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Chan LYT, Yuen WLP, Raghuraman R. Concomitant Cement Spacer and Peri-spacer Fractures Seven Years After First-stage Revision Knee Arthroplasty: A Case Report. J Orthop Case Rep 2024; 14:78-83. [PMID: 38681934 PMCID: PMC11043965 DOI: 10.13107/jocr.2024.v14.i04.4366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/25/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Prosthetic joint infections (PJIs) remain an undesirable complication after total knee arthroplasties. Two-stage revision arthroplasty is the current standard of care for treating PJIs. However, the incidence of spacer retention for prolonged periods is increasing, with little known about its potential complications. Case Report We present a case of a 64-year-old female of Southeast Asian descent who had a cement spacer maintained in-situ for 7 years due to poor patient compliance with subsequent follow-up. Conclusion While patients have satisfactory functional outcomes with the cement spacer, it is not meant for permanent weight bearing. Two-stage revision arthroplasties are only as effective as patients' compliance with subsequent follow-up and surgery. Clinicians must discourage patients from forgoing subsequent follow-up visits and surgery despite satisfactory function and quality of life with the cement spacer in situ to prevent complications related to prolonged retention of cement spacers.
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Affiliation(s)
- Li Yi Tammy Chan
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Rodrigues-Lopes R, Silva F, Torres J. Periprosthetic shoulder infection management: one-stage should be the way: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:722-737. [PMID: 37839627 DOI: 10.1016/j.jse.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND There is still no consensus among surgeons on whether to perform a 1- or 2-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection, and other clinical complications in order to discuss which is the best strategy for treating periprosthetic joint infection after shoulder arthroplasty. METHODS Upon research using the PubMed, Scopus, and Web of Science databases, in November 2022, studies that presented 1- or 2-stage surgical revision as a treatment for periprosthetic joint infection after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) score. Reinfection and complication rates were extracted, and pooled estimates were calculated using the random-effect model. RESULTS After careful screening, 44 studies were included, 5 reporting on 1-stage and 30 on 2-stage revisions and 9 assessing both strategies. A total of 185 shoulders were reported in 1-stage revision studies, whereas 526 shoulders were reported in 2-stage revision studies. The overall pooled random-effects reinfection rate was 6.68% (95% confidence interval [CI]: 3.76-10.13), with low heterogeneity (I2 = 28%, P = .03). One-stage revision showed a reinfection rate of 1.14% (95% CI: 0.00-4.88), whereas 2-stage revision analysis revealed a reinfection rate of 8.81% (95% CI: 4.96-13.33). There were significant statistical differences between 1- and 2-stage reinfection rates (P = .04). The overall pooled rate for other clinical complications was 16.76% (95% CI: 9.49-25.15), with high heterogeneity (I2 = 70%, P < .01). One-stage revision had a complication rate of 6.11% (95% CI: 1.58-12.39), whereas the 2-stage revision complication rate was 21.26% (95% CI: 11.51-32.54). This difference was statistically significant (P = .03). CONCLUSIONS This is the first systematic review and meta-analysis showing significant statistical differences between 1- and 2-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, 1-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.
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Affiliation(s)
| | - Fábia Silva
- Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal
| | - João Torres
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal
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Yeo PY, Joseph T, Kunnasegaran R. Short-term outcomes of articular cement spacer in the treatment of prosthetic knee joint infections: a retrospective case series. Singapore Med J 2023:386982. [PMID: 37929559 DOI: 10.4103/singaporemedj.smj-2021-389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Ping Yen Yeo
- Department of Orthopaedic Surgery, Khoo Teck Puat Hospital; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Titus Joseph
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Su X, Zhu B, Qin L, Yang J, Wei L, Xu Z, Wei K, Wang J, Chen L, Zhao C, Chen C, Huang W, Xiong Y, Hu N. Joint fluid interleukin-6 combined with the neutral polymorphonuclear leukocyte ratio (PMN%) as a diagnostic index for chronic periprosthesis infection after arthroplasty. J Orthop Traumatol 2023; 24:34. [PMID: 37402969 DOI: 10.1186/s10195-023-00712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND The diagnosis of periprosthetic joint infection (PJI) remains a challenge in clinical practice. Many novel serum and joint fluid biomarkers have important implications for the diagnosis of PJI. The presented study evaluated the value of joint fluid interleukin-6 (IL-6) combined with the neutral polymorphonuclear leukocyte (PMN%) ratio for chronic PJI diagnosis after arthroplasty. MATERIALS AND METHODS Sixty patients with chronic PJI or aseptic failure who underwent hip or knee revision from January 2018 to January 2020 in our department were included in this retrospective study. According to the 2013 MSIS diagnostic criteria, the 60 patients were divided into a PJI group and a non-PJI group (30 patients per group). We collected the joint fluid before surgery and determined the level of IL-6 and the PMN% by ELISA, and the differences between the two groups were compared. The diagnostic efficacy of joint fluid IL-6 combined with PMN% in chronic PJI was analyzed using a receiver operating characteristic curve (ROC curve). RESULTS The diagnosis of PJI using joint fluid IL-6 combined with PMN% presented an area under the curve of 0.983, which was more accurate than the areas under the curve for diagnosis using IL-6 and PMN% individually (0.901 and 0.914, respectively). The optimal threshold values for IL-6 and PMN% were 662.50 pg/ml and 51.09%, respectively. Their sensitivity and specificity were 96.67% and 93.33%, respectively. The accuracy of the diagnosis of PJI was 95.00%. CONCLUSIONS Joint fluid IL-6 combined with PMN% can be used as an auxiliary method to detect chronic infection around the prosthesis after hip/knee arthroplasty. LEVEL OF EVIDENCE Patients who underwent hip/knee revision at the First Hospital of Chongqing Medical University for periprosthetic infection or aseptic failure of the prosthesis after hip/knee arthroplasty from January 2018 to January 2020 were included. Trial registration This study was approved by the ethics committee of the First Hospital of Chongqing Medical University on September 26, 2018 (local ethics committee number: 20187101) and registered with the China Clinical Trials Registry (registration number: ChiCTR1800020440) with an approval date of December 29, 2018.
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Affiliation(s)
- Xudong Su
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Bo Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Leilei Qin
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Jianye Yang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Li Wei
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Zhenghao Xu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Keyu Wei
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Jiayi Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Li Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Chen Zhao
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Cheng Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China
| | - Yan Xiong
- Department of Orthopedics, Daping Hospital, Army Medical University, Chongqing, China.
| | - Ning Hu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Laboratory of Orthopedics, Chongqing Medical University, Chongqing, 400016, China.
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Sambri A, Fiore M, Rondinella C, Morante L, Paolucci A, Giannini C, Alfonso C, De Paolis M. Mechanical complications of hip spacers: a systematic review of the literature. Arch Orthop Trauma Surg 2023; 143:2341-2353. [PMID: 35414129 PMCID: PMC10110705 DOI: 10.1007/s00402-022-04427-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/17/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Temporary spacers used in the staged revision of a hip prosthetic joint infection (PJI) have been associated with several mechanical complications with very variable reported general complications rates up to 73%. The aim of this systematic review was to assess the mechanical complications associated with hip antibiotic-loaded spacers when treating periprosthetic hip PJI. METHODS Through an electronic systematic search of PubMed, articles reporting mechanical complications of spacers used in the treatment of hip PJI were reviewed. Dislocations, spacer fracture, femoral fractures, and acetabular lysis rates were evaluated. RESULTS Forty studies were included. Standardized molded spacers had a significantly higher weighted mean of total mechanical complication rates (37.2%) when compared to standardized preformed spacers (13.8%, p = 0.039), while no significant difference was found between molded spacers and manually shaped spacers. Spacer dislocation was the most frequent complication. No significant difference in mechanical complication rate was found between spacers with and without any metallic component. CONCLUSIONS Spacer placement in chronic PJI of the hip with bone and soft-tissue defects is challenging and bears a high risk of mechanical failures and progressive bone loss during the interim period. A careful patient selection for spacer implantation is mandatory.
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Affiliation(s)
- Andrea Sambri
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.
- University of Bologna, Bologna, Italy.
| | | | | | | | | | | | - Calogero Alfonso
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Massimiliano De Paolis
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
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Huang C, Chen Y, Ding H, Huang Z, Zhang C, Li W, Liu X, Tu Z, Zhang W, Fang X. Metal Artifact Reduction Sequences MRI: A Useful Reference for Preoperative Diagnosis and Debridement Planning of Periprosthetic Joint Infection. J Clin Med 2022; 11:jcm11154371. [PMID: 35955986 PMCID: PMC9369276 DOI: 10.3390/jcm11154371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/26/2022] Open
Abstract
The diagnosis and treatment of periprosthetic joint infection (PJI) is complex and the use of MRI in PJI is gaining attention from orthopedic surgeons as MR technology continues to advance. This study aimed to investigate whether metal artefact reduction sequence (MARS) MRI could be used as an adjunct in the preoperative diagnosis of PJI and to explore its role in PJI debridement planning. From January 2020 to November 2021, participants with metal joint prostheses that needed to be judged for infection were prospectively enrolled. According to Musculoskeletal Infection Society standards, 31 cases were classified as infection, and 20 as non-infection. The sensitivity and specificity of MARS MRI for the diagnosis of PJI were 80.65% and 75%, respectively. In MARS MRI, the incidence of bone destruction, lamellar synovitis, and extracapsular soft tissue oedema were significantly higher in PJI than in non-PJI. Fourteen suspicious occult lesions were found in the preoperative MARS MRI in 9 cases, and the location of 9 infection lesions was confirmed intraoperatively. In conclusion, MARS MRI is an effective diagnostic tool for PJIand can provide a visual reference for preoperative surgical planning.
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Affiliation(s)
- Changyu Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
| | - Yang Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
| | - Haiqi Ding
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
| | - Zida Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
| | - Chaofan Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
| | - Wenbo Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
| | - Xi Liu
- Department of Radiology and Imaging, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (X.L.); (Z.T.)
| | - Zhanhai Tu
- Department of Radiology and Imaging, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (X.L.); (Z.T.)
| | - Wenming Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
- Correspondence: (W.Z.); (X.F.)
| | - Xinyu Fang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, China; (C.H.); (Y.C.); (H.D.); (Z.H.); (C.Z.); (W.L.)
- Correspondence: (W.Z.); (X.F.)
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