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Prosthetic articular infection

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...
February 1, 2016: 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...
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
D Enea, V Cigna, C Sgolacchia, L Tozzi, A Verdenelli, A Gigante
PURPOSE: Fully conforming, mobile-bearing total knee replacement (TKR) was initially designed using a posterior cruciate-sacrificing (CS) technique. Rotating-platform TKR that could also be performed retaining the posterior cruciate developed afterwards. The purpose of this study was to compare the clinical and functional outcomes of patients who had either cruciate-retaining (CR) or cruciate-sacrificing (CS) TKR at a minimum follow-up of 2 years with the same prosthetic design. METHODS: One hundred and two consecutive TKR (88 patients) were performed at the same institution either with CS (56 TKR-49 patients) or with CR (46 TKR-39 patients) technique...
August 2015: Musculoskeletal Surgery
R Hessler, A Lunebourg, J-F Fisher, S Trachsel, A Cometta
With the ageing of the population, articular prosthetic replacements are becoming more and more frequent. One of the most feared complications is prosthetic infection, mostly due to bacteria of the cutaneous flora. Listeria monocytogenes is rarely the cause. This paper describes the management of a hip prosthetic infection due to Listeria monocytogenes. The patient was cured with antimicrobial therapy and a two-stage exchange. This case report creates an opportunity to review the literature in the aim of determining the risk factors and the optimal care...
November 12, 2014: Revue Médicale Suisse
Ivan Benčić, Aljoša Matejčić, Bojan Dojčinović, Tomislav Ćuti
Reverse shoulder prosthesis has become one of the most often used prosthetic implants in shoulder replacement surgery. It has a wide spectrum of indications, starting from comminuted humeral fractures and posttraumatic arthritis to arthritis caused by the rotator cuff loss. Its application at our hospital began in 2004, at first in few specific cases and with time in ever growing number of patients. Over 8 years, more than 250 reverse shoulder prostheses were implanted at our institution. In addition, our surgeons supervised its application in other hospitals all over Croatia...
September 2014: Acta Clinica Croatica
Yuming Shen, Dong Han, Fengjun Qin
OBJECTIVE: To investigate the risk factors of skin necrosis around incision after total knee arthroplasty (TKA), and explore the measures of prevention and treatment. METHODS: Between June 2007 and June 2013,7 patients with skin necrosis around incision after TKA were treated. There were 5 males and 2 females with an average age of 69 years (range, 59-78 years), including osteoarthritis in 4 cases, traumatic arthritis in 2 cases, and rheumatoid arthritis in 1 case...
August 2014: Chinese Journal of Reparative and Reconstructive Surgery
A J Mirza, A V Lombardi, M J Morris, K R Berend
Direct anterior approaches to the hip have gained popularity as a minimally invasive method when performing primary total hip replacement (THR). A retrospective review of a single institution joint registry was performed in order to compare patient outcomes after THR using the Anterior Supine Intermuscular (ASI) approach versus a more conventional direct lateral approach. An electronic database identified 1511 patients treated with 1690 primary THRs between January 2006 and December 2010. Our results represent a summary of findings from our previously published work...
November 2014: Bone & Joint Journal
Lucinda Barrett, Bridget Atkins
Prosthetic joint infection (PJI) complicates ∼1% of arthroplasties but accounts for considerable morbidity. Both the timing and features of PJI can vary widely. Patients may present with early (≤3 months post-operatively), delayed (3-24 months) or late disease (>24 months). They may be acutely unwell with systemic signs of sepsis or describe only a chronically painful joint with or without sinus formation. Diagnostic criteria as proposed by the Infectious Diseases Society of America and the Musculoskeletal Infection Society highlight the importance of joint sampling to obtain histological and robust microbiological evidence...
September 2014: Journal of Antimicrobial Chemotherapy
Chuan Ye, Riguang Liu, Changying Sun, Jianhao Lin, Hu Li, Houxiang Re, Bo Sun, Qi Sun, Long Yang
PURPOSE: This study was a retrospective analysis of early and mid-term clinical effects and perioperative management of cementless bilateral synchronous total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) with bilateral hip ankylosis. METHODS: Fifteen AS patients (30 hips) with bilateral hip ankylosis were managed with cementless bilateral synchronous THA. Surgical outcome was evaluated using the visual analogue scale (VAS), the range of motion and the Harris score...
December 2014: International Orthopaedics
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