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Prosthetic articular infection

Francesco Muratori, Francesca Totti, Antonio D'Arienzo, Maurizio Scorianz, Guido Scoccianti, Giovanni Beltrami, Francesco Rosario Campo, Carmine Citarelli, Rodolfo Capanna, Domenico Andrea Campanacci
Due to advances in neoadjuvant therapies and preoperative imaging modalities, joint-sparing resections have become appealing in bone tumor surgery. However, the intercalary reconstruction of metadiaphyseal bone defects of the femur and the tibia after juxta-articular tumor resection remains challenging. Both biological and prosthetic reconstructions have been used for joint-sparing resections, but little is known about the long-term outcome of these procedures. The authors reviewed a consecutive series of 64 patients treated with joint-sparing intercalary resection and reconstruction with bone grafts...
June 1, 2018: Surgical Technology International
Jendrik Hardes, Marcel-Philipp Henrichs, Georg Gosheger, Wiebke Guder, Markus Nottrott, Dimosthenis Andreou, Eike Bormann, Maria Eveslage, Gregor Hauschild, Arne Streitbürger
PURPOSE: Proximal tibia replacements are commonly associated with post-operative complications and poor functional results due to an insufficiency of the extensor mechanism. METHODS: This study evaluated the clinical results with a special emphasis of the extensor mechanism reconstruction with a reattachment tube and complications after intra-articular resection of the proximal tibia and reconstruction with a tumour endoprosthesis (MUTARS®) in 98 patients (median age 18 years) with malignant bone tumours or giant cell tumours...
March 22, 2018: International Orthopaedics
Maïté Van Cauter, Olivier Cornu, Jean-Cyr Yombi, Hector Rodriguez-Villalobos, Ludovic Kaminski
BACKGROUND: Prosthetic Joint Infection (PJI) is a rare but devastating complications with high morbitity and mortality. The identification of the causal microorganism remains crucial and determines therapeutic strategies and success. Microbiology cultures remain the common method to diagnose PJI. Unfortunately, 14% of intra-articular punctures remain negative after culture. The microorganisms are best detected by inoculation of microbiology samples in blood culture bottles (Bactec), or after sonication of the implant and polymerase chain reaction (PCR)...
2018: PloS One
Joaquin Sanchez-Sotelo
Prosthetic replacement of the elbow joint has continued to improve over time. Widespread implantation of certain designs has led to identification a few successful elements of elbow arthroplasty, as well as several opportunities for improvement. Current hot topics in elbow arthroplasty include triceps-preserving exposures, implantation of components with better-expected wear performance, management of the ulnar nerve, prevention of infection, and the development of successful cementless components. Total elbow arthroplasty has the potential to improve pain, function and quality of life for many patients with articular destruction secondary to inflammatory arthropathy or as a consequence of trauma...
January 2017: Shoulder & Elbow
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
Suresh Jude Antony
Use of intra-articular antibiotics for the treatment of arthroplasty infections has gained some interest over the last few years. This method has several advantages including: lack of systemic toxicity, ease of administration, and potentially better cure rates. The treatment of fungal infections in prosthetic joint arthroplasties is problematic with high failure and recurrence rates. We present 2 patients with Candida parasilosis and Candida albicans infections within the arthroplasty that were successfully treated with a single stage revision/spacer placement in conjunction with the use of intra-articular amphotericin B...
October 26, 2016: Infectious Disorders Drug Targets
Suresh Antony
Use of intra-articular antibiotics has been used by some centers although not widely accepted by most orthopedic centers (1-4) In a study published by our group in June 2015 in patients who were treated with single stage exchange arthroplasty with intra-articular antibiotics, we noted that the majority of the patients treated with this modality did well. However, there was a subset of the patients that failed therapy as well. We decided to look at this group of patients and see if we could make constructive recommendations that would help clinicians select the right patients for this procedure so as to improve clinical outcomes...
July 13, 2016: Infectious Disorders Drug Targets
Germán L Farfalli, Pablo A I Slullitel, D Luis Muscolo, Miguel A Ayerza, Luis A Aponte-Tinao
BACKGROUND: Chondroblastoma is an uncommon, benign, but locally aggressive bone tumor that occurs in the apophyses or epiphyses of long bones, primarily in young patients. Although some are treated with large resections, aggressive curettage and bone grafting are more commonly performed to preserve the involved joint. Such intralesional resection may result in damage to the growth plate and articular cartilage, which can result in painful arthritis. Prior studies have focused primarily on oncologic outcomes rather than long-term joint status and functional outcomes...
March 2017: Clinical Orthopaedics and related Research
Hélène Chaussade, David Lebeaux, Guillaume Gras, Emilie Catherinot, Blandine Rammaert, Sylvain Poiree, Hervé Lecuyer, Valérie Zeller, Louis Bernard, Olivier Lortholary
Nocardia are Gram-positive filamentous bacteria responsible for infections ranging from opportunistic life-threatening disseminated diseases to chronic skin and soft-tissue infections.Even if virtually all organs can be infected, articular involvement is rare. Therefore, we report 3 recent cases and performed a literature review of cases of Nocardia arthritis in order to describe clinical features, therapeutic challenges, and outcome of these patients.Among 34 patients (31 in the literature plus our 3 cases), 21 (62%) were due to hematogenous dissemination, 9 (26%) were due to direct bacterial inoculation through the skin, and in 4 cases, the mechanism of infection was unknown...
October 2015: Medicine (Baltimore)
Suresh J Antony, Richard S Westbrook, John S Jackson, Jacob S Heydemann, Jenny L Nelson
Prosthetic joint infections (PJI) of the hip and knee are uncommon, but result in significant morbidity and mortality when they do occur. Current management consists of a combination of either single- or two-stage exchange of the prosthesis and/or exchange of polymer components with intravenous (IV) antibiotics (4-6 weeks) and intraoperative debridement of the joint prior to reimplantation. However, failure rate, morbidity, and expense associated with current management are high, especially if the infection involves resistant pathogens and/or osteomyelitis...
2015: Infectious Diseases
Frederick A Matsen, Ning Li, Huizhong Gao, Shaoqing Yuan, Stacy M Russ, Paul D Sampson
BACKGROUND: Increased length of hospital stay, hospital readmission, and revision surgery are adverse outcomes that increase the cost of elective orthopaedic procedures, such as shoulder arthroplasty. Awareness of the factors related to these adverse outcomes will help surgeons and medical centers design strategies for minimizing their occurrence and for managing their associated costs. METHODS: We analyzed data from the New York Statewide Planning and Research Cooperative System on 17,311 primary shoulder arthroplasties performed from 1998 to 2011 to identify factors associated with extended lengths of hospitalization after surgery, readmission within ninety days, and surgical revision...
August 5, 2015: Journal of Bone and Joint Surgery. American Volume
Cheng Tang, Feng Wang, Yanjie Hou, Shanshan Lu, Wei Tian, Yan Xu, Chengzhe Jin, Liming Wang
Accurate and timely diagnosis of prosthetic joint infection is essential to initiate early treatment and achieve a favorable outcome. In this study, we used a rabbit model to assess the feasibility of technetium-99m-labeled annexin V for detecting prosthetic joint infection. Right knee arthroplasty was performed on 24 New Zealand rabbits. After surgery, methicillin-susceptible Staphylococcus aureus was intra-articularly injected to create a model of prosthetic joint infection (the infected group, n = 12)...
May 2015: Journal of Biomedical Research
Julian F Maempel, Fraser Riddoch, Neville Calleja, Ivan J Brenkel
BACKGROUND AND PURPOSE: Total knee replacement (TKR) is being increasingly performed in elderly patients, yet there is little information on specific requirements and complication rates encountered by this group. We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts. PATIENTS AND METHODS: We analyzed prospectively gathered data on 3,144 consecutive primary TKRs (in 2,092 patients aged less than 75 years, 694 patients aged between 75 and 80 years, and 358 patients aged over 80 years at the time of surgery)...
2015: Acta Orthopaedica
Rodolfo Capanna, Francesca Totti, Ingrid C M Van der Geest, Daniel A Müller
HYPOTHESIS: Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. METHODS: The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws...
August 2015: Journal of Shoulder and Elbow Surgery
Qiang Zuo, Lele Dong, Weidong Mu, Lingyun Zhou, Tongping Hu, Hua Zhang
Reports of fungal infection after total knee arthroplasty are extremely rare. In most reports, the infecting organism is a Candida species. The present report describes a case involving a 73-year-old immunocompetent woman who underwent total knee arthroplasty and presented one month later with signs of prosthetic infection. She underwent joint debridement and the fluid was sent for culture and sensitivity testing. The culture showed growth of Trichosporon asahii. The patient was administered intravenous and intra-articular injections of amphotericin B, followed by antifungal treatment with voriconazole for one year...
January 2015: Canadian Journal of Infectious Diseases & Medical Microbiology
Laura Campanacci, Nikolin Alì, José Manuel Pinto Silva Casanova, Jennifer Kreshak, Marco Manfrini
BACKGROUND: Reconstruction of the proximal part of the tibia in children with megaprostheses or standard composite devices removes the distal femoral physis, and osteoarticular allografts have a high incidence of mechanical failure. We evaluated the results of an alternative original technique for proximal tibial reconstruction after tumor resection. METHODS: Nineteen children, ranging in age from six to sixteen years, who underwent surgical resection and reconstruction with a resurfaced allograft-prosthetic composite were retrospectively reviewed at a mean follow-up time of seventy-eight months...
February 4, 2015: Journal of Bone and Joint Surgery. American Volume
Yong Zhao, Kegui Liu, Tao Sun, Yuchi Zhao, Dexin Zou, Jiangwei Tan, Jingning Li, Shudong Zhang, Yangde Liu
OBJECTIVE: To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty (THA) for ischemic necrosis of femoral head and provide rationales for clinical practice. METHODS: From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited. The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67...
December 9, 2014: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Akio Kanda, Kazuo Kaneko, Osamu Obayashi, Atsuhiko Mogami
INTRODUCTION: Treatment of femoral neck fractures in young adults may require total hip arthroplasty or hip hemiarthroplasty using a bipolar cup. The latter can, however, result in migration of the femoral head and poor long-term results. CASE PRESENTATION: We report a case of femoral head migration after hemiarthroplasty performed for femoral neck fracture that had occurred 22 years earlier, when the patient (a Japanese man) was 20 years old. He experienced peri-prosthetic fracture of the femur, subsequent migration of the prosthesis, and a massive bone defect of the pelvic side acetabular roof...
January 15, 2015: Journal of Medical Case Reports
Guangwen Ma, Zongsheng Yin, Fei Huang, Qing Wang, Yong Yin, Hao Wang, Yunfeng Wu, Jiahua Li
OBJECTIVE: To evaluate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) for medial compartmental osteoarthritis of the knee. METHODS: Between January 2008 and October 2013, 18 patients with medial compartmental osteoarthritis of the knee were treated by UKA, including 11 males and 7 females with an average age of 67.2 years (range, 60-72 years). The disease duration ranged from 3 to 5 years (mean, 3.7 years). All patients had loading pain and walk-associated pain of the medial compartmental knee...
October 2014: Chinese Journal of Reparative and Reconstructive Surgery
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