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Periprosthetic infection

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https://www.readbyqxmd.com/read/28195606/use-of-articulating-spacer-technique-in-revision-total-knee-arthroplasty-complicated-by-sepsis-a-systematic-meta-analysis
#1
John C Spivey, George N Guild, Giles R Scuderi
Periprosthetic infection after total knee arthroplasty is a devastating complication, and 2-stage exchange is the standard of care in North America. Articulating spacers are effective in treating periprosthetic joint infections, but the optimal articulating spacer construct has yet to be identified. The authors performed a systematic review using MEDLINE, MEDLINE In-Process, EMBASE, BIOSIS, ClinicalTrials.gov, and Cochrane Database of Systematic Reviews. They identified 34 articles meeting inclusion criteria, producing 1016 spacers for comparison...
February 13, 2017: Orthopedics
https://www.readbyqxmd.com/read/28194713/use-of-compressive-osseointegration-endoprostheses-for-massive-bone-loss-from-tumor-and-failed-arthroplasty-a-viable-option-in-the-upper-extremity
#2
Krista A Goulding, Adam Schwartz, Steven J Hattrup, R Lor Randall, Donald Lee, Damian M Rispoli, Daniel M Lerman, Christopher Beauchamp
BACKGROUND: Endoprostheses using principles of compressive osseointegration have shown good survivorship in several studies involving the lower extremity; however, no series to our knowledge have documented the use of this technology in the management of massive bone loss in the upper limb. QUESTIONS/PURPOSES: (1) What proportion of upper extremity implants using compressive osseointegration fixation principles achieved durable short-term fixation, and what were the modes of failure? (2) What surgical complications resulted from reconstruction using this technique? METHODS: A multiinstitutional retrospective review identified nine patients (five women; four men) who underwent 13 endoprosthetic replacements between 2003 and 2014 using compressive osseointegration (Compliant(®) Pre-stress Device [CPS]; Biomet Inc, Warsaw, IN, USA) in the upper extremity, including two proximal humeri, two humeral diaphyses, seven distal humeri, and two proximal ulna...
February 13, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28185753/predicting-the-incremental-hospital-cost-of-adverse-events-among-medicare-beneficiaries-in-the-comprehensive-joint-replacement-program-during-fiscal-year-2014
#3
Steven D Culler, David S Jevsevar, Kevin J McGuire, Kevin G Shea, Kenneth M Little, Michael J Schlosser
BACKGROUND: The Medicare program's Comprehensive Care for Joint Replacement (CJR) payment model places hospitals at financial risk for the treatment cost of Medicare beneficiaries (MBs) undergoing lower extremity joint replacement (LEJR). METHODS: This study uses Medicare Provider Analysis and Review File and identified 674,777 MBs with LEJR procedure during fiscal year 2014. Adverse events (death, acute myocardial infarction, pneumonia, sepsis or shock, surgical site bleeding, pulmonary embolism, mechanical complications, and periprosthetic joint infection) were studied...
January 16, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28167881/poor-prognosis-of-patients-treated-for-periprosthetic-joint-infection
#4
REVIEW
Cynthia A Kahlenberg, Alexia Hernandez-Soria, Michael B Cross
The study by Gomez et al., "The Fate of Spacers in the Treatment of Periprosthetic Joint Infection," evaluates the clinical course and success rate of treatment of periprosthetic joint infection with two-stage revision with spacer placement in the interim period. The current review critically analyzes the findings of this study and examines how these findings may influence patient care in the field of hip and knee replacement. Gomez et al. report sobering results of two-stage revision with spacer placement for periprosthetic joint infection...
February 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
https://www.readbyqxmd.com/read/28165600/early-periprosthetic-joint-infection-and-debridement-antibiotics-and-implant-retention-in-arthroplasty-for-femoral-neck-fracture
#5
Carl Mellner, Thomas Eisler, Björn Knutsson, Sebastian Mukka
INTRODUCTION: Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population.The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty. METHODS: A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution...
January 31, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/28162880/surgical-management-of-periprosthetic-shoulder-infections
#6
Geoffrey P Stone, Rachel E Clark, Kathleen C O'Brien, Lisa Vaccaro, Peter Simon, Adam J Lorenzetti, Brent C Stephens, Mark A Frankle
BACKGROUND: The treatment of periprosthetic joint infection is a difficult challenge in shoulder arthroplasty. This study investigated 1-stage modular component exchange vs. 1-stage complete removal and reimplantation (CRR) vs. 2-stage revision arthroplasty for periprosthetic joint infection. METHODS: Between January 1, 2004, and December 31, 2012, 79 patients received a component exchange (n = 15), CRR (n = 45), or a 2-stage (n = 19) revision for infection. A binary logistic regression analysis was performed to determine factors presenting the greatest risk of reinfection...
February 2, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28160020/diagnosis-of-periprosthetic-joint-infection-using-alpha-defensin-test-or-multiplex-pcr-ideal-diagnostic-test-still-not-found
#7
Arnold J Suda, Marco Tinelli, Nils D Beisemann, Yoram Weil, Amal Khoury, Oliver E Bischel
PURPOSE: Diagnosing periprosthetic infection remains a challenge. Multiplex-PCR and biomarkers such as alpha-defensin are potentially useful and fast methods for detecting periprosthetic infection. This study compared these new methods with clinical assessment, conventional microbiological methods and histo-pathological examination. METHODS: Twenty-eight consecutive patients with 30 joints and a mean age of 67.7 years (range 39 to 88) with removal of total hip arthroplasty (THA) or total knee replacement (TKR) were included in this study...
February 4, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28155210/corr-insights-%C3%A2-what-is-the-accuracy-of-nuclear-imaging-in-the-assessment-of-periprosthetic-knee-infection-a-meta-analysis
#8
Thomas Ilchmann
No abstract text is available yet for this article.
February 2, 2017: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/28153684/analysis-of-complication-rates-following-perioperative-transfusion-in-shoulder-arthroplasty
#9
A Jordan Grier, Abiram Bala, Colin T Penrose, Thorsten M Seyler, Michael P Bolognesi, Grant E Garrigues
BACKGROUND: Postoperative anemia requiring a blood transfusion is not uncommon following anatomic total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). However, the potential complications in patients undergoing transfusion after shoulder arthroplasty remain unclear. The goal of this study was to examine the postoperative outcomes of patients receiving blood transfusions following TSA and RTSA. METHODS: Using the Medicare Standard Analytic Files database, we identified all patients undergoing TSA or RTSA between 2005 and 2010...
January 30, 2017: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/28150224/isolated-acetabular-revision-with-femoral-stem-retention-after-bipolar-hip-arthroplasty
#10
Nobuhiro Kaku, Tomonori Tabata, Hiroaki Tagomori, Hiroshi Tsumura
INTRODUCTION: In bipolar hemiarthroplasty, migration of the outer cup component into the acetabular cup, with evidence of severe osteolysis in the acetabulum, commonly occurs without loosening of the femoral component. The merits of retaining the stable femoral component in these cases have been debated. Our study aimed to determine whether revision of the acetabular component in isolation could be successfully performed. MATERIALS AND METHODS: The data of 54 patients (61 hips), 44 women, and 10 men, aged 67...
February 1, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28145954/intra-articular-vancomycin-powder-eliminates-methicillin-resistant-s-aureus-in-a-rat-model-of-a-contaminated-intra-articular-implant
#11
Adam I Edelstein, Joseph A Weiner, Ralph W Cook, Danielle S Chun, Emily Monroe, Sean M Mitchell, Abhishek Kannan, Wellington K Hsu, S David Stulberg, Erin L Hsu
BACKGROUND: Periprosthetic joint infection following hip and knee arthroplasty leads to poor outcomes and exorbitant costs. Topical vancomycin powder has been shown to decrease infection in many procedures such as spine surgery. The role of vancomycin powder in the setting of total joint arthroplasty remains undefined. Our aim was to evaluate the efficacy of intra-articular vancomycin powder in preventing infection in a rat model of a contaminated intra-articular implant. METHODS: Thirty-two female Sprague-Dawley rats underwent knee arthrotomy and implantation of a femoral intramedullary wire with 1 mm of intra-articular communication...
February 1, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28145953/vancomycin-and-ceftazidime-in-bone-cement-as-a-potentially-effective-treatment-for-knee-periprosthetic-joint-infection
#12
Yung-Heng Hsu, Chih-Chien Hu, Pang-Hsin Hsieh, Hsin-Nung Shih, Steve W N Ueng, Yuhan Chang
BACKGROUND: The aim of this study was to determine the optimal formulation of antibiotic-loaded bone cement for knee periprosthetic joint infection. We used both in vitro and in vivo models incorporating various broad-spectrum antibiotics and tested their efficacy against gram-positive and gram-negative bacteria. METHODS: Bone cement specimens loaded with 4 g of either vancomycin or teicoplanin and 4 g of ceftazidime, imipenem, or aztreonam were studied to measure their in vitro antibiotic release characteristics and antibacterial capacities against methicillin-susceptible Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Escherichia coli...
February 1, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28145948/total-knee-arthroplasty-after-anterior-cruciate-ligament-reconstruction-not-just-a-routine-primary-arthroplasty
#13
Tyler Steven Watters, Yuan Zhen, J Ryan Martin, Daniel L Levy, Jason M Jennings, Douglas A Dennis
BACKGROUND: Despite the success of restoring joint stability and improving early functional outcomes after anterior cruciate ligament (ACL) reconstruction, the long-term risk of developing symptomatic osteoarthritis requiring total knee arthroplasty is higher than that in the uninjured population. The purpose of this study was to compare operative characteristics and early outcomes of patients undergoing total knee arthroplasty after ACL reconstruction with those of a matched cohort of control subjects with primary osteoarthritis and no history of ligament reconstruction...
February 1, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28134047/effectiveness-of-leucocyte-esterase-as-a-diagnostic-test-for-acute-septic-arthritis
#14
V K Gautam, Rishabh Saini, Siddharth Sharma
BACKGROUND: We hypothesized that leucocyte esterase strip test can aid in diagnosing septic arthritis in native synovial fluid because leucocyte esterase concentrations would be elevated at the infection site because of secretion by recruited neutrophils. METHOD: The cohort included 27 patients (suspected septic arthritis and normal subjects). A standard chemical test strip (graded as negative, trace, +, ++ or +++) was used to detect the presence of leucocyte esterase...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28130016/cortical-strut-allograft-support-of-modular-femoral-junctions-during-revision-total-hip-arthroplasty
#15
Chin Tat Lim, Derek F Amanatullah, James I Huddleston, Katherine L Hwang, William J Maloney, Stuart B Goodman
BACKGROUND: There is risk of junction failure when using modular femoral stems for revision total hip arthroplasty (THA), especially with loss of bone stock in the proximal femur. Using a cortical strut allograft may provide additional support of a modular femoral construct in revision THA. METHODS: We reviewed prospectively gathered clinical and radiographic data for 28 revision THAs performed from 2004 to 2014 using cementless modular femoral components with cortical strut allograft applied to supplement proximal femoral bone loss: 5 (18%) were fluted taper designs and 23 (82%) were porous cylindrical designs All the patients had a Paprosky grade IIIA or greater femoral defect...
December 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28127738/the-role-of-rankl-rank-opg-system-in-the-canine-model-of-hip-periprosthetic-infection-osteolysis
#16
Hao-Wei Zhang, Li Peng, Wen-Bo Li, Ke-Guan Song
PURPOSE: We aimed to investigate whether the RANKL/RANK/OPG system is associated with the incidence of periprosthetic osteolysis with septic loosening, and to investigate the differences of RANKL/RANK/OPG system expression in synovial fluid surrounding the normal and septic loosening hip prosthesis in canine models. METHODS: Twelve healthy adult mongrel canines were divided into two groups: experimental and control. Femoral head and stem replacements were conducted on the right side in both groups...
January 24, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28116505/total-hip-arthroplasty-after-failed-treatment-of-proximal-femur-fracture
#17
Tomonori Tetsunaga, Kazuo Fujiwara, Hirosuke Endo, Tomoyuki Noda, Tomoko Tetsunaga, Toru Sato, Naofumi Shiota, Toshifumi Ozaki
INTRODUCTION: Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures. MATERIALS AND METHODS: We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture...
January 23, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28112789/periprosthetic-fractures-in-megaprostheses-algorithmic-approach-to-treatment
#18
Olga D Savvidou, Vasileios I Sakellariou, Panayiotis Megalooikonomou, Andreas F Mavrogenis, Panayiotis J Papagelopoulos
With increases in both life expectancy and the number of patients with endoprosthetic replacements, more periprosthetic fractures are expected to occur. Periprosthetic fractures related to megaprostheses present a treatment challenge, with a high incidence (one-third of affected patients) of secondary revision as a result of prosthetic loosening, infection, nonunion, refracture, or even amputation. Efforts to improve endoprosthetic reconstruction should focus on preventing postoperative complications. Understanding the causes of complications and strategies to avoid them could lead to significant improvements in implant survival, limb function, and patient outcomes...
January 20, 2017: Orthopedics
https://www.readbyqxmd.com/read/28109928/fdg-uptake-by-prosthetic-arterial-grafts-in-large-vessel-vasculitis-is-not%C3%A2-specific-for-active-disease
#19
Taryn Youngstein, Enrico Tombetti, Jaita Mukherjee, Tara D Barwick, Adil Al-Nahhas, Emyr Humphreys, Julian Nash, Jacqueline Andrews, Elena Incerti, Elisabetta Tombolini, Annalaura Salerno, Silvia Sartorelli, Giuseppe A Ramirez, Maurizio Papa, Maria Grazia Sabbadini, Luigi Gianolli, Francesco De Cobelli, Federico Fallanca, Elena Baldissera, Angelo A Manfredi, Maria Picchio, Justin C Mason
OBJECTIVES: This study investigated the incidence and clinical significance of arterial graft-associated uptake of fluorodeoxyglucose in large-vessel vasculitis (LVV). BACKGROUND: The role of (18)F-labeled fluorodeoxyglucose-positron emission tomography/computed tomography ([(18)F]FDG-PET/CT) in the management of LVV remains to be defined. Although [(18)F]FDG uptake at arterial graft sites raises concerns regarding active arteritis or infection, its clinical significance in LVV has never been formally studied...
January 11, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28109672/optimizing-follow-up-after-anatomic-total-shoulder-arthroplasty
#20
Bradley Schoch, Jean David Werthel, Cathy D Schleck, William S Harmsen, John Sperling, Joaquín Sánchez-Sotelo, Robert H Cofield
BACKGROUND: With increases in both total shoulder arthroplasty (TSA) volumes and patient life expectancies, the number of patients requiring follow-up after shoulder arthroplasty continues to grow exponentially. The purpose of this study is to establish a data-based follow-up schedule minimizing unnecessary patient and health care system costs without sacrificing patient care. METHODS: Between January 1975 and January 2013, 2786 consecutive anatomic TSAs were performed at our institution...
January 19, 2017: Journal of Shoulder and Elbow Surgery
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