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Arthroplasty irrigation

Michael A Flierl, Brian M Culp, Kamil T Okroj, Bryan D Springer, Brett R Levine, Craig J Della Valle
BACKGROUND: One proposed strategy to increase the success of irrigation and debridement with implant retention for the treatment of acute periprosthetic joint infection (PJI) is the use of dissolvable antibiotic-impregnated calcium sulfate beads to provide a local depot of antibiotics. The purpose of this study was to evaluate the outcome of such an approach. METHODS: Thirty-two patients with acute hematogenous (18 patients; 1 bilateral) or acute postoperative (14 patients) PJIs who underwent irrigation and debridement with implant retention and addition of antibiotic-impregnated calcium sulfate beads were retrospectively reviewed...
March 29, 2017: Journal of Arthroplasty
Scott R Nodzo, Keely K Boyle, Allina A Nocon, Michael W Henry, David J Mayman, Geoffrey H Westrich
BACKGROUND: Previous work has suggested a failed irrigation and debridement (I&D) before a 2-stage exchange negatively impacts the outcome of the subsequent 2-stage revision. METHODS: This was a retrospective review of 132 patients who underwent a 2-stage exchange without prior I&D (2-Stage), and 45 patients had a failed I&D before their 2-stage exchange (I&D+2Stage) between April 2009 and April 2015. Charts were reviewed for patient demographics, presenting inflammatory laboratory values, type of antibiotic spacer used, surgical details, microbiology data, length of postoperative antibiotic treatment, and reoperation...
March 22, 2017: Journal of Arthroplasty
Wael A Rahman, Hussain A Kazi, Jeffery D Gollish
AIM: To investigate success of one stage exchange with retention of fixed acetabular cup. METHODS: Fifteen patients treated by single stage acetabular component exchange with retention of well-fixed femoral component in infected total hip arthroplasty (THA) were retrospectively reviewed. Inclusion criteria were patients with painful chronic infected total hip. The patient had radiologically well fixed femoral components, absence of major soft tissue or bone defect compromising, and infecting organism was not poly or virulent micro-organism...
March 18, 2017: World Journal of Orthopedics
Rafael Franco-Cendejas, Claudia A Colín-Castro, Melissa Hernández-Durán, Luis E López-Jácome, Silvestre Ortega-Peña, Guillermo Cerón-González, Samuel Vanegas-Rodríguez, Jaime A Mondragón-Eguiluz, Eduardo Acosta-Rodríguez
BACKGROUND: Periprosthetic joint infections are mainly caused by Gram-positive cocci. Leuconostoc mesenteroides is a rare microorganism mainly causing bloodstream infections. At times, it might be confused with another type of cocci and give rise to misdiagnosed infections. Molecular diagnosis and biofilm production comprise important techniques to guide antibiotic treatment. CASE PRESENTATION: A 68-year-old Hispanic female with a previous history of bilateral knee arthroplasty presented with acute right-knee inflammation and gait impairment...
March 23, 2017: BMC Infectious Diseases
Jatin Prakash, Jong-Keun Seon, Yong Jin Park, Cheng Jin, Eun-Kyoo Song
BACKGROUND: The efficacy of tranexamic acid to decrease post-operative blood loss and blood transfusion is well established in literature. However, the ideal mode of administration is debatable. Limited literature has compared all the available modes of administration including intravenous (IV), topical irrigation and retrograde through drain. We hypothesized that no difference would be present in either form of administration of tranexamic acid. METHODS: Fifty patients in four groups were enrolled for study...
January 2017: Journal of Orthopaedic Surgery
James M Hartford, Michael J Bellino
BACKGROUND: Concerns arise over the early complications encountered during the learning curve for the direct anterior approach for total hip arthroplasty. PURPOSE: The purpose of this study is to examine the learning experience of a single surgeon in adapting this approach. METHODS: The 1st 500 primary total hip arthroplasties are reviewed. The patients were evaluated out to 3 months. Rates of major complications, reoperations, periprosthetic fractures, heterotopic ossification, leg length discrepancies and lateral femoral cutaneous nerve deficits were identified for each of 100 patients...
February 17, 2017: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Luca Daniele, Michael Le, Adam Franklin Parr, Lochlin Mark Brown
Scedosporium prolificans, also known as Scedosporium inflatum, is a fungus widespread in soil, sewage, and manure. This species is highly virulent and is an emerging opportunistic pathogen found in penetrating injuries in immunocompromised patients. Here we report on an immunocompetent patient with bilateral hip S. prolificans-associated osteomyelitis and septic arthritis caused by intentional penetrating trauma. The condition was refractory to initial antimicrobial suppression and surgical irrigation and debridement...
2017: Case Reports in Orthopedics
Rui He, Liu Yang, Lin Guo, Hao Chen, Ying Zhang, Dian-Ming Jiang
OBJECTIVE: Acute hematogenous infection is a devastating complication that can occur after total knee arthroplasty (TKA). The best strategies for management of this infection remain controversial. Two-stage revision has been well described as the gold standard for the management of chronic late infections. However, there is a paucity of information presently available on the management and outcomes of patients treated for acute hematogenous infections. The purpose of the present study was to report the outcome of acute hematogenous infections following TKA with the treatment of irrigation, debridement, and retention of the prosthetic components...
November 2016: Orthopaedic Surgery
Mitchell R Klement, Colin T Penrose, Abiram Bala, Cynthia L Green, Richard C Mather, Samuel S Wellman, Michael P Bolognesi, Thorsten M Seyler
PURPOSE: Solid organ transplants (SOT) continue to increase with recipients living longer than ever before. The lifelong immunosuppression in these patients also may place them at increased risk for postoperative complications. The efficacy of total hip arthroplasty (THA) in this patient population is undisputed but previous studies investigating the complication profiles in these patients often are underpowered to identify rare complications as well as make comparisons between individual organs...
December 24, 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
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
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...
April 2017: Journal of Arthroplasty
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
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
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...
January 2017: Journal of Shoulder and Elbow Surgery
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
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...
April 2017: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
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)
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
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
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
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