51
|
Jauregui JJ, Kim JK, Shield WP, Harb M, Illical EM, Adib F, Maheshwari AV. Hip fusion takedown to a total hip arthroplasty-is it worth it? A systematic review. INTERNATIONAL ORTHOPAEDICS 2017; 41:1535-1542. [PMID: 28349181 DOI: 10.1007/s00264-017-3436-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Patients with surgically or spontaneously fused hips are often dissatisfied with their overall function and the debilitating effect on adjacent joints. Therefore, in properly selected patients, hip fusion-takedown and conversion to total hip arthroplasty (THA) can result in improved function and decreased pain. We aimed to (1) evaluate the indications for conversion, (2) evaluate the clinical outcomes, (3) analyze the overall complications, and (4) identify the overall satisfaction following the procedure. METHODS A systematic and comprehensive literature search was performed to analyze studies evaluating conversion of hip fusion to THA. After reviewing 3,882 studies, 27 total studies (1,104 hips) met our inclusion/exclusion criteria and were included in our final analysis. A weighted mean of rates was determined for each complication, including infection, instability, loosening, nerve-related, abductor-related, venous thrombotic event, and revision. RESULTS The study population consisted of 53.2% male and 46.8% female subjects. The mean age at time of conversion was 52 years (range 36-65 years), the mean time until follow-up was 9.2 years (range 2.5-17.3), and the mean duration of arthrodesis was 27.7 years (range 11-40.2). As measured by Harris Hip Score, overall clinical outcomes improved from 58.1 points (range 42.4-70 points) pre-operatively to 80.0 (range 62-93.5) post-operatively. The specific complication rates were 5.3% (range 0-43.6%) for infection, 2.6% (range 0-15.4%) for instability, 6.2% (range 0-17.2%) for loosening, 4.7% (range 0-13%) for nerve-related complications, 13.1% (range 0-87%) for abductor-related complications, and 1.2% (range 0-13%) for venous thrombotic events. The revision rate was 12.0% (range 0-43.6%). CONCLUSION Takedown of a fused-hip can be a challenging procedure. Although patients can benefit functionally, both patients and surgeons need to be aware of the complications and increased risk of further revision procedures, which should be an important part of the pre-operative discussion.
Collapse
Affiliation(s)
- Julio J Jauregui
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Joseph K Kim
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA
| | - William P Shield
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Matthew Harb
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA
| | - Emmanuel M Illical
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA
| | - Farshad Adib
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD, USA
| | - Aditya V Maheshwari
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Medical Center, 450 Clarkson Avenue, MSC 30, Brooklyn, NY, USA.
| |
Collapse
|
52
|
Moore AJ, Whitehouse MR, Gooberman-Hill R, Heddington J, Beswick AD, Blom AW, Peters TJ. A UK national survey of care pathways and support offered to patients receiving revision surgery for prosthetic joint infection in the highest volume NHS orthopaedic centres. Musculoskeletal Care 2017; 15:379-385. [PMID: 28332761 PMCID: PMC5763340 DOI: 10.1002/msc.1186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Deep prosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. It is difficult to treat, and patients often require multiple major revision surgeries to eradicate the infection. Treatment can have negative and long‐term impact on patients' quality of life. Understanding current service provision provides valuable information needed to design and evaluate support interventions for patients. Aim This survey aimed to identify usual care pathways and support in UK National Health Service (NHS) orthopaedic centres for patients receiving revision surgery for PJI after hip or knee replacement. Methods The 20 highest volume NHS orthopaedic centres treating prosthetic joint infection after hip or knee replacement were approached. Consultant orthopaedic surgeons specializing in treating PJI were invited to participate in a telephone or email survey about usual care provision and support for PJI. Findings Sixteen centres completed the survey. Findings showed a high degree of variation nationally in follow‐up time‐points after revision surgery. Multidisciplinary approaches to care focused more on clinical care and physical rehabilitation than social and psychological care. Patient management and referral to support services also varied and barriers to referrals included lack of availability or access to services, lack of knowledge of services, shortage of staff, and complexities of referring outside of the hospital catchment area. Conclusions Our findings suggest that future development of interventions should focus on more inclusive and patient‐centred multidisciplinary approaches to care. Such interventions could more completely address psychological and social as well as physical aspects of patients' recovery.
Collapse
Affiliation(s)
- Andrew J Moore
- Musculoskeletal Research Unit, University of Bristol, UK
| | | | | | | | | | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, UK
| | - Tim J Peters
- Musculoskeletal Research Unit, University of Bristol, UK
| |
Collapse
|
53
|
Lawrenz JM, Mesko NW, Higuera CA, Molloy RM, Simpfendorfer C, Babic M. Treatment Challenges of Prosthetic Hip Infection with Associated Iliacus Muscle Abscess: Report of 5 Cases and Literature Review. J Bone Jt Infect 2017; 2:127-135. [PMID: 28540149 PMCID: PMC5441144 DOI: 10.7150/jbji.16429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Prosthetic joint infection is an unfortunate though well-recognized complication of total joint arthroplasty. An iliacus and/or iliopsoas muscle abscess is a rarely documented presentation of hip prosthetic joint infection. It is thought an unrecognized retroperitoneal nidus of infection can be a source of continual seeding of the prosthetic hip joint, prolonging attempts to eradicate infection despite aggressive debridement and explant attempts. The current study presents five cases demonstrating this clinical scenario, and discusses various treatment challenges. In each case we report the patient's clinical history, pertinent imaging, management and outcome. Diagnosis of the iliacus muscle abscess was made using computed tomography imaging. In brief, the mean number of total drainage procedures (open and percutaneous) per patient was 4.2, and outcomes consisted of one patient with a hip girdlestone, two patients with delayed revisions, and two patients with retained prosthesis. All patients ended with functional pain and on oral antibiotic suppression with an average follow up of 18 months. This article highlights an iliacus muscle abscess as an unrecognized source of infection to a prosthetic hip. It demonstrates resilience to standard treatment protocols for prosthetic hip infection, and is associated with poor patient outcomes. Aggressive surgical debridement appears to remain critical to treatment success, and early retroperitoneal debridement of the abscess should be considered.
Collapse
Affiliation(s)
- Joshua M Lawrenz
- Cleveland Clinic Foundation, 9500 Euclid Ave.Cleveland, OH 44195, USA
| | - Nathan W Mesko
- Cleveland Clinic Foundation, 9500 Euclid Ave.Cleveland, OH 44195, USA
| | - Carlos A Higuera
- Cleveland Clinic Foundation, 9500 Euclid Ave.Cleveland, OH 44195, USA
| | - Robert M Molloy
- Cleveland Clinic Foundation, 9500 Euclid Ave.Cleveland, OH 44195, USA
| | | | - Maja Babic
- Cleveland Clinic Foundation, 9500 Euclid Ave.Cleveland, OH 44195, USA
| |
Collapse
|
54
|
Park CH, Lee YK, Koo KH. Lower Urinary Tract Infection and Periprosthetic Joint Infection after Elective Primary Total Hip Arthroplasty. Hip Pelvis 2017; 29:30-34. [PMID: 28316960 PMCID: PMC5352723 DOI: 10.5371/hp.2017.29.1.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/04/2017] [Accepted: 01/23/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a grave complication. Urinary tract infection (UTI) as a source for PJI is controversial. Our purposes were, (1) to evaluate the incidence of PJI after elective primary THA and (2) to determine whether UTI was associated with a risk of PJI after elective primary THA. Materials and Methods We retrospectively reviewed the medical records of 527 patients who underwent elective primary THA by using universal aseptic technique from May 2003 to October 2007. UTI group (13 patients) was defined as patients who underwent THA in status of having an UTI, and the remaining patients were defined as control group (514 patients). We compared the incidence of PJI in both groups. Results During the study period, the incidence of PJI was 0%, regardless of existence (or presence) of UTI. Conclusion There was no significant association between UTI and PJI, when cautiously performed THA.
Collapse
Affiliation(s)
- Chan Ho Park
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
55
|
Analysis of causative microorganism in 248 primary hip arthroplasties revised for infection: a study using the NJR dataset. Hip Int 2017; 26:82-9. [PMID: 26821692 DOI: 10.5301/hipint.5000313] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This study aimed to describe the epidemiology of the causative organism in a series of primary hip arthroplasties revised for a diagnosis of periprosthetic joint infection (PJI) in England and Wales. METHODS Patient data from the National Joint Registry (NJR) was linked to microbiology data held by Public Health England (PHE) which identified a series of 248 primary hip arthroplasties revised for PJI between 2003 and 2014. Definitive cultures, isolated at time of revision surgery, were available for all cases. Total hip arthroplasty (n = 239, 96%) and hip resurfacing (n = 5, 2%) were the most commonly performed primary procedures. A two-stage revision was the most common operative management (n = 174, 70%). RESULTS 202 (81%) cases were infected with a single genus microorganism and the most commonly implicated genus was Staphylococcus species (70% of all single genus infections). Staphylococcus species were also the most commonly identified microorganism in mixed genus infections (74% of patient's cultures). There was a significant difference in microorganism distribution when comparing uncemented vs cement implant fixation, with a higher incidence of Gram-negative infection observed in the uncemented group (p = 0.048, Chi-square). CONCLUSIONS Both prophylactic and therapeutic antibiotic regimes should be focused on targeting Staphylococci.
Collapse
|
56
|
Kunutsor SK, Beswick AD, Peters TJ, Gooberman-Hill R, Whitehouse MR, Blom AW, Moore AJ. Health Care Needs and Support for Patients Undergoing Treatment for Prosthetic Joint Infection following Hip or Knee Arthroplasty: A Systematic Review. PLoS One 2017; 12:e0169068. [PMID: 28046049 PMCID: PMC5207523 DOI: 10.1371/journal.pone.0169068] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/24/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hip and knee arthroplasty are common interventions for the treatment of joint conditions, most notably osteoarthritis. Although many patients benefit from surgery, approximately 1% of patients develop infection afterwards known as deep prosthetic joint infection (PJI), which often requires further major surgery. OBJECTIVE To assess support needs of patients undergoing treatment for PJI following hip or knee arthroplasty and to identify and evaluate what interventions are routinely offered to support such patients. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, Web of Science, PsycINFO, Cinahl, Social Science Citation Index, The Cochrane Library, and reference lists of relevant studies from January 01, 1980 to October 05, 2016. SELECTION CRITERIA Observational (prospective or retrospective cohort, nested case-control or case-control) studies, qualitative studies, or clinical trials conducted in patients treated for PJI and/or other major adverse occurrences following hip or knee arthroplasty. REVIEW METHODS Data were extracted by two independent investigators and consensus was reached with involvement of a third. Given the heterogeneous nature of study designs, methods, and limited number of studies, a narrative synthesis is presented. RESULTS Of 4,213 potentially relevant citations, we identified one case-control, one prospective cohort and two qualitative studies for inclusion in the synthesis. Patients report that PJI and treatment had a profoundly negative impact affecting physical, emotional, social and economic aspects of their lives. No study evaluated support interventions. CONCLUSION The findings demonstrate that patients undergoing treatment for PJI have extensive physical, psychological, social and economic support needs. The interpretation of study results is limited by variation in study design, outcome measures and the small number of relevant eligible studies. However, our review highlights a lack of evidence about support strategies for patients undergoing treatment for PJI and other adverse occurrences following hip or knee arthroplasty. There is a need to design, implement and evaluate interventions to support these patients. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2015: CRD42015027175.
Collapse
Affiliation(s)
- Setor K. Kunutsor
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew D. Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Tim J. Peters
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Michael R. Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Andrew J. Moore
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
57
|
Kim JL, Park JH, Han SB, Cho IY, Jang KM. Allogeneic Blood Transfusion Is a Significant Risk Factor for Surgical-Site Infection Following Total Hip and Knee Arthroplasty: A Meta-Analysis. J Arthroplasty 2017; 32:320-325. [PMID: 27682006 DOI: 10.1016/j.arth.2016.08.026] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/21/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Blood loss occurs significantly more frequently during total hip and knee arthroplasty than among any other type of orthopedic operation, which can sometimes lead to requiring a blood transfusion. Although allogeneic blood transfusion has been identified as a risk factor for postoperative surgical-site infection following arthroplasty, results are inconclusive. The purpose of this study was to conduct a systematic meta-analysis to investigate whether having an allogeneic blood transfusion significantly increases the risk for surgical-site infection, particularly after total hip and knee arthroplasty. METHODS We performed a systematic review and meta-analysis using random-effect models. Using an electronic database search, we selected 6 studies that included data on 21,770 patients and among these studies compared the postoperative infection rate between an allogeneic blood-transfusion exposure group and a nonexposure group. We calculated the pooled odds ratios and 95% confidence intervals for the groups. RESULTS The prevalences of surgical-site infections in our pooled analyses were 2.88% and 1.74% for the transfusion and nontransfusion groups, respectively. The allogeneic blood transfusion group had a significantly higher frequency of surgical-site infections based on pooled analysis using a random-effect model (pooled odds ratio = 1.71, 95% confidence interval: 1.23-2.40, P = .002). CONCLUSION Allogeneic blood transfusion is a significant risk factor for increasing the surgical-site infection rate after total hip and knee arthroplasty.
Collapse
Affiliation(s)
- Jeong Lae Kim
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Hoon Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Il Youp Cho
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| |
Collapse
|
58
|
Strategies for Soft-Tissue Management of Complex Joint Revision Arthroplasty. Plast Reconstr Surg 2016; 138:1344-1351. [DOI: 10.1097/prs.0000000000002762] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
59
|
The Use of a Supra-Acetabular Antibiotic-Loaded Cement Shelf to Improve Hip Stability in First-Stage Infected Total Hip Arthroplasty. J Arthroplasty 2016; 31:2574-2578. [PMID: 27235330 DOI: 10.1016/j.arth.2016.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Antibiotic-loaded cement spacers in first-stage revision total hip arthroplasty (THA) for managing infection are associated with high dislocation and fracture rates. The aim of this study was to report the use of an antibiotic-loaded cemented supra-acetabular roof augmentation to reinforce hip stability after cement spacer insertion for first-stage total hip revision in the treatment of infected THA. METHODS We retrospectively reviewed a consecutive series of 50 THAs involving 47 patients with an infected hip requiring staged revisions of THA. We documented dislocation, reinfection, and time for revision and outcome. RESULTS There were no cases of hip dislocation, cement fractures, or any other technical complications associated with the use of the roof augmentation lip. Thirteen cases (26%) had a cemented spacer for longer than 120 days. Seven (14%) cases had recurrent infection after staged revision THA. CONCLUSION The antibiotic-loaded cemented supra-acetabular roof augment improved femoral head spacer coverage for patients requiring a staged revision THA for infection.
Collapse
|
60
|
Coraça-Huber DC, Ammann CG, Nogler M, Fille M, Frommelt L, Kühn KD, Fölsch C. Lyophilized allogeneic bone tissue as an antibiotic carrier. Cell Tissue Bank 2016; 17:629-642. [PMID: 27631323 PMCID: PMC5116047 DOI: 10.1007/s10561-016-9582-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/01/2016] [Indexed: 01/05/2023]
Abstract
The rising number of primary joint replacements worldwide causes an increase of revision surgery of endoprostheses due bacterial infection. Revision surgery using non-cemented implants seems beneficial for the long-term outcome and the use of antibiotic-impregnated bone grafts might control the infection and give a good support for the implant. In this study we evaluated the release of antibiotics from fresh-frozen and lyophilized allogeneic bone grafts. Lyophilized bone chips and fresh frozen bone chips were mixed with gentamicin sulphate, gentamicin palmitate, vancomycin, calcium carbonate/calcium sulphate impregnated with gentamicin sulphate, and calcium carbonate/calcium sulphate bone substitute material impregnated with vancomycin. The efficacy of each preparation was measured by drug release tests and bacterial susceptibility using B. subtilis, S. aureus and methicillin-resistant Staphylococcus aureus. The release of gentamicin from lyophilized bone was similar to the release rate from fresh frozen bone during all the experimental time. That fact might be related to the similar porosity and microstructure of the bone chips. The release of gentamicin from lyophilized and fresh frozen bone was high in the first and second day, decreasing and keeping a low rate until the end of the second week. Depending on the surgical strategy either polymethylmethacrylate or allogeneic bone are able to deliver sufficient concentrations of gentamicin to achieve bacterial inhibition within two weeks after surgery. In case of uncemented revision of joint replacements allogeneic bone is able to deliver therapeutic doses of gentamicin and peak levels immediately after implantation during a fortnight. The use of lyophilized and fresh frozen bone allografts as antibiotic carriers is recommended for prophylaxis of bone infection.
Collapse
Affiliation(s)
- Débora C Coraça-Huber
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria.
| | - Christoph G Ammann
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Michael Nogler
- Experimental Orthopaedics, Department of Orthopaedic Surgery, Medical University of Innsbruck, Innrain 36, 6020, Innsbruck, Austria
| | - Manfred Fille
- Division of Hygiene and Medical Microbiology, Medical University Innsbruck, Schöpfstr. 41, 3rd Floor, Innsbruck, Austria
| | - Lars Frommelt
- Institute for Infectiology, Clinical Microbiology and Hospital Care, ENDO Clinic Hamburg, Holstenstraße 2, Hamburg, Germany
| | - Klaus-Dieter Kühn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Auenbruggerplatz 5, Graz, Austria
| | - Christian Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Giessen, Baldingerstraße, Marburg, Germany
| |
Collapse
|
61
|
Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
62
|
Pereira LC, Kerr J, Jolles BM. Intra-articular steroid injection for osteoarthritis of the hip prior to total hip arthroplasty. Bone Joint J 2016; 98-B:1027-35. [DOI: 10.1302/0301-620x.98b8.37420] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 03/10/2016] [Indexed: 11/05/2022]
Abstract
Aims Using a systematic review, we investigated whether there is an increased risk of post-operative infection in patients who have received an intra-articular corticosteroid injection to the hip for osteoarthritis prior to total hip arthroplasty (THA). Methods Studies dealing with an intra-articular corticosteroid injection to the hip and infection following subsequent THA were identified from databases for the period between 1990 to 2013. Retrieved articles were independently assessed for their methodological quality. Results A total of nine studies met the inclusion criteria. Two recommended against a steroid injection prior to THA and seven found no risk with an injection. No prospective controlled trials were identified. Most studies were retrospective. Lack of information about the methodology was a consistent flaw. Conclusions The literature in this area is scarce and the evidence is weak. Most studies were retrospective, and confounding factors were poorly defined or not addressed. There is thus currently insufficient evidence to conclude that an intra-articular corticosteroid injection administered prior to THA increases the rate of infection. High quality, multicentre randomised trials are needed to address this issue. Cite this article: Bone Joint J 2016;98-B:1027–35.
Collapse
Affiliation(s)
- L. C. Pereira
- Centre Hospitalier Universitaire Vaudois, Site
Hôpital Orthopédique, Avenue Pierre Decker
4, CH-1011 Lausanne, Switzerland
| | - J. Kerr
- Therap-ease Treatment Centre, 382
Morningside Road, Edinburgh, EH10
5HX, UK
| | - B. M. Jolles
- Centre Hospitalier Universitaire Vaudois, Site
Hôpital Orthopédique, Avenue Pierre Decker
4, CH-1011 Lausanne, Switzerland
| |
Collapse
|
63
|
First Clinical Experience With Thermal-Sprayed Silver Oxide-Containing Hydroxyapatite Coating Implant. J Arthroplasty 2016; 31:1498-503. [PMID: 26810376 DOI: 10.1016/j.arth.2015.12.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/24/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prosthetic joint infection is a serious complication of implant therapy. To prevent prosthetic joint infection, we previously reported the features of silver oxide-containing hydroxyapatite (Ag-HA), which was prepared by mixing silver (a metal with antimicrobial activity) with HA. In this study, we evaluated the potential issues of total hip arthroplasty (THA) with an Ag-HA-coated implant. METHODS We prepared an implant for THA that was coated with Ag-HA. In this study, the implant contained silver at a maximum quantity of 2.9 mg/implant. In this prospective interventional study, we performed THA with this implant in 20 patients and investigated the effects of silver. RESULTS Blood silver levels peaked at 2 weeks after THA and gradually decreased thereafter. The highest blood silver level recorded during the postoperative follow-up was 6.0 ng/mL, which was within the normal range. The Harris Hip Scores increased in all cases, and activities of daily living improved markedly after THA with Ag-HA-coated implants. Implant failure was absent on radiography. No adverse reaction to silver was noted, and argyria was not observed in any case. No patients have developed infection after surgery. CONCLUSION This is the first clinical study of Ag-HA-coated implants in THA. Our Ag-HA-coated implants markedly improved patients' activities of daily living without causing any adverse reactions attributable to silver in the human body. Ag-HA is expected to reduce postoperative infections and prevent decreased quality of life in patients undergoing prosthetic arthroplasty, thus leading to more favorable outcomes.
Collapse
|
64
|
Wyatt M, Beswick A, Kunutsor S, Wilson M, Whitehouse M, Blom A. The Alpha-Defensin Immunoassay and Leukocyte Esterase Colorimetric Strip Test for the Diagnosis of Periprosthetic Infection: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2016; 98:992-1000. [PMID: 27307359 PMCID: PMC4901182 DOI: 10.2106/jbjs.15.01142] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Synovial biomarkers have recently been adopted as diagnostic tools for periprosthetic joint infection (PJI), but their utility is uncertain. The purpose of this systematic review and meta-analysis was to synthesize the evidence on the accuracy of the alpha-defensin immunoassay and leukocyte esterase colorimetric strip test for the diagnosis of PJI compared with the Musculoskeletal Infection Society diagnostic criteria. METHODS We performed a systematic review to identify diagnostic technique studies evaluating the accuracy of alpha-defensin or leukocyte esterase in the diagnosis of PJI. MEDLINE and Embase on Ovid, ACM, ADS, arXiv, CERN DS (Conseil Européen pour la Recherche Nucléaire Document Server), CrossRef DOI (Digital Object Identifier), DBLP (Digital Bibliography & Library Project), Espacenet, Google Scholar, Gutenberg, HighWire, IEEE Xplore (Institute of Electrical and Electronics Engineers digital library), INSPIRE, JSTOR (Journal Storage), OAlster (Open Archives Initiative Protocol for Metadata Harvesting), Open Content, Pubget, PubMed, and Web of Science were searched for appropriate studies indexed from inception until May 30, 2015, along with unpublished or gray literature. The classification of studies and data extraction were performed independently by 2 reviewers. Data extraction permitted meta-analysis of sensitivity and specificity with construction of receiver operating characteristic curves for each test. RESULTS We included 11 eligible studies. The pooled diagnostic sensitivity and specificity of alpha-defensin (6 studies) for PJI were 1.00 (95% confidence interval [CI], 0.82 to 1.00) and 0.96 (95% CI, 0.89 to 0.99), respectively. The area under the curve (AUC) for alpha-defensin and PJI was 0.99 (95% CI, 0.98 to 1.00). The pooled diagnostic sensitivity and specificity of leukocyte esterase (5 studies) for PJI were 0.81 (95% CI, 0.49 to 0.95) and 0.97 (95% CI, 0.82 to 0.99), respectively. The AUC for leukocyte esterase and PJI was 0.97 (95% CI, 0.95 to 0.98). There was substantial heterogeneity among studies for both diagnostic tests. CONCLUSIONS The diagnostic accuracy for PJI was high for both tests. Given the limited number of studies and the large cost difference between the tests, more independent research on these tests is warranted. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- M.C. Wyatt
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom,E-mail address for M.C. Wyatt:
| | | | | | - M.J. Wilson
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | | | - A.W. Blom
- University of Bristol, Bristol, United Kingdom
| |
Collapse
|
65
|
Daptomycin-loaded static cement spacer: salvage for a failed first-stage revision of a total knee replacement with vancomycin resistance. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
66
|
Strange S, Whitehouse MR, Beswick AD, Board T, Burston A, Burston B, Carroll FE, Dieppe P, Garfield K, Gooberman-Hill R, Jones S, Kunutsor S, Lane A, Lenguerrand E, MacGowan A, Moore A, Noble S, Simon J, Stockley I, Taylor AH, Toms A, Webb J, Whittaker JP, Wilson M, Wylde V, Blom AW. One-stage or two-stage revision surgery for prosthetic hip joint infection--the INFORM trial: a study protocol for a randomised controlled trial. Trials 2016; 17:90. [PMID: 26883420 PMCID: PMC4756538 DOI: 10.1186/s13063-016-1213-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 02/04/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective. The main aim of this randomised controlled trial is to determine whether there is a difference in patient-reported outcome measures 18 months after randomisation for one-stage or two-stage revision surgery. METHODS/DESIGN INFORM (INFection ORthopaedic Management) is an open, two-arm, multi-centre, randomised, superiority trial. We aim to randomise 148 patients with eligible PJI of the hip from approximately seven secondary care NHS orthopaedic units from across England and Wales. Patients will be randomised via a web-based system to receive either a one-stage revision or a two-stage revision THR. Blinding is not possible due to the nature of the intervention. All patients will be followed up for 18 months. The primary outcome is the WOMAC Index, which assesses hip pain, function and stiffness, collected by questionnaire at 18 months. Secondary outcomes include the following: cost-effectiveness, complications, re-infection rates, objective hip function assessment and quality of life. A nested qualitative study will explore patients' and surgeons' experiences, including their views about trial participation and randomisation. DISCUSSION INFORM is the first ever randomised trial to compare two widely accepted surgical interventions for the treatment of PJI: one-stage and two-stage revision THR. The results of the trial will benefit patients in the future as the main focus is on patient-reported outcomes: pain, function and wellbeing in the long term. Patients state that these outcomes are more important than those that are clinically derived (such as re-infection) and have been commonly used in previous non-randomised studies. Results from the INFORM trial will also benefit clinicians and NHS managers by enabling the comparison of these key interventions in terms of patients' complication rates, health and social resource use and their overall cost-effectiveness. TRIAL REGISTRATION Current controlled trials ISRCTN10956306 (registered on 29 January 2015); UKCRN ID 18159.
Collapse
Affiliation(s)
- Simon Strange
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK. .,North Bristol NHS Trust, Brunel Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, ᅟ.
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Tim Board
- Wrightington Hospital, Wigan and Leigh NHS Foundation Trust, Hall Lane, Appley Bridge, Wrightington, Lancashire, WN6 9EP, UK.
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Ben Burston
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation, Oswestry, Shropshire, SY10 7AG, UK.
| | - Fran E Carroll
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Paul Dieppe
- University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Kirsty Garfield
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Stephen Jones
- Cardiff and Vale University Health Board, University Hospital Llandough, Penlan Road, Llandough, CF64 2XX, UK.
| | - Setor Kunutsor
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Athene Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. .,Bristol Randomised Trials Collaboration, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Alasdair MacGowan
- North Bristol NHS Trust, Brunel Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, ᅟ.
| | - Andrew Moore
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Joanne Simon
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. .,Bristol Randomised Trials Collaboration, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Ian Stockley
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Adrian H Taylor
- Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford, OX3 7HE, UK.
| | - Andrew Toms
- Royal Devon and Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK.
| | - Jason Webb
- North Bristol NHS Trust, Brunel Building, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, ᅟ.
| | - John-Paul Whittaker
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation, Oswestry, Shropshire, SY10 7AG, UK.
| | - Matthew Wilson
- Royal Devon and Exeter NHS Foundation Trust, Barrack Rd, Exeter, Devon, EX2 5DW, UK.
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Level 1 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| |
Collapse
|
67
|
Moore AJ, Blom AW, Whitehouse MR, Gooberman-Hill R. Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery. BMJ Open 2015; 5:e009495. [PMID: 26644124 PMCID: PMC4679895 DOI: 10.1136/bmjopen-2015-009495] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. DESIGN Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. SETTING Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). PARTICIPANTS 19 patients participated (12 men, 7 women, age range 56-88 years, mean age 73.2 years). RESULTS Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants' mobility, and further burdens associated with additional complications. CONCLUSIONS Deep PJI impacted on all aspects of patients' lives. 2-stage revision had greater impact than 1-stage revision on participants' well-being because the time in between revision procedures meant long periods of immobility and related psychological distress. Participants expressed a need for more psychological and rehabilitative support during treatment and long-term recovery.
Collapse
Affiliation(s)
- Andrew J Moore
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| |
Collapse
|
68
|
Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. Re-Infection Outcomes following One- and Two-Stage Surgical Revision of Infected Hip Prosthesis: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0139166. [PMID: 26407003 PMCID: PMC4583275 DOI: 10.1371/journal.pone.0139166] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022] Open
Abstract
Background The two-stage revision strategy has been claimed as being the “gold standard” for treating prosthetic joint infection. The one-stage revision strategy remains an attractive alternative option; however, its effectiveness in comparison to the two-stage strategy remains uncertain. Objective To compare the effectiveness of one- and two-stage revision strategies in treating prosthetic hip infection, using re-infection as an outcome. Design Systematic review and meta-analysis. Data Sources MEDLINE, EMBASE, Web of Science, Cochrane Library, manual search of bibliographies to March 2015, and email contact with investigators. Study Selection Cohort studies (prospective or retrospective) conducted in generally unselected patients with prosthetic hip infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision. No clinical trials were identified. Review Methods Data were extracted by two independent investigators and a consensus was reached with involvement of a third. Rates of re-infection from 38 one-stage studies (2,536 participants) and 60 two-stage studies (3,288 participants) were aggregated using random-effect models after arcsine transformation, and were grouped by study and population level characteristics. Results In one-stage studies, the rate (95% confidence intervals) of re-infection was 8.2% (6.0–10.8). The corresponding re-infection rate after two-stage revision was 7.9% (6.2–9.7). Re-infection rates remained generally similar when grouped by several study and population level characteristics. There was no strong evidence of publication bias among contributing studies. Conclusion Evidence from aggregate published data suggest similar re-infection rates after one- or two-stage revision among unselected patients. More detailed analyses under a broader range of circumstances and exploration of other sources of heterogeneity will require collaborative pooling of individual participant data. Systematic Review Registration PROSPERO 2015: CRD42015016559
Collapse
Affiliation(s)
- Setor K. Kunutsor
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
- * E-mail:
| | - Michael R. Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - Ashley W. Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | - Andrew D. Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom
| | | |
Collapse
|
69
|
Eto S, Miyamoto H, Shobuike T, Noda I, Akiyama T, Tsukamoto M, Ueno M, Someya S, Kawano S, Sonohata M, Mawatari M. Silver oxide-containing hydroxyapatite coating supports osteoblast function and enhances implant anchorage strength in rat femur. J Orthop Res 2015; 33:1391-7. [PMID: 25808232 DOI: 10.1002/jor.22903] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 03/10/2015] [Indexed: 02/04/2023]
Abstract
Antibacterial silver with hydroxyapatite (Ag-HA) is a promising coating material for imparting antibacterial properties to implants. We previously reported that 3% (w/w) silver with HA (3% Ag-HA) has both antibacterial activity and osteoconductivity. In this study, we investigated the effects of Ag-HA on the in vitro osteoblast function and the in vivo anchorage strength and osteoconductivity of implants. Production of the osteoblast marker alkaline phosphatase, but not cytotoxicity, was observed in cells of the osteoblast cell line MC3T3-E1 cultured on the 3% Ag-HA-coated surface. These results were similar to those observed with silver-free HA coating. In contrast, a significant high level of cytotoxicity was observed when the cells were cultured on a 50% Ag-HA-coated surface. The anchorage strength of implants inserted into the femur of Sprague-Dawley (SD) rats was enhanced by coating the implants with 3% Ag-HA. On the 3% Ag-HA-coated surface, both metaphyseal and diaphyseal areas were largely covered with new bone and had adequate osteoconductivity. These results suggest that 3% Ag-HA, like conventional HA, promotes osteogenesis by supporting osteoblast viability and function and thereby contributes to sufficient anchorage strength of implants. Application of 3% Ag-HA, which combines the osteoconductivity of HA and the antibacterial activity of silver, to prosthetic joints will help prevent postoperative infections.
Collapse
Affiliation(s)
- Shuichi Eto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Hiroshi Miyamoto
- Departments of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Takeo Shobuike
- Departments of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Iwao Noda
- Research Department, KYOCERA Medical Corporation, Osaka, 532-0003, Japan
| | - Takayuki Akiyama
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Masaya Ueno
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Shinsuke Someya
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Shunsuke Kawano
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, 849-8501, Japan
| |
Collapse
|
70
|
Petti CA, Stoddard GJ, Sande MA, Samore MH, Simmon KE, Hofmann A. The Suspected Infected Prosthetic Joint: Clinical Acumen and Added Value of Laboratory Investigations. PLoS One 2015; 10:e0131609. [PMID: 26181332 PMCID: PMC4504711 DOI: 10.1371/journal.pone.0131609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/02/2015] [Indexed: 12/18/2022] Open
Abstract
Consensus definitions have emerged for the discrimination between infected and uninfected prosthetic joints but diagnostic uncertainty often occurs. We examined the accuracy of orthopaedic surgeons’ assessments to diagnose the infected prosthetic hip or knee and elucidated the added value of laboratory parameters. A prospective cohort study of patients undergoing revision arthroplasty of hip or knee was conducted over a one-year period. Orthopaedic surgeons’ determinations prior to arthroplasty were recorded. A reference diagnostic standard was determined retrospectively by independent review from 3 infectious diseases physicians. Patients were followed up to 12 months. For 198 patients enrolled, 228 surgical encounters (110 knee, 118 hip) were classified by independent reviewers as 176 uninfected and 52 infected. Orthopaedic surgeons’ preoperative diagnoses of infection had high diagnostic accuracy (sensitivity 89%, specificity 99%, PPV 98%, NPV 97%). Addition of intraoperative findings and histopathology improved their diagnostic accuracy. Addition of culture and PCR results improved sensitivity of diagnostic determinations but not specificity. We provide evidence that clinical acumen has high diagnostic accuracy using routine preoperative parameters. Histopathology from intraoperative specimens would improve surgeons’ diagnostic accuracy but culture and PCR from intraoperative specimens could create greater diagnostic uncertainty. This study is critical to further our understanding of the added value, if any, of laboratory testing to support clinical decision making for the suspected infected joint and allow us to identify diagnostic gaps for emerging technologies to fill that will improve our ability to diagnose the infected prosthetic joint.
Collapse
Affiliation(s)
- Cathy A. Petti
- Department of Medicine, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Gregory J. Stoddard
- Department of Medicine, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
| | - Merle A. Sande
- Department of Medicine, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
| | - Matthew H. Samore
- Department of Medicine, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
| | - Keith E. Simmon
- Associated Regional and University Pathologists Laboratories Institute of Clinical and Experimental Pathology, Salt Lake City, Utah, United States of America
| | - Aaron Hofmann
- Department of Orthopaedic Surgery, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
| |
Collapse
|
71
|
Teng S, Yi C, Krettek C, Jagodzinski M. Smoking and risk of prosthesis-related complications after total hip arthroplasty: a meta-analysis of cohort studies. PLoS One 2015; 10:e0125294. [PMID: 25909602 PMCID: PMC4409354 DOI: 10.1371/journal.pone.0125294] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 03/11/2015] [Indexed: 12/20/2022] Open
Abstract
Objective Increasing evidence suggests that smoking may increase the incidence of prosthesis-related complications after total hip arthroplasty (THA). We performed a meta-analysis of cohort studies to quantitatively evaluate the association between smoking and the risk of prosthesis-related complications after THA. Methods Relevant articles published before August 15, 2014, were identified by searching the PubMed, EMBASE and Cochrane library databases. Pooled risk ratios (RRs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated with either a fixed- or random-effects model. Results Six cohort studies, involving a total of 8181 participants, were included in the meta-analysis. Compared with the patients who never smoked, smokers had a significantly increased risk of aseptic loosening of prosthesis (summary RR=3.05, 95% CI: 1.42-6.58), deep infection (summary RR=3.71, 95% CI: 1.86-7.41) and all-cause revisions (summary RR=2.58, 95% CI: 1.27-5.22). However, no significant difference in the risk of implant dislocation (summary RR= 1.27, 95% CI: 0.77-2.10) or length of hospital stay (WMD=0.03, 95% CI: -0.65-0.72) was found between smokers and nonsmokers. Conclusions Smoking is associated with a significantly increased risk of aseptic loosening of prosthesis, deep infection and all-cause revisions after THA, but smoking is not correlated with a risk of implant dislocation or the length of hospital stay after surgery.
Collapse
Affiliation(s)
- Songsong Teng
- Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany
- Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Chengqing Yi
- Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
- * E-mail:
| | - Christian Krettek
- Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany
| | - Michael Jagodzinski
- Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany
- Department of Orthopedic Trauma, Agaplesion ev. Hospital Bethel, Bückeburg, Germany
| |
Collapse
|
72
|
Abstract
Prosthetic joint infection (PJI) still remains a significant problem. In line with the forecasted rise in joint replacement procedures, the number of cases of PJI is also anticipated to rise. The formation of biofilm by causative pathogens is central to the occurrence and the recalcitrance of PJI. The subject of microbial biofilms is receiving increasing attention, probably as a result of the wide acknowledgement of the ubiquity of biofilms in the natural, industrial, and clinical contexts, as well as the notorious difficulty in eradicating them. In this review, we discuss the pertinent issues surrounding PJI and the challenges posed by biofilms regarding diagnosis and treatment. In addition, we discuss novel strategies of prevention and treatment of biofilm-related PJI.
Collapse
Affiliation(s)
| | | | - Jason C Webb
- Avon Orthopedic Centre, Southmead Hospital,University of Bristol
| |
Collapse
|
73
|
Coraça-Huber DC, Wurm A, Fille M, Hausdorfer J, Nogler M, Vogt S, Kühn KD. Antibiotic-loaded calcium carbonate/calcium sulfate granules as co-adjuvant for bone grafting. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5344. [PMID: 25578698 DOI: 10.1007/s10856-014-5344-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/31/2014] [Indexed: 06/04/2023]
Abstract
In this study HERAFILL(®) granules containing gentamicin was evaluated as a bone void filling material once mixed with allograft bone grafts. The efficacy of the bone grafts mixed with HERAFILL(®) was measured by drug release tests and bacterial susceptibility using Bacillus subtilis, Staphylococcus epidermidis and Staphylococcus aureus. The effect of storage at -80 °C on the delivery and efficacy of gentamicin from bone grafts mixed with HERAFILL(®) was also investigated. Higher elution of gentamicin was detected in all stored groups (1 and 6 months) in comparison with non-stored samples. The gentamicin elution released from all groups was efficient on reducing S. aureus and S. epidermidis CFU. The susceptibility tests using S. aureus showed less resistance of the strain after 1 month of the elution storage. That resistance was not observed after 6 months of storage. The capacity of bone grafts to act as gentamicin carriers has been confirmed in this study. The different granules sizes did not interfere in the delivery rate of the antibiotics or in the activity against the bacteria. Storage at -80 °C does not interfere on the antibiotic activity.
Collapse
Affiliation(s)
- Débora C Coraça-Huber
- Experimental Orthopaedics, Medical University Innsbruck, Innrain 36 1st floor, 6020, Innsbruck, Austria,
| | | | | | | | | | | | | |
Collapse
|
74
|
Yuasa T, Yamakawa J, Maezawa K, Kaneko K. Prospective study on antimicrobial prophylaxis in total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:737-40. [DOI: 10.1007/s00590-014-1540-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/28/2014] [Indexed: 12/23/2022]
|
75
|
Coraça-Huber D, Hausdorfer J, Fille M, Nogler M, Kühn KD. Calcium carbonate powder containing gentamicin for mixing with bone grafts. Orthopedics 2014; 37:e669-72. [PMID: 25102500 DOI: 10.3928/01477447-20140728-50] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/27/2013] [Indexed: 02/03/2023]
Abstract
Bone grafts are used for reconstructing bone defects caused by implant-associated complications, trauma, and tumors. Surgery with bone allografts is complex and time consuming; therefore, it is prone to a higher infection rate (2.0%-2.5%). In the case of site infection, systemically administered antibiotics cannot reach the infected bone graft. This study evaluated the use of resorbable bone graft substitute powder (HERAFILL; Heraeus Medical GmbH, Wehrheim, Germany) as a bone void-filling material as well as an antibiotic carrier for mixing with bone grafts. The antibiotic activity of the bone chips mixed with HERAFILL powder was measured by drug release tests and bacterial susceptibility with Bacillus subtilis, Staphylococcus epidermidis, and Staphylococcus aureus. HERAFILL powder was added to the bone chips (bone chips/HERAFILL; w/w = 1:1), mixed with a spatula, and vortexed for 1 minute. Gentamicin base release was evaluated in phosphate-buffered saline for up to 7 days using B subtilis bioassay. Antimicrobial efficacy was tested with S aureus and S epidermidis. The average amount of gentamicin base released from bone chips mixed with HERAFILL at 0 to 12 hours was 99.66 mg/mL. On day 7, the gentamicin base released 0.42 mg/mL. The elution released from bone chips mixed with HERAFILL promoted the formation of a zone of inhibition on S epidermidis and S aureus plates. This study confirmed the capacity of bone grafts to act as antibiotic carriers once mixed with HERAFILL powder. Bone chips mixed with HERAFILL showed efficacy against S aureus and S epidermidis.
Collapse
|
76
|
Lee PTH, Lakstein DL, Lozano B, Safir O, Backstein J, Gross AE. Mid-to long-term results of revision total hip replacement in patients aged 50 years or younger. Bone Joint J 2014; 96-B:1047-51. [DOI: 10.1302/0301-620x.96b8.31587] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Revision total hip replacement (THR) for young patients is challenging because of technical complexity and the potential need for subsequent further revisions. We have assessed the survivorship, functional outcome and complications of this procedure in patients aged < 50 years through a large longitudinal series with consistent treatment algorithms. Of 132 consecutive patients (181 hips) who underwent revision THR, 102 patients (151 hips) with a mean age of 43 years (22 to 50) were reviewed at a mean follow-up of 11 years (2 to 26) post-operatively. We attempted to restore bone stock with allograft where indicated. Using further revision for any reason as an end point, the survival of the acetabular component was 71% (sd 4) and 54% (sd 7) at ten- and 20 years. The survival of the femoral component was 80% (sd 4) and 62% (sd 6) at ten- and 20 years. Complications included 11 dislocations (6.1%), ten periprosthetic fractures (5.5%), two deep infections (1.1%), four sciatic nerve palsies (2.2%; three resolved without intervention, one improved after exploration and freeing from adhesions) and one vascular injury (0.6%). The mean modified Harris Hip Score was 41 (10 to 82) pre-operatively, 77 (39 to 93) one year post-operatively and 77 (38 to 93) at the latest review. This overall perspective on the mid- to long-term results is valuable when advising young patients on the prospects of revision surgery at the time of primary replacement. Cite this article: Bone Joint J 2014;96-B:1047–51.
Collapse
Affiliation(s)
- P. T. H. Lee
- Royal London Hospital, Barts
Health NHS Trust. Whitechapel Rd, London, E1
1BB, UK
| | | | - B. Lozano
- Hospital San Felipe de Jesus, Paseo
de los Leones #2508, Col. Cumbres her Sector, Monterey, N.L.
64610, México
| | - O. Safir
- Mount Sinai Hospital, Division
of Orthopaedic Surgery, 600 University Avenue, Toronto, Ontario
M5G 1X5, Canada
| | - J. Backstein
- Mount Sinai Hospital, Division
of Orthopaedic Surgery, 600 University Avenue, Toronto, Ontario
M5G 1X5, Canada
| | - A. E. Gross
- Mount Sinai Hospital, Division
of Orthopaedic Surgery, 600 University Avenue, Toronto, Ontario
M5G 1X5, Canada
| |
Collapse
|
77
|
Klatte TO, Kendoff D, Sabihi R, Kamath AF, Rueger JM, Gehrke T. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study. J Arthroplasty 2014; 29:1443-8. [PMID: 24559522 DOI: 10.1016/j.arth.2014.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 12/18/2013] [Accepted: 01/14/2014] [Indexed: 02/01/2023] Open
Abstract
During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction.
Collapse
Affiliation(s)
- Till Orla Klatte
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Daniel Kendoff
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Reza Sabihi
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Johannes M Rueger
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| |
Collapse
|
78
|
Increased release time of antibiotics from bone allografts through a novel biodegradable coating. BIOMED RESEARCH INTERNATIONAL 2014; 2014:459867. [PMID: 25045678 PMCID: PMC4090498 DOI: 10.1155/2014/459867] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 11/17/2022]
Abstract
The use of bone allografts is contraindicated in septic revision surgery due to the high risk of graft reinfection. Antibiotic release from the graft may solve the problem and these combinations can theoretically be used for prevention or even therapy of infection. The present study investigated whether amoxicillin, ciprofloxacin, and vancomycin alone or in combination with chitosan or alginate are suitable for short-term or long-term bone coating. Human bone allografts were prepared from femoral head and lyophilized. Antibiotic coating was achieved by incubating the grafts in antibiotic solution and freeze-drying again. Two biopolymers chitosan and alginate were used for creating sustained-release implantable coatings and the drug release profile was characterized in vitro by spectrophotometry. Using lyophilization with or without chitosan only resulted in short-term release that lasted up to 48 hours. Alginate coating enabled a sustained release that lasted for 8 days with amoxicillin, 28 days with ciprofloxacin coating, and 50 days with vancomycin coating. Using only implantable biodegradable allograft and polymers, a sustained release of antibiotics was achieved with ciprofloxacin and vancomycin for several weeks. Since the calculated daily release of the antibiotic was lower than the recommended IV dose, the calcium alginate coated bone graft can support endoprosthesis revision surgery.
Collapse
|
79
|
Shirai T, Tsuchiya H, Nishida H, Yamamoto N, Watanabe K, Nakase J, Terauchi R, Arai Y, Fujiwara H, Kubo T. Antimicrobial megaprostheses supported with iodine. J Biomater Appl 2014; 29:617-23. [PMID: 24913616 DOI: 10.1177/0885328214539365] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deep infection associated with implants remains a serious complication of orthopedic surgery. We developed iodine coating for titanium implants. In this study, we performed a clinical trial of iodine-coated megaprostheses to evaluate its safety and antibacterial effects. Forty-seven patients with malignant bone tumor or pyogenic arthritis were treated using iodine-supported titanium megaprostheses between July 2008 and May 2013. The mean age was 53.6 years (range, 15-85 years). Twenty-six patients were males and 21 were females. The diagnoses included malignant bone tumor in 29 cases, infected total knee arthroplasty in 11 cases, chronic osteomyelitis due to pyogenic arthritis in six cases and loosening of total knee arthroplasty in one case. The iodine-supported implants used were 42 Kyocera Limb Salvage System and five KOBELCO K-MAX K-3. These megaprostheses were used to prevent infection in 21 patients, treat active infections in 26 patients. The mean follow-up period was 30.1 months (range, 8-50). Infection was prevented in 20 out of 21 patients. Only one patient had surgical site infection caused by Pseudomonas aeruginosa and was cured by intravenous administration of antibiotics alone without removal of the implant. In 26 treatment cases involving one- or two-stage revision surgery, infection subsided without any additional surgery. In all cases, there were no signs of infection at the time of the last follow-up. White blood cell and C-reactive protein levels returned to normal within four weeks after surgery. To confirm systemic effects of iodine, thyroid hormone levels in the blood were examined. Abnormalities of thyroid gland function were not detected. Loosening of the implants was not observed. Excellent bone ingrowth and ongrowth were found around iodine-supported megaprostheses. The iodine-supported titanium megaprostheses are highly effective and show promise for the prevention and treatment of infections in large bone defects. No cytotoxicity or adverse effects were detected with this treatment.
Collapse
Affiliation(s)
- Toshiharu Shirai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Koji Watanabe
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Ryu Terauchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Yuji Arai
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan
| |
Collapse
|
80
|
Coraça-Huber DC, Wurm A, Fille M, Hausdorfer J, Nogler M, Kühn KD. Effect of freezing on the release rate of gentamicin palmitate and gentamicin sulfate from bone tissue. J Orthop Res 2014; 32:842-7. [PMID: 24676909 DOI: 10.1002/jor.22602] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/30/2014] [Indexed: 02/04/2023]
Abstract
In this study we evaluated gentamicin palmitate salt and gentamicin sulfate salt mixed with bone chips after storage at -80°C. Different concentration rates of gentamicin sulfate and gentamicin palmitate were mixed with human bone chips and stored for 1-6 months at -80°C. Nonstored samples were used as control. The release of the antibiotics from the bone was carried out in phosphate-buffered saline. Antibiotic concentrations in the elutions were determined with microbiological agar diffusion assay using Bacillus subtilis. Susceptibility tests were carried out using Staphylococci strains. The rate of gentamicin base (GB) released from bone was similar for all gentamicin salts and all storage conditions. The elutions released were efficient on reducing S. aureus and S. epidermidis CFU during all storage time. In resume, the capacity of bone grafts to act as gentamicin carriers has been confirmed in this study. GS + GP showed equivalent efficacy against S. aureus and S. epidermidis compared with GS pure. The lower delivery rate of GS + GP, related to its affinity with fat tissue can be an advantage for longer release times, increasing the local protection against infections. Storage at -80°C does not interfere on the gentamicin salts activity used.
Collapse
|
81
|
Kosashvili Y, Drexler M, Backstein D, Safir O, Lakstein D, Safir A, Chakravertty R, Dwyer T, Gross A. Dislocation after the first and multiple revision total hip arthroplasty: comparison between acetabulum-only, femur-only and both component revision hip arthroplasty. Can J Surg 2014; 57:E15-8. [PMID: 24666453 DOI: 10.1503/cjs.000913] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation between the components revised during hip arthroplasty (femur only, acetabulum only and both components) to the rates of dislocation in the first and multiple revision THA. METHODS We obtained data from consecutive revision THAs performed between January 1982 and December 2005. Patients were grouped into femur-only revision, acetabulum-only revision and revision THA for both components. RESULTS A total of 749 revision THAs performed during the study period met our inclusion criteria: 369 first-time revisions and 380 repeated revisions. Dislocation rates in patients undergoing first-time revisions (5.69%) were significantly lower than in those undergoing repeated revisions (10.47%; p = 0.022). Within the group of first-time revisions, dislocation rates for acetabulum-only revisions (10.28%) were significantly higher than those for both components (4.61%) and femur-only (0%) reconstructions (p = 0.025). CONCLUSION Although patients undergoing first-time revisions had lower rates of dislocations than those undergoing repeated revisions, acetabulum-only reconstructions performed at first-time revision arthroplasty entailed an increased risk for instability.
Collapse
Affiliation(s)
- Yona Kosashvili
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - Michael Drexler
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - David Backstein
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - Oleg Safir
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - Dror Lakstein
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - Alex Safir
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - Raja Chakravertty
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| | - Tim Dwyer
- The Department of Orthopaedic Sports Medicine, University of Toronto, Women's College Hospital, Toronto, Ont
| | - Allan Gross
- The Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ont
| |
Collapse
|
82
|
Rahaman MN, Bal BS, Huang W. Review: emerging developments in the use of bioactive glasses for treating infected prosthetic joints. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 41:224-31. [PMID: 24907755 DOI: 10.1016/j.msec.2014.04.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/02/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
Bacterial contamination of implanted orthopedic prostheses is a serious complication that requires prolonged systemic antibiotic therapy, major surgery to remove infected implants, bone reconstruction, and considerable morbidity. Local delivery of high doses of antibiotics using poly(methyl methacrylate) (PMMA) cement as the carrier, along with systemic antibiotics, is the standard treatment. However, PMMA is not biodegradable, and it can present a surface on which secondary bacterial infection can occur. PMMA spacers used to treat deep implant infections must be removed after resolution of the infection. Alternative carrier materials for antibiotics that could also restore deficient bone are therefore of interest. In this article, the development of bioactive glass-based materials as a delivery system for antibiotics is reviewed. Bioactive glass is osteoconductive, converts to hydroxyapatite, and heals to hard and soft tissues in vivo. Consequently, bioactive glass-based carriers can provide the combined functions of controlled local antibiotic delivery and bone restoration. Recently-developed borate bioactive glasses are of particular interest since they have controllable degradation rates coupled with desirable properties related to osteogenesis and angiogenesis. Such glasses have the potential for providing a new class of biomaterials, as substitutes for PMMA, in the treatment of deep bone infections.
Collapse
Affiliation(s)
- Mohamed N Rahaman
- Department of Materials Science and Engineering, Missouri University of Science and Technology, Rolla, MO 65409, USA.
| | - B Sonny Bal
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO 65211, USA
| | - Wenhai Huang
- Institute of Bioengineering and Information Technology Materials, School of Materials Science and Engineering, Tongji University, Shanghai 200092, China
| |
Collapse
|
83
|
Wolf M, Clar H, Friesenbichler J, Schwantzer G, Bernhardt G, Gruber G, Glehr M, Leithner A, Sadoghi P. Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange. INTERNATIONAL ORTHOPAEDICS 2014; 38:1363-8. [PMID: 24638215 DOI: 10.1007/s00264-014-2309-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 02/18/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE Prosthetic hip joint infection remains a challenging socio-economic problem. Curative treatment is usually a one- or two-stage revision surgery, but neither of these options has yet emerged as the treatment of choice. The aim of this study was to evaluate which of these methods produced superior outcomes. METHODS A retrospective study was performed including 92 patients with deep infections after implantation of primary total hip arthroplasty (THA) who had undergone either one-stage or two-stage revision surgery at a single centre. Infections were classified according to McPherson and we evaluated the rate of persisting infection or reinfection after surgical intervention. RESULTS The two-stage revision surgery revealed superior outcomes for the analysed infection categories compared to the one-stage procedure except for the least serious category of infections (i.e. McPherson Stage I/A/1, early postoperative infection, no systemic comorbidities, local status uncompromised). Eradication of prosthetic infection was achieved in 94.5 % (n = 52) within the group of two-stage exchange, and 56.8 % (n = 21) of patients treated with a one-stage procedure. Outcome of patients following a one-stage or a two-stage exchange was overall significantly different with p < 0.001. Further deviations between the described two procedures were noted in the subgroups following the classification described by McPherson. CONCLUSIONS Our results indicate superiority of two-stage revision surgery in case of serious infections. The authors believe that decisions on the surgical approach for the treatment of deep prosthesis infections should be made on the basis of standardized staging systems.
Collapse
Affiliation(s)
- Matthias Wolf
- Department of Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
84
|
Mauerer A, Lange B, Welsch GH, Heidenau F, Adler W, Forst R, Richter RH. Release of Cu2+ from a copper-filled TiO2 coating in a rabbit model for total knee arthroplasty. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:813-821. [PMID: 24343105 DOI: 10.1007/s10856-013-5116-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 11/29/2013] [Indexed: 06/03/2023]
Abstract
The aim of this study was the investigation of a copper-filled TiO2 coating, that in vitro showed good antibacterial properties combined with good tissue tolerance in an animal model. To better understand the antibacterial mechanism of the bioactive coating the release of copper (Cu) ions over time was monitored to be able to detect possible threats as well as possible fields of application. 30 New Zealand White rabbits were divided into two groups with 15 animals per group. In group 1 (control group) Ti6Al4 V bolts were implanted into the distal femur, in group 2 the Ti6Al4 V bolts were coated with four TiO2-coatings with integrated Cu(2+)-ions (4 × Cu-TiO2). Blood tests were performed weekly until the animals were sacrificed 4 weeks postoperative. The maximum peak of Cu and ceruloplasmin concentration could be seen in both groups one week postoperative, whereas the Cu values in group II were significantly higher. The Cu concentration in both groups approximated the initial basic values 4 weeks postoperative. The 4 × Cu-TiO2 coating tested in our rabbit model for total knee arthroplasty is an active coating that releases potentially antibacterial Cu(2+) for 4 weeks with a peak 1 week postoperative. The bioactive coating could be a promising approach for a use in the field of implant related infection, orthopaedic revision and tumor surgery in the future.
Collapse
Affiliation(s)
- Andreas Mauerer
- Department of Orthopaedic Trauma Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany,
| | | | | | | | | | | | | |
Collapse
|
85
|
Scherrer CB, Mannion AF, Kyburz D, Vogt M, Kramers-de Quervain IA. Infection risk after orthopedic surgery in patients with inflammatory rheumatic diseases treated with immunosuppressive drugs. Arthritis Care Res (Hoboken) 2014; 65:2032-40. [PMID: 23861140 DOI: 10.1002/acr.22077] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/04/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The influence of specific medications on the risk of postoperative infection in patients with rheumatoid arthritis and other inflammatory rheumatic diseases (IRDs) remains unclear. This retrospective study examined the risk of postoperative infection at the site of surgery in patients treated with immunosuppressive drugs (including biologic agents) undergoing different types of orthopedic surgery. METHODS The study included 50,359 cases of orthopedic surgery performed in our hospital between 2000 and 2008. The primary outcome was operation-related infection. IRD patients were compared with those with degenerative or posttraumatic disorders, and in IRD patients, the effect of immunosuppressive medication, specifically tumor necrosis factor α (TNFα) inhibitors and their preoperative management, was examined. RESULTS There were 373 operation-related infections (0.8%) of 47,887 cases in the degenerative/posttraumatic group and 49 (2.0%) of 2,472 in the IRD group (higher infection rate in the IRD group; odds ratio [OR] 2.58 [95% confidence interval (95% CI) 1.91-3.48], P < 0.001). In the IRD group, elbow and foot surgery had the highest infection rates. The risk of infection was significantly increased in patients taking multiple conventional disease-modifying antirheumatic drugs (DMARDs; OR 2.49 [95% CI 1.06-5.84], P = 0.036) or TNFα inhibitors (OR 2.54 [95% CI 1.08-5.97], P = 0.032). The risk was especially high (6 [12%] of 49) if the last dose of TNFα inhibitor was given <1 administration interval before surgery. CONCLUSION The risk of postoperative infection was elevated in patients with IRDs, especially those taking >1 conventional DMARD or TNFα inhibitors. It may be advisable to consider stopping TNFα inhibitors ≥1 administration interval before surgery, since the risk of postoperative infection appears to be higher if the operation occurs within this period.
Collapse
|
86
|
Incidence of bacterial contamination in primary THA and combined hardware removal: analysis of preoperative aspiration and intraoperative biopsies. J Arthroplasty 2013; 28:1677-80. [PMID: 23523208 DOI: 10.1016/j.arth.2013.02.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/04/2013] [Accepted: 02/16/2013] [Indexed: 02/01/2023] Open
Abstract
Prior fracture surgery in the setting of subsequent arthroplasty may confer an increased risk of infection. The current authors retrospectively reviewed 122 patients from 2006 to 2010. Joint aspirations performed preoperatively in two of 52 patients revealed bacterial growth. Preoperative CRP levels were elevated in 22.8% with a mean value of 10.4 mg/L (range 5.5 to 33.3). Intra-operative cultures were performed in 109 patients, with a single patient sample exhibiting bacterial growth (0.9%). Preoperative aspiration showed a sensitivity of 1.0 and specificity of 0.98 (P<0.039) for bacterial contamination. There was no postoperative periprosthetic infection noted. In conclusion the retrieval of internal fixation devices and total hip arthroplasty can be performed safely as a single stage procedure without significantly increasing the risk of periprosthetic infection.
Collapse
|
87
|
Whitehouse MR, Stefanovich-Lawbuary NS, Brunton LR, Blom AW. The impact of leg length discrepancy on patient satisfaction and functional outcome following total hip arthroplasty. J Arthroplasty 2013; 28:1408-14. [PMID: 23507069 DOI: 10.1016/j.arth.2012.12.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/04/2012] [Accepted: 12/18/2012] [Indexed: 02/06/2023] Open
Abstract
A series of 191 patients undergoing THA with a standardised stem were studied. The effect of leg length discrepancy (LLD) on patient function (Oxford Hip Score), health measures (Short Form 12) and satisfaction (Self-Administered Patient Satisfaction Scale) at a mean 3.8 years of follow up (range 3.3 to 4.9) is reported. 8.9% of cases had shortening, 0.5% no LLD and 90.6% had lengthening. In 21.5% the LLD was more than 10mm, in 37.1% 5-10mm, and in 40.9% 0-5mm. There was no significant difference in patient reported outcome measures (PROMs) according to LLD. Correlation of recorded measurements between multiple observers was excellent (0.93). LLD following total hip arthroplasty remains common but in this series, was not correlated with PROMs.
Collapse
Affiliation(s)
- Michael R Whitehouse
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Lower Level AOC, Southmead Hospital, Westbury-on-Trym, UK
| | | | | | | |
Collapse
|
88
|
Whitehouse MR, Dacombe PJ, Webb JCJ, Blom AW. Impaction grafting of the acetabulum with ceramic bone graft substitute: high survivorship in 43 patients with a mean follow-up period of 4 years. Acta Orthop 2013; 84:371-6. [PMID: 23992140 PMCID: PMC3768036 DOI: 10.3109/17453674.2013.824801] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Loss of bone stock remains a challenge in revision hip surgery. Grafting with allograft is well established, but there are problems with availability, cost, infection, antigenicity, reproducibility, and stability of the created construct. BoneSave is a biphasic porous ceramic consisting of sintered 80% tricalcium phosphate and 20% hydroxyapatite. In vitro and in vivo studies, including its use mixed with allograft, have shown good results in impaction grafting. This is the first reported series of its use alone in impaction grafting of the acetabulum. METHODS We conducted a retrospective review of a cohort of 43 consecutive patients undergoing impaction grafting of contained acetabular defects by multiple surgeons at a single centre. All patients received uncemented acetabular components. They were followed up radiographically, together with self-reported satisfaction scale (SAPS), Oxford hip score (OHS), and Short-Form 12 (SF12) health survey. Kaplan-Meier survivorship analysis was performed with revision of the acetabular component, revision of any part of the construct, and reoperation as endpoints. RESULTS The fate of all cases was known. Mean follow-up was 4 years. 5 patients died during follow-up, with their constructs in situ. The survivorship of the acetabular component was 98% (95% CI: 85-100) at 7 years. 1 acetabular component was revised for infection and there was 1 radiographic acetabular failure. The median OHS was 36 (6-48), the median SF12 PCS was 36 (14-57), the median SAPS was 75 (0-100), and the median SF12 MCS was 50 (23-64). The graft material had incorporated in all 3 zones of the acetabulum in 33 out of 37 cases with complete radiographic follow-up. INTERPRETATION Medium-term results show that BoneSave alone is a reliable material for impaction grafting of contained defects in the acetabulum at revision surgery.
Collapse
Affiliation(s)
- Michael R Whitehouse
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Southmead Hospital, Westbury-on-Trym; Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Peter J Dacombe
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Southmead Hospital, Westbury-on-Trym; Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jason C J Webb
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Southmead Hospital, Westbury-on-Trym; Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Southmead Hospital, Westbury-on-Trym; Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
89
|
Whitehouse MR, Dacombe PJ, Webb JCJ, Blom AW. Impaction grafting of the acetabulum with ceramic bone graft substitute mixed with femoral head allograft: high survivorship in 43 patients with a median follow-up of 7 years: a follow-up report. Acta Orthop 2013; 84:365-70. [PMID: 23594223 PMCID: PMC3768035 DOI: 10.3109/17453674.2013.792031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Restoration of bone stock at revision hip surgery remains a challenge. Alternative graft materials with suitable mechanical properties for impaction grafting have been sought due to issues with infection, antigenicity, cost, and availability of allograft. We have previously presented good short-term results of the use of BoneSave, a biphasic porous ceramic bone graft substitute, consisting of sintered 80% tricalcium phosphate and 20% hydroxyapatite, in a 50:50 mix with femoral head allograft. We now present the medium-term results. METHODS We conducted a retrospective review of a cohort of 43 consecutive patients undergoing impaction grafting of contained acetabular defects by multiple surgeons at a single center. 34 patients received uncemented acetabular components and 9 received cemented components. Patients were followed up radiographically and with the self-reported satisfaction scale (SAPS), Oxford hip score (OHS), and the Short-Form 12 (SF12) health survey. Kaplan-Meier survivorship analysis was performed with revision of the acetabular component, revision of any part of the construct, and reoperation as endpoints. RESULTS The fate of all cases was known. Median follow-up of the surviving patients was 80 (69-106) months. 15 patients died during the follow-up period, 14 with their construct in situ. The survivorship of the grafted acetabulum and acetabular component was 94% (95% CI: 99-78) at 7 years. 1 patient had been revised for aseptic loosening of the acetabulum and 1 for deep infection. The mean OHS was 31 (SD 12), the mean SF12 physical-component score (PCS) was 38 (SD 13), the median SAPS was 83 (0-100), and the median SF12 mental-component score (MCS) was 55 (23-65). The graft material became incorporated in all 3 zones of the acetabulum in 23 out of 24 cases that had complete radiographic follow-up. INTERPRETATION These medium-term results show that BoneSave is a reliable material for impaction grafting of the acetabulum when used in conjunction with femoral head allograft.
Collapse
Affiliation(s)
- Michael R Whitehouse
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Lower Level AOC, Southmead Hospital, Westbury-on-Trym,Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Peter J Dacombe
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jason C J Webb
- Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Department of Academic Orthopaedics, University of Bristol, Lower Level AOC, Southmead Hospital, Westbury-on-Trym,Avon Orthopaedic Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| |
Collapse
|
90
|
Gentamicin palmitate as a new antibiotic formulation for mixing with bone tissue and local release. Cell Tissue Bank 2013; 15:139-44. [PMID: 23793827 DOI: 10.1007/s10561-013-9384-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/14/2013] [Indexed: 01/05/2023]
Abstract
During surgery with bone grafting, the impaction of bone tissue creates an avascular area where local circulation is disrupted. If infections arise, they may prevent systemically administered antibiotics from reaching the infected bone. In this study we evaluated gentamicin palmitate (GP) mixed with gentamicin sulfate (GS) as a coating for bone chips (BCh). The efficacy of the coated BCh was measured by gentamicin base release tests using B. subtilis, S. epidermidis and S. aureus. Gentamicin base release was evaluated in phosphate-buffered saline for up to 7 days using B. subtilis bioassay. Antimicrobial efficacy was tested with S. aureus and S. epidermidis. A significant difference on the release of gentamicin base between GS and GS + GP was observed. S. epidermidis are significantly more susceptible to GS + GP and GS than S. aureus. BCh can act as gentamicin carriers and showed efficacy against S. aureus and S. epidermidis.
Collapse
|
91
|
Song Z, Borgwardt L, Høiby N, Wu H, Sørensen TS, Borgwardt A. Prosthesis infections after orthopedic joint replacement: the possible role of bacterial biofilms. Orthop Rev (Pavia) 2013; 5:65-71. [PMID: 23888204 PMCID: PMC3718238 DOI: 10.4081/or.2013.e14] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/10/2013] [Accepted: 03/10/2013] [Indexed: 12/16/2022] Open
Abstract
Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore, important to understand the comprehensive interaction between the microbiological situation and the host immune responses that lead to prosthesis infections. Evidence indicates that prosthesis infections are actually biofilm-correlated infections that are highly resistant to antibiotic treatment and the host immune responses. The authors reviewed the related literature in the context of their clinical experience, and discussed the possible etiology and mechanism leading to the infections, especially problems related to bacterial biofilm, and prophylaxis and treatment of infection, including both microbiological and surgical measures. Recent progress in research into bacterial biofilm and possible future treatment options of prosthesis-related infections are discussed.
Collapse
|
92
|
Sims AL, Baker P, Bellamy R, McMurtry IA. Outpatient parenteral antibiotic therapy in primary hip and knee arthroplasty infection managed with debridement and retention of prosthesis: a retrospective cohort study. Surg Infect (Larchmt) 2013; 14:293-6. [PMID: 23672241 DOI: 10.1089/sur.2012.078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Attempted joint salvage of infected primary arthroplasty traditionally has utilized joint washouts in combination with costly long-term inpatient parenteral antibiotic regimens. Outpatient and home parenteral antibiotic therapy (OHPAT) represents a potential alternative. However, there is a lack of published data on its value for primary deep arthroplasty infection. This paper describes the surgical and microbiologic outcomes of a cohort of patients with deep arthroplasty infections treated with OHPAT after surgical washout and debridement. METHODS Local OHPAT records identified all patients who underwent attempted joint salvage of a primary hip or knee replacement complicated by a deep post-operative infection between February 2006 and February 2009. Minimum follow-up for all patients was 24 mos. For each patient, hospital records were reviewed to ascertain the effectiveness of treatment. RESULTS In total, 14 patients (10 total knee replacements; four total hip replacements) were identified from the records. Eleven joints (79%) were salvaged. There was a trend toward a higher salvage rate with early infection (<6 mos after primary surgery), with eight of nine joints (89%) being salvaged, versus 60% (three of five) for later presentation. Methicillin-sensitive Staphylococcus aureus was the most common organism identified (43% of cases), and 57% of infections were polymicrobial. The average duration of OHPAT was 58 days. Two patients were readmitted because of clinical deterioration, both of whom later required revision. All patients, regardless of their outcomes, stated they were satisfied with the OHPAT service and believed it was more convenient than inpatient treatment. We estimate OHPAT saved approximately £13,000 per patient episode. CONCLUSIONS Use of OHPAT for deep infection after primary arthroplasty has a high success rate. It is effective at identifying patients failing treatment, is cost-effective, and has a high level of patient satisfaction.
Collapse
Affiliation(s)
- Alex L Sims
- James Cook University Hospital, Middlesbrough, United Kingdom.
| | | | | | | |
Collapse
|
93
|
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73-156. [PMID: 23461695 DOI: 10.1089/sur.2013.9999] [Citation(s) in RCA: 684] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Dale W Bratzler
- College of Public Health, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
94
|
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195-283. [DOI: 10.2146/ajhp120568] [Citation(s) in RCA: 1364] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
95
|
Talatzko S, Deprey SM, Hager N. Comprehensive facility-wide approach improves outcomes after lower extremity surgical arthroplasty in an acute care hospital. J Healthc Qual 2013; 36:17-27. [PMID: 23294000 DOI: 10.1111/jhq.12000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The number of total knee and hip arthroplasty is predicted to rise 174% and 673%, respectively, over the next 20 years due to the expected rise in the baby boomer population. Along with increased numbers or procedures performed is the rise in cost and potential medical complications from hospitalizations. The purpose of this study is to describe one rural hospital's facility-wide procedure to streamline processes and standardize care without compromising patient medical needs prior to, and during, the acute phase of total knee and hip arthroplasty. Data were compared before and after the facility-wide procedure was implemented. Results found shorter length of hospital stay and significantly more discharges directly home all without increasing medical complications after the facility-wide procedure was implemented.
Collapse
|
96
|
Gemella haemolysans Infection in Total Hip Arthroplasty. Case Rep Orthop 2012; 2012:691703. [PMID: 23227390 PMCID: PMC3504247 DOI: 10.1155/2012/691703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 03/15/2012] [Indexed: 12/16/2022] Open
Abstract
Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.
Collapse
|
97
|
Shigemura T, Kishida S, Iida S, Oinuma K, Nakamura J, Takahashi K, Harada Y. Cementless total hip arthroplasty for osteonecrosis of the femoral head in systemic lupus erythematosus: a study with 10–16 years of follow-up. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s12570-012-0149-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
98
|
Abstract
Prosthetic joint infections represent a major therapeutic challenge for both healthcare providers and patients. This article reviews the predisposing factors, pathogenesis, microbiology, diagnosis, treatment, and prophylaxis of prosthetic joint infection. The most optimal management strategy should be identified on the basis of a number of considerations, including type and duration of infection, antimicrobial susceptibility of the infecting pathogen, condition of infected tissues and bone stock, patient wishes, and functional status.
Collapse
Affiliation(s)
- Saima Aslam
- Division of Infectious Diseases, Department of Medicine, University of California, San Diego, 200 W. Arbor Drive, NARF 307, MC 8415, San Diego, CA, 92103, USA,
| | | |
Collapse
|
99
|
Post-operative radiographic factors and patient-reported outcome after total hip replacement. Hip Int 2012; 22:153-9. [PMID: 22547373 DOI: 10.5301/hip.2012.9225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2012] [Indexed: 02/04/2023]
Abstract
Although total hip replacement (THR) is considered a very successful surgical intervention, a proportion of patients experience persistent pain or disability, and/or dissatisfaction with the outcome of surgery. Our aim was to determine whether post-operative radiographic variables were predictive of patient-reported pain, function and satisfaction after primary THR. At 1-3 years after surgery patients completed the WOMAC Pain scale, WOMAC Function scale and a validated measure of satisfaction with the outcome of surgery. Post-operative radiographs taken prior to discharge were graded for the restoration of offset, restoration of leg length, anteroposterior (AP) alignment of the femoral stem and AP acetabular inclination. Binary logistic regression was used to identify whether radiographic variables were significant predictors of patient-reported outcome scores. Radiographic and patient-reported outcomes data were available for 452 THR patients. No radiographic predictors were found to be significant predictors of patient reported pain, function or satisfaction at 1-3 years after THR. This highlights that patients with continuing problems after THR may benefit from a thorough multidisciplinary assessment to diagnose the underlying cause of the problems.
Collapse
|
100
|
Long-term patient-reported outcomes after total hip replacement: comparison to the general population. Hip Int 2012; 22:160-5. [PMID: 22547380 DOI: 10.5301/hip.2012.9230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2012] [Indexed: 02/04/2023]
Abstract
Hip replacement is one of the most common elective procedures performed in the NHS, with patients generally reporting good mid-term outcomes. However, patient-reported long-term outcomes have been less well studied. The aim of this study was to explore the extent of variation in long-term patient reported outcomes after total hip replacement (THR), and to compare outcomes to a control population without THR. All patients who had undergone primary THR at one centre 12-16 years ago and who had previously completed an Oxford hip score (OHS) 5-8 years post-operatively were invited to complete a postal OHS. Participants in the control group who had not undergone hip or knee replacement also completed an OHS. The Oxford hip score (OHS) was completed by 407 THR patients and 927 controls. The median score of 18 for the THR patients was significantly worse than the median score of 12 for the control group (p <0.001). Similar results were found when comparisons were stratified by age. There was considerable variation in change in OHS from 5-8 years to 12-16 years post-operatively, although a significant worsening in outcome was found only in patients over 80 years old. Patients continue to report good functional outcomes at 12-16 years after THR, although function is signficantly worse than the general population who have not undergone THR.
Collapse
|