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Infection in orthopedics

Alexander P Decilveo, Bartlomiej W Szczech, Jacob Topfer, James C Wittig
Expandable endoprostheses have become an acceptable modality to address the issue of limb-length inequality in limb-sparing procedures for skeletally immature patients afflicted with lower extremity bone sarcomas. This study retrospectively analyzed postoperative outcomes and complications for 7 patients (8 limbs) who underwent minimally invasive or noninvasive reconstruction during a 12-year period. Musculoskeletal Tumor Society (MSTS) scores and complication rates were reported. Mean functional outcome (MSTS scores) at final follow-up was 93...
October 25, 2016: Orthopedics
Ryan A Durfee, Scott A Sabo, G Douglas Letson, Odion Binitie, David Cheong
Metastatic lesions of the acetabulum can be painful and debilitating. First-line treatment is multimodal and consists of disease-specific chemotherapy, osteoclastic inhibitors, analgesics, and radiation therapy. When these therapies fail, surgical intervention usually is indicated and varies from regional defect stabilization to large periacetabular reconstructions that are demanding procedures with high rates of complications. Percutaneous cement augmentation (acetabuloplasty) of lesions in selected patients has been explored as a less invasive method of lesional control...
October 25, 2016: Orthopedics
J Schmolders, S Koob, P Schepers, P H Pennekamp, S Gravius, D C Wirtz, R Placzek, A C Strauss
PURPOSE AND OBJECTIVE: Bone resection regarding adequate surgical margins is the treatment of choice for malignant bone tumors. In the case of metastasis-related complications, so-called skeletal-related events, it is highly important to achieve pain relief and a stable joint situation to re-mobilize the patients immediately following surgery. To bridge the often large osseous defect zones after tumor resection, both cemented and uncemented modular endoprosthetic systems are widely used...
October 25, 2016: Archives of Orthopaedic and Trauma Surgery
Rhodri L Williams, Wayne N Ayre, Wasim S Khan, Amisha Mehta, Rhidian Morgan-Jones
BACKGROUND: Thorough debridement is mandatory in revision for infected total knee arthroplasties (TKA). We investigated a novel adjuvant chemical debridement strategy using acetic acid (AA) that seeks to create a hostile environment for microorganisms. We report the first orthopedic in vivo series using an AA soak in infected TKAs. We also investigated the in vitro efficacy of AA against bacteria isolated from these knees. METHODS: Twenty-three patients with infected TKA were treated with a standard debridement protocol and chemical debridement with a 20-minute AA soak...
September 28, 2016: Journal of Arthroplasty
Hongyi Shao, Chi-Lung Chen, Mitchell G Maltenfort, Camilo Restrepo, Richard H Rothman, Antonia F Chen
BACKGROUND: Total hip arthroplasty (THA) is one of the most successful orthopedic surgeries performed in the last 50 years. However, controversies still exist between conducting 1- or 2-stage bilateral THA. METHODS: Using PubMed, Ovid, Embase, and Cochrane library databases, we searched for papers written between January 1995 and October 2015 that contained the following search terms: "one-stage or two-stage" or "simultaneous or staged," and "hip" and "arthroplasty or replacement...
September 28, 2016: Journal of Arthroplasty
Jessica C Rivera, Renee M Greer, Mary Ann Spott, Anthony E Johnson
BACKGROUND: The Military Orthopaedic Trauma Registry (MOTR) was designed to replicate the Department of Defense Trauma Registry's (DoDTR's) role as pillar for data-driven management of extremity war wounds. The MOTR continuously undergoes quality assurance checks to optimize the registry data for future quality improvement efforts. We conducted a quality assurance survey of MOTR entrants to determine if a simple MOTR data pull could provide robust orthopedic-specific information toward the question of causes for late amputation...
November 2016: Journal of Trauma and Acute Care Surgery
J J Wang, Y Y Xue, M Tang
With the rapid development of modern science and technology, the application of nanomaterial is ubiquitous in our daily life and medical field, in which the application related to nano-silver is more extensive. On one hand, it can make positive effects, such as anti-bacteria, anti-virus, anti-fungi, anti-parasitic infection and anti-tumor. In particular, its anti-bacterial activity in some acute or chronic treatment of infected wounds is more prominent. The application in diseases of gynecology, orthopedics, cardiovascular system, oral cavity, and ophthalmology is increasing...
October 20, 2016: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Jon Hedgecock, P Christopher Cook, John Harrast, Judith F Baumhauer, Brian D Giordano
Hip preservation surgery encompasses various surgical procedures that have the goal of decreasing the progression of osteoarthritis, preserving normal hip function, and delaying the need for arthroplasty. These procedures can encompass arthroscopic, open, and combined techniques. This study investigated the trends and complications associated with open hip preservation surgery performed by candidates undergoing Part II of the American Board of Orthopaedic Surgery examination. The American Board of Orthopaedic Surgery Part II surgeon case database was queried from the years 2003 to 2013 for Current Procedural Terminology (CPT) codes related to open hip preservation surgery in patients 10 years and older...
October 18, 2016: Orthopedics
Carolyn R Schaeffer, Tra-My N Hoang, Craig M Sudbeck, Malik Alawi, Isaiah E Tolo, D Ashley Robinson, Alexander R Horswill, Holger Rohde, Paul D Fey
Staphylococcus epidermidis is a leading cause of hospital-associated infections, including those of intravascular catheters, cerebrospinal fluid shunts, and orthopedic implants. Multiple biofilm matrix molecules with heterogeneous characteristics have been identified, including proteinaceous, polysaccharide, and nucleic acid factors. Two of the best-studied components in S. epidermidis include accumulation-associated protein (Aap) and polysaccharide intercellular adhesin (PIA), produced by the enzymatic products of the icaADBC operon...
September 2016: MSphere
Sara C Keller, Sara E Cosgrove, Yvonne Higgins, Damani A Piggott, Greg Osgood, Paul G Auwaerter
Background.  The use of suppressive antibiotics in treatment of orthopedic hardware infections (OHIs), including spinal hardware infections, prosthetic joint infections, and infections of internal fixation devices, is controversial. Methods.  Over a 4-year period at 2 academic medical centers, patients with OHI who were treated with debridement and retention of hardware components, with single-stage exchange, or without surgery were studied to determine whether use of oral antibiotics for at least 6 months after diagnosis impacts successful treatment of the infection at 1 year after diagnosis...
October 2016: Open Forum Infectious Diseases
Daniel Pérez-Prieto, María E Portillo, Lluís Puig-Verdié, Albert Alier, Carlo Gamba, Pau Guirro, Santos Martínez-Díaz, Juan P Horcajada, Andrej Trampuz, Joan C Monllau
BACKGROUND: Culture negative prosthetic joint infections (PJI) still remain an issue even with the advantages of the new diagnostic tools for PJI. This is why some orthopedic surgeons have reservations relative to the use of preoperative antibiotic prophylaxis when a PJI is suspected. The purpose of the present study was to evaluate the influence of preoperative antibiotic prophylaxis on intraoperative cultures. MATERIAL AND METHODS: An enhanced diagnostic protocol for PJI (Zimmerli criteria) was used for the inclusion criteria in order to collect all PJI that were seen in a university hospital...
September 23, 2016: Diagnostic Microbiology and Infectious Disease
A Deny, C Loiez, V Deken, S Putman, A Duhamel, J Girard, G Pasquier, C Chantelot, E Senneville, H Migaud
: Factors that predict the occurrence of a surgical site infection due to methicillin-resistant Staphylococcus aureus (MRSA) are not well known; however this information could be used to modify the recommended antimicrobial prophylaxis. We carried out a retrospective study of S. aureus infections on orthopedic implants to determine: (1) whether epidemiological factors can be identified that predict a MRSA infection, (2) the impact of these factors as evidenced by the odds ratio (OR). HYPOTHESIS: Risk factors for a MRSA infection can be identified from a cohort of patients with S...
October 12, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
A Schnabel, U Range, G Hahn, T Siepmann, R Berner, C M Hedrich
Historically, osteomyelitis was considered an infectious disorder. More recently, inflammatory mechanisms were recognized causing a significant proportion of pediatric osteomyelitis. This study was to compare characteristics of children with chronic non-bacterial (CNO) and bacterial osteomyelitis (BOM). A chart review of osteomyelitis patients from the departments of pediatrics, pediatric surgery, orthopedic surgery, and oral and maxillofacial surgery was conducted in a tertiary referral center, covering the years 2004-2014...
October 11, 2016: Rheumatology International
B Fink, R Lass
Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1...
October 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Arianna Barbara Lovati, Marta Bottagisio, Elena de Vecchi, Enrico Gallazzi, Lorenzo Drago
The demand for joint replacement and surgical treatment is continuously increasing, thus representing a clinical burden and a cost for the healthcare system. Among several pathogens involved in implant-related infections, staphylococci account for the two-thirds of clinically isolated bacteria. Despite most of them are highly virulent microorganisms (Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa), low virulent bacteria (Staphylococcus epidermidis, Propionibacterium acnes) are responsible for delayed, low-grade infections without specific clinical signs and hardly distinguishable from aseptic prosthetic failure...
October 9, 2016: Advances in Experimental Medicine and Biology
Zhaojun Jia, Peng Xiu, Pan Xiong, Wenhao Zhou, Yan Cheng, Shicheng Wei, Yufeng Zheng, Tingfei Xi, Hong Cai, Zhongjun Liu, Cai-Mei Wang, Wei-Ping Zhang, Zhi-Jiang Li
Restoring large-scale bone defects, where osteogenesis is slow while infections lurk, with biomaterials represents a formidable challenge in orthopedic clinics. Here, we propose a scaffold-based multipurpose anti-infection and bone repairing strategy to meet such restorative needs. To do this, personalized multifunctional titanium meshes were produced through an advanced additive manufacturing process and dual "TiO2‒poly(dopamine)/Ag (nano)" post modifications, yielding macroporous constructs with micro/nanoporous walls and nanosilver bullets immobilized/embedded therein...
October 5, 2016: ACS Applied Materials & Interfaces
Louise Kruse Jensen, Janne Koch, Bent Aalbaek, Arshnee Moodley, Thomas Bjarnsholt, Kasper Nørskov Kragh, Andreas Petersen, Henrik Elvang Jensen
Implant-associated osteomyelitis (IAO) is a common complication in orthopedic surgery. The aim of this study was to elucidate how deep IAO can go into the peri-implanted bone tissue within a week. The study was performed in a porcine model of IAO. A small steel implant and either 10(4) CFU/kg body weight of Staphylococcus aureus or saline was inserted into the right tibial bone of 12 pigs. The animals were consecutively killed on day 2, 4 and 6 following implantation. Bone tissue around the implant was histologically evaluated...
October 5, 2016: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
Martin Salgado, Felipe Fernández, Carolina Avilés, Cecilia Cordova
INTRODUCTION: The presence of postoperative seromadesis is common, corresponding to the presence of serum in the subcutaneous tissue post a surgical event. Erythromycin has been reported as sclerosing, although not in orthopedic surgery. We report a case of erythromycin seromadesis in orthopedic surgery. CASE PRESENTATION: We present a case of a 63-year-old woman having undergone femoral prosthesis surgery and total hip replacement with a subfacial seroma without findings of infection, refractory to standard treatment of compression bandages, massage and cleaning surgery in two oportunities...
April 2016: Journal of Orthopaedic Case Reports
Ali Yeganeh, Mani Mahmodi, Hosein Farahini, Mehdi Moghtadaei
INTRODUCTION: Severe defects in long bones can be caused by several factors such as trauma that lead to open wound and secondary infections after surgery. Induced membrane technique is one of the therapeutic strategies that can be used for these patients. Due to importance of this method and lack of information about this technique in Iran. AIM: this study was performed to investigate technical strengths and weakness of induced membrane technique. MATERIAL AND METHODS: This case series study conducted on 21 patients with bone defects in the femur and tibia and metatarsal bones referred to orthopedic clinic of Rasoul Akram Hospital, Tehran, Iran, for induced membrane surgery in 2012-2015...
July 27, 2016: Medical Archives
Jai Gon Seo, Sang Min Kim, Jung Min Shin, Youngjun Kim, Byung Hoon Lee
INTRODUCTION: Simultaneous bilateral total knee arthroplasty (TKA) has been associated with a high risk of morbidity and mortality. The orthopedic surgeon must, therefore, decide whether bilateral simultaneous TKA is a safe operation to perform and endeavor to decrease the risk of serious complications or even death. METHODS: This retrospective review included 2098 consecutive patients who underwent bilateral simultaneous TKAs by the protocol used in our institution, including the use of extramedullary instruments to minimize medullary canal invasion and overlapping procedures for both knees to decrease operation time...
November 2016: Archives of Orthopaedic and Trauma Surgery
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