around the knee requires rapid assessment, early and aggressive débridement, and durable, contoured coverage. Several reconstructive options are available to tailor soft-tissue coverage to the location, size, and depth of the wound. Special consideration should be given to the timing of the intervention, management of infection, and prosthesis salvage...
September 26, 2016: Journal of the American Academy of Orthopaedic Surgeons
Georgios K Triantafyllopoulos, Vasileios Soranoglou, Stavros G Memtsoudis, Lazaros A Poultsides
Periprosthetic joint infections (PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement (I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state...
September 18, 2016: World Journal of Orthopedics
Jared M Newman, Jaiben George, Alison K Klika, Stephen F Hatem, Wael K Barsoum, W Trevor North, Carlos A Higuera
BACKGROUND: Periprosthetic joint infection is a serious complication after THA and commonly is treated with a two-stage revision. Antibiotic-eluting cement spacers are placed for local delivery of antibiotics. Aspirations may be performed before the second-stage reimplantation for identification of persistent infection. However, limited data exist regarding the diagnostic parameters of synovial fluid aspiration with or without saline lavage from a hip with an antibiotic-loaded cement spacer...
September 26, 2016: Clinical Orthopaedics and related Research
Philipp Born, Thomas Ilchmann, Werner Zimmerli, Lukas Zwicky, Peter Graber, Peter E Ochsner, Martin Clauss
Background and purpose - The use of uncemented revision stems is an established option in 2-stage procedures in patients with periprosthetic joint infection (PJI) after total hip arthroplasty (THA). However, in 1-stage procedures, they are still rarely used. There are still no detailed data on radiological outcome after uncemented 1-stage revisions. We assessed (1) the clinical outcome, including reoperation due to persistent infection and any other reoperation, and (2) the radiological outcome after 1- and 2-stage revision, using an uncemented stem...
September 23, 2016: Acta Orthopaedica
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