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Arthroplasty irrigation

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https://www.readbyqxmd.com/read/27911455/functional-outcomes-of-infected-hip-arthroplasty-a-comparison-of-different-surgical-treatment-options
#1
Benjamin V Herman, Mark Nyland, Lyndsay Somerville, Steven J MacDonald, Brent A Lanting, James L Howard
BACKGROUND: Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) can be treated with irrigation and debridement with head and polyethylene exchange (IDHPE) or 2-stage revision (2SR). Few studies have compared patient-reported outcome measures (PROMs) in patients managed with these treatments. METHODS: A retrospective review identified 137 patients who had an infected primary THA between 1986-2013. Control cohorts were matched according to age and Charlton Comorbidity Index (CCI)...
November 28, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/27876465/is-there-still-a-role-for-irrigation-and-debridement-with-liner-exchange-in-acute-periprosthetic-total-knee-infection
#2
Andrés F Duque, Zachary D Post, Rex W Lutz, Fabio R Orozco, Sergio H Pulido, Alvin C Ong
BACKGROUND: Periprosthetic joint infection (PJI) is an important cause of failure in total knee arthroplasty. Irrigation and debridement including liner exchange (I&D/L) success rates have varied for acute PJI. The purpose of this study is to present results of a specific protocol for I&D/L with retention of total knee arthroplasty components. METHODS: Sixty-seven consecutive I&D/L patients were retrospectively evaluated. Inclusion criteria for I&D/L were as follows: fewer than 3 weeks of symptoms, no immunologic compromise, intact soft tissue sleeve, and well-fixed components...
November 1, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27789094/periprosthetic-joint-infections-caused-by-enterococci-have-poor-outcomes
#3
Michael M Kheir, Timothy L Tan, Carlos Higuera, Jaiben George, Craig J Della Valle, Mary Shen, Javad Parvizi
BACKGROUND: The definitive treatment and outcome of periprosthetic joint infection (PJI) caused by Enterococcus species is unknown. We performed a multi-institutional study to analyze the characteristics and treatment outcomes of patients with enterococcal PJI and to define an effective treatment protocol. METHODS: We retrospectively reviewed all PJIs at 3 institutions between 1999 and 2014 using an electronic query followed by manual chart review. We included patients who met the Musculoskeletal Infection Society's criteria for PJI and had at least 1 positive intraoperative culture for any Enterococcus species...
September 28, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/27672567/implant-retention-after-acute-and-hematogenous-periprosthetic-hip-and-knee-infections-whom-when-and-how
#4
REVIEW
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
https://www.readbyqxmd.com/read/27514636/management-of-acute-or-late-hematogenous-infection-after-shoulder-arthroplasty-with-irrigation-d%C3%A3-bridement-and-component-retention
#5
Taylor Dennison, Eduard Alentorn-Geli, Andrew T Assenmacher, John W Sperling, Joaquín Sánchez-Sotelo, Robert H Cofield
BACKGROUND: Irrigation and débridement (I&D) with component retention is an appealing alternative to both patients and surgeons for the management of acute or late hematogenous deep periprosthetic shoulder infection (PSI). However, the success rate and results of I&D are poorly documented. This study reports the outcomes and complications of this treatment strategy for acute and delayed-onset acute hematogenous PSI. METHODS: Between 1980 and 2010, 10 shoulders (9 patients) underwent I&D with component retention for the management on an acute or delayed-onset acute hematogenous PSI at a single institution...
August 8, 2016: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/27365477/infection-in-total-elbow-arthroplasty-with-stable-components-outcomes-of-a-staged-surgical-protocol-with-retention-of-the-components
#6
P N Streubel, J P Simone, B F Morrey, J Sanchez-Sotelo, M E Morrey
AIMS: We describe the use of a protocol of irrigation and debridement (I&D) with retention of the implant for the treatment of periprosthetic infection of a total elbow arthroplasty (TEA). This may be an attractive alternative to staged re-implantation. PATIENTS AND METHODS: Between 1990 and 2010, 23 consecutive patients were treated in this way. Three were lost to follow-up leaving 20 patients (21 TEAs) in the study. There were six men and 14 women. Their mean age was 58 years (23 to 76)...
July 2016: Bone & Joint Journal
https://www.readbyqxmd.com/read/27346244/management-of-acute-periprosthetic-joint-infection-of-the-knee-algorithms-for-the-on-call-surgeon
#7
Robert Petretta, Jonathan Phillips, Andrew Toms
Periprosthetic joint infection (PJI) remains a serious complication following a total knee replacement. Infections rates following arthroplasty range from 0.5% to 3%. The acutely infected knee replacement often presents to the on call Orthopaedic Surgeon who can often lack the expertise or resources for the definitive management. However, obtaining an early and accurate diagnosis and potentially performing an early treatment such as irrigation and debridement may be required by the on call surgeon. Management of these patients should include a team of specialists including Medical or Intensive Care, and Infectious Disease...
June 23, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
https://www.readbyqxmd.com/read/27310945/effects-of-cold-irrigation-on-early-results-after-total-knee-arthroplasty-a-randomized-double-blind-controlled-study
#8
Zhirui Li, Daohong Liu, Jiyuan Dong, Long Gong, Yong Wang, Peifu Tang, Yan Zhang
Several studies have indicated that pain peaks at 24 to 48 hours after total knee arthroplasty (TKA) surgery. TKA has been associated with disruption in normal sleep patterns, swelling knee, and significant blood loss. However, a satisfactory regime to resolve these mentioned problems has yet to be found.In this study, a total of 420 patients were randomly allocated into two groups and treated with continuous irrigation of either 4000 mL cold saline with 0.5% epinephrine or normal temperature solution. Clinical outcomes including pain scores at rest during postoperative three days, drainage output, analgesic consumption, decreased hemoglobin, sleep quality, and satisfaction rate were analyzed...
June 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27282686/water-based-lubricant-as-an-adjunct-to-wound-toilet-validation-of-a-technique-by-experiment
#9
Haroon Rehman, Iain Rankin, Kim Ferguson, Bryn Jones, Mark Frame
INTRODUCTION: Metal debris can produce a foreign body inflammatory reaction or as third body wear in the situation of joint arthroplasty. We evaluate a simple method for reducing this debris using a sterile water-based lubricating gel. MATERIALS AND METHODS: Eight experimental surgical models consisting of porcine muscle overlying a polyethylene tube with a titanium locking plate and screws secured were constructed. Four models had water based lubricating gel applied to the wound edges, four were left without as controls...
August 2016: Injury
https://www.readbyqxmd.com/read/27132529/risk-assessment-and-usefulness-of-musculocutaneous-flap-transposition-for-recurrent-septic-arthritis-of-the-hip-in-adults
#10
Tadahiko Ohtsuru, Yasuaki Murata, Yuji Morita, Hiroyuki Sakurai, Yoshiharu Kato
PURPOSE: Septic arthritis of the hip joint in adults often progresses to recurrent infections that require repeated surgeries for treatment. The purpose of the present study was to assess the risk of a recalcitrant hip infection and the usefulness of musculocutaneous flap transposition. METHODS: 15 adult patients who underwent surgeries for the treatment of hip infections were retrospectively analysed. Patients who recovered from infection by undergoing arthroscopy, open irrigation, debridement, continuous irrigation, resection arthroplasty, and/or the placement of antibiotic-loaded acrylic cement were classified into Group A (n = 10)...
April 23, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
https://www.readbyqxmd.com/read/27098324/use-of-the-reamer-irrigator-aspirator-decreases-carotid-and-cranial-embolic-events-in-a-canine-model
#11
Anna N Miller, Dwight Deal, James Green, Timothy Houle, William Brown, Clara Thore, David Stump, Lawrence X Webb
BACKGROUND: Approximately 2 million patients in the United States annually undergo total joint arthroplasty with reaming and placement of intramedullary nails, resulting in extravasation of bone marrow and fat into the circulatory system and potentially causing fat embolism syndrome. Acute and chronic changes in mental status documented after these procedures may be related to embolic events. The Reamer/Irrigator/Aspirator (RIA) device has been shown to decrease intramedullary pressure during reaming...
April 20, 2016: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/27043727/higher-frequency-of-reoperation-with-a-new-bicruciate-retaining-total-knee-arthroplasty
#12
Jesse C Christensen, Justin Brothers, Gregory J Stoddard, Mike B Anderson, Christopher E Pelt, Jeremy M Gililland, Christopher L Peters
BACKGROUND: With as many as 25% of patients reporting residual knee symptoms after primary total knee arthroplasty (TKA), alternative implant designs and surgical techniques have been proposed to further reduce these symptoms. There is growing evidence that retention of the anterior cruciate ligament (ACL) results in more natural knee kinematics; thus, implants with more normal joint mechanics could provide improved physical function postoperatively and reduce the amount of residual symptoms...
April 4, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27011845/hip-arthroscopy-for-the-management-of-trauma-a-literature-review
#13
Justin T Newman, Adriana J Saroki, Marc J Philippon
The first descriptions of the use of hip arthroscopy for traumatic injuries were presented in 1980. One paper described arthroscopy for the removal of a bullet fragment while others reported using hip arthroscopy to remove fragments following total hip arthroplasty. With the application of traction and modification of arthroscopic instruments, hip arthroscopy has become a useful tool in treating trauma to the hip. Most of the literature describes traumatic hip dislocation. Several studies have documented the successful use of arthroscopy for removal of loose bodies, but it has also been used to treat labral tears, chondral defects and acetabular rim fractures...
October 2015: Journal of Hip Preservation Surgery
https://www.readbyqxmd.com/read/26894222/which-route-of-tranexamic-acid-administration-is-more-effective-to-reduce-blood-loss-following-total-knee-arthroplasty
#14
Sohrab Keyhani, Ali Akbar Esmailiejah, Mohammad Reza Abbasian, Farshad Safdari
BACKGROUND: The most appropriate route of tranexamic acid administration is controversial. In the current study, we compared the efficacy of intravenous (IV) and topical intra-articular tranexamic acid in reducing blood loss and transfusion rate in patients who underwent primary total knee arthroplasty. METHODS: One hundred twenty 120 patients were scheduled to undergo primary total knee arthroplasty. Patients were randomly allocated to three equal groups: IV tranexamic acid (500 mg), topical tranexamic acid (3 g in 100 mL normal saline) and the control...
January 2016: Archives of Bone and Joint Surgery
https://www.readbyqxmd.com/read/26831479/antibiotic-tolerant-staphylococcus-aureus-biofilm-persists-on-arthroplasty-materials
#15
Kenneth L Urish, Peter W DeMuth, Brian W Kwan, David W Craft, Dongzhu Ma, Hani Haider, Rocky S Tuan, Thomas K Wood, Charles M Davis
BACKGROUND: The continued presence of biofilm may be one cause of the high risk of failure observed with irrigation and débridement with component retention in acute periprosthetic joint infection (PJI). There is a poor understanding of the role of biofilm antibiotic tolerance in PJI. QUESTIONS/PURPOSES: (1) Do increasing doses of cefazolin result in decreased viable biofilm mass on arthroplasty materials? (2) Is cefazolin resistance phenotypic or genotypic? (3) Is biofilm viability a function of biofilm depth after treatment with cefazolin? (4) Is the toxin-antitoxin system, yoeB expression, associated with antibiotic stress? METHODS: Methicillin-sensitive Staphylococcus aureus biofilm was cultured on total knee arthroplasty (TKA) materials and exposed to increasing doses of cefazolin (control, 0...
July 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/26688182/diagnosis-and-management-of-knee-osteoarthritis-chinese-medicine-expert-consensus-2015
#16
Wei-heng Chen, Xian-xiang Liu, Pei-jian Tong, Hong-sheng Zhan
Literature review shows that Chinese medicine and other related treatment are still the main stream treatment of knee osteoarthritis. Currently, there is short of handbook guiding Chinese medicine from evidence-based medical evidence, so it is a top priority to develop a clinical guideline from the expert consensus. After several rounds of discussion during the conference and examination by letter, which has collected opinions from nearly one hundred experts, consensus was reached. Nonpharmacologic interventions include health education, medical exercise, acupuncture, massage, acupotomology, and physiotherapy...
February 2016: Chinese Journal of Integrative Medicine
https://www.readbyqxmd.com/read/26325147/two-stage-primary-total-knee-arthroplasty-with-well-designed-antibiotic-laden-cement-spacer-block-for-infected-osteoarthritic-knees-the-first-case-series-from-china
#17
Chen Yi, Zhou Yiqin, Zhou Qi, Zhao Hui, Ding Zheru, Fu Peiling, Wu Yuli, Wu Haishan
OBJECTIVE: We aimed to assess the efficacy of applying a two-stage primary total knee arthroplasty (TKA) with an antibiotic-laden cement spacer block to treat infected osteoarthritic knees. METHODS: This retrospective study included 17 cases of severely infected osteoarthritic knees treated with two-stage primary TKA. Open debridement and irrigation with insertion of a well-designed antibiotic cement spacer was performed as the first stage. Systemic antibiotics were used in the interval period...
December 2015: Surgical Infections
https://www.readbyqxmd.com/read/26272061/the-results-of-two-stage-revision-tka-using-ceftazidime-vancomycin-impregnated-cement-articulating-spacers-in-tsukayama-type-ii-periprosthetic-joint-infections
#18
Michael Drexler, Tim Dwyer, Paul R T Kuzyk, Yona Kosashvilli, Mansour Abolghasemian, Gilad J Regev, Assaf Kadar, Tal Frenkel Rutenberg, David Backstein
PURPOSE: This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). METHODS: A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39-87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin...
October 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/26264944/streptococcus-gordonii-prosthetic-joint-infection-in-the-setting-of-vigorous-dental-flossing
#19
Rick Klein, Ala S Dababneh, Bharath Raj Varatharaj Palraj
A 65-year-old woman with osteoarthritis, who underwent knee replacement 5 years prior, developed sudden onset knee pain and swelling. She had voluntarily starting a vigorous dental flossing regimen prior to the onset of symptoms. The patient underwent right knee arthrotomy, irrigation and debridement of right total knee arthroplasty and exchange of polyethylene with retention of the prosthesis. Intraoperative cultures grew Streptococcus gordonii. She was treated with 6 weeks of ceftriaxone and was later placed on oral antibiotic suppression...
2015: BMJ Case Reports
https://www.readbyqxmd.com/read/26253269/does-preoperative-antimicrobial-prophylaxis-influence-the-diagnostic-potential-of-periprosthetic-tissues-in-hip-or-knee-infections
#20
Klemen Bedenčič, Martina Kavčič, Nataša Faganeli, Rene Mihalič, Blaž Mavčič, Jožica Dolenc, Zlatka Bajc, Rihard Trebše
BACKGROUND: Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions. QUESTIONS/PURPOSES: We wished to determine whether administration of preoperative antibiotics decreases the likelihood of diagnosing PJI in patients undergoing revision hip or knee arthroplasty in whom infection is suspected...
January 2016: Clinical Orthopaedics and related Research
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