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Galanis A, Karampitianis S, Vlamis J, Karampinas P, Vavourakis M, Vlachos C, Papagrigorakis E, Zachariou D, Sakellariou E, Varsamos I, Patilas C, Tsiplakou S, Papaioannou V, Kamariotis S. Corynebacterium striatum Periprosthetic Hip Joint Infection: An Uncommon Pathogen of Concern? Healthcare (Basel) 2024; 12:273. [PMID: 38275553 PMCID: PMC10815444 DOI: 10.3390/healthcare12020273] [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: 11/28/2023] [Revised: 01/08/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Total hip arthroplasty is indubitably a dominant elective surgery in orthopaedics, contributing to prodigious improvement in the quality of life of patients with osteoarthritis. One of the most potentially devastating complications of this operation is periprosthetic joint infection. Immunocompromised patients might be afflicted by infrequent low-virulence organisms not typically detected with conventional procedures. Consequently, employing advanced identification methods, such as the circumstantial sonication of orthopaedic implants, could be crucial to managing such cases. CASE PRESENTATION We present a peculiar case of a 72-year-old female patient suffering from a chronic periprosthetic hip infection due to Corynebacterium striatum. The pathogen was only identified after rigorous sonication of the extracted implants. The overall management of this case was immensely exacting, primarily because of the patient's impaired immune system, and was finally treated with two-stage revision in our Institution. LITERATURE REVIEW Although copious literature exists concerning managing periprosthetic hip infections, no concrete guidelines are available for such infections in multimorbid or immunocompromised patients with rare low-virulence microorganisms. Hence, a diagnostic work-up, antibiotic treatment and appropriate revision timeline must be determined. Sonication of extracted implants could be a powerful tool in the diagnostic arsenal, as it can aid in identifying rare microbes, such as Corynebacterium spp. Pertinent antibiotic treatment based on antibiogram analysis and apposite final revision-surgery timing are the pillars for effective therapy of such infections. CLINICAL RELEVANCE Corynebacterium striatum has been increasingly recognized as an emerging cause of periprosthetic hip infection in the last decade. A conspicuous rise in such reports has been observed in multimorbid or immunocompromised patients after the COVID-19 pandemic. This case is the first report of Corynebacterium striatum periprosthetic hip infection diagnosed solely after the sonication of extracted implants. This paper aims to increase awareness surrounding Corynebacterium spp. prosthetic joint infections, while highlighting the fields for further apposite research.
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Affiliation(s)
- Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Spyridon Karampitianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - John Vlamis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Panagiotis Karampinas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Christos Vlachos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Eftychios Papagrigorakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Iordanis Varsamos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Christos Patilas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Kifisia, 14561 Athens, Greece; (A.G.); (S.K.); (J.V.); (P.K.); (C.V.); (E.P.); (D.Z.); (E.S.); (I.V.); (C.P.)
| | - Sofia Tsiplakou
- Department of Microbiology, KAT General Hospital, Kifisia, 14561 Athens, Greece; (S.T.); (V.P.); (S.K.)
| | - Vasiliki Papaioannou
- Department of Microbiology, KAT General Hospital, Kifisia, 14561 Athens, Greece; (S.T.); (V.P.); (S.K.)
| | - Spyridon Kamariotis
- Department of Microbiology, KAT General Hospital, Kifisia, 14561 Athens, Greece; (S.T.); (V.P.); (S.K.)
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Galanis A, Dimopoulou S, Karampinas P, Vavourakis M, Papagrigorakis E, Sakellariou E, Karampitianis S, Zachariou D, Theodora M, Antsaklis P, Daskalakis G, Vlamis J. The correlation between transient osteoporosis of the hip and pregnancy: A review. Medicine (Baltimore) 2023; 102:e35475. [PMID: 37832084 PMCID: PMC10578699 DOI: 10.1097/md.0000000000035475] [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: 08/02/2023] [Accepted: 09/13/2023] [Indexed: 10/15/2023] Open
Abstract
Transient osteoporosis of the hip is indubitably a comparatively infrequent entity affecting both men and women worldwide. Its occurrence in the course of pregnancy, specifically in the third trimester, and lactation are of paramount concernment. The exact association between transient hip osteoporosis and pregnancy is precarious. Etiology and potential pathophysiological mechanisms behind this correlation are still to be utterly defined. Magnetic resonance imaging is highly regarded as the gold standard imaging method for assiduous assessment of this disorder. Physicians of copious medical specialties should practice scrupulous techniques for early and pertinent diagnosis when pregnant women are presented with persistent hip pain, as differential diagnosis with femoral head avascular necrosis can be exceedingly arduous. Treatment is predominantly conservative with protected weight-bearing and analgesic medication in the first line of management. In terms of prognosis, the disease ordinarily resolves spontaneously after a few months. Further research is required in order to elucidate the ambiguity surrounding the establishment of globally approved diagnosis and treatment guidelines for pregnancy-associated transient hip osteoporosis. This paper aims to accentuate the significance of this particular disorder by providing a succinct review of the existing literature, augmenting clinicians' knowledge about the features of pregnancy-related transient proximal femur osteoporosis.
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Affiliation(s)
- Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Stefania Dimopoulou
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panagiotis Karampinas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Eftychios Papagrigorakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Spyridon Karampitianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Marianna Theodora
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - Panagiotis Antsaklis
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - George Daskalakis
- 1st Department of Obstetrics and Gynecology, National & Kapodistrian University of Athens, Alexandra General Hospital, Athens, Greece
| | - John Vlamis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
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Karampinas P, Galanis A, Vlamis J, Vavourakis M, Papagrigorakis E, Sakellariou E, Zachariou D, Karampitianis S, Vasiliadis E, Pneumaticos S. The Role of Ultrasonography in Hip Impingement Syndromes: A Narrative Review. Diagnostics (Basel) 2023; 13:2609. [PMID: 37568972 PMCID: PMC10416868 DOI: 10.3390/diagnostics13152609] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/28/2023] [Accepted: 08/05/2023] [Indexed: 08/13/2023] Open
Abstract
Hip pain is indubitably a frequent clinical problem deriving from copious etiologies. Hip impingement syndromes are one of the most prevalent causes of persistent groin pain, especially in young and active patients. Diligent imaging of the hip region is indispensable to discern femoroacetabular impingement, as the differential diagnosis of hip pain can be exceedingly arduous. Despite hip radiography being plain and broadly attainable, it offers narrow information concerning soft tissue pathologies around the hip joint (extra-articular hip impingement syndromes). Magnetic resonance imaging and arthrography remain the gold standard examination for detecting intra-articular pathologies; however, they are widely considered expensive, time-consuming and characterized by confined. Consequently, ultrasonography has emerged as an alternative valuable diagnostic tool for distinguishing the underlying abnormalities that trigger femoroacetabular impingement. Proper hip ultrasound examination provides dynamic assessment, while also beneficial for guided intervention around the hip joint. Ultrasound hip examination is exacting due to its complex regional anatomy and deep location. It is capable of providing detailed information about various hip quadrants. An adept operator can identify both intra-articular and extra-articular pathologies. In addition, with ultrasonography, hip injections have been rendered relatively undemanding, aiding in therapeutic and diagnostic purposes. This paper aims to provide a succinct and compendious review of the existing literature, accentuating the crucial role of ultrasonography in diagnosing hip impingement syndromes and determining whether an additional examination is required regarding distinguishing between intra-articular and extra-articular syndromes.
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Affiliation(s)
| | | | | | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (P.K.); (A.G.)
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