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Periprosthetic infection

Sandrine Mariaux, Ulrika Furustrand Tafin, Olivier Borens
Introduction : When treating periprosthetic joint infection with a two-stage procedure, antibiotic-impregnated spacers can be used in the interval between prosthetic removal and reimplantation. In our experience, cultures of sonicated spacers are most often negative. The objective of the study was to assess whether that sonication causes an elution of antibiotics, leading to elevated antibiotic concentrations in the sonication fluid inhibiting bacterial growth and thus causing false-negative cultures. Methods : A prospective monocentric study was performed from September 2014 to March 2016...
2018: Journal of Bone and Joint Infection
Mohamed Omar, Maximilian Petri, Nael Hawi, Christian Krettek, Jörg Eberhard, Emmanouil Liodakis
PURPOSE: The aim of this study was to assess the diagnostic accuracy of swab polymerase chain reaction (PCR) compared with tissue culture as the current gold standard. METHODS: Forty-one consecutive patients were prospectively enrolled undergoing revision arthroplasty due to septic and aseptic reasons. Infection classification was done according to the criteria of the Musculoskeletal Infection Society. Intraoperatively, tissue samples of the periprosthetic membrane were collected for culture analysis, and swabs were taken from the accessible implant surface to perform 16S ribosomal RNA PCR...
January 2018: Journal of Orthopaedic Surgery
Kasandra R Dassoulas, Jessica Wang, Jenna Thuman, Idorenyin Ndem, Christine Schaeffer, Madeline Stovall, Alexandra Tilt, Andy Lee, Kant Y Lin, Christopher A Campbell
BACKGROUND: Infection is the most significant complication in implant-based breast reconstruction, potentially leading to reconstructive failure. We hypothesized that implementation of an evidence-based protocol marked by preoperative decolonization and sterility optimization would result in a decline in postoperative infection rates. METHODS: Informed by a literature review, we developed an evidence-based, perioperative infection prevention protocol implemented in 2015...
March 13, 2018: Annals of Plastic Surgery
Aldo Riesgo, Frank Liporace
Periprosthetic joint infection (PJI) is one of the most catastrophic and difficult to manage complications following total hip and total knee arthroplasty. As the number of total joint arthroplasties continues to increase, the burden of PJI will continue to further strain resources. As such, orthopedic surgeons consider four principles crucial in appropriately managing difficult or complex cases of PJI: identification, debridement, antibiotics, and patience. Indications and techniques for nonoperative treatment, debridement with implant retention, and one- and two-stage exchange arthroplasty are reviewed...
March 2018: Bulletin of the Hospital for Joint Diseases
Zhi-Sen Gao, Yong-Gang Zhou, Yin-Qiao Du, Shang Piao, Jing-Yang Sun, Ya-Wen Peng, Wen-Ming Wu
OBJECTIVE: To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision. METHODS: From January 2005 to June 2015, 57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of (61.3±11.9) years old. According to the drug resistance of methicillin, the patients were divided into methicillin sensitive group(MSCoN) and methicillin resistance(MRCoN) group, 25 cases in MSCoN group(9 knees and 16 hips) included 12 males and 13 females, 32 cases in MRCoN group(11 knees and 21 hips) included 14 males and 18 females...
February 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Jing-Yang Sun, Yong-Gang Zhou, Yin-Qiao Du, Shang Piao, Sen Wang, Zhi-Sen Gao, Wen-Ming Wu, Hai-Yang Ma
OBJECTIVE: To observe the clinical effect of ceramic on ceramic total hip arthroplasty(THA)in Crowe IV developmental dysplasia of the hip(DDH). METHODS: From April 2008 to December 2015, 137 hips of 111 Crowe IV DDH patients received THA using Forte or Delta ceramic on ceramic by one senior surgeon, which consists of 85 unilateral hips and 26 bilateral hips. The average age of the patients was(38.88±10.83) years old ranging from 18 to 68 years old. The mean follow-up was(41...
February 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Anny Lam, Magnus Rasmussen, Olof Thompson
BACKGROUND/AIM: Streptococci cause approximately 10% of prosthetic joint infections (PJIs). The aim of this study was to identify the characteristics of patients with streptococcal PJIs and to describe the treatment and outcome of streptococcal PJIs in Skåne county between 2011 and 2015. METHODS: Patients with streptococcal PJIs with positive cultures or PCRs on samples from joint aspirate and/or periprosthetic tissue between 2011 and 2015 in Skåne county, were identified and medical records were studied...
March 13, 2018: Infectious Diseases
Junren Lu, Jing Han, Chi Zhang, Zhenjun Yao, Yi Yang
Although two-stage revision surgery is generally considered as the gold standard treatment for periprosthetic joint infection (PJI) after total knee arthroplasty, the procedure is limited by the costs of commercially preformed spacers used for treatment. In this work, we aim to report a modified approach by which the cost of the spacer could be significantly reduced without compromising eradication of infection. Between 2010 and 2016, we performed a total of 11 two-stage revision arthroplasties using a surgically handmade spacer with a new polyethylene insert...
February 6, 2018: Journal of Knee Surgery
Michael A Mont, David J Backstein, Viktor E Krebs, J Bohannon Mason, Michael J Taunton, John J Callaghan
No abstract text is available yet for this article.
February 27, 2018: Journal of Arthroplasty
Maria Teresa Trentinaglia, Catherine Van Der Straeten, Ilaria Morelli, Nicola Logoluso, Lorenzo Drago, Carlo L Romanò
BACKGROUND: Antibacterial coatings (ABCs) of implants have proven safe and effective to reduce postsurgical infection, but little is known about their possible economic impact on large-scale use. This study evaluated the point of economic balance, during the first year after surgery, and the potential overall annual healthcare cost savings of 3 different antibacterial technologies applied to joint arthroplasty: a dual-antibiotic-loaded bone cement (COPAL G + C), an antibacterial hydrogel coating (DAC), and a silver coating (Agluna)...
February 10, 2018: Journal of Arthroplasty
Adolph V Lombardi, Antonio G Manocchio, Keith R Berend, Michael J Morris, Joanne B Adams
INTRODUCTION: Short stem femoral components in primary total hip arthroplasty (THA) have increased in popularity since the advent of minimally invasive surgical techniques. The concept of a short stem is particularly compatible with tapered designs where the goal is to offload forces proximally in the femur. The purpose of this retrospective review was to review our early experience with a short, tapered titanium femoral component with updated design features. MATERIALS AND METHODS: Beginning in November 2011 through February 2012, 92 consented patients (93 hips), at a single center, were treated with primary cementless THA using a short stem, tapered femoral component (Taperloc® Complete Microplasty; Zimmer Biomet, Warsaw, Indiana) and were available for review with a minimum two-year follow-up...
March 12, 2018: Surgical Technology International
Ahmed Siddiqi, Nicole E George, Peter B White, Bartlomiej W Szczech, John V Thompson, Jennifer I Etcheson, Chukwuweike U Gwam, Alexander T Caughran, Ronald E Delanois, James Nace
INTRODUCTION: Periprosthetic joint infection (PJI) following primary total knee arthroplasty (TKA) is a challenging complication for surgeons and patients alike. Although two-stage revision arthroplasty remains the gold standard PJI management in the United States, one-stage revision has had success in many parts of Europe. The aim of this study was to retrospectively review: 1) ultimate treatment success; 2) necessary antibiotic duration; 3) change in knee range of motion (ROM); and 4) final Knee Society Scores (KSS) in a case series of patients managed with retention of articulating antibiotic spacers following PJI...
March 12, 2018: Surgical Technology International
Christopher T Born, Joseph A Gil, Joey P Johnson
Periprosthetic fractures around total knee arthroplasty have become an increasingly common and challenging orthopaedic problem. Appropriate management of these fractures depends on careful scrutiny of radiographs and a thorough clinical history to exclude the diagnosis of a periprosthetic infection. In a periprosthetic tibial fracture with a stable, well-aligned tibial component and well-aligned mechanical tibial axis, the fracture can be successfully managed with closed reduction and cast immobilization; meticulous follow-up is essential to ensure that the alignment is maintained...
March 9, 2018: Journal of the American Academy of Orthopaedic Surgeons
Adam I Edelstein, Kamil T Okroj, Thea Rogers, Craig J Della Valle, Scott M Sporer
BACKGROUND: Treatment of periprosthetic joint infections commonly involves insertion of an antibiotic-loaded cement spacer (ACS). The risk for acute kidney injury (AKI) related to use of antibiotic spacers has not been well defined. We aimed to identify the incidence of and risk factors for AKI after placement of an ACS. METHODS: We performed a prospective cohort study of patients with an infected primary total hip or knee arthroplasty treated with ACSs with vancomycin, gentamicin, and tobramycin...
February 12, 2018: Journal of Arthroplasty
Maryam Rezapoor, Timothy L Tan, Mitchell G Maltenfort, Javad Parvizi
BACKGROUND: Iodophor-impregnated adhesive incise drapes are widely used during surgeries for reducing surgical site contamination. There is little evidence to support the latter belief. This study evaluated the efficacy of iodophor-impregnated adhesive drapes for reducing bacterial contamination and counts at the incision site during hip surgery. METHODS: In this prospective, randomized clinical trial, we enrolled 101 patients undergoing open joint preservation procedure of the hip...
February 2, 2018: Journal of Arthroplasty
Marcello De Fine, Gianluca Giavaresi, Milena Fini, Andrea Illuminati, Silvio Terrando, Giovanni Pignatti
INTRODUCTION: This study tried to ascertain (1) the accuracy of synovial fluid white blood cell count and polymorphonucleate percentage in the diagnosis of periprosthetic hip and knee infections, (2) which test yielded superior test performance, and (3) the influence on diagnostic accuracy of study characteristics such as patient number, study design, study level, anatomic site, and threshold value. METHODS: A systematic search was conducted including papers assessing more effective cutoffs for synovial fluid tests, having comparative design, evaluating an exclusive cohort of hip or knee prostheses, including a clear definition of infected cases, and reporting sufficient data for the calculation of true-positive, false-positive, false-negative, and true-negative...
March 9, 2018: International Orthopaedics
Ruben Scholten, Jetze Visser, Job L C Van Susante, Corné J M Van Loon
Background and purpose - The Synovasure lateral flow test was developed as a rapid test for the detection or exclusion of periprosthetic joint infection (PJI). 3 studies have reported promising results on its diagnostic value in total joint revision surgery. We aimed to assess the sensitivity and specificity of the Synovasure test to exclude infection in patients undergoing revision surgery for suspected early aseptic loosening of a total hip or knee arthroplasty. Patients and methods - In a prospective study design, 37 patients who underwent revision surgery for suspected early aseptic loosening (< 3 years after primary arthroplasty) were included...
March 6, 2018: Acta Orthopaedica
Yoshinobu Saitoh, Takao Setoguchi, Takako Yoshioka, Junichiro Nishi, Akihide Tanimoto, Setsuro Komiya
OBJECTIVE: The aim of this study was to evaluate whether intraoperative histopathological examination could predict the risk of relapse of infection in periprosthetic joint infections (PJI). METHODS: The study included 25 patients (14 women and 11 men, with a mean age of 67.0 years (range, 37-83 years)), who had two-staged revision surgery for a PJI. Following prosthetic removal in the first stage, all patient underwent an intraoperative histopathological examination during the second stage...
March 1, 2018: Acta Orthopaedica et Traumatologica Turcica
Craig J Della Valle, Tyler E Calkins, Joshua J Jacobs
There has been an increasing use of modularity at the head-neck junction in total hip arthroplasty to more closely mimic the native anatomy, allowing for optimal leg length and stability. Corrosion at this junction in metal-on-polyethylene bearings can lead to an adverse local tissue reaction (ALTR). This increasingly prevalent condition should be considered in the differential diagnosis of hip pain and difficulty ambulating. A recent symposium by the American Academy of Hip and Knee Surgeons described the diagnosis, etiology, management, and prevention of taper corrosion...
March 1, 2018: Journal of Arthroplasty
Jaiben George, Jared M Newman, Alison K Klika, Evan M Miller, Timothy L Tan, Javad Parvizi, Carlos A Higuera
BACKGROUND: Staphylococcus aureus is the predominant cause of periprosthetic joint infection (PJI) and can persist at the time of planned second stage of 2-stage revision arthroplasty, despite antibiotic cement spacer insertion and parenteral antibiotic therapy. Given the rapid emergence of antibiotic resistance, it is important to determine whether the antibiotic susceptibility of microorganisms changes between the stages of a 2-stage revision. METHODS: A total of 1614 2-stage revision hip/knee arthroplasties performed for PJI at 2 academic institutions from 2000 to 2015 were identified...
March 1, 2018: Journal of Arthroplasty
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