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PJI prevention

Brian L Dial, Alexander J Lampley, Cynthia L Green, Rhett Hallows
Purpose: Total hip arthroplasty (THA) is a successful surgery for the treatment of hip osteoarthritis; however, the risk of a post-operative prosthetic joint infection (PJI) remains at 1% to 2%. The purpose of this study was to investigate the safety profile of using vancomycin powder (VP) to reduce infection rates by reviewing acute postoperative complications. Materials and Methods: A retrospective review of 265 consecutive patients undergoing THA was performed...
March 2018: Hip & Pelvis
Valérie A Zeller, Valérie-Anne Letembet, Vanina A Meyssonnier, Beate Heym, Jean-Marc Ziza, Simon D Marmor
BACKGROUND: Cutibacterium spp. (formerly Propionibacterium) are slow-growing cutaneous anaerobic commensals, rarely reported in prosthetic joint infections (PJIs). We describe epidemiological, clinical, biological, and radiological characteristics of 15 Cutibacterium avidum PJIs, their treatments, and outcomes. METHODS: This study is an observational, monocenter study (January 2004 to April 2017), with comparison of C avidum vs Cutibacterium acnes (n = 40) PJI characteristics...
February 12, 2018: Journal of Arthroplasty
Michael Müller, Andrej Trampuz, Tobias Winkler, Carsten Perka
INTRODUCTION: Periprosthetic infection (PJI) is one of the most severe complications in joint arthroplasty. Correct diagnosis and adequate therapy represent an enormous interdisciplinary challenge. The necessary interdisciplinarity and complexity of treatment require therapy in centres. However, the high costs have not yet been analysed or discussed and are problematic. The aim of this work is therefore to compare the costs within a year of treatment in a department specialised in the treatment of periprosthetic infections...
February 7, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Dirk Zajonz, Alexander Brand, Christian Lycke, Orkun Özkurtul, Jan Theopold, Ulrich J A Spiegl, Andreas Roth, Christoph Josten, Johannes K M Fakler
PURPOSE: Periprosthetic joint infections (PJI) after hemiarthroplasty for geriatric femoral neck fractures are a devastating complication that results in serious morbidity and increased mortality. Identifying risk factors associated with early infection after HA for hip fractures may offer an opportunity to address and prevent this complication in many patients. The aim of this study was to evaluate preoperative risk factors for early PJI after HA in hip fracture patients. METHODS: From January 2010 to December 2015, 312 femoral neck fractures (AO/OTA 31-B) in 305 patients were included in this single-center, retrospective study...
January 16, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
S J Song, J K Bae, C H Park, M C Yoo, D K Bae, K I Kim
INTRODUCTION: Although total knee arthroplasty (TKA) in haemophilic arthropathy can reduce severe joint pain and improve functional disability, it is technically demanding. AIM: To evaluate mid-term outcomes and complications of TKA in haemophilic arthropathy. METHODS: This study retrospectively reviewed 131 consecutive primary TKAs in a single institute. The mean age was 41.0 years old, and the mean follow-up period was 6.8 years. Clinical and radiographic results were evaluated...
November 29, 2017: Haemophilia: the Official Journal of the World Federation of Hemophilia
Aldo M Riesgo, Brian K Park, Christina P Herrero, Stephen Yu, Ran Schwarzkopf, Richard Iorio
BACKGROUND: Irrigation and debridement with modular component and liner exchange (IDLE) is a low morbidity procedure for treatment of periprosthetic joint infection (PJI) with reported failure rates exceeding 50%. Dilute povidone-iodine lavage has been shown to be safe and effective in decreasing acute PJI in primary total joint arthroplasty. Vancomycin powder has also shown to be effective in preventing infection in spine surgery. We hypothesize that a vancomycin povidone-iodine protocol (VIP) used in conjunction with IDLE can increase infection-free survivorship after acute PJI...
March 2018: Journal of Arthroplasty
Cortney E Heim, Debbie Vidlak, Jessica Odvody, Curtis W Hartman, Kevin L Garvin, Tammy Kielian
Prosthetic joint infection (PJI) is a devastating complication of joint arthroplasty surgery typified by biofilm formation. Currently, mechanisms whereby biofilms persist and evade immune-mediated clearance in immune competent patients remain largely ill-defined. Therefore, the current study characterized leukocyte infiltrates and inflammatory mediator expression in tissues from patients with PJI compared to aseptic loosening. CD33+ HLA-DR- CD66b+ CD14-/low granulocytic myeloid-derived suppressor cells (G-MDSCs) were the predominant leukocyte population at sites of human PJI compared to aseptic tissues...
November 15, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Rajeshwari Nair, Marin L Schweizer, Namrata Singh
Older adults are at increased risk for septic arthritis and prosthetic joint infections (PJI), owing at least in part to comorbid conditions and frailty. An increasing number of older adults undergo total joint arthroplasty to improve their quality of life. Infections in older adults differ from younger populations by the causative organisms, a great proportion of which are Staphylococcal infections. Targeting important modifiable and nonmodifiable risk factors may prevent or reduce the burden of joint infections in older adults...
December 2017: Infectious Disease Clinics of North America
Perez Agaba, Beau J Kildow, Herman Dhotar, Thorsten M Seyler, Michael Bolognesi
Optimal prophylaxis for prevention of venous thromboembolism (VTE) after total joint arthroplasty (TJA) remains debated. The purpose of this study was to compare postoperative complications in patients receiving different VTE chemoprophylactic regimens. Using a nationwide healthcare database, 72,670 THA patients without a history of VTE were identified. Study cohorts received VTE prophylaxis within 30 days postoperatively. Odds ratios and 95% confidence intervals were used to assess 30-day and 90-day postoperative complications (hematoma, hemorrhage, transfusion, pulmonary embolism (PE), VTE, prosthetic joint infection (PJI), and incision/drainage (I&D))...
December 2017: Journal of Orthopaedics
Matthew P Siljander, Ali H Sobh, Kevin C Baker, Erin A Baker, Lige M Kaplan
BACKGROUND: Periprosthetic joint infection (PJI) is a rare yet challenging problem in total hip and knee arthroplasties. The management of PJI remains difficult primarily due to the evolution of resistance by the infecting organisms. METHODS: This review profiles acquired mechanisms of bacterial resistance and summarizes established and emerging techniques in PJI diagnosis, prevention, and treatment. RESULTS: New techniques in PJI diagnosis and prevention continue to be explored...
January 2018: Journal of Arthroplasty
Dirk Zajonz, Undine Birke, Mohamed Ghanem, Torsten Prietzel, Christoph Josten, Andreas Roth, Johannes K M Fakler
BACKGROUND: Hip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of aseptic implants as an infection prophylaxis is already proven; however, the significance of these coatings in septic reimplantation of large implants is still not sufficiently investigated...
September 2, 2017: BMC Musculoskeletal Disorders
Hong-Kwon Yoon, Seong-Hee Cho, Dong-Yeong Lee, Byeong-Hun Kang, Sang-Hyuk Lee, Dong-Gyu Moon, Dong-Hee Kim, Dae-Cheol Nam, Sun-Chul Hwang
Purpose: The prevalence of periprosthetic joint infection (PJI) has increased with the increasing incidence of arthroplasty surgery. Considering identification of causative microorganisms is crucial for treatment of PJI, culture-negative (CN) PJI is a significant clinical issue. The purpose of the present study is to describe epidemiology, diagnosis and treatment of CN PJI based on review of the literature to help prevent delayed diagnosis and improve clinical outcomes of CN PJI. Methods: MEDLINE, EMBASE, Cochrane Library and Scopus databases were searched for articles on CN PJI...
September 1, 2017: Knee Surgery & related Research
John-Jairo Aguilera-Correa, Ana Conde, Maria-Angeles Arenas, Juan-Jose de-Damborenea, Miguel Marin, Antonio L Doadrio, Jaime Esteban
The Ti-6Al-4V alloy is one of the most commonly used in orthopedic surgery. Despite its advantages, there is an increasing need to use new titanium alloys with no toxic elements and improved biomechanical properties, such as Ti-13Nb-13Zr. Prosthetic joint infections (PJI) are mainly caused by Gram-positive bacteria; however, Gram-negative bacteria are a growing problem due to associated multidrug resistance. In this study, the bacterial adherence and viability on the Ti-13Nb-13Zr alloy have been compared to that of the Ti-6Al-4V alloy using 16 collection and clinical strains of bacterial species related to PJI: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa...
August 11, 2017: Biomedical Materials
M Honkanen, E Jämsen, M Karppelin, R Huttunen, H Huhtala, A Eskelinen, J Syrjänen
OBJECTIVES: Patients who undergo elective joint replacement are traditionally screened and treated for preoperative bacteriuria to prevent periprosthetic joint infection (PJI). More recently, this practice has been questioned. The purpose of this study was to determine whether preoperative bacteriuria is associated with an increased risk of PJI. METHODS: Patients who had undergone a primary hip or knee replacement in a tertiary care hospital between September 2002 and December 2013 were identified from the hospital database (23 171 joint replacements, 10 200 hips, and 12 971 knees)...
July 29, 2017: Clinical Microbiology and Infection
Ruba Khader, Joseph Tingey, Steven Sewall
PURPOSE: The orthopedic literature has shown an increasing incidence of prosthetic joint infections (PJIs) associated with Propionibacterium acnes (P acnes). These infections present serious diagnostic and management challenges to the treating surgeons. In this review, the authors report on cases of P acnes-related temporomandibular joint (TMJ) PJIs that have been diagnosed and treated at their institution. MATERIALS AND METHODS: After approval by the institutional review board, information was obtained through a retrospective chart review...
December 2017: Journal of Oral and Maxillofacial Surgery
Chuan Kong Koh, Irene Zeng, Saiprassad Ravi, Mark Zhu, Kelly G Vince, Simon W Young
BACKGROUND: Although large series from national joint registries may accurately reflect indications for revision TKAs, they may lack the granularity to detect the true incidence and relative importance of such indications, especially periprosthetic joint infections (PJI). QUESTIONS/PURPOSES: Using a combination of individual chart review supplemented with New Zealand Joint Registry data, we asked: (1) What is the cumulative incidence of revision TKA? (2) What are the common indications for revising a contemporary primary TKA? (3) Do revision TKA indications differ at various followup times after primary TKA? METHODS: We identified 11,134 primary TKAs performed between 2000 and 2015 in three tertiary referral hospitals...
September 2017: Clinical Orthopaedics and related Research
Pablo Sanz-Ruiz, Esther Carbó-Laso, Juan Carlos Del Real-Romero, Francisca Arán-Ais, Yolanda Ballesteros-Iglesias, Eva Paz-Jiménez, Magdalena Sánchez-Navarro, María Ángeles Pérez-Limiñana, Javier Vaquero-Martín
Two-stage exchange with antibiotic-loaded bone cement spacers remains the gold standard for chronic periprosthetic joint infection (PJI). Rifampicin is highly efficient on stationary-phase staphylococci in biofilm; however, its addition to PMMA to manufacture spacers prevents polymerization and reduces mechanical properties. Isolation of rifampicin during polymerization by microencapsulation could allow manufacturing rifampicin-loaded bone cement maintaining elution and mechanical properties. Microcapsules of rifampicin with alginate, polyhydroxybutyratehydroxyvalerate (PHBV), ethylcellulose and stearic acid (SA) were synthesized...
May 23, 2017: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Jaiben George, Alison K Klika, Carlos A Higuera
Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue...
2017: Journal of Bone and Joint Infection
Nicola Ratto, Chiara Arrigoni, Federica Rosso, Matteo Bruzzone, Federico Dettoni, Davide Edoardo Bonasia, Roberto Rossi
Total joint arthroplasty (TJA) is one of the most common orthopaedic procedures. Nevertheless, several complications can lead to implant failure.Peri-prosthetic joint infections (PJI) certainly represent a significant challenge in TJA, constituting a major cause of prosthetic revision. The surgeon may have an important role in reducing the PJI rate by limiting the impact of significant risk factors associated to either the patient, the operative environment or the post-operative care.In the pre-operative period, several preventive measures may be adopted to manage reversible medical comorbidities...
September 2016: EFORT open reviews
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