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Oe K, Iida H, Otsuki Y, Toyoda T, Kobayashi F, Sogawa S, Nakamura T, Saito T. Validity of a preoperative scoring system for surgical management of periprosthetic hip infection: one-stage vs. two-stage revision. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05279-5. [PMID: 38662000 DOI: 10.1007/s00402-024-05279-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/10/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION There are no widely accepted algorithms for determining optimal treatment for periprosthetic joint infection (PJI). Our study aimed to confirm the validity of a previously published scoring system in a larger number of patients to support a rational surgical treatment strategy for periprosthetic hip infection. MATERIALS AND METHODS Between February 2001 and December 2020, we performed 155 consecutive revision total hip arthroplasties (THAs) for PJI, with mean follow-up of 6 years. One-stage revision THA was performed in 56 hips and two-stage revision THA in 99 hips. Prosthesis survival from recurrent infection was determined by Kaplan-Meier analysis, using implant removal as the endpoint. The pre-operative scoring system (full score of 12 points), including 6 essential elements, was retrospectively evaluated. RESULTS The 10-year survival rates were 98% for one-stage (95% confidence interval [CI], 94-100) and 87% (95% CI, 79-96) for two-stage revision THA. Multivariate Cox regression analysis provided a total preoperative score as an independent risk factor for implant removal (hazard ratio, 0.17; 95% CI, 0.06-0.49; p < 0.001). The sensitivity and specificity at the cut-off of 4 points on the scoring system were 80% and 91%, respectively. The average score for one-stage revision THA in successful and failed cases were 8.9 and 6.0, and for two-stage revision THA were 6.5 and 3.9, respectively. We found significant differences between successful cases in one- and two-stage revision THA (p < 0.05). CONCLUSIONS The preoperative scoring system was useful for managing PJI. One-stage revision THA is recommended in patients scoring ≥ 9 points, and meticulously performed two-stage revision THA is encouraged for patients scoring ≥ 4 points.
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Affiliation(s)
- Kenichi Oe
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Hirokazu Iida
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yosuke Otsuki
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Takashi Toyoda
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Fumito Kobayashi
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Shohei Sogawa
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Tomohisa Nakamura
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
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Bastard C, Aïm F, Meyssonnier V, Kerroumi Y, Marion B, Zeller V, Marmor S. One-stage revision for infected shoulder arthroplasty: prospective, observational study of 37 patients. JSES Int 2023; 7:2433-2439. [PMID: 37969534 PMCID: PMC10638573 DOI: 10.1016/j.jseint.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Periprosthetic joint infection is a severe complication of joint replacement surgery. Thus two-stage exchange remains the gold standard, one-stage exchange is now widely recommended. We hypothesized that, for patients with chronic periprosthetic shoulder infection (PSI), treatment with a one-stage exchange would be an effective approach to eradicate infection, relieve pain, and restore function to the involved shoulder. Materials and methods This monocenter cohort study in a Bone and Joint Infection Referral Center (11/2003-05/2020) included all patients with confirmed PSI treated by one-stage revision. Data were extracted from the prospective database, including demographics, infection characteristics, and functional evaluations (range of motion and Constant Score at admission and last follow-up). The primary outcome was the 2-year reinfection-free rate. Results We included 37 patients. The refection-free rate was 5%. The most commonly isolated pathogen was Cutibacterium acnes (68%), isolated alone (15 patients, 41%) or as polymicrobial infections (10 patients, 27%). The Constant Score increased significantly from 24 to 53 (P = .001). Range of motion (forward elevation, abduction) was also significantly improved after surgery. Mean active forward elevation increased significantly by 45° from 60° to 105° postoperatively (P < .001), mean abduction increased by 42° from 55° to 97° (P < .001). Discussion Results from our prospective cohort-extracted series suggest that one-stage revision is a reliable treatment with a low infection recurrence rate. Improved functional outcomes can be achieved with one-stage exchange. Our patients' overall functional results were similar to those previously reported for one-stage revision and better than those reported after two-stage exchange. Patients with multiple previous surgeries seem to have worse functional outcomes than the subgroup without surgery before the index arthroplasty. Conclusions Our results and literature search findings suggest that one-stage revisions effectively eradicate PSIs, with good functional outcomes.
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Affiliation(s)
- Claire Bastard
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Florence Aïm
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, 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, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Blandine Marion
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
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Okafor CE, Nghiem S, Byrnes J. One-stage revision versus debridement, antibiotics, and implant retention (DAIR) for acute prosthetic knee infection: an exploratory cohort study. Arch Orthop Trauma Surg 2023; 143:5787-5792. [PMID: 37101087 PMCID: PMC10449712 DOI: 10.1007/s00402-023-04891-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/16/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Studies have shown that debridement, antibiotics, and implant retention (DAIR) is an effective procedure for acute infection of total knee arthroplasty (TKA). This study aimed to explore DAIR and one-stage revision for homogenous cohorts with acute postoperative and acute hematogenous infection of TKA, without compelling indications to perform a staged revision. MATERIALS AND METHODS This study was an exploratory analysis that used retrospective data from Queensland Health, Australia, for DAIR and one-stage revision of TKA between June 2010 and May 2017 (3-year average follow-up). The re-revision burden, mortality rate, and the cost of the interventions were explored. Costs were expressed in 2020 Australian dollars. RESULTS There were 15 (DAIR) and 142 (one-stage) patients with homogenous characteristics in the sample. The re-revision burden for DAIR was 20%, while for one-stage revision it was 12.68%. Two deaths were associated with a one-stage revision and no death was associated with DAIR. The total cost since the index revision of DAIR, $162,939, was higher than for one-stage revision $130,924 (p value = 0.501), due to higher re-revision burden. CONCLUSIONS This study would suggest the use of one-stage revision over DAIR for acute postoperative and acute hematogenous infection of TKA. It suggests that there could be other potential criteria which have not been ascertained that need to be considered for optimal DAIR selection. The study indicates the need for more research and, of note, high-quality randomized controlled trials to provide a well-defined treatment protocol with high level of evidence to guide patient selection for DAIR.
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Affiliation(s)
- Charles Ebuka Okafor
- Centre for Applied Health Economics, School of Medicine, and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia.
- Menzies Health Institute, Griffith University, Queensland, Australia.
| | - Son Nghiem
- Department of Health Services, Research and Policy, Australian National University, Canberra, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, School of Medicine, and Dentistry, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
- Menzies Health Institute, Griffith University, Queensland, Australia
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Kocaoğlu H, Hennes F, Abdelaziz H, Neufeld ME, Gehrke T, Citak M. Survival analysis of one-stage exchange of infected unicompartmental knee arthroplasty: a single-center study with minimum 3 years follow-up. Eur J Orthop Surg Traumatol 2023; 33:327-333. [PMID: 35066655 DOI: 10.1007/s00590-021-03187-7] [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] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The rates of unicompartmental knee arthroplasty (UKA) are increasing yet little data exists regarding management of periprosthetic joint infections (PJI) after UKA, particularly utilizing one-stage revision. The aim of this study was to determine the septic and all-cause revision-free survival of UKA PJIs treated with one-stage revision, as well as functional outcomes and risk factors for failure. METHODS A retrospective review of one-stage septic revisions with a hinged or rotating hinged implant between 2000 and 2015 at a single institution was performed. Results of 15 patients with a minimum of 3-year follow-up (mean = 93 months; range 37-217) were evaluated by means of infection control, survivorship, patient reported functional score and possible causal factors for a re-revision. Kaplan-Meier curves and Cox regression analysis were used. RESULTS After a mean of 8 years of follow-up infection control rate was 93.3%, the survivorship free of any reoperation, including both septic and aseptic causes, was 80% at 5 years and 64.2% at ten years and average Lysholm score was 72.7 ± 21.3 (33-100). CONCLUSION One-stage revision for PJI of UKA using a hinged knee design has excellent infection-free survival at mid to long-term follow-up. Likewise, patient reported functional outcomes are promising. However, one-third of patients required aseptic reoperation and aseptic loosening was the dominant etiology.
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Affiliation(s)
- Hakan Kocaoğlu
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany. .,Department of Orthopaedics and Traumatology, Faculty of Medicine, Ankara University, Ibn-i Sina Hospital Talatpasa Blvd, 06100, Ankara, Turkey.
| | - Fabian Hennes
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.,Zentrum für Rehabilitationmedizin/Sportmedizin, BG Klinikum Hamburg, Bergerdorfer Strasse 10, 21033, Hamburg, Germany
| | - Hussein Abdelaziz
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Michael E Neufeld
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany.,Division of Lower Limb Reconstruction, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Thorsten Gehrke
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Germany
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Wang XC, Zhang XM, Cai WL, Li Z, Ma C, Liu YH, He QL, Yan TS, Cao XW. One-stage revision arthroplasty in a patient with ochronotic arthropathy accompanied by joint infection: A case report. World J Clin Cases 2022; 10:9036-9043. [PMID: 36157667 PMCID: PMC9477060 DOI: 10.12998/wjcc.v10.i25.9036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/22/2022] [Accepted: 07/29/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ochronotic arthropathy (OcA) is a rare disease, which is caused by the accumulation of homogentisic acid in the joint. Patients with OcA have obvious joint pain and the disease progresses rapidly, eventually resulting in disability. Arthroplasty is an efficacious treatment in patients with OcA. However, when OcA patients have joint infection, is joint replacement an option? In the present report, we performed total knee arthroplasty in a patient with OcA and knee infection under the guidance of one-stage revision theory.
CASE SUMMARY A 64-year-old male was referred to our hospital due to severe left knee pain with limited mobility for 2 years. On physical examination, the patient was found to have dark brown pigmentation of the sclera and auricle. Laboratory test results showed elevations in C-reactive protein level (65.79 mg/L) and erythrocyte sedimentation rate (90.00 mm/h). The patient underwent debridement of the left knee joint, during which the cartilage surface of the knee joint was found to be black-brown in color. Bacterial culture of synovial fluid revealed Achromobacter xylosoxidans. We then carried out arthroplasty under the guidance of the theory of one-stage revision. After surgery, the patient's left knee joint pain disappeared and function recovered without joint infection.
CONCLUSION OcA accompanied by joint infection is rare. One-stage revision arthroplasty may be a treatment option for this disease.
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Affiliation(s)
- Xiao-Chao Wang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Xiao-Min Zhang
- Department of Orthopaedics, Xi’an International Medical Center Hospital, Xi’an 710100, Shaanxi Province, China
| | - Wan-Ling Cai
- Department of Surgery, Baoji Hospital of Traditional Chinese Medicine, Baoji 721000, Shaanxi Province, China
| | - Zhen Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Chao Ma
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Yi-Hai Liu
- Department of Orthopaedics, Xi’an International Medical Center Hospital, Xi’an 710100, Shaanxi Province, China
| | - Qi-Lian He
- Department of Orthopaedics, Xi’an International Medical Center Hospital, Xi’an 710100, Shaanxi Province, China
| | - Tian-Sheng Yan
- Department of Orthopaedics, Xi’an International Medical Center Hospital, Xi’an 710100, Shaanxi Province, China
| | - Xue-Wei Cao
- Department of Orthopaedic Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
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Federico F, Gabriele C, Alessandro R, Luigi S, Alessandro M, Alessandro A, Stefano A. Candida periprosthetic infection of the knee: a systematic review of surgical treatments and clinical outcomes. Eur J Orthop Surg Traumatol 2022. [PMID: 35182240 DOI: 10.1007/s00590-022-03224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Candida periprosthetic joint infections (PJIs) are a rare cause of prosthesis revision with severe consequences and challenging treatment. This study aims to produce a systematic analysis of types of treatment and outcome of knee Candida PJIs and their correlation with specific pathogen species. METHODS During April 2021, a literature search was performed according to PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guideline. Reviewers used the Oxford Level of Evidence (LoE) and Methodological index for non-randomized studies (MINORS) score. Modal value of surgical, pharmacological treatment and outcome along with the correlation between types of treatment and outcome was calculated through Chi-square or Fisher exact test. RESULTS In total, 115 cases were collected through 51 articles, identifying 116 pathogens. Candida albicans was the most frequent pathogen. Analysis of LoE reveals 40 LoE 5 and 11 LoE 4. Thirteen patients underwent one-stage revision, 46 patients two-stage revision, 6 patients resection arthroplasty and arthrodesis, 4 patients long-term antifungal therapy, and 3 patients debridement with prosthesis retention. Global rate of success was 85.14%. Modal distribution revealed a preference for two-stage revision and Fluconazole in medical therapy. No difference in terms of fungal eradication was found among Candida species (p = 0.503) and for treatments except for two-stage revision and resection arthroplasty (p = 0.0125) or debridement with implant retention (p = 0.0498), and the rest of procedures and resection arthroplasty (0.0192). MINORS score was poor. CONCLUSIONS Analysis of the literature did not highlight any difference between types of surgical treatment and pathogens in terms of relapse or infection eradication. However, two-stage replacement may be preferred, allowing healing of infection in most cases.
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Wang HY, Zhang Md R, Luo ZY, Wang Md PhD D, Pei FX, Tang X, Zhou ZK. One-Stage Arthroplasty or Revision for Seronegative Infections in Hip and Knee. Orthop Surg 2019; 12:38-49. [PMID: 31788965 PMCID: PMC7031574 DOI: 10.1111/os.12545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/03/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To assess the safety and effectiveness of one‐stage total joint arthroplasty (TJA) or revision for seronegative infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods This retrospective study included a total of 495 patients who had undergone one‐stage total joint (hip or knee) arthroplasty or revision with a diagnosis of osteoarthritis secondary to sepsis, osteoarthritis or osteonecrosis of the femoral head (ONFH) secondary to internal fixation surgery of the hip joint, and one‐stage revision for prosthesis loosening after THA or TKA from January 2012 to December 2016. Bacterial cultures were taken from all patients (from joint fluid or articular cavity fluid and four to six different parts of soft tissues) during the operation. If the cultures were positive, patients received antibiotic treatment. Microbiology results from surgical samples, clinical evaluations, SF‐12 score (physical component summary [PCS] and mental component summary [MCS]), Harris hip score (HHS) or Hospital for Special Surgery (HSS) score, and patients' satisfaction was recorded at every follow‐up session. Results A total of 24 patients had a positive result for bacterial culture (4.85%). The bacterial culture results showed that there were 19 cases (79.16%) of gram‐positive cocci (Staphylococcus aureus), 4 cases (16.67%) of gram‐negative bacilli, and 1 case (4.17%) of fungi. For at least 24 months (mean 35 months) follow‐up, no reinfection was discovered. The mean HHS or HSS score improved significantly from 36.29 points preoperatively to 84.21 points postoperatively (P < 0.001). The mean PCS score improved from 10.15 preoperatively to 20.34 postoperatively, and the mean MCS from 13.22 preoperatively to 21.76 postoperatively, with significant differences. Most of the patients were satisfied. Conclusion One‐stage arthroplasty or revision with exhaustive debridement, adequate dosage, and duration of sensitive antibiotics is safe and effective for patients who have seronegative infection of hip or knee joints.
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Affiliation(s)
- Hao-Yang Wang
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Rui Zhang Md
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.,Rehabilitation Medicine Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ze-Yu Luo
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Duan Wang Md PhD
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Fu-Xing Pei
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopaedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Cao L. [Present situation and prospect of diagnosis and treatment of periprosthetic joint infections]. Zhonghua Wai Ke Za Zhi 2019; 57:321-325. [PMID: 31091584 DOI: 10.3760/cma.j.issn.0529-5815.2019.05.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Periprosthetic joint infection (PJI) as an insurmountable challenge has always represented a serious concern for orthopedic surgeons. Accurate diagnosis and reasonable treatment of PJI are the keys to deal with this challenge.The diagnosis of PJI is mainly based on clinical manifestations, joint fluid biochemistry, pathogen culture and biomarkers at present. New pathogen culture methods and specific biomarkers in recent years are hot topics in PJI research. In terms of treatment, two-stage revision is still considered to be the 'gold standard' protocol. However, more and more centers around the world have begun to accept and try one-stage revision as a treatment for PJI.
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Affiliation(s)
- L Cao
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Capuano N, Logoluso N, Gallazzi E, Drago L, Romanò CL. One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection. Knee Surg Sports Traumatol Arthrosc 2018; 26:3362-7. [PMID: 29549387 DOI: 10.1007/s00167-018-4896-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/12/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Aim of this study was to verify the hypothesis that a one-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, provides similar infection recurrence rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic joint infection (PJI). METHODS In this two-center case-control, study, 22 patients, treated with a one-stage procedure, using implants coated with an antibiotic-loaded hydrogel [defensive antibacterial coating (DAC)], were compared with 22 retrospective matched controls, treated with a two-stage revision procedure, without the coating. RESULTS At a mean follow-up of 29.3 ± 5.0 months, two patients (9.1%) in the DAC group showed an infection recurrence, compared to three patients (13.6%) in the two-stage group. Clinical scores were similar between groups, while average hospital stay and antibiotic treatment duration were significantly reduced after one-stage, compared to two-stage (18.9 ± 2.9 versus 35.8 ± 3.4 and 23.5 ± 3.3 versus 53.7 ± 5.6 days, respectively). CONCLUSIONS Although in a relatively limited series of patients, our data shows similar infection recurrence rate after one-stage exchange with DAC-coated implants, compared to two-stage revision without coating, with reduced overall hospitalization time and antibiotic treatment duration. These findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections. LEVEL OF EVIDENCE III.
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Abstract
Periprosthetic joint infection (PJI) is one of the most feared and challenging complications following total knee arthroplasty. We provide a detailed description of our current understanding regarding the management of PJI of the knee, including diagnostic aids, pre-operative planning, surgical treatment, and outcome.
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Affiliation(s)
- T Gehrke
- Helios Endo-Klinik, Holstenstr.2, 22767 Hamburg, Germany
| | - P Alijanipour
- Rothman Institute, 125 S 9th St Ste 1000, Philadelphia, PA 19107, USA
| | - J Parvizi
- Rothman Institute, 125 S 9th St Ste 1000, Philadelphia, PA 19107, USA
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Jeroense KTV, Kuiper JWP, Colen S, Schade RP, Saouti R. One-stage revision in two cases of Salmonella prosthetic hip infection. World J Clin Cases 2014; 2:304-308. [PMID: 25032209 PMCID: PMC4097161 DOI: 10.12998/wjcc.v2.i7.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/17/2014] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
We describe two cases of prosthetic joint infection (PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been described as well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.
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