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Fraval A, Zappley NR, Brown SA. Methylene Blue Infiltration As a Method for Distinguishing Superficial and Deep Infections. J Arthroplasty 2024; 39:224-228. [PMID: 37531982 DOI: 10.1016/j.arth.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND There are no established objective methods to reliably differentiate between superficial and deep infection in the setting of total hip arthroplasty. We employed a technique of distinguishing superficial and deep infections by infiltrating methylene blue to a prosthetic hip during infection workup to determine its effectiveness and to characterize its utility in defining the joint cavity where deep debridement is required. METHODS An analysis was conducted on 35 patients who preoperatively received an injection of methylene blue under radiological guidance to their total hip arthroplasty. Where established periprosthetic joint infection (PJI) criteria were not met, without signs of methylene blue beyond the deep fascia, the infection was considered superficial, and debridement remained superficial to the deep fascia. Where diagnosis of PJI was confirmed preoperatively or the presence of methylene blue in the wound cavity confirmed deep contamination, the prosthesis was addressed with methylene blue staining defining the joint cavity as a guide for debridement. RESULTS There were 11 patients who had no methylene blue extrusion into the superficial compartment and did not meet PJI criteria. Eight patients failed to meet PJI criteria preoperatively, but had extrusion of methylene blue, confirming a deep infection intraoperatively. There were 16 patients who met PJI criteria preoperatively with methylene blue acting as a visual guide to the joint space. CONCLUSION Infiltrating methylene blue in a prosthetic hip is useful in differentiating between superficial or deep infections where PJI workup is indeterminate. Where deep infection is present, its utility in defining the joint cavity may be advantageous.
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Affiliation(s)
- Andrew Fraval
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicolina R Zappley
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scot A Brown
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Lovis C, Seidel A, Matvieieva N, Neupetsch C, Teicher U, Lemme G, Ben Achour A, Barth M, Ihlenfeldt S, Drossel WG. Unique Device Identification-Based Linkage of Hierarchically Accessible Data Domains in Prospective Surgical Hospital Data Ecosystems: User-Centered Design Approach. JMIR Med Inform 2023; 11:e41614. [PMID: 36705946 PMCID: PMC9919462 DOI: 10.2196/41614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The electronic health record (EHR) targets systematized collection of patient-specific, electronically stored health data. The EHR is an evolving concept driven by ongoing developments and open or unclear legal issues concerning medical technologies, cross-domain data integration, and unclear access roles. Consequently, an interdisciplinary discourse based on representative pilot scenarios is required to connect previously unconnected domains. OBJECTIVE We address cross-domain data integration including access control using the specific example of a unique device identification (UDI)-expanded hip implant. In fact, the integration of technical focus data into the hospital information system (HIS) is considered based on surgically relevant information. Moreover, the acquisition of social focus data based on mobile health (mHealth) is addressed, covering data integration and networking with therapeutic intervention and acute diagnostics data. METHODS In addition to the additive manufacturing of a hip implant with the integration of a UDI, we built a database that combines database technology and a wrapper layer known from extract, transform, load systems and brings it into a SQL database, WEB application programming interface (API) layer (back end), interface layer (rest API), and front end. It also provides semantic integration through connection mechanisms between data elements. RESULTS A hip implant is approached by design, production, and verification while linking operation-relevant specifics like implant-bone fit by merging patient-specific image material (computed tomography, magnetic resonance imaging, or a biomodel) and the digital implant twin for well-founded selection pairing. This decision-facilitating linkage, which improves surgical planning, relates to patient-specific postoperative influencing factors during the healing phase. A unique product identification approach is presented, allowing a postoperative read-out with state-of-the-art hospital technology while enabling future access scenarios for patient and implant data. The latter was considered from the manufacturing perspective using the process manufacturing chain for a (patient-specific) implant to identify quality-relevant data for later access. In addition, sensor concepts were identified to use to monitor the patient-implant interaction during the healing phase using wearables, for example. A data aggregation and integration concept for heterogeneous data sources from the considered focus domains is also presented. Finally, a hierarchical data access concept is shown, protecting sensitive patient data from misuse using existing scenarios. CONCLUSIONS Personalized medicine requires cross-domain linkage of data, which, in turn, require an appropriate data infrastructure and adequate hierarchical data access solutions in a shared and federated data space. The hip implant is used as an example for the usefulness of cross-domain data linkage since it bundles social, medical, and technical aspects of the implantation. It is necessary to open existing databases using interfaces for secure integration of data from end devices and to assure availability through suitable access models while guaranteeing long-term, independent data persistence. A suitable strategy requires the combination of technical solutions from the areas of identity and trust, federated data storage, cryptographic procedures, and software engineering as well as organizational changes.
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Affiliation(s)
| | - André Seidel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Nataliia Matvieieva
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Constanze Neupetsch
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Professorship for Adaptronics and Lightweight Design in Production, Technische Universität Chemnitz, Chemnitz, Germany
| | - Uwe Teicher
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Gordon Lemme
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Anas Ben Achour
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany
| | - Martin Barth
- Fraunhofer Institute for Ceramic Technologies and Systems IKTS, Dresden, Germany
| | - Steffen Ihlenfeldt
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Chair of Machine Tools Development and Adaptive Controls, Technische Universität Dresden, Dresden, Germany
| | - Welf-Guntram Drossel
- Fraunhofer Institute for Machine Tools and Forming Technology IWU, Dresden, Germany.,Professorship for Adaptronics and Lightweight Design in Production, Technische Universität Chemnitz, Chemnitz, Germany
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Hipfl C, Karczewski D, Oronowicz J, Pumberger M, Perka C, Hardt S. Total hip arthroplasty for destructive septic arthritis of the hip using a two-stage protocol without spacer placement. Arch Orthop Trauma Surg 2023; 143:19-28. [PMID: 34097122 PMCID: PMC9886611 DOI: 10.1007/s00402-021-03981-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The optimal treatment of patients with a degenerative joint disease secondary to an active or chronic septic arthritis of the hip is unclear. The aim of the present study was to report on our experience with two-stage total hip arthroplasty (THA) using a contemporary treatment protocol without spacer insertion. MATERIALS AND METHODS Our prospective institutional database was used to identify all patients with degenerative septic arthritis treated with a non-spacer two-stage protocol between 2011 and 2017. Clinical outcomes included interim revision, periprosthetic infection (PJI) and aseptic revision rates. Restoration of leg-length and offset were assessed radiographically. Modified Harris hip score (mHHS) were obtained. Treatment success was defined using the modified Delphi consensus criteria. Mean follow-up was 62 months (13-110). RESULTS A total of 33 patients with a mean age of 60 years (13-85) were included. 55% of the cohort was male and average Charlson Comorbidity Index (CCI) was 3.7 (0-12). 21 patients (64%) had an active/acute infection and 12 patients (36%) were treated for chronic/quiescent septic arthritis. Overall, 11 patients (33%) had treatment failure, including 5 patients who failed to undergo THA, 2 interim re-debridement for persistent infection, and 4 patients who developed PJI after an average of 7 months (0.3-13) following THA. The most common identified pathogen was Staphylococcus aureus (42.4%). No aseptic revision was recorded following THA. Leg-length and offset were successfully restored. Mean mHHS improved from 35.2 points to 73.4 points. CONCLUSION Two-stage THA without spacer placement is a viable treatment option for destructive septic arthritis of the hip, demonstrating comparable rates of infection control and functional outcome. However, definitive resection arthroplasty is not uncommon in these often critically ill patients.
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Affiliation(s)
- Christian Hipfl
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Karczewski
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jakub Oronowicz
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carsten Perka
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Hardt
- grid.6363.00000 0001 2218 4662Department of Orthopaedic Surgery, Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Ghimire A, Song J. Anti-Periprosthetic Infection Strategies: From Implant Surface Topographical Engineering to Smart Drug-Releasing Coatings. ACS APPLIED MATERIALS & INTERFACES 2021; 13:20921-20937. [PMID: 33914499 PMCID: PMC8130912 DOI: 10.1021/acsami.1c01389] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite advanced implant sterilization and aseptic surgical techniques, periprosthetic bacterial infection remains a major challenge for orthopedic and dental implants. Bacterial colonization/biofilm formation around implants and their invasion into the dense skeletal tissue matrices are difficult to treat and could lead to implant failure and osteomyelitis. These complications require major revision surgeries and extended antibiotic therapies that are associated with high treatment cost, morbidity, and even mortality. Effective preventative measures mitigating risks for implant-related infections are thus in dire need. This review focuses on recent developments of anti-periprosthetic infection strategies aimed at either reducing bacterial adhesion, colonization, and biofilm formation or killing bacteria directly in contact with and/or in the vicinity of implants. These goals are accomplished through antifouling, quorum-sensing interfering, or bactericidal implant surface topographical engineering or surface coatings through chemical modifications. Surface topographical engineering of lotus leaf mimicking super-hydrophobic antifouling features and cicada wing-mimicking, bacterium-piercing nanopillars are both presented. Conventional physical coating/passive release of bactericidal agents is contrasted with their covalent tethering to implant surfaces through either stable linkages or linkages labile to bacterial enzyme cleavage or environmental perturbations. Pros and cons of these emerging anti-periprosthetic infection approaches are discussed in terms of their safety, efficacy, and translational potentials.
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Affiliation(s)
- Ananta Ghimire
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jie Song
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Gu A, Adriani M, Malahias MA, Fassihi SC, Nocon AA, Bostrom MP, Sculco PK. Reliability and Validity of Acetabular and Femoral Bone Loss Classification Systems in Total Hip Arthroplasty: A Systematic Review. HSS J 2020; 16:288-295. [PMID: 33088242 PMCID: PMC7534882 DOI: 10.1007/s11420-020-09766-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND A variety of classification systems have been developed to help surgeons treat patients with acetabular or femoral bone loss in total hip arthroplasty, yet no "gold standard" for classification has been agreed upon. Furthermore, the reliability and validity of the available classification systems remain unknown. QUESTIONS/PURPOSE The aims of our study were to determine the reliability and validity of the three most common acetabular and femoral bone loss classification systems (Paprosky, American Academy of Orthopaedic Surgeons [AAOS], and Saleh and Gross). METHODS A systematic review of the literature was performed to identify studies that reported on the reliability or validity (or both) of the acetabular and femoral components of the three bone loss classification systems. RESULTS In all, seven articles met our inclusion criteria. Six studies reported on the reliability (all six studies) or validity (three studies) of acetabular bone loss rating systems (286 acetabula), and five analyzed reliability (all five studies) or validity (three studies) of femoral bone loss classification systems (364 femurs). In studies in which either the Paprosky or AAOS acetabular bone loss classifications were used, the classification systems were considered unreliable in 75% and 100% of them, respectively. On the femoral side, the Paprosky classification demonstrated moderate interobserver and good intraobserver reliability. The AAOS femoral bone classification was found to have good intraobserver reliability but poor interobserver reliability. The Saleh and Gross acetabular and femoral bone loss classification systems yielded mixed results, but each was considered reliable in one of the studies looking at these aspects of the systems. CONCLUSION Although surgical techniques, treatment options, and advanced imaging available to the surgeon have evolved over the past few decades, the acetabular and femoral bone loss classification systems, first developed in the 1990s, have remained largely unchanged. Our results indicate that improvements to these systems are necessary in order for them to be as useful as possible in planning the surgical course.
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Affiliation(s)
- Alex Gu
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Marco Adriani
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Safa C. Fassihi
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, Washington, DC USA
| | - Allina A. Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Mathias P. Bostrom
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY 10021 USA
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Positive Microbiological Findings at the Site of Presumed Aseptic Revision Arthroplasty Surgery of the Hip and Knee Joint: Is a Surgical Revision Always Necessary? BIOMED RESEARCH INTERNATIONAL 2020; 2020:2162136. [PMID: 32461967 PMCID: PMC7232730 DOI: 10.1155/2020/2162136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/31/2023]
Abstract
Little is known about patients that undergo presumed aseptic revision arthroplasty surgery of the hip and knee joint and having positive microbiological findings of the intraoperatively taken tissue samples. 228 “aseptic” operations were retrospectively analyzed from prospectively collected data with regard to the following parameters: demographic data; reasons for primary and revision surgery, respectively; time between primary and revision surgery; preoperative laboratory findings; microbiological and histopathological findings; type and length of systemic antibiotic therapy; clinical outcome; and follow-up. Identification of microorganisms was present in 8.8% of the cases (9.3% of the hip and 7.8% of the knee cases). Preoperatively, the median CRP value was 8.4 mg/l (normal values 0-5.0 mg/l) and the median WBC count 8,100 × 106/l (normal values 3, 700‐10,100 × 106/l). The most common identified organism was methicillin-resistant Staphylococcus epidermidis in 30%, followed by viridans streptococci in 15% of the cases. In 7 cases, the microbiological findings were interpreted as a contamination, and no antibiotic therapy was administered. In the other cases, a systemic antibiotic therapy was applied for a time period between 2 weeks and 3 months. 68.4% of the patients did not have any infectious complications at a median follow-up of 20 (3-42) months. The present study indicates that more than 2/3 of the cases with positive microbiological findings at the site of presumed aseptic revision arthroplasty surgery of the hip and knee joint can be successfully treated conservatively and they do not require any further surgical therapy.
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Aguilera-Correa JJ, Garcia-Casas A, Mediero A, Romera D, Mulero F, Cuevas-López I, Jiménez-Morales A, Esteban J. A New Antibiotic-Loaded Sol-Gel Can Prevent Bacterial Prosthetic Joint Infection: From in vitro Studies to an in vivo Model. Front Microbiol 2020; 10:2935. [PMID: 32010069 PMCID: PMC6978913 DOI: 10.3389/fmicb.2019.02935] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/06/2019] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to evaluate the effect of a moxifloxacin-loaded organic-inorganic sol-gel with different antibiotic concentration in the in vitro biofilm development and treatment against Staphylococcus aureus, S. epidermidis, and Escherichia coli, cytotoxicity and cell proliferation of MC3T3-E1 osteoblasts; and its efficacy in preventing the prosthetic joint infection (PJI) caused by clinical strains of S. aureus and E. coli using an in vivo murine model. Three bacterial strains, S. epidermidis ATCC 35984, S. aureus 15981, and, E. coli ATCC 25922, were used for microbiological studies. Biofilm formation was induced using tryptic-soy supplemented with glucose for 24 h, and then, adhered and planktonic bacteria were estimated using drop plate method and absorbance, respectively. A 24-h-mature biofilm of each species growth in a 96-well plate was treated for 24 h using a MBECTM biofilm Incubator lid with pegs coated with the different types of sol-gel, after incubation, biofilm viability was estimated using alamrBlue. MC3T3-E1 cellular cytotoxicity and proliferation were evaluated using CytoTox 96 Non-Radioactive Cytotoxicity Assay and alamarBlue, respectively. The microbiological studies showed that sol-gel coatings inhibited the biofilm development and treated to a mature biofilm of three evaluated bacterial species. The cell studies showed that the sol-gel both with and without moxifloxacin were non-cytotoxic and that cell proliferation was inversely proportional to the antibiotic concentration containing by sol-gel. In the in vivo study, mice weight increased over time, except in the E. coli-infected group without coating. The most frequent symptoms associated with infection were limping and piloerection; these symptoms were more frequent in infected groups with non-coated implants than infected groups with coated implants. The response of moxifloxacin-loaded sol-gel to infection was either total or completely absent. No differences in bone mineral density were observed between groups with coated and non-coated implants and macrophage presence lightly increased in the bone grown directly in contact with the antibiotic-loaded sol-gel. In conclusion, moxifloxacin-loaded sol-gel coating is capable of preventing PJI caused by both Gram-positive and Gram-negative species.
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Affiliation(s)
| | - Amaya Garcia-Casas
- Department of Materials Science and Engineering, University Carlos III of Madrid, Madrid, Spain
| | - Aranzazu Mediero
- Bone and Joint Research Unit, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - David Romera
- Clinical Microbiology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Francisca Mulero
- Molecular Imaging Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Irene Cuevas-López
- Experimental Surgery and Animal Research Service, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Antonia Jiménez-Morales
- Department of Materials Science and Engineering, University Carlos III of Madrid, Madrid, Spain
- Álvaro Alonso Barba Technological Institute of Chemistry and Materials, Carlos III University of Madrid, Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
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Anagnostakos K, Meyer C. Partial two-stage exchange at the site of periprosthetic hip joint infections. Arch Orthop Trauma Surg 2019; 139:869-876. [PMID: 30927063 DOI: 10.1007/s00402-019-03180-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In the past 10 years an increasing number of studies about partial two-stage exchange arthroplasty in the management of periprosthetic hip infections have been published. The aim of the present work was to systematically review the current knowledge about this procedure, and critically verify the success as well as the complications of this treatment option. MATERIALS-METHODS A literature search was performed through PubMed until June 2018. Search terms were "partial two stage hip" and "partial retention hip", and "retaining well fixed hip". RESULTS A total of 7 studies reporting on a total of 80 patients could be identified. All studies had a level of evidence IV. The great majority of the studies reported on the isolated removal of the acetabular cup and placement of an antibiotic-loaded cement spacer head onto the retained, well-fixed stem. Most of the periprosthetic infections were caused by staphylococci. The infection eradication rate varied between 81.3 and 100% at a mean follow-up between 19 and 70 months. Poor outcome was observed at the site of MRSA infections. CONCLUSIONS The partial two-stage exchange arthroplasty appears to be a possible option in the management of PJI when one prosthetic component is well-fixed so that their removal might result in significant bone loss and compromise of fixation at the time of the later prosthesis reimplantation, and the causative organisms are not multiresistant. The small numbers published about this protocol does not allow for a generalization of application and should be only applied in highly selected patients. Future studies with larger collectives and longer follow-ups are welcome to evaluate the clinical success of this option and its possible role in the management of PJI.
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Affiliation(s)
- Konstantinos Anagnostakos
- Zentrum für Orthopädie und Unfallchirurgie, Städtisches Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Germany.
| | - Christof Meyer
- Zentrum für Orthopädie und Unfallchirurgie, Städtisches Klinikum Saarbrücken, Winterberg 1, 66119, Saarbrücken, Germany
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Perni S, Caserta S, Pasquino R, Jones SA, Prokopovich P. Prolonged Antimicrobial Activity of PMMA Bone Cement with Embedded Gentamicin-Releasing Silica Nanocarriers. ACS APPLIED BIO MATERIALS 2019; 2:1850-1861. [DOI: 10.1021/acsabm.8b00752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stefano Perni
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, United Kingdom
| | - Sergio Caserta
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Napoli 80125, Italy
| | - Rossana Pasquino
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Napoli 80125, Italy
| | - Steve A. Jones
- University Hospital Llandough, Cardiff & Vale University Health Board, Penlan Road, Penarth, Vale of Glamorgan, Wales CF64 2XX, United Kingdom
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, United Kingdom
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Amanatullah D, Dennis D, Oltra EG, Marcelino Gomes LS, Goodman SB, Hamlin B, Hansen E, Hashemi-Nejad A, Holst DC, Komnos G, Koutalos A, Malizos K, Martinez Pastor JC, McPherson E, Meermans G, Mooney JA, Mortazavi J, Parsa A, Pécora JR, Pereira GA, Martos MS, Shohat N, Shope AJ, Zullo SS. Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S329-S337. [PMID: 30348576 DOI: 10.1016/j.arth.2018.09.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Perni S, Martini-Gilching K, Prokopovich P. Controlling release kinetics of gentamicin from silica nano-carriers. Colloids Surf A Physicochem Eng Asp 2018. [DOI: 10.1016/j.colsurfa.2017.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Khan U, Torrance E, Townsend R, Davies S, Mackenzie T, Funk L. Low-grade infections in nonarthroplasty shoulder surgery. J Shoulder Elbow Surg 2017; 26:1553-1561. [PMID: 28359693 DOI: 10.1016/j.jse.2017.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/24/2016] [Accepted: 01/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recent studies have identified the diagnostic challenge of low-grade infections after shoulder arthroplasty surgery. Infections after nonarthroplasty procedures have not been reported. This study assessed patient-related risk factors, outcomes, and clinical presentation of low-grade infection after open and arthroscopic nonarthroplasty shoulder surgery. METHODS The cases of 35 patients presenting with suspected low-grade infection were reviewed. Biopsy specimens taken at revision surgery were cultured in the sterile environment of a class II laminar flow cabinet and incubated for a minimum of 14 days at a specialist orthopedic microbiology laboratory. Patient-related factors (age, occupation, injection), index surgery, and infection characteristics (onset of symptoms, duration to diagnosis, treatment) were analyzed. RESULTS Positive cultures were identified in 21 cases (60.0%), of which 15 were male patients (71%). Of all patients with low-grade infection, 47.6% were male patients between 16 and 35 years of age. Propionibacterium acnes and coagulase-negative staphylococcus were the most common organisms isolated (81.1% [n = 17] and 23.8% [n = 5], respectively). Of 14 negative culture cases, 9 were treated with early empirical antibiotics (64.3%); 7 patients reported symptomatic improvement (77.8%). Of 5 patients treated with late empirical antibiotics, 4 stated improvement. Patients presented with symptoms akin to resistant postoperative frozen shoulder (persistent pain and stiffness, unresponsive to usual treatments). CONCLUSION Young male patients are at greatest risk for low-grade infections after arthroscopic and open nonarthroplasty shoulder surgery. P. acnes was the most prevalent organism. Patients presented with classic postoperative frozen shoulder symptoms, resistant to usual treatments. Interestingly, 78.6% of patients with negative cultures responded positively to empirical treatment.
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Affiliation(s)
- Umair Khan
- University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK
| | | | | | | | | | - Lennard Funk
- The Arm Clinic at Wilmslow Hospital, Wilmslow, UK; Wrightington Hospital, Wigan, UK; University of Salford, School of Health Sciences, Manchester, UK.
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Weisenstein DB, Popescu IA. ["Barking" micturition noise as sign of acute hip-TEP-late infection]. DER ORTHOPADE 2016; 45:789-91. [PMID: 27456529 DOI: 10.1007/s00132-016-3300-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article presents the case of a patient with an acute late infection of the hip prosthesis. At first, complaints in the hip region were in the foreground. Shortly after the revision operation the patient noticed a barking noise during micturition, as sign of a pneumaturia. The following diagnostics showed a perforated sigmoid diverticulitis with a sigmoid-urinary bladder-fistula.
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Affiliation(s)
- D B Weisenstein
- Klinik für Orthopädie, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292, Trier, Deutschland.
| | - I-A Popescu
- Klinik für Orthopädie, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292, Trier, Deutschland
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Abstract
INTRODUCTION Treatment of periprosthetic joint infection following revision-Total Hip Arthroplasty is more problematic when there is poor bone quality and severe bone loss. Migration of revision prosthesis with a long stem to the knee joint in infected cases makes treatment more complex. In these cases, total femoral replacement is the only treatment option and eradication of infection is mandatory before the replacement. In 2-staged reconstruction treatment, there is a need for a PROSTALAC to replace the whole femur. METHODS We describe here a novel hybrid type (custom-made plus off-the-shelf) total femoral PROSTALAC for cases in need of whole femoral bone and femoral component removal for the treatment of periprosthetic joint infection in total hip arthroplasty. RESULT Both sides of the PROSTALAC have anatomical joint surfaces, so the articulation with the acetabulum proximally is expected to be more stable. The off-the-shelf anatomic joint surface of the PROSTALAC distally allows articulation compatible with a proximal tibial off-the-shelf spacer. CONCLUSIONS This simple hybrid-type total femoral PROSTALAC can be adjusted to femoral length, has anatomical joint surfaces that produce a more stable articulation, and can articulate with an off-the-shelf proximal tibial spacer.
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Vacuum plasma sprayed coatings using ionic silver doped hydroxyapatite powder to prevent bacterial infection of bone implants. Biointerphases 2016; 11:011012. [DOI: 10.1116/1.4943225] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Wendling A, Mar D, Wischmeier N, Anderson D, McIff T. Combination of modified mixing technique and low frequency ultrasound to control the elution profile of vancomycin-loaded acrylic bone cement. Bone Joint Res 2016; 5:26-32. [PMID: 26843512 PMCID: PMC4852785 DOI: 10.1302/2046-3758.52.2000412] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine if combining variations in mixing technique of antibiotic-impregnated polymethylmethacrylate (PMMA) cement with low frequency ultrasound (LFUS) improves antibiotic elution during the initial high phase (Phase I) and subsequent low phase (Phase II) while not diminishing mechanical strength. METHODS Three batches of vancomycin-loaded PMMA were prepared with different mixing techniques: a standard technique; a delayed technique; and a control without antibiotic. Daily elution samples were analysed using flow injection analysis (FIA). Beginning in Phase II, samples from each mix group were selected randomly to undergo either five, 15, 45, or 0 minutes of LFUS treatment. Elution amounts between LFUS treatments were analysed. Following Phase II, compression testing was done to quantify strength. A-priori t-tests and univariate ANOVAs were used to compare elution and mechanical test results between the two mix groups and the control group. RESULTS The delayed technique showed a significant increase in elution on day one compared with the standard mix technique (p < 0.001). The transition point from Phase I to Phase II occurred on day ten. LFUS treatments significantly increased elution amounts for all groups above control. Delayed technique resulted in significantly higher elution amounts for the five-minute- (p = 0.004) and 45-minute- (p < 0.001) duration groups compared with standard technique. Additionally, the correlations between LFUS duration and total elution amount for both mix techniques were significant (p = 0.03). Both antibiotic-impregnated groups exhibited a significant decrease in offset yield stress compared with the control group (p < 0.001), however, their lower 95% confidence intervals were all above the 70 MPa limit defined by International Standards Organization (ISO) 5833-2 reference standard for acrylic bone cement. CONCLUSION The combination of a delayed mix technique with LFUS treatments provides a reasonable means for increasing both short- and long-term antibiotic elution without affecting mechanical strength.Cite this article: Dr. T. McIff. Combination of modified mixing technique and low frequency ultrasound to control the elution profile of vancomycin-loaded acrylic bone cement. Bone Joint Res 2016;5:26-32. doi: 10.1302/2046-3758.52.2000412.
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Affiliation(s)
- A Wendling
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - D Mar
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - N Wischmeier
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - D Anderson
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - T McIff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Risk factors and a prognostic model of hip periprosthetic infection recurrence after surgical treatment using articulating and non-articulating spacers. INTERNATIONAL ORTHOPAEDICS 2015; 40:1381-7. [PMID: 26686498 DOI: 10.1007/s00264-015-3072-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was evaluation of the efficacy of the first step of a two-stage procedure for treatment of hip prosthetic joint infection (PJI) using articulating and non-articulating spacers as well as development of a prediction model and prognostic score for infection recurrence. METHODS In a cohort of 217 patients treated for PJI of the hip, demographic characteristics, clinical symptoms, body temperature, body mass index (BMI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC), microbiological cultures and the type of the spacer used were retrospectively analyzed for association with the recurrence of PJI. RESULTS Patients with infection recurrence had increased levels of ESR and CRP (P < 0.001) together with higher BMI and shorter infection manifestation period after previous surgery (P < 0.05). Among these patients, there was no significant difference of clinical characteristics between subjects with articulating and non-articulating spacers. Microbial associations were more often identified in patients with recurrent infection (50 %, P < 0.01) where Gram-negative bacteria were predominant (61.5 %, P < 0.01). These patients had higher percentage of Acinetobacter sp. and P. aeruginosa isolates (28.2 %, P < 0.01). CONCLUSIONS Efficacy of the first step of two-stage revision was 64.1 %. Placement of either articulating or non-articulating spacers did not influence recovery from PJI. Laboratory values of ESR, CRP, BMI and the type of previous surgery were identified as main factors that affect outcomes of the two-stage procedure. A prognostic model with the calculation of a total risk score for PJI recurrence was developed.
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McManamon C, de Silva JP, Delaney P, Morris MA, Cross GLW. Characteristics, interactions and coating adherence of heterogeneous polymer/drug coatings for biomedical devices. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 59:102-108. [PMID: 26652354 DOI: 10.1016/j.msec.2015.09.103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 11/25/2022]
Abstract
With this rise in surgical procedures it is important to focus on the mobility and safety of the patient and reduce the infections that are associated with hip replacements. We examine the mechanical properties of gentamicin sulphate as a model antimicrobial layer for titanium-alloy based prosthetic hips to help prevent methicillin-resistant Staphylococcus aureus infection after surgery. A top layer of poly(lactic-co-glycolic acid) is added to maintain the properties of the gentamicin sulphate as well as providing a drug delivery system. Through the use of nanoindentation and micro-scratch techniques it is possible to determine the mechanical and adhesive properties of this system. Nanoindentation determined the modulus values for the poly(lactic-co-glycolic acid) and gentamicin sulphate materials to be 8.9 and 5.2GPa, respectively. Micro-scratch established that the gentamicin sulphate layer is strongly adhered to the Ti alloy and forces of 30N show no cohesive or adhesive failure. It was determined that the poly(lactic-co-glycolic acid) is ductile in nature and delaminates from the gentamicin sulphate layer of at 0.5N.
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Affiliation(s)
- Colm McManamon
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Johann P de Silva
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; School of Physics, Trinity College Dublin, Dublin 2, Ireland
| | - Paul Delaney
- Department of Chemistry, Supercritical Fluid Centre and Materials Section, University College Cork, Cork, Ireland
| | - Michael A Morris
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; Department of Chemistry, Supercritical Fluid Centre and Materials Section, University College Cork, Cork, Ireland
| | - Graham L W Cross
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland; School of Physics, Trinity College Dublin, Dublin 2, Ireland.
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19
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Systematic review and meta-analysis of randomized controlled trials of antibiotics and antiseptics for preventing infection in people receiving primary total hip and knee prostheses. Antimicrob Agents Chemother 2015; 59:6696-707. [PMID: 26259793 PMCID: PMC4604400 DOI: 10.1128/aac.01331-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 07/31/2015] [Indexed: 12/23/2022] Open
Abstract
Infection rates in primary (first-time) major joint arthroplasty continue to be a significant issue. The effect of antibiotic and antiseptic prophylaxis on outcomes for this type of surgery has not been adequately reviewed. A systematic search of the main databases for randomized controlled trials (RCTs) evaluating antibiotics and antiseptics was conducted to evaluate the predetermined endpoints of infection, adverse events, costs, quality of life, and concentration levels of antibiotics. A meta-analysis using pooled effect estimates and fixed-effect and random-effect models of risk ratios (RR), calculated with 95% confidence intervals (CI), was utilized. Thirty (30) RCTs examined the effects of antibiotic and antiseptic prophylaxis on infections after primary total hip arthroplasty (THA) (total of 11,597 participants) and total knee arthroplasty (TKA) (total of 6,141 participants). For THA, preoperative systemic intravenous (i.v.) antibiotic prophylaxis may be effective in reducing the incidence of infection after THA from 6 months to ≥5 years. For TKA, there is no RCT evidence that antibiotics and/or antiseptics have any effect on infection rate. Preoperative systemic antibiotic prophylaxis in primary THA may be effective at reducing infection rate. There is no evidence that timing, route of administration, or concentration levels have an effect on reducing infections, adverse events, or costs in THA or TKA. Many of the trials included in this study were published in the 1980s and 1990s. Thus, it would be important to replicate a number of them based on current patient demographics and incidence of bacterial resistance.
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20
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Darouiche RO, Mosier MC, Voigt J. Antibiotics and antiseptics for preventing infection in people receiving primary total joint prostheses. Hippokratia 2015. [DOI: 10.1002/14651858.cd010363.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rabih O Darouiche
- Baylor College of Medicine; Center for Prostheses Infection; 1333 Moursund Ave, Suite A221 Houston Texas USA 77030
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Claro T, Kavanagh N, Foster TJ, O'Brien FJ, Kerrigan SW. Staphylococcus epidermidis serine--aspartate repeat protein G (SdrG) binds to osteoblast integrin alpha V beta 3. Microbes Infect 2015; 17:395-401. [PMID: 25749709 DOI: 10.1016/j.micinf.2015.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 01/20/2015] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
Staphylococcus epidermidis is the leading etiologic agent of orthopaedic implant infection. Contamination of the implanted device during insertion allows bacteria gain entry into the sterile bone environment leading to condition known as osteomyelitis. Osteomyelitis is characterised by weakened bones associated with progressive bone loss. The mechanism through which S. epidermidis interacts with bone cells to cause osteomyelitis is poorly understood. We demonstrate here that S. epidermidis can bind to osteoblasts in the absence of matrix proteins. S. epidermidis strains lacking the cell wall protein SdrG had a significantly reduced ability to bind to osteoblasts. Consistent with this, expression of SdrG in Lactococcus lactis resulted in significantly increased binding to the osteoblasts. Protein analysis identified that SdrG contains a potential integrin recognition motif. αVβ3 is a major integrin expressed on osteoblasts and typically recognises RGD motifs in its ligands. Our results demonstrate that S. epidermidis binds to recombinant purified αVβ3, and that a mutant lacking SdrG failed to bind. Blocking αVβ3 on osteoblasts significantly reduced binding to S. epidermidis. These studies are the first to identify a mechanism through which S. epidermidis binds to osteoblasts and potentially offers a mechanism through which implant infection caused by S. epidermidis leads to osteomyelitis.
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Affiliation(s)
- T Claro
- Microbial Infection Group, Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - N Kavanagh
- Microbial Infection Group, Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland
| | - T J Foster
- Department of Microbiology, Moyne Institute of Preventive Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - F J O'Brien
- Tissue Engineering Research Group, Department of Anatomy, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; Trinity Centre for Bioengineering, Trinity College Dublin (TCD), College Green, Dublin 2, Ireland; Advanced Materials and Bioengineering Research (AMBER) Centre, RCSI & TCD, Dublin 2, Ireland
| | - S W Kerrigan
- Microbial Infection Group, Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland; School of Pharmacy, Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin 2, Ireland.
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22
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Gravius S, Randau TM, Casadonte R, Kriegsmann M, Friedrich MJ, Kriegsmann J. Investigation of neutrophilic peptides in periprosthetic tissue by matrix-assisted laser desorption ionisation time-of-flight imaging mass spectrometry. INTERNATIONAL ORTHOPAEDICS 2014; 39:559-67. [PMID: 25277763 DOI: 10.1007/s00264-014-2544-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 09/17/2014] [Indexed: 01/11/2023]
Abstract
PURPOSE The accurate diagnosis of periprosthetic joint infection (PJI) relies on clinical investigation, laboratory parameters, radiological methods, sterile joint aspiration for synovial fluid leucocyte count and microbiological analysis and tissue sampling for histopathology. Due to the limits in specificity and sensitivity of these methods, molecular techniques and new biomarkers were introduced into the diagnostic procedure. Histological examination is related to the amount of neutrophils in the periprosthetic tissue in frozen sections and formalin-fixed paraffin embedded material (FFPE). However, the threshold of neutrophils per defined area of tissue among various studies is very inconsistent. METHODS We have applied matrix-assisted laser desorption ionisation time-of-flight imaging mass spectrometry (MALDI IMS) to a total of 32 periprosthetic tissue samples of patients with PJI to detect peptides associated with areas of neutrophil infiltration. RESULTS Specific peaks associated with a high amount of neutrophils were detected. Of these m/z peaks, four could be assigned to predictive neutrophil molecules. These peptides include annexin A1, calgizzarin (S100A11), calgranulin C (S100A12) and histone H2A. By MALDI IMS, these peptides could be shown to be co-localised with the infiltration of neutrophils in the immediate vicinity of the periprosthetic interface, whereas more distant areas did not show neutrophil invasion or infection-related peptides. CONCLUSIONS MALDI IMS is a new method allowing identification of neutrophil peptides in periprosthetic tissues and may be a surrogate for counting neutrophils as an objective parameter for PJI.
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Affiliation(s)
- Sascha Gravius
- Department of Orthopedics and Trauma Surgery, University Clinic of Bonn, Sigmund Freud Str. 25, 53105, Bonn, Germany,
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Trindade R, Albrektsson T, Tengvall P, Wennerberg A. Foreign Body Reaction to Biomaterials: On Mechanisms for Buildup and Breakdown of Osseointegration. Clin Implant Dent Relat Res 2014; 18:192-203. [DOI: 10.1111/cid.12274] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Ricardo Trindade
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Tomas Albrektsson
- Department of Biomaterials; Institute of Clinical Sciences; Göteborg University; Göteborg Sweden
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Pentti Tengvall
- Department of Biomaterials; Institute of Clinical Sciences; Göteborg University; Göteborg Sweden
| | - Ann Wennerberg
- Head of Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
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Anagnostakos K, Schmitt C. Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention? World J Orthop 2014; 5:218-224. [PMID: 25035823 PMCID: PMC4095013 DOI: 10.5312/wjo.v5.i3.218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/02/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention. A literature search was performed through PubMed until September 2013. Search terms were “DAIR (debridement, antibiotics, irrigation, and retention)” alone and in combination with “hip” as well as “hip infection + prosthesis retention”. A total of 11 studies reporting on 292 cases could be identified. Five different treatment modalities have been described with varying success rates (debridement-21% infection eradication rate; debridement + lavage-75% infection eradication rate; debridement, lavage, with change of modular prosthesis components-70.4% infection eradication rate; debridement, lavage, change of modular prosthesis components + vacuum-assisted closure-92.8% infection eradication rate; acetabular cup removal + spacer head onto retained stem-89.6% infection eradication rate). With regard to the postoperative antibiotic therapy, no general consensus could be drawn from the available data. Debridement, antibiotic therapy, irrigation, and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections. The current literature does not allow for generalization of conclusions with regard to the best treatment modality. A large, multi-center study is required for identification of the optimal treatment of these infections.
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25
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The role of ultrasonography in the assessment of peri-prosthetic hip complications. J Ultrasound 2014; 18:245-50. [PMID: 26261466 DOI: 10.1007/s40477-014-0107-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Total hip arthroplasty (THA) is a widespread option for treating hip osteoarthritis. Peri-prosthetic complications after THA represent a common event influencing patient outcome and costs. The purpose of this paper is to report the use of ultrasonography (US) to detect peri-prosthetic complications in symptomatic patients who underwent THA. METHODS We retrospectively reviewed the records of patients with THA who underwent imaging evaluation between January 2009 and December 2012 at two different institutions. We evaluated the presence/absence of superficial and/or deep peri-prosthetic collections as well as the presence/absence of a cutaneous sinus tract. For patients who underwent both MRI and US, a concordance correlation analysis between US and MR findings was performed. RESULTS In the reference period, 532 symptomatic patients (mean age ± standard deviation 74 ± 12 years) underwent X-ray and MRI examinations for suspected peri-prosthetic complications. Among them, 111 (20.9 %) underwent also US. Overall, 108 patients underwent both US and MRI. US findings included 67 superficial collections, 48 subcutaneous fistulas, 74 deep peri-prosthetic collections. Twenty-four patients had solid, mass-like peri-prosthetic collections. In 11 patients, no peri-prosthetic complications were seen. MRI findings included 68 superficial collections, 49 subcutaneous fistulas, 79 deep peri-prosthetic collections. Twenty-four patients had solid, mass-like peri-prosthetic collections. In four patients, no peri-prosthetic complications were seen. Concordance analysis between US and MRI findings showed almost perfect agreement (k ≥ 0.89). CONCLUSION US is an efficient and practical imaging modality to evaluate peri-prosthetic complications in patients with THA, being almost comparable to MRI in detecting and characterizing these complications.
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Puhto AP, Puhto TM, Niinimäki TT, Leppilahti JI, Syrjälä HPT. Two-stage revision for prosthetic joint infection: outcome and role of reimplantation microbiology in 107 cases. J Arthroplasty 2014; 29:1101-4. [PMID: 24461248 DOI: 10.1016/j.arth.2013.12.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 11/27/2013] [Accepted: 12/18/2013] [Indexed: 02/08/2023] Open
Abstract
Two-stage revision is widely used for the treatment of prosthetic joint infections. However, the duration of antibiotic treatment between stages and role of reimplantation microbiology are controversial. The purpose of this study was to evaluate the outcome and influence of the reimplantation microbiology of two-staged revisions with 6 weeks of antibiotic treatment. We retrospectively reviewed 107 patients treated with two-stage revision between 2001 and 2009. The overall treatment success rate was 94.4%. The reimplantation cultures were positive in 5/97 (5.2%) cases, and only one of them failed. Therefore, we achieved excellent results with a 6-week course of antibiotics between stages in two-stage revision. Positive reimplantation cultures do not seem to be associated with worse outcomes.
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Affiliation(s)
- Ari-Pekka Puhto
- Department of Operative Care, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland
| | - Teija M Puhto
- Department of Operative Care, Department of Infection Control, Oulu University Hospital, Finland
| | - Tuukka T Niinimäki
- Department of Operative Care, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland
| | - Juhana I Leppilahti
- Department of Operative Care, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Finland
| | - Hannu P T Syrjälä
- Department of Operative Care, Department of Infection Control, Oulu University Hospital, Finland
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Kargupta R, Bok S, Darr CM, Crist BD, Gangopadhyay K, Gangopadhyay S, Sengupta S. Coatings and surface modifications imparting antimicrobial activity to orthopedic implants. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2014; 6:475-95. [PMID: 24867883 DOI: 10.1002/wnan.1273] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/23/2014] [Accepted: 04/06/2014] [Indexed: 12/24/2022]
Abstract
Bacterial colonization and biofilm formation on an orthopedic implant surface is one of the worst possible outcomes of orthopedic intervention in terms of both patient prognosis and healthcare costs. Making the problem even more vexing is the fact that infections are often caused by events beyond the control of the operating surgeon and may manifest weeks to months after the initial surgery. Herein, we review the costs and consequences of implant infection as well as the methods of prevention and management. In particular, we focus on coatings and other forms of implant surface modification in a manner that imparts some antimicrobial benefit to the implant device. Such coatings can be classified generally based on their mode of action: surface adhesion prevention, bactericidal, antimicrobial-eluting, osseointegration promotion, and combinations of the above. Despite several advances in the efficacy of these antimicrobial methods, a remaining major challenge is ensuring retention of the antimicrobial activity over a period of months to years postoperation, an issue that has so far been inadequately addressed. Finally, we provide an overview of additional figures of merit that will determine whether a given antimicrobial surface modification warrants adoption for clinical use.
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Affiliation(s)
- Roli Kargupta
- Department of Bioengineering, University of Missouri, Columbia, MO, USA
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Lyu B, Tikhilov RM, Shubnyakov II, Razorenov VL, Denisov AO, Bozhkova SA, Artyukh VA, Klitsenko OA, Totoev ZA. EFFICIENCY OF THE FIRST STAGE OF TWO-STAGED REVISION SURGERY IN PATIENTS WITH PERIPROSTHETIC HIP INFECTION. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2014. [DOI: 10.21823/2311-2905-2014-0-3-5-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Shen H, Wang QJ, Zhang XL, Jiang Y. Novel articulating medullary-sparing spacer for the treatment of infectious hip arthritis. Orthopedics 2013; 36:e404-8. [PMID: 23590777 DOI: 10.3928/01477447-20130327-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two-stage total hip arthroplasty (THA) is considered a safe choice for the treatment of primary infectious arthritis of the hip. In cases where the proximal portion of the femur is intact without infection, the use of a spacer with a femoral stem during the interim would disturb the normal femoral medullary cavity. The authors report the technical procedure and outcomes of cases using a novel medullary sparing, antibiotic-loaded hip spacer for the treatment of hip infections.Five consecutive patients (5 hips) with infectious arthritis of the hip were treated in a 2-stage approach using an intraoperatively made medullary-sparing hip spacer. During the first-stage THA, after thorough debridement of potentially infected and necrotic soft tissues, the spacer was inserted into the femoral neck and fixed without opening the femoral canal. Antibiotics were administered for at least 6 weeks and were continued until the infection was controlled clinically, after which the second-stage THA was completed.Infection was eradicated in all 5 hips. Average follow-up was 39.6 months (range, 30-59 months). At most recent follow-up, no recurrence of infection was observed. No specific complications were associated with the use of this novel spacer. Average Harris Hip Score improved from 35.2 (range, 28-43) before the first-stage THA to 61.6 (range, 54-71) between the 2 stages and to 93.6 (range, 89-99) at final follow-up. All patients ambulated with the aid of crutches during the interim period.
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Affiliation(s)
- Hao Shen
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Shanghai No. 6th Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Republic of China.
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Molina-Manso D, del Prado G, Ortiz-Pérez A, Manrubia-Cobo M, Gómez-Barrena E, Cordero-Ampuero J, Esteban J. In vitro susceptibility of Staphylococcus aureus and Staphylococcus epidermidis isolated from prosthetic joint infections. J Antibiot (Tokyo) 2012; 65:505-8. [PMID: 22854340 DOI: 10.1038/ja.2012.62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prosthetic joint infections (PJI) are severe complications in Orthopedics, with Staphylococcus aureus and Staphylococcus epidermidis being the most commonly isolated pathogens. The variable antimicrobial susceptibility found in these microorganisms, along with the increasing number of methicillin-resistant strains, increases the difficulty of antibiotic selection and makes it necessary to perform individual susceptibility studies to select the optimal antibiotic treatment. The aim of this study was to evaluate the in vitro susceptibility pattern of 35 clinical strains isolated from PJI (17 S. aureus and 18 S. epidermidis) against rifampin, vancomycin, tygecicline, clindamycin, cotrimoxazole, cloxacillin, ciprofloxacin, daptomycin and fosfomycin. In vitro susceptibility assays were performed using the broth microdilution method and agar dilution for fosfomycin. MBC was also determined. Tygecicline and daptomycin showed the highest antimicrobial activity with low MIC(90) values, and no resistant strains were detected. On the other hand, ciprofloxacin and cloxacillin exhibited a poor antimicrobial effect with a high percentage of nonsusceptible strains in both species. Bactericidal activity rates revealed the bacteriostatic behavior of rifampin, tygecicline, cotrimoxazole, fosfomycin and clindamycin, whereas vancomycin and cloxacillin showed species- and strain-dependent behavior. Daptomycin and ciprofloxacin were observed to be efficient bactericidal agents against the tested strains. According to our data, rifampin, tigecycline, daptomycin and fosfomycin showed high in vitro activity against most staphylococcal strains isolated from the PJIs tested, although daptomycin seems to be the best alternative to vancomycin therapy.
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Affiliation(s)
- Diana Molina-Manso
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain
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Lange J, Troelsen A, Thomsen RW, Søballe K. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol 2012; 4:57-73. [PMID: 22500127 PMCID: PMC3324993 DOI: 10.2147/clep.s29025] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisions for chronic infection in hip arthroplasties. METHODS The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Relevant studies were identified using PubMed and Embase. We assessed studies that included patients with a chronic infection of a hip arthroplasty treated with either one-stage or two-stage revision and with available data on occurrence of reinfections. We performed a meta-analysis estimating absolute risk of reinfection using a random-effects model. RESULTS We identified 36 studies eligible for inclusion. None were randomized controlled trials or comparative studies. The patients in these studies had received either one-stage revision (n = 375) or two-stage revision (n = 929). Reinfection occurred with an estimated absolute risk of 13.1% (95% confidence interval: 10.0%-17.1%) in the one-stage cohort and 10.4% (95% confidence interval: 8.5%-12.7%) in the two-stage cohort. The methodological quality of most included studies was considered low, with insufficient data to evaluate confounding factors. CONCLUSIONS Our results may indicate three additional reinfections per 100 reimplanted patients when performing a one-stage versus two-stage revision. However, the risk estimates were statistically imprecise and the quality of underlying data low, demonstrating the lack of clear evidence that two-stage revision is superior to one-stage revision among patients with chronically infected hip arthroplasties. This systematic review underscores the need for improvement in reporting and collection of high-quality data and for large comparative prospective studies on this issue.
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Affiliation(s)
- Jeppe Lange
- Lundbeck Foundation Center for Fast-Track Hip and Knee Surgery, Aarhus C
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Vanni D, Pantalone A, Colucci C, Andreoli E, Salini V. Bone grafts and bone graft substitutes in prosthetic hip surgery replacement. Int J Immunopathol Pharmacol 2011; 24:51-4. [PMID: 21669138 DOI: 10.1177/03946320110241s210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The need for bone grafting procedures to replace skeletal defects has become more considerable because of increased opportunities to save major bone loss. We report our experience and a critical analysis about the role of bone grafts and bone graft substitutes in prosthetic hip surgery replacement.
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Affiliation(s)
- D Vanni
- Orthopaedics Division, "G. d'Anunzio" University of Chieti, Italy
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[Hip joint infections - Results of a questionnaire among 28 university orthopedic departments]. DER ORTHOPADE 2011; 40:781-92. [PMID: 21837461 DOI: 10.1007/s00132-011-1785-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Despite numerous prophylactic measures infections still remain a hazardous complication in orthopedic surgery. MATERIAL AND METHODS A questionnaire about hip joint infections was sent to all university orthopedic departments in Germany and Austria. The questionnaire included 33 questions with respect to demographic data, causative organisms, diagnostic measures, treatment options for early and late infections, antibiotic therapy and prosthesis reimplantation. RESULTS The participation rate was 70%. The most frequent primary surgical indication was primary total hip replacement and Staphylococcus aureus and S. epidermidis were the most common pathogens identified. All departments performed a joint aspiration for diagnosis confirmation but for other diagnostic measures a great discrepancy could be observed. In the treatment of early infections removable components were always exchanged, whereas a local antibiotic therapy was not always employed. With regard to late infections a two-stage protocol was more frequently used than a one-stage treatment, whereby the implantation of a cement spacer was more commonly performed than a resection arthroplasty. The time between stages varied between 6 and 12 weeks and systemic antibiotics were administered for a mean time of 6 weeks. For prosthesis reimplantion cementless components were mostly used but no clear tendency could be determined for systemic antibiotic therapy. CONCLUSION Treatment of hip joint infections among German and Austrian university orthopedic departments is only partly carried out in a similar manner.
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Magnetic resonance imaging of painful total hip replacement: detection and characterisation of periprosthetic fluid collection and interobserver reproducibility. Radiol Med 2011; 117:85-95. [DOI: 10.1007/s11547-011-0706-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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Bone and joint infections in adults: a comprehensive classification proposal. ACTA ACUST UNITED AC 2011; 1:207-217. [PMID: 21837262 PMCID: PMC3150792 DOI: 10.1007/s12570-011-0056-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 03/31/2011] [Indexed: 11/14/2022]
Abstract
Introduction and methods Ten currently available classifications were tested for their ability to describe a continuous cohort of 300 adult patients affected by bone and joint infections. Each classification only focused, on the average, on 1.3 ± 0.4 features of a single clinical condition (osteomyelitis, implant-related infections, or septic arthritis), being able to classify 34.8 ± 24.7% of the patients, while a comprehensive classification system could describe all the patients considered in the study. Result and conclusion A comprehensive classification system permits more accurate classification of bone and joint infections in adults than any single classification available and may serve for didactic, scientific, and clinical purposes.
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Lischer S, Körner E, Balazs DJ, Shen D, Wick P, Grieder K, Haas D, Heuberger M, Hegemann D. Antibacterial burst-release from minimal Ag-containing plasma polymer coatings. J R Soc Interface 2011; 8:1019-30. [PMID: 21247951 DOI: 10.1098/rsif.2010.0596] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Biomaterials releasing silver (Ag) are of interest because of their ability to inhibit pathogenic bacteria including antibiotic-resistant strains. In order to investigate the potential of nanometre-thick Ag polymer (Ag/amino-hydrocarbon) nanocomposite plasma coatings, we studied a comprehensive range of factors such as the plasma deposition process and Ag cation release as well as the antibacterial and cytocompatible properties. The nanocomposite coatings released most bound Ag within the first day of immersion in water yielding an antibacterial burst. The release kinetics correlated with the inhibitory effects on the pathogens Pseudomonas aeruginosa or Staphylococcus aureus and on animal cells that were in contact with these coatings. We identified a unique range of Ag content that provided an effective antibacterial peak release, followed by cytocompatible conditions soon thereafter. The control of the in situ growth conditions for Ag nanoparticles in the polymer matrix offers the possibility to produce customized coatings that initially release sufficient quantities of Ag ions to produce a strong adjacent antibacterial effect, and at the same time exhibit a rapidly decaying Ag content to provide surface cytocompatibility within hours/days. This approach seems to be favourable with respect to implant surfaces and possible Ag-resistance/tolerance built-up.
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Affiliation(s)
- Stefanie Lischer
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, CH-9014 St.Gallen, Switzerland
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