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parvizi periprosthetic infection

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
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
Kamil T Okroj, Tyler E Calkins, Erdan Kayupov, Michael M Kheir, Joshua S Bingham, Christopher P Beauchamp, Javad Parvizi, Craig J Della Valle
BACKGROUND: In patients with adverse local tissue reaction (ALTR) secondary to a failed metal-on-metal (MoM) bearing or corrosion at the head-neck junction in a metal-on-polyethylene bearing, ruling in or out periprosthetic joint infection (PJI) can be challenging. Alpha-defensin has emerged as an accurate test for PJI. The purpose of this multicenter, retrospective study was to evaluate the accuracy of the alpha-defensin synovial fluid test in detecting PJI in patients with ALTR. METHODS: We reviewed medical records of 26 patients from 3 centers with ALTR that had an alpha-defensin test performed...
January 16, 2018: Journal of Arthroplasty
Yong Seuk Lee, Young-Kyun Lee, Seung Bum Han, Chang Hyun Nam, Javad Parvizi, Kyung-Hoi Koo
BACKGROUND: Early detection followed by prompt intervention is essential for the treatment of periprosthetic joint infection (PJI). D-dimer, a fibrin degradation product, characteristically changes rapidly during early postoperative period and has a short half-life. The aim of this prospective study was to measure postoperative change of D-dimer level after joint arthroplasty in conjunction with ESR and CRP. METHODS: ESR, CRP, and D-dimer levels were measured on the day before surgery, postoperative days 1, 2, 3, and 5 and weeks 2 and 6 in 65 patients who underwent elective primary total hip arthroplasty (38 hips in 38 patients) or total knee arthroplasty (27 knees in 27 patients)...
February 13, 2018: Journal of Orthopaedic Surgery and Research
M Tarabichi, N Shohat, K Goswami, J Parvizi
AIMS: The diagnosis of periprosthetic joint infection can be difficult due to the high rate of culture-negative infections. The aim of this study was to assess the use of next-generation sequencing for detecting organisms in synovial fluid. MATERIALS AND METHODS: In this prospective, single-blinded study, 86 anonymized samples of synovial fluid were obtained from patients undergoing aspiration of the hip or knee as part of the investigation of a periprosthetic infection...
February 2018: Bone & Joint Journal
Michael M Kheir, Alexander J Rondon, Alexandra Woolsey, Heather Hansen, Timothy L Tan, Javad Parvizi
BACKGROUND: A prior survey of members of the American Association of Hip and Knee Surgeons revealed that 78% of responding surgeons were named as a defendant in at least 1 lawsuit, and 69% of these lawsuits were dismissed or settled out of court. The most common sources of litigation were nerve injury, limb-length discrepancy, and infection. This study examined common reasons for lawsuits after total joint arthroplasty (TJA) in a single metropolitan area. METHODS: A retrospective review of lawsuits filed between 2009 and 2015 in a 5-county metropolitan area was performed, including 30 hospitals and 113 TJA surgeons...
December 14, 2017: Journal of Arthroplasty
Majd Tarabichi, Noam Shohat, Karan Goswami, Abtin Alvand, Randi Silibovsky, Katherine Belden, Javad Parvizi
BACKGROUND: Next-generation sequencing is a well-established technique for sequencing of DNA and has recently gained attention in many fields of medicine. Our aim was to evaluate the accuracy of next-generation sequencing in identifying the causative organism(s) in patients with periprosthetic joint infection. METHODS: In this prospective study, samples were collected from 65 revision arthroplasties (39 knees and 26 hips) and 17 primary arthroplasties (9 hips and 8 knees)...
January 17, 2018: Journal of Bone and Joint Surgery. American Volume
Mehrnoush H Yeganeh, Michael M Kheir, Alisina Shahi, Javad Parvizi
The incidence of periprosthetic joint infection (PJI) among patients with rheumatoid arthritis (RA) is 1.6× greater than in patients undergoing the same procedure for osteoarthritis. This higher risk "may" be due to the immunosuppressive therapies for RA patients including corticosteroids, such as prednisone, and disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. There is a debate about the role of DMARDs in increasing the incidence of subsequent PJI. Studies show conflicting results, with some demonstrating no significant increase in the rates of PJI and some finding otherwise...
November 23, 2017: Journal of Arthroplasty
Mitchell R Klement, Ahmed Siddiqi, Justin M Rock, Thorsten M Seyler, Javad Parvizi, Antonia F Chen
BACKGROUND: The diagnosis of periprosthetic joint infection (PJI) can be made when 1 major criterion or 3 of 5 minor criteria are present. However, the outcomes of patients with a major vs minor criteria for diagnosis have not been studied. The objective of this study was to evaluate if a difference in outcome of surgical intervention existed between patients with PJI who were diagnosed with a major criterion or a combination of minor criteria. METHODS: A retrospective chart review identified 277 primary total hip or knee arthroplasty patients who had developed PJI based on the International Consensus Meeting definition...
December 14, 2017: Journal of Arthroplasty
Maryam Rezapoor, Abtin Alvand, Elzbieta Jacek, Taylor Paziuk, Mitchell G Maltenfort, Javad Parvizi
BACKGROUND: Strategies to prevent bacterial fallout and reduce particle count in the operating room (OR) are key components of preventing periprosthetic joint infection. Although OR traffic control is an important factor, a quantitative study has not been performed to investigate the influence of personnel and door opening on OR air quality. This simulated study aimed to examine the influence of these 2 factors on particle density in OR with and without the laminar air flow (LAF). METHODS: Both experiments took place within an empty OR of an arthroplasty unit equipped with an LAF system...
March 2018: Journal of Arthroplasty
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J Appl Biomater Funct Mater. 2014; 12(1):13-20 What role do periodontal pathogens play in osteoarthritis and periprosthetic joint infections of the knee? Ehrlich GD, Hu FZ, Sotereanos N, Sewicke J, Parvizi J, Nara PL, Arciola CR PMID: 24921460 DOI: 10.5301/jabfm.5000203 Accepted on 09/11/2013 Available online on 02/06/2014 Published online on 12/06/2014 The above article appeared in J Appl Biomater Funct Mater 2014;12(1):13-20. The studies under the clinical trial set forth in the article were performed with a large group of co-investigators...
October 18, 2017: Journal of Applied Biomaterials & Functional Materials
Alisina Shahi, Michael M Kheir, Majd Tarabichi, Hamid R S Hosseinzadeh, Timothy L Tan, Javad Parvizi
BACKGROUND: Despite the availability of a battery of tests, the diagnosis of periprosthetic joint infection (PJI) continues to be challenging. Serum D-dimer assessment is a widely available test that detects fibrinolytic activities that occur during infection. We hypothesized that patients with PJI may have a high level of circulating D-dimer and that the presence of a high level of serum D-dimer may be a sign of persistent infection in patients awaiting reimplantation. METHODS: This prospective study was initiated to enroll patients undergoing primary and revision arthroplasty...
September 6, 2017: Journal of Bone and Joint Surgery. American Volume
Javad Parvizi, Sue Barnes, Noam Shohat, Charles E Edmiston
In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI...
August 14, 2017: American Journal of Infection Control
Alisina Shahi, Timothy L Tan, Michael M Kheir, Dean D Tan, Javad Parvizi
BACKGROUND: Diagnosis of periprosthetic joint infection (PJI) remains a challenge despite a wide variety of available diagnostic tests. The question that arises is which of these tests has a better performance for diagnosing PJI. Diagnostic odds ratio (DOR) has been described as the best indicator for test performance. METHODS: To compare the performance of the standard diagnostic tests, the DOR of serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), synovial fluid (SF) white blood cell (WBC) count, SF polymorphonuclear (PMN%), and leukocyte esterase (LE) were calculated...
September 2017: Journal of Arthroplasty
Majd Tarabichi, Noam Shohat, Michael M Kheir, Muyibat Adelani, David Brigati, Sean M Kearns, Pankajkumar Patel, John C Clohisy, Carlos A Higuera, Brett R Levine, Ran Schwarzkopf, Javad Parvizi, William A Jiranek
BACKGROUND: Although HbA1c is commonly used for assessing glycemic control before surgery, there is no consensus regarding its role and the appropriate threshold in predicting adverse outcomes. This study was designed to evaluate the potential link between HbA1c and subsequent periprosthetic joint infection (PJI), with the intention of determining the optimal threshold for HbA1c. METHODS: This is a multicenter retrospective study, which identified 1645 diabetic patients who underwent primary total joint arthroplasty (1004 knees and 641 hips) between 2001 and 2015...
September 2017: Journal of Arthroplasty
Gaurav Sharma, Sang Wook Lee, Oliver Atanacio, Javad Parvizi, Tae Kyun Kim
BACKGROUND: Various types of dressing materials are available for wound care following hip and knee arthroplasty. However, it is unclear if one material is more beneficial than the others in terms of wound complications and fluid handling capacity. RESEARCH QUESTIONS: We performed a meta-analysis of randomized controlled trials comparing alternative wound dressing materials for the post-operative management of wounds following THA and TKA with respect to (1) incidence of wound complications including infection and (2) fluid handling capacity...
July 2017: International Orthopaedics
Majd Tarabichi, Andrew N Fleischman, Alisina Shahi, Shaoqi Tian, Javad Parvizi
BACKGROUND: Leukocyte esterase (LE) is a rapid, point-of-care test for periprosthetic joint infection. The purpose of this study was to provide a tool for interpreting LE based on an initial serologic screening. METHODS: We reviewed the records of 319 patients who had erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) screening before hip or knee aspiration; 102 had elevated ESR and CRP levels, 64 had an elevated ESR or CRP level, and 153 had normal serology...
March 27, 2017: Journal of Arthroplasty
Benjamin M Zmistowski, Corey T Clyde, Elie S Ghanem, James R Gotoff, Carl A Deirmengian, Javad Parvizi
BACKGROUND: Determining optimal timing of reimplantation during 2-stage exchange for periprosthetic joint infection (PJI) remains elusive. Joint aspiration for synovial white blood cell (WBC) count and neutrophil percentage (PMN%) before reimplantation is widely performed; yet, the implications are rarely understood. Therefore, this study investigates (1) the diagnostic yield of synovial WBC count and differential analysis and (2) the calculated thresholds for persistent infection. METHODS: Institutional PJI databases identified 129 patients undergoing 2-stage exchange arthroplasty who had joint aspiration before reimplantation between February 2005 and May 2014...
April 6, 2017: Journal of Arthroplasty
Carlos A Higuera, Benjamin Zmistowski, Tennison Malcom, Wael K Barsoum, Scott M Sporer, Philipp Mommsen, Daniel Kendoff, Craig J Della Valle, Javad Parvizi
BACKGROUND: There is a paucity of data regarding the threshold of synovial fluid white blood-cell (WBC) count and polymorphonuclear cell (neutrophil) percentage of the WBC count (PMN%) for the diagnosis of chronic periprosthetic joint infection (PJI) after total hip arthroplasty. Despite this, many organizations have provided guidelines for the diagnosis of PJI that include synovial fluid WBC count and PMN%. We attempted to define a threshold for synovial fluid WBC count and PMN% for the diagnosis of chronic PJI of the hip using a uniform definition of PJI and to investigate any variations in the calculated thresholds among institutions...
May 3, 2017: Journal of Bone and Joint Surgery. American Volume
AliSina Shahi, Javad Parvizi
The role of serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as the first line for evaluating a patient with periprosthetic joint infection (PJI) has been debunked.We are living in the era of biomarkers for the diagnosis of PJI, and to that effect, several biomarkers have been introduced such as synovial fluid alpha defensin and leukocyte esterase.The synovial fluid leukocyte esterase test has a low cost, is accessible, and has provided promising results for diagnosing PJI.There is an urgent need for an accurate and reliable serum biomarker for diagnosing patients with PJI...
July 2016: EFORT open reviews
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