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Kayani B, Bengoa F, Howard LC, Neufeld ME, Masri BA. Articulating Spacers in Total Hip Arthroplasty: Surgical Technique and Outcomes. Orthop Clin North Am 2024; 55:181-192. [PMID: 38403365 DOI: 10.1016/j.ocl.2023.06.002] [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] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Although one-stage exchange arthroplasty is gaining popularity, two-stage exchange arthroplasty remains the gold standard for the treatment of periprosthetic joint infections. Use of an articulating spacer for this procedure offers an avenue for maintaining hip motion and controlled weight-bearing, allowing local antibiotic elution. However, there is no uniform consensus on the optimal surgical protocol for using articulating spacers. This review describes the surgical technique for undertaking a first-stage exchange arthroplasty using an articulating spacer and discusses the pertinent literature on key concepts relating to periprosthetic joint infections in total hip arthroplasty to guide effective surgical decision making in these patients.
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Affiliation(s)
- Babar Kayani
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada.
| | - Francisco Bengoa
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Lisa C Howard
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Michael E Neufeld
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Bassam A Masri
- Division of Lower Limb Reconstruction & Oncology, Vancouver General Hospital, Vancouver, British Columbia V5Z 1M9, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
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Van Engen MG, Carender CN, Glass NA, Noiseux NO. Outcomes After Successful Debridement, Antibiotic, and Implant Retention Therapy for Periprosthetic Joint Infection in Total Knee Arthroplasty. J Arthroplasty 2024; 39:483-489. [PMID: 37572722 DOI: 10.1016/j.arth.2023.08.015] [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: 04/12/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Controversy surrounds debridement, antibiotic and implant retention (DAIR) for treatment of acute periprosthetic joint infection (PJI). Data regarding DAIR's rate of infection resolution is variable with little investigation of functional outcomes. METHODS We identified 191 DAIR cases at a single institution from 2008 to 2020. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and Patient Reported Outcome Measurement Information System-10 (PROMIS) scores were collected. Patient Reported Outcome Scores were obtained from 60 cases. Median follow-up (IQR) was 4.5 (2.1 to 7.6) versus 3.0 (1.2 to 5.3) years for the control group. Mean scores were compared to a cohort of uncomplicated total knee arthroplasties matched by age, body mass index, and sex using generalized linear models adjusted for follow-up duration. Kaplan-Meier survivorship curves for PJI were constructed. RESULTS Mean Patient Reported Outcome Scores for the DAIR cohort were 57.2 ± 19.7 for KOOS-JR, 41.6 ± 7.1 for PROMIS physical health (PH), and 46.6 ± 8.7 for PROMIS mental health (MH). Mean control group values were 65.8 ± 21.0 for KOOS-JR, 44.6 ± 8.4 for PROMIS PH, and 49.2 ± 9.2 for PROMIS MH. No difference was observed in KOOS-JR (P = .83) or PROMIS MH (P = .11). PROMIS PH was lower in the DAIR cohort compared to the control group (P = .048). Median follow-up (years) for all 191 cases was 5.9 (range, 0.5 to 13.1). Survivorship (years) without subsequent operation for infection was 84% at 1, 82% at 2, and 79% at 5. CONCLUSION Knee and MH outcomes in successful DAIR procedures were similar to uncomplicated total knee arthroplasty. DAIR's success rate was 79% in treating acute PJI at 5 years. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Matthew G Van Engen
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher N Carender
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicolas O Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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De Meo D, Martini P, Pennarola MF, Guarascio G, Rivano Capparuccia M, Iaiani G, Candela V, Gumina S, Villani C. Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study. Gels 2023; 9:758. [PMID: 37754439 PMCID: PMC10530128 DOI: 10.3390/gels9090758] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023] Open
Abstract
Periprosthetic joint infections (PJI) are among the most difficult complications to treat in orthopaedic surgery. Debridement, antibiotics, and implant retention (DAIR) represent an efficient strategy for acute PJI, especially when resorbable local antibiotic carriers and coatings are used. The aim of this pilot study was to evaluate the difference between using antibiotic-loaded hydrogel (ALH) and calcium sulphate (CS) beads in the DAIR procedure. We analysed 16 patients who had been treated since 2018 for acute PJI, namely eight patients with knee PJI (50%), seven with hip PJI (43.7%), and one with shoulder PJI (6.2%). Nine patients were treated with the Debridement, Antibiotic Coating and Retention of the Implant (DACRI) method, while seven were treated with the Debridement, Antibiotic Pearls, Retention of the Implant (DAPRI) method. We found no significant differences between the two groups in terms of age, sex, the American Society of Anesthesiologists risk score, Charlson Comorbidity Index, localisation, days from onset to diagnosis and pathogenesis. Furthermore, no differences were found between the DACRI and DAPRI groups in terms of infection control (15 patients, 93.75% with p = 0.36) and last C-Reactive Protein values (p = 0.26), with a mean follow-up of 26.1 ± 7.7 months. Treatment for one patient affected by knee Candida albicans PJI in the DACRI group was not successful. In conclusion, DAPRI and DACRI appear to be safe and effective treatments for PJIs. This evidence will encourage the development of new clinical research into local carriers and coatings for use in acute implant-associated infections.
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Affiliation(s)
- Daniele De Meo
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
| | - Paolo Martini
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
| | - Maria Francesca Pennarola
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
| | - Giovanni Guarascio
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
| | - Marco Rivano Capparuccia
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00100 Rome, Italy
| | - Giancarlo Iaiani
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00100 Rome, Italy
| | - Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
| | - Ciro Villani
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00100 Rome, Italy; (P.M.); (M.F.P.); (G.G.); (V.C.); (S.G.); (C.V.)
- M.I.T.O. (Malattie Infettive in Traumatologia e Ortopedia-Infections in Traumatology and Orthopedics Surgery) Study Group, Policlinico Umberto I Hospital, Viale del Policlinico 155, 00161 Rome, Italy; (M.R.C.); (G.I.)
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Portier E, Zeller V, Kerroumi Y, Heym B, Marmor S, Chazerain P. Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints. J Bone Jt Infect 2022; 7:81-90. [PMID: 35464147 PMCID: PMC9022469 DOI: 10.5194/jbji-7-81-2022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/26/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract. Background: Arthroplasty after septic arthritis (SA) treatment raises
diagnostic and therapeutic questions. The main objective was to evaluate
infection-free survival of patients undergoing total knee arthroplasty (TKA) or total hip
arthroplasty (THA) post-SA. Other objectives were to describe the
population's characteristics, surgical strategies, results of preoperative
examinations and cultures of intraoperative samples taken at implantation,
and postoperative antibiotic therapy.
Methods: This is a retrospective, observational, monocenter study, from January 2005 to May 2019, including all patients undergoing TKA or THA with prior or ongoing SA
in the same joint. Infection–free survival was analyzed and reported.
Results: Forty-seven patients, 29 men, 49 joints operated on (30 knees, 19 hips),
were included. Median SA-to-arthroplasty interval was 32 [1–216] weeks. It
was <2 years for 43 joints and <6 months for 19 joints. Six
patients underwent arthroplasty while still on SA treatment. One-stage
arthroplasty was done for 43 joints and two-stage arthroplasty for 6 joints. Eight (16 %)
cultures of intraoperative specimens were positive. Median durations of
postoperative antibiotic therapy were 10 d for sterile cultures and 82 d for those that were positive. At 2 years, infection-free survival rate was
95.9 % (±0.02). After a median follow-up of 47 [18–142] months, no SA
relapse was observed, but five patients developed new periprosthetic joint infections (PJIs) with a different
microorganism.
Conclusion: Arthroplasty may be a post-SA option, even within a short period of time.
One-stage arthroplasty can be done if synovectomy is thorough,
intraoperative samples are taken and antibiotics are administered until those
culture results become available. We observed no SA relapse, but new PJIs
occurred.
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Affiliation(s)
- Elodie Portier
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Rhumatologie, Groupe Hospitalier Diaconesses Croix
Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Médecine interne et Infectiologie, Groupe
Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier
Diaconesses Croix Saint-Simon, Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier
Diaconesses Croix Saint-Simon, Paris, France
| | - Pascal Chazerain
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Rhumatologie, Groupe Hospitalier Diaconesses Croix
Saint-Simon, Paris, France
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Unfried RI, Krause LMF, Cezimbra HM, Pacheco LS, Larangeira JA, Ribeiro TA. A Retrospective Observational Cohort Study of Periprosthetic Hip Infection Treated by one-stage Method Including Cases With Bone Graft Reconstruction. Clin Med�Insights�Arthritis�Musculoskelet Disord 2022; 15:11795441221090344. [PMID: 35547099 PMCID: PMC9081729 DOI: 10.1177/11795441221090344] [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] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Purpose: Prosthetic joint infection (PJI) is a devastating complication that can affect hip arthroplasty. Its treatment is extremely difficult, and issues regarding the optimal treatment remain unanswered. This study intended to show the effectiveness of the one-stage treatment of PJI. Materials and Methods: A retrospective observational cohort study performed from July 2014- August 2018. All patients with suspected PJI were included. Major and minor criteria developed by the International Consensus on Periprosthetic Joint Infection (ICPJI) was used to define infection. Laboratory tests and image exams were performed, and all patients were followed for at least 2 years. Outcomes: Success rate (2018 ICPJI definition to success) in treatment of PJI using one-stage revision method. Clinical and functional outcomes defined by Harris Hip Score (HHS). Results: Thirty-one patients were screened and 18 analyzed. 69.85 ± 9.76 years was the mean age. Mean follow-up time was 63.84 ± 18.55 months. Ten patients had acetabular defects and required bone graft reconstruction. Sixteen patients were classified as Tier 1, 1 as Tier 3D, and as 1 Tier 3E. Almost 90% of patients submitted to one-stage revision with acetabulum graft reconstruction were free of infection. The overall infection survival rate was 78.31±6.34 months. Candida albicans and sinus tract were statistically significant in univariate Cox’s analysis. The predictor of one-stage revision surgery failure that remained final Cox’s regression model was C. albicans (hazard ratio [HR]: 4.47). Conclusion: Treatment through one-stage revision surgery associated with 6 months of antimicrobial is a viable option with acceptable results even when bone graft reconstruction is necessary. C. albicans was a strong predictor of failure in this cohort.
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Affiliation(s)
- Ricardo Issler Unfried
- Department of and Traumatology, University Hospital of Santa Maria (SOT-HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Master’s Course in Health and Life Sciences, Universidade Franciscana (UFN), Santa Maria, Brazil
| | | | - Helen Minussi Cezimbra
- Department of Infectious Diseases, University Hospital of Santa Maria, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Liliane Souto Pacheco
- Medicine School, Hospital São Francisco de Assis (HSFA), Universidade Franciscana (UFN), Santa Maria, Brazil
- Department of Infectious Diseases, University Hospital of Santa Maria, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - João Alberto Larangeira
- Department of and Traumatology, University Hospital of Santa Maria (SOT-HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Tiango Aguiar Ribeiro
- Department of and Traumatology, University Hospital of Santa Maria (SOT-HUSM), Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Master’s Course in Health and Life Sciences, Universidade Franciscana (UFN), Santa Maria, Brazil
- Medicine School, Hospital São Francisco de Assis (HSFA), Universidade Franciscana (UFN), Santa Maria, Brazil
- Postgraduate Program of Health Science, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Department of Surgery in Orthopaedic, Medicine School, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
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Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of bacterial colonisation of vancomycin-gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication. Eur J Orthop Surg Traumatol 2021; 32:1661-1669. [PMID: 34677662 DOI: 10.1007/s00590-021-03151-5] [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] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In two-stage replacements for septic loosening, some studies have suggested an association between bacterial colonisation of spacers and a higher number of complications after implantation of the definitive prosthesis. Our study aimed to determine the reoperation rate of patients undergoing two-stage revision surgery according to the culture results of spacer sonication. METHODS A retrospective observational study was conducted in which hip or knee spacers implanted at our institution with a diagnosis of periprosthetic joint infection from 2010 to 2018 were analysed. Patients were grouped into three categories: A. Patients with positive spacer sonication fluid culture, with or without positive cultures of the rest of the samples. B. Patients with negative spacer sonication culture and negative cultures of the rest of intraoperative samples. C. Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples. RESULTS A total of 45 spacers were analysed: 10 were included in group A, 24 in group B and 11 in group C. The reoperation rate during the first year after the 2-stage revision surgery was 20%, 29.2% and 54.5% for each group, respectively, due to an infection in 10%, 20.8% and 45.5%. Spacers were colonised in all cases by low virulent micro-organisms. CONCLUSION In our study, bacterial colonisation of the spacer is not associated with a higher rate of reoperation. The group of patients with positive intraoperative cultures during the second-stage had the highest reoperation rate.
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Affiliation(s)
- Sandra Huguet
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain.
- Department of Traumatology and Orthopaedics, Consorci Sanitari de l'Alt Penedès - Garraf, Barcelona, Spain.
| | - Martí Bernaus
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lucía Gómez
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Eva Cuchí
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Department of Microbiology, CATLAB, Viladecavalls, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases - Osteoarticular Infections Unit, Hospital Clínic, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
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Deng W, Li R, Shao H, Yu B, Chen J, Zhou Y. Comparison of the success rate after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection among patients with or without a sinus tract. BMC Musculoskelet Disord 2021; 22:895. [PMID: 34674675 PMCID: PMC8532350 DOI: 10.1186/s12891-021-04756-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/29/2021] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND The relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract. METHODS Consecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored. RESULTS One hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038). CONCLUSIONS The presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.
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Affiliation(s)
- Wang Deng
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Road, Xicheng District, Beijing, 100035, China
| | - Rui Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100039, China
| | - Hongyi Shao
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Road, Xicheng District, Beijing, 100035, China
| | - Baozhan Yu
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100039, China.,Department of Orthopaedics, Bao Ding Gem Flower Eastern Hospital, Bao Ding, Hebei, China
| | - Jiying Chen
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing, 100039, China.
| | - Yixin Zhou
- Department of Orthopedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Road, Xicheng District, Beijing, 100035, China.
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8
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Zajonz D, Zimmerlich B, Möbius R, Edel M, Przybyl J, Höch A, Fakler JKM, Roth A, Ghanem M. Knee arthrodesis as last resort for persistent knee joint infections : Comparison of extramedullary and intramedullary treatment. Orthopade 2021; 50:207-213. [PMID: 32666143 PMCID: PMC7925473 DOI: 10.1007/s00132-020-03939-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Knee joint arthrodesis is an established treatment for periprosthetic infections (PPI) providing stability and pain relief. In this study the outcome after arthrodesis of the knee joint for persistent infections was compared and evaluated depending on the surgical procedure (intramedullary vs. extramedullary). Material and methods In a retrospective case analysis, all patients who underwent knee joint arthrodesis between 1 January 2010 and 31 December 2016 were identified and divided into two groups: IMA and EMA. All patients were examined clinically and radiologically and the patient files were evaluated. In addition, the FIM score, the LEFS, the WHOQOL-BREF and NRS were evaluated. Results The median LEFS score for the IMA group was 26 points and in the EMA group 2 points (p = 0.03). The IMA patients showed a median pain scale at rest of 0 and during exercise of 2. The EMA group recorded a pain scale of 3 at rest and 5 during exercise (p = 0.28 at rest; p = 0.43 during exercise). In the IMA group the median postsurgical leg length difference was −2.0 cm and −2.5 cm in the EMA group (p = 0.31). At the end of the follow-up examinations, the FIM score of patients in the IMA group was 74.5 points and 22 points in the EMA group (p = 0.07). Conclusion The study showed that no arthrodesis procedure is obviously superior with respect to the postoperative outcome. The IMA combines advantages especially in the early phase after surgery in terms of function as well as patient comfort and is therefore currently the procedure of choice. The attending physician should be familiar with the advantages and disadvantages of the various procedures in order to be able to make an individual decision and thus maximize the chance of treatment success.
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Affiliation(s)
- Dirk Zajonz
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany. .,Center for Research on Musculoskeletal Systems, ZESBO, Semmelweisstraße 14, 04103, Leipzig, Germany. .,Department of Orthopaedic Surgery, Traumatology and Reconstructive Surgery, Zeisigwald Hospital Chemnitz, Zeisigwaldstraße 101, 09130, Chemnitz, Germany.
| | - Benedikt Zimmerlich
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.,Clinic for Orthopaedics and Trauma Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Straße 2, 04552, Borna, Germany
| | - Robert Möbius
- Center for Research on Musculoskeletal Systems, ZESBO, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Melanie Edel
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.,Center for Research on Musculoskeletal Systems, ZESBO, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Johanna Przybyl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Andreas Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.,Center for Research on Musculoskeletal Systems, ZESBO, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Johannes K M Fakler
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Mohamed Ghanem
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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9
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George JC, Sainulabdeen J, Chittaranjan S, George K, Babu S. Single-Stage Revision With Fluconazole Monotherapy in Fungal Prosthetic Knee Joint Infections. Arthroplast Today 2021; 7:238-241. [PMID: 33659600 PMCID: PMC7892626 DOI: 10.1016/j.artd.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/16/2022] Open
Abstract
Fungal prosthetic joint infection is rare, and two-stage revision is usually advocated. We present our experience with 2 cases of fungal prosthetic knee joint infection presenting 25 months and 3 years after index surgery. Both patients were managed with single-stage revision arthroplasty and fluconazole monotherapy. They remain asymptomatic with good knee society score after 2 years of follow-up. Preoperative workup of all aseptic loosening cases should include extended culture for fungal elements. Single-stage revision with antifungal therapy for 3 months gives good results in nonimmunocompromised patients with good soft-tissue envelope.
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Affiliation(s)
- James C George
- Department of Orthopaedics, Believer's Church Medical College and Hospital, Thiruvalla, Kerala, India
| | - Jishar Sainulabdeen
- Department of Orthopaedics, Believer's Church Medical College and Hospital, Thiruvalla, Kerala, India
| | - Samuel Chittaranjan
- Department of Orthopaedics, Believer's Church Medical College and Hospital, Thiruvalla, Kerala, India
| | - Koshy George
- Department of Orthopaedics, Believer's Church Medical College and Hospital, Thiruvalla, Kerala, India
| | - Subin Babu
- Department of Orthopaedics, Believer's Church Medical College and Hospital, Thiruvalla, Kerala, India
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10
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Zhu MF, Kim K, Cavadino A, Coleman B, Munro JT, Young SW. Success Rates of Debridement, Antibiotics, and Implant Retention in 230 Infected Total Knee Arthroplasties: Implications for Classification of Periprosthetic Joint Infection. J Arthroplasty 2021; 36:305-310.e1. [PMID: 32868114 DOI: 10.1016/j.arth.2020.07.081] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [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: 06/03/2020] [Revised: 07/11/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is the most common cause of failure following total knee arthroplasty (TKA). This study aimed to determine the success of debridement, antibiotics, and implant retention (DAIR) in a large cohort of TKA PJIs and assess the utility of current classification systems in predicting DAIR outcomes in early postoperative, late hematogenous, and chronic PJIs. METHODS In a multicenter review over 15 years, 230 patients underwent DAIR for first episode PJI following primary TKA. Patient demographics, disease and surgical factors, treatment regime, and outcomes were identified. Univariate and multivariate survival analyses were performed to identify factors associated with successful DAIR. Continuous variables with predictive value were further analyzed using receiver operating characteristic curves. The ability to predict DAIR outcomes of multiple classification systems was also assessed. RESULTS Patients were followed for an average of 6.9 years. The overall success rate of DAIR was 53.9%. On receiver operating characteristic analysis, 3 months (area under the curve = 0.63) and 1-year age (area under the curve = 0.66) of implant cut-offs was similarly predictive of outcomes. On multivariate survival analysis, DAIR was successful in 64% of "early" PJIs (implant <1 year) vs 38% of "late hematogenous" PJIs (implant >1 year; odds ratio [OR] 1.78, P = .01). For late PJIs (implant >1 year), Staphylococcus aureus (OR 4.70, P < .001) and gram-negative infections (OR 2.56, P = .031) were risk factors for DAIR failure. CONCLUSION DAIR has a high failure rate in all PJIs occurring more than a year post primary TKA, particularly when caused by S aureus or gram-negative bacteria. The age of implant is an important predictor of DAIR outcomes.
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Affiliation(s)
- Mark F Zhu
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Katy Kim
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Alana Cavadino
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Simon W Young
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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11
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Perez S, Dauchy FA, Salvo F, Quéroué M, Durox H, Delobel P, Chambault R, Ade M, Cazanave C, Desclaux A, Fabre T, Dutronc H. Severe adverse events during medical and surgical treatment of hip and knee prosthetic joint infections. Infect Dis Now 2020; 51:346-350. [PMID: 33096203 DOI: 10.1016/j.medmal.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/02/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The management of prosthetic joint infection requires a complex treatment procedure and can be associated with complications. However, the occurrence of severe adverse events during this intervention has been poorly evaluated. PATIENTS AND METHODS A 5-year multicentric retrospective study including patients from 3 hospitals in the South-Western France referral center for complex bone and joint infections (Crioac GSO) and treated for hip or knee prosthetic joint infection with 1 or 2-stage implant exchanges. The objective was to describe grade≥3 adverse events, according to the CTCAE classification, occurring within 6 weeks after surgery and to identify their associated factors. RESULTS One hundred and eighteen patients were identified. We observed 71 severe events in 50 patients (42.3%; 95% confidence interval [CI95%]: 33.8-51.4%). Sixteen severe events were an evolution of the infection. The remaining 55 others (47 grade 3 and 8 grade 4) occurred in 41 patients (34.7%; CI95%: 26.8-43.7%). They were distributed as follows: 27 (49.1%) medical complications, 21 (38.2%) surgical complications and 7 (12.7%) antibiotic-related complications. The main identified risk factor was a two-stage prosthetic exchange with OR=3.6 (CI95% [1.11-11.94], P=0.032). Obesity was limit of significance with OR=3.3 (CI95% [0.9-12.51], P=0.071). Infection with coagulase negative Staphylococcus was a protective factor with OR=0.3 (CI95% [0.12-0.99], P=0.047). CONCLUSION Severe adverse events are frequent following prosthetic exchange for PJI (34.7%) and are related to the high frequency of comorbidities in this population and to the complex surgical procedures required. The risk factor significantly associated with these events was a two-stage exchange.
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Affiliation(s)
- S Perez
- Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - F-A Dauchy
- Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France; South Western France referral center for complex bone and joint infections (Crioac GSO), France
| | - F Salvo
- Medical pharmacology service, Bordeaux CHU, Bordeaux, France
| | - M Quéroué
- Informatic unit, medical information service, Bordeaux CHU, Bordeaux, France
| | - H Durox
- South Western France referral center for complex bone and joint infections (Crioac GSO), France; Infectious and tropical disease service, Limoges CHU, Limoges, France
| | - P Delobel
- South Western France referral center for complex bone and joint infections (Crioac GSO), France; Infectious and tropical disease service, Toulouse CHU, Toulouse, France
| | - R Chambault
- Hospital Pharmacy, Toulouse CHU, Toulouse, France
| | - M Ade
- Hospital Pharmacy, Toulouse CHU, Toulouse, France
| | - C Cazanave
- Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - A Desclaux
- Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France
| | - T Fabre
- South Western France referral center for complex bone and joint infections (Crioac GSO), France; Orthopedic surgery service, Bordeaux CHU, Bordeaux, France
| | - H Dutronc
- Infectious and tropical disease service, Bordeaux CHU, hôpital Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux, France; South Western France referral center for complex bone and joint infections (Crioac GSO), France.
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12
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Ohlmeier M, Filitarin S, Delgado G, Frings J, Abdelaziz H, Salber J, Frommelt L, Gehrke T, Citak M. Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection. J Med Microbiol 2020; 69:1100-1104. [PMID: 32639225 DOI: 10.1099/jmm.0.001229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction. Periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange.Aim. This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs.Methodology. Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1-9 years). Reinfection and complications rates after the one-stage exchange were analysed.Results. Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive Staphyloccocus epidermidis.Conclusion. One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.
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Affiliation(s)
- Malte Ohlmeier
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Sergei Filitarin
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Giorgio Delgado
- Department of Orthopedics, Philippine General Hospital, University of the Philippines Manila, Taft Avenue, Manila 1000, Philippines
| | - Jannik Frings
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Hussein Abdelaziz
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Jochen Salber
- Department of Surgery, Ruhr-University Bochum, Germany
| | - Lars Frommelt
- Department of Infectious Diseases, Clinical Microbiology and Infection Control, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Thorsten Gehrke
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
| | - Mustafa Citak
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany
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13
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Ohlmeier M, Delgado G, Calderon CA, Hartwig CH, Gehrke T, Citak M. Are Patients With a History of Septic Arthritis Undergoing Total Knee Arthroplasty at Higher Risk for Revision Surgery? A Single-Center Study. J Arthroplasty 2020; 35:1857-1861. [PMID: 32247677 DOI: 10.1016/j.arth.2020.02.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/13/2020] [Accepted: 02/28/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The decision to perform a total knee arthroplasty (TKA) on a previously infected knee is made complicated by the higher risk for both a periprosthetic joint infection (PJI) and early failure. There is currently no standard in the treatment strategy for this group of patients. We here report the outcomes of performing a primary TKA on patients with a prior septic knee arthritis. The aim of our study is to analyze the survival rates of patients with a history of septic arthritis undergoing TKA. METHODS From 2010 to 2018, all patients treated in our institution with a minimum follow-up of 1 year, who have previous histories of knee joint infections and underwent a primary TKA were included in the study. All patients underwent the same surgical protocol and were given systemic and local antibiotic treatment. RESULTS Of the 68 knees, there were 4 surgical revisions (5.9%). These included 2 septic revisions due to PJI (2.9%), 1 open arthrolysis for arthrofibrosis (1.5%), and 1 aseptic revision for implant loosening (1.5%). Sixty-four (64) knees (94%) had survived without any surgical interventions and the Kaplan-Meier analysis demonstrated an overall survivorship free from PJI of 97.1% at a mean of 5 years (range 1-9, standard deviation ±2.5 years). CONCLUSION TKA is a suitable option for patients with a prior septic arthritis of the knee, provided that proper surgical technique and the utilization of systemic and local antibiotics are employed. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Malte Ohlmeier
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Giorgio Delgado
- Department of Orthopedics, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Claudia Arias Calderon
- Department of Trauma and Orthopedic Surgery, Hospital Nacional Edgardo Rebagliati Martins, Jesús María, Peru
| | - Carl-Heinz Hartwig
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Joint Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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14
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Li C, Ojeda-Thies C, Renz N, Margaryan D, Perka C, Trampuz A. The global state of clinical research and trends in periprosthetic joint infection: A bibliometric analysis. Int J Infect Dis 2020; 96:696-709. [PMID: 32434084 DOI: 10.1016/j.ijid.2020.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to estimate the trends and state of research in periprosthetic joint infection (PJI). METHODS Publications on PJI published between 1998 and 2018 were searched in the Web of Science database and analyzed using bibliometrics. The Altmetric score and Research Interest score were combined to provide a weighted count. The scope of the Altmetric score includes >16 weighted composite scores from websites such as Twitter, Facebook, and YouTube, whereas the Research Interest score is calculated from information derived from ResearchGate. RESULTS Total of 3245 published documents were identified. The largest contribution was made by the United States, with the institution contributing most being the Rothman Institute. The most relative articles were published by the Journal of Arthroplasty, whereas the highest citation frequency journal was Clinical Orthopaedics and Related Research. There was a positive correlation between citation counts and Research Interest scores, while the Altmetric Attention score showed a negative value for highly cited articles. CONCLUSIONS Based on the current trends of globalization, there is a rising trend in publications on PJI, with the largest annual contributions made by the United States. The most influential contributors are researchers from the United States and Europe. Twitter is used as a platform to communicate knowledge by most PJI researchers. The most recent research has focused on the diagnosis and risk factors of PJI.
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15
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Roerdink RL, Huijbregts HJTAM, van Lieshout AWT, Dietvorst M, van der Zwaard BC. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong) 2020; 27:2309499019860468. [PMID: 31284831 DOI: 10.1177/2309499019860468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current literature occasionally considers septic arthritis in native joints and prosthetic joint infections as equal pathologies. However, significant differences can be identified. The aim of this review of literature is to describe these differences in definitions, pathology, diagnostic workups, treatment strategies, and prognosis.
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Affiliation(s)
- Ramon Lucas Roerdink
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
| | | | | | - Martijn Dietvorst
- 4 Department of Orthopedic Surgery at Máxima Medical Center, The Netherlands
| | - Babette Corine van der Zwaard
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
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16
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Bistolfi A, Ferracini R, Albanese C, Vernè E, Miola M. PMMA-Based Bone Cements and the Problem of Joint Arthroplasty Infections: Status and New Perspectives. Materials (Basel) 2019; 12:E4002. [PMID: 31810305 PMCID: PMC6926619 DOI: 10.3390/ma12234002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023]
Abstract
Polymethyl methacrylate (PMMA)-based bone cement is a biomaterial that has been used over the last 50 years to stabilize hip and knee implants or as a bone filler. Although PMMA-based bone cement is widely used and allows a fast-primary fixation to the bone, it does not guarantee a mechanically and biologically stable interface with bone, and most of all it is prone to bacteria adhesion and infection development. In the 1970s, antibiotic-loaded bone cements were introduced to reduce the infection rate in arthroplasty; however, the efficiency of antibiotic-containing bone cement is still a debated issue. For these reasons, in recent years, the scientific community has investigated new approaches to impart antibacterial properties to PMMA bone cement. The aim of this review is to summarize the current status regarding antibiotic-loaded PMMA-based bone cements, fill the gap regarding the lack of data on antibacterial bone cement, and explore the progress of antibacterial bone cement formulations, focusing attention on the new perspectives. In particular, this review highlights the innovative study of composite bone cements containing inorganic antibacterial and bioactive phases, which are a fascinating alternative that can impart both osteointegration and antibacterial properties to PMMA-based bone cement.
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Affiliation(s)
- Alessandro Bistolfi
- AO Citta’ della Salute e della Scienza. CTO Hospital, Department of Orthopedics. Via Zuretti 29, 10126 Turin, Italy; (A.B.); (C.A.)
| | - Riccardo Ferracini
- IRCCS Ospedale Policlinico San Martino, Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy;
| | - Carlo Albanese
- AO Citta’ della Salute e della Scienza. CTO Hospital, Department of Orthopedics. Via Zuretti 29, 10126 Turin, Italy; (A.B.); (C.A.)
| | - Enrica Vernè
- Department of Applied Science and Technology, PolitoBIOMed Lab, Politecnico di Torino, C.so Duca Degli Abruzzi 24, 10129 Torino, Italy;
| | - Marta Miola
- Department of Applied Science and Technology, PolitoBIOMed Lab, Politecnico di Torino, C.so Duca Degli Abruzzi 24, 10129 Torino, Italy;
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17
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Li C, Renz N, Trampuz A, Ojeda-Thies C. Twenty common errors in the diagnosis and treatment of periprosthetic joint infection. Int Orthop 2020; 44:3-14. [PMID: 31641803 DOI: 10.1007/s00264-019-04426-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.
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18
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Fillingham YA, Della Valle CJ, Suleiman LI, Springer BD, Gehrke T, Bini SA, Segreti J, Chen AF, Goswami K, Tan TL, Shohat N, Diaz-Ledezma C, Schwartz AJ, Parvizi J. Definition of Successful Infection Management and Guidelines for Reporting of Outcomes After Surgical Treatment of Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society (MSIS). J Bone Joint Surg Am 2019; 101:e69. [PMID: 31318814 DOI: 10.2106/jbjs.19.00062] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Craig J Della Valle
- Departments of Orthopaedic Surgery (C.J.D.V.) and Infectious Disease (J.S.), Rush University Medical Center, Chicago, Illinois
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bryan D Springer
- Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center, Charlotte, North Carolina
| | - Thorsten Gehrke
- Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Stefano A Bini
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - John Segreti
- Departments of Orthopaedic Surgery (C.J.D.V.) and Infectious Disease (J.S.), Rush University Medical Center, Chicago, Illinois
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karan Goswami
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Timothy L Tan
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Noam Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Adam J Schwartz
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Javad Parvizi
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
An algorithm for managing periprosthetic joint infections (PJIs) after total hip replacement (THR) surgery using a multidisciplinary approach and a clearly defined protocol may improve infection eradication rates. In this article, we present an algorithm for the management of different types of PJIs including the acutely infected cemented and cementless THRs where the components are well-fixed postoperatively and when the infection is secondary to haematogenous spread in previously well-functioning and well-fixed implants. For chronic PJIs where the components are often loose, the standard treatment includes a two-stage revision procedure. However, in a highly selected subset of patients, a single-stage approach has been utilised with high rates of eradicating infections.
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Affiliation(s)
- Mohamed Sukeik
- Foothills Medical Centre, 1403 29 St NW Calgary, AB T2N 2T9, Canada
| | - Fares Sami Haddad
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK
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