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Haasper C, Buttaro M, Hozack W, Aboltins CA, Borens O, Callaghan JJ, Ivo de Carvalho P, Chang Y, Corona P, Da Rin F, Esposito S, Fehring TK, Flores Sanchez X, Lee GC, Martinez-Pastor JC, Mortazavi SMJ, Noiseux NO, Peng KT, Schutte HD, Schweitzer D, Trebse R, Tsiridis E, Whiteside L. Irrigation and debridement. J Orthop Res 2014; 32 Suppl 1:S130-5. [PMID: 24464886 DOI: 10.1002/jor.22556] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Ikeuchi M, Okanoue Y, Izumi M, Fukuda G, Aso K, Sugimura N, Kawakami T, Tani T. Diagnostic value of triple-phase bone scintigraphy for the diagnosis of infection around antibiotic-impregnated cement spacers. SPRINGERPLUS 2013; 2:401. [PMID: 24024089 PMCID: PMC3766509 DOI: 10.1186/2193-1801-2-401] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/21/2013] [Indexed: 12/17/2022]
Abstract
Introduction Two-stage revision arthroplasty is today considered as the gold standard for control of chronic deep prosthetic infection. Although the revision arthroplasty should only be considered when infection is eliminated, the diagnosis of residual infection prior to the revision remains a challenging problem. Materials and methods We evaluated triple-phase bone scintigraphy as a useful diagnostic test for the detection of residual infection around the antibiotic-impregnated cement spacer in patients waiting for the second-stage revision hip or knee arthroplasty. Increased uptake of radioisotope in all three phases was considered positive for infection. The final diagnosis was based on histopathological results in addition to microbiologic examinations of surgical specimens. Results Histopathological examination showed positive in 17 and negative in 13 out of 30 examinations. Among 17 samples positive for histopathology, there were only 4 samples positive for bacterial culture. All samples negative for histopathology showed negative for bacterial culture. The positive and negative predictive values of triple-phase bone scintigraphy for the presence of infection were 80% and 90%, respectively. The diagnostic sensitivity was 94% and the specificity was 69%. Conclusion Triple-phase bone scintigraphy was useful in the diagnosis of infection around the articulating cement spacer. In particular, when triple-phase bone scintigraphy shows negative, the residual infection around the cement spacer is unlikely.
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Affiliation(s)
- Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505 Japan
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Nasal MRSA screening for surgical patients: predictive value for postoperative infections caused by MRSA. Surg Today 2013; 44:1018-25. [PMID: 23824338 DOI: 10.1007/s00595-013-0648-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/30/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Postoperative methicillin-resistant Staphylococcus aureus (MRSA) infections are occasionally fatal. We hypothesized that nasal MRSA screening might predict the risk of postoperative MRSA infections. The aim of the current study was to elucidate the relationship between the positivity of nasal MRSA screening and postoperative MRSA infections. METHODS Six hundred and fourteen surgical patients who were admitted to the intensive care unit and underwent nasal MRSA screening between April 2006 and March 2011 were divided into MRSA-positive and -negative groups. The incidence of postoperative MRSA infections in the MRSA-positive and MRSA-negative groups were compared, and various risk factors for MRSA infections were evaluated. RESULTS The incidence of postoperative MRSA infections, such as pneumonia and enteritis, in the MRSA-positive group was significantly higher than that in the MRSA-negative group (41.9 vs. 3.1 %). The significant independent risk factors for postoperative MRSA infections were a positive MRSA screening, an operation lasting more than 300 min and an emergency operation. A positive MRSA screening was the most statistically significant risk factor for postoperative MRSA pneumonia and enteritis, but was not a risk factor for MRSA surgical site infections. CONCLUSION Nasal MRSA screening can help to identify patients who have an increased risk of developing postoperative MRSA infections, and would enable physicians to take a prompt action if these complications occur.
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Royo A, Bertrand ML, Ramos L, Fernandez-Gordillo F, Guerado E. Is there still a place for continuous closed irrigation in the management of periprosthetic total knee infection? Open Orthop J 2013; 7:205-10. [PMID: 23919095 PMCID: PMC3731809 DOI: 10.2174/1874325001307010205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 12/25/2012] [Accepted: 04/21/2013] [Indexed: 01/25/2023] Open
Abstract
In recent decades, many technical improvements have been achieved in the use of prosthetic joints, and the risk
of infection has been greatly reduced, to current rates of 0.4-2.0% following primary knee replacement. However, the
increasing rate of joint replacements being performed means that the absolute number of such infections remains
significant and poses substantial costs to healthcare systems worldwide. Accordingly, further strategies to treat and
prevent total joint infections should be investigated. Infections following knee replacements can compromise the function and durability of arthroplasty. When these infections
occur during the immediate postoperative period, irrigation and debridement with component retention can be attempted
to salvage the implant. This is an attractive, cheap, low-morbidity treatment for periprosthetic knee infection. However,
the results published regarding this procedure are uneven; some studies report the eradication of prosthetic joint infection
by debridement alone in 70-90% of cases but conversely, others have reported a high failure rate for this procedure,
averaging 68% (61-82%). The difference could be attributed in part to the multiplicity of variables that may influence the
success of the procedure. One such is that of treatment with a continuous irrigation system, which has the theoretical
advantage of enabling the administration of antimicrobial agents, as well as the drainage of debris and blood clots. The objective of this study is to elucidate the overall efficacy of irrigation and debridement with prosthesis retention in
infected total knee arthroplasty and to determine whether the addition of a continuous irrigation system influences this
efficacy.
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Affiliation(s)
- Antonio Royo
- Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol. University of Malaga, Spain
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Hinarejos P, Guirro P, Leal J, Montserrat F, Pelfort X, Sorli ML, Horcajada JP, Puig L. The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees. J Bone Joint Surg Am 2013; 95:769-74. [PMID: 23636182 DOI: 10.2106/jbjs.l.00901] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of antibiotic-loaded cement is believed to prevent infection in primary total knee arthroplasty, but there is a lack of randomized studies to support this concept. The aim of this study was to evaluate the use of an antibiotic-loaded cement to reduce the infection rate in primary total knee arthroplasty. METHODS This is a prospective randomized study with 2948 cemented total knee arthroplasties, in which bone cement without antibiotic was used in 1465 knees (the control group) and a bone cement loaded with erythromycin and colistin was used in 1483 knees (the study group). All patients received the same systemic prophylactic antibiotics. The patients were followed for a minimum of twelve months. The rate of infection was analyzed according to the criteria of the Centers for Disease Control and Prevention. RESULTS The rate of deep infection (1.4% in the control group and 1.35% in the study group; p = 0.96) and the rate of superficial infection (1.2% and 1.8%, respectively; p = 0.53) were similar in both groups. The factors related to a higher rate of deep infection in a multivariate analysis were male sex and an operating time of >125 minutes. CONCLUSIONS The use of erythromycin and colistin-loaded bone cement in total knee arthroplasty did not lead to a decrease in the rate of infection when systemic prophylactic antibiotics were used, a finding that suggests that the use of antibiotic-loaded bone cement would not be indicated in the general population. Further research is needed to assess whether its use is recommended for patients with a higher risk of infection.
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Affiliation(s)
- Pedro Hinarejos
- Department of Orthopedic Surgery, Parc de Salut Mar, Universitat Autònoma Barcelona, Hospital de la Esperanza, Sant Josep de la Muntanya, 12, 08024 Barcelona, Spain.
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Simultaneous bilateral total knee arthroplasty. A multicenter feasibility study. Orthop Traumatol Surg Res 2013; 99:191-5. [PMID: 23465514 DOI: 10.1016/j.otsr.2012.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 12/10/2012] [Accepted: 12/17/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The value and risk of simultaneous total knee arthroplasty (TKA) in patients with bilateral knee arthritis is a subject of debate. HYPOTHESES The risk of complications following simultaneous bilateral TKA will be increased compared to the rates published in the literature for unilateral TKA, and the clinical and functional outcomes will be poorer in this particular group. MATERIALS AND METHODS One hundred and twenty-three patients who underwent simultaneous bilateral TKA between 2005 and 2011 in five specialized, high volume centers were evaluated. The files were analyzed retrospectively after a mean 33 months of follow-up. RESULTS The mean hospital stay was 11 days. Mean blood loss was 4.1g/dL. A postoperative transfusion was performed in 68 patients (55%), with a mean 3.1 units of blood. The mean global IKS score increased from 90 to 150 points. Eighty patients would agree to undergo simultaneous bilateral TKA again (65%), and 70 would recommend this procedure to others (57%). DISCUSSION The hypothesis was not confirmed: the risk of complications was not increased compared to the generally accepted risk of a unilateral procedure. The risk of complications in this study was very similar to that published in the literature for the same therapeutic strategy. Therefore, there is no solid medical evidence to prevent recommending this strategy. The results of the participating centers suggest that this therapeutic approach should be continued in selected indications. LEVEL OF EVIDENCE IV, retrospective study.
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Abstract
In vitro fabrication of tissues and the regeneration of internal organs are no longer regarded as science fiction but as potential remedies for individuals suffering from chronic degenerative diseases. Tissue engineering has generated much interest from researchers in many fields, including cell and molecular biology, biomedical engineering, transplant medicine, and organic chemistry. Attempts to build tissues or organs in vitro have utilized both scaffold and scaffold-free approaches. Despite considerable progress, fabrication of three-dimensional tissue constructs in vitro remains a challenge. In this chapter, we introduce and discus current concepts of tissue engineering with particular focus on future clinical application.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31827525d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Talmo CT, Aghazadeh M, Bono JV. Perioperative complications following total joint replacement. Clin Geriatr Med 2012; 28:471-87. [PMID: 22840309 DOI: 10.1016/j.cger.2012.05.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Total joint arthroplasty is a safe and highly effective treatment for moderate to severe osteoarthritic symptoms and other causes of joint derangement in the elderly population. Significant improvements in pain, function, and quality of life are nearly universal, with a low rate of complications and adverse outcomes. Because of its success and cost-effectiveness, the rate of utilization of TJR is increasing, and all health care providers must be familiar with the potential complications and perioperative management of these patients. Elderly patients may be at a higher risk for postoperative medical complications; however, the majority of these complications are minor and many are avoidable with appropriate preoperative screening and careful postoperative management. As with all patients undergoing TJR, patients should be prophylactically treated for infection and thromboembolism and carefully followed for the development of these potential complications as well as fracture, hip dislocation, and neurovascular dysfunction. Postoperative delirium may be minimized and prophylactically treated in appropriate elderly patients to maximize recovery and promote safety.
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Affiliation(s)
- Carl T Talmo
- New England Baptist Hospital, Tufts University, Boston, MA 02120, USA
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Kapadia BH, Johnson AJ, Naziri Q, Mont MA, Delanois RE, Bonutti PM. Increased revision rates after total knee arthroplasty in patients who smoke. J Arthroplasty 2012; 27:1690-1695.e1. [PMID: 22633104 DOI: 10.1016/j.arth.2012.03.057] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 03/28/2012] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to compare the clinical outcomes of total knee arthroplasty in patients who reported a history of tobacco use with those who were nonsmokers. Between 2006 and 2009, there were 131 total knee arthroplasties performed in patients who were smokers and 490 in patients who did not smoke. At a mean follow-up of 47 months (range, 24-79 months), the patients who were smokers had a statistically decreased overall survivorship of 90% (13 revisions) compared with 99% (5 revisions) in the nonsmokers. Surgical complication rates were not significantly different between the 2 groups; however, there was a significant difference in medical complications. Total knee arthroplasty in smokers has a higher risk of negative clinical outcomes compared with nonsmokers.
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Affiliation(s)
- Bhaveen H Kapadia
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
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Sewick A, Makani A, Wu C, O’Donnell J, Baldwin KD, Lee GC. Does dual antibiotic prophylaxis better prevent surgical site infections in total joint arthroplasty? Clin Orthop Relat Res 2012; 470:2702-7. [PMID: 22290130 PMCID: PMC3441989 DOI: 10.1007/s11999-012-2255-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION It is unclear which antibiotic regimen provides the best prophylaxis against surgical site infection (SSI) in patients undergoing hip and knee surgery. QUESTIONS/PURPOSES Therefore, we determined whether dual antibiotic prophylaxis (1) reduced the rate of SSI compared to single antibiotic prophylaxis and (2) altered the microbiology of SSI. METHODS We retrospectively reviewed 1828 primary THAs and TKAs performed between September 1, 2008 and December 31, 2010. We divided patients into two groups: (1) those who received a dual prophylactic antibiotic regimen of cefazolin and vancomycin (unless allergy), or (2) received cefazolin (unless allergy) as the sole prophylactic antibiotic. There were 701 males and 1127 females with an average age of 56 years (range, 15–97 years). We limited followup to 1 year, presuming subsequent infections were not related to the initial surgery. RESULTS During this period, there were 22 SSIs (1.2%). The infection rates for dual antibiotic prophylaxis compared to a single antibiotic regimen were 1.1% and 1.4%, respectively. Of 1328 patients treated with dual antibiotic prophylaxis, only one (0.08%) SSI was culture positive for methicillin resistant Staphylococcus aureus (MRSA), while four of 500 patients (0.8%) receiving only cefazolin prophylaxis had culture positive MRSA infection at the time of reoperation. CONCLUSION The addition of vancomycin as a prophylactic antibiotic agent apparently did not reduce the rate of SSI compared to cefazolin alone. Use of vancomycin in addition to cefazolin appeared to reduce the incidence of MRSA infections; however, the number needed to treat to prevent a single MRSA infection was very high. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amy Sewick
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Amun Makani
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Chia Wu
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Judith O’Donnell
- Department of Infectious Disease, Presbyterian Medical Center, Philadelphia, PA 19104 USA
| | - Keith D. Baldwin
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
| | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104 USA
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Mahmoud SSS, Odak S, Qazzafi Z, McNicholas MJ. Primary total knee arthroplasty infected with Serratia marcescens. BMJ Case Rep 2012; 2012:bcr-2012-006179. [PMID: 22987901 DOI: 10.1136/bcr-2012-006179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report an unusual case of a Serratia marcescens infection of total knee arthroplasty 4 weeks after the procedure following aspiration carried out on the ward (contrary to local protocol). This was successfully treated with thorough wound debridement, irrigation, change of the polyethylene liner and systemic antibiotics using intravenous meropenem for 3 weeks followed by oral ciprofloxacin for another 3 weeks. Our patient made an uneventful recovery and there was no reported recurrence of infection at 8 months of follow-up. We are unsure as to whether the infection was introduced at the time of the joint aspiration or was a complication of the initial procedure despite all the standard aseptic measures taken at the time of surgery.
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Affiliation(s)
- Samer S S Mahmoud
- Department of Trauma and Orthopaedics, University Hospital Aintree, Liverpool, UK.
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Boekel P, Blackshaw R, Van Bavel D, Riazi A, Hau R. Sterile stockinette in orthopaedic surgery: a possible pathway for infection. ANZ J Surg 2012; 82:838-43. [DOI: 10.1111/j.1445-2197.2012.06208.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2012] [Indexed: 02/04/2023]
Affiliation(s)
| | | | - Dirk Van Bavel
- Royal Melbourne Hospital; Melbourne; Victoria; Australia
| | - Arash Riazi
- Bendigo Health; Bendigo; Victoria; Australia
| | - Raphael Hau
- Orthopaedics; Northern Health; Epping; Victoria; Australia
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Zmistowski B, Parvizi J. Identification and treatment of infected total hip arthroplasty. Expert Rev Anti Infect Ther 2012; 10:509-18. [PMID: 22512759 DOI: 10.1586/eri.12.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Periprosthetic joint infection (PJI) in the hip following prosthetic joint placement is a devastating outcome of an otherwise often successful surgical treatment (total-hip arthroplasty). Management of PJI is dependent upon accurate diagnosis and successful treatment, both of which are challenging. Recently, great strides have been made in improving the diagnosis of PJI, which has no 'gold standard' diagnostic tool. Proper diagnosis is essential as untreated or undetected PJI can quickly lead to biofilm formation on the implant surface depending upon the infecting organism. Upon complete biofilm formation, successful treatment requires prosthetic resection with immediate or delayed reimplantation. Even with the most aggressive surgical treatment, PJI eradication currently has a success rate of approximately 80%. Unfortunately, technologies to improve the local delivery of antibiotics are not expected to be available in the near future.
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Affiliation(s)
- Benjamin Zmistowski
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
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