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Aitchison LP, Jayanetti V, Lindstrom ST, Sekel R. Myobacterium bovis peri-prosthetic hip infection with successful prosthesis retention following intravesical BCG therapy for bladder carcinoma. Australas Med J 2015; 8:307-14. [PMID: 26576201 DOI: 10.4066/amj.2015.2475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Systemic dissemination and peri-prosthetic infection of Mycobacterium bovis (M. bovis) following intravesical Bacillus Calmette-Guerin (BCG) therapy presents a rare but significant complication of treatment for non-muscle invasive bladder carcinoma. We present a patient with Mycobacterium bovis infection of a prosthetic hip nine months following BCG therapy for bladder cancer. The debridement and (implant) prosthesis retention approach in conjunction with anti-tuberculous medication (DAIR) employed in this case, allowed the same prosthesis to be retained. This case report highlights the importance of physician awareness of the possibility BCG peri-prosthetic infections.
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Affiliation(s)
| | - Viran Jayanetti
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Steven T Lindstrom
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ronald Sekel
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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102
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Debridement, antibiotics, irrigation, and retention (DAIR) of the prosthesis after hip hemiarthroplasty infections. Does it work? Int J Artif Organs 2015; 38:454-60. [PMID: 26391366 DOI: 10.5301/ijao.5000430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Debridement, antibiotic, and implant retention (DAIR) is an attractive treatment modality after hip hemiarthroplasty (HA) infections. Data about the success of the procedure after acute onset infections is lacking. The aim of this study was to analyze the clinical outcome and associated risk factors. METHODS A multicenter, retrospective cohort study was designed, including 39 patients with acute onset prosthetic infection who had undergone debridement and irrigation with prosthesis retention. The primary outcome measure was infection eradication without prosthesis removal. We also analyzed how the success rate was influenced by the length of the interval between implantation of the prosthesis and the beginning of the treatment. RESULTS The overall success rate was 41%. Sedimentation rate over 60 mm/h and the longer duration (2 weeks) after prosthesis implantation were found as factors negatively influencing the success rate. CONCLUSIONS Our results indicated limited success to DAIR- treated patients with infected HA. The high failure rate of DAIR treatment after 2 weeks from the implantation should be taken into consideration.
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103
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Debridement with prosthesis retention and antibiotherapy vs. two-stage revision for periprosthetic knee infection within 3 months after arthroplasty: a case–control study. Clin Microbiol Infect 2015; 21:851.e11-7. [DOI: 10.1016/j.cmi.2015.05.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 12/16/2022]
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104
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Franchelli S, Pesce M, Savaia S, Marchese A, Barbieri R, Baldelli I, De Maria A. Clinical and Microbiological Characterization of Late Breast Implant Infections after Reconstructive Breast Cancer Surgery. Surg Infect (Larchmt) 2015; 16:636-44. [PMID: 26171650 DOI: 10.1089/sur.2014.146] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Implant infections represent a relevant problem after immediate breast cancer reconstruction. In addition to difficulties in distinguishing early infections from other post-surgical complications (such as hematoma, seroma, and liponecrosis) late breast implant infections still represent a grey area of our knowledge with regards to heir definition and management. To address this issue, we prospectively monitored breast cancer patients at their center. METHODS Between February 1, 2009, and May 31, 2013, we enrolled all patients undergoing breast implant reconstruction or expander-to-prosthesis substitution. Patients without at least 6 mo of post-operative observation were excluded. We collected data from patient records including age, days from surgery (DFS), chemotherapy/radiotherapy, infecting microorganism, type of implant, antibiotic management and eventual implant removal. Sixty days from surgery were defined as the clinical threshold between early and late infection. Infections were further classified according to a graded scale into possible, probable and microbiologically proved. RESULTS Seventy-eight infections were recorded out of 766 surgical procedures (10.2%). Fifty-three (67%) cases occurred early ≤60 DFS, and 25 (33%) occurred late (i.e., beyond 60 d). By defining infection types as possible, probable or proved, the majority of late infections were classified as proved (84%) compared with 56% of early infections (p=0.0014). Microbiological isolate distribution was similar in proved early infections compared with proved late infections. Among late infections, a delayed occurrence was observed after prosthesis placement compared with expander insertion. Late infections were fraught with lower treatment success rates (12% vs. 41%, p=0.009). CONCLUSION Late infection represents a consistent proportion of infections after immediate breast implant reconstruction or prosthesis placement and bear lower chance of salvage after treatment. An increased attention is warranted to improve prevention and treatment strategies.
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Affiliation(s)
- Simonetta Franchelli
- 1 SC Chirurgia Plastica e Ricostruttiva, IRCCS AOU San Martino-IST , Genoa, Italy
| | - Marianna Pesce
- 1 SC Chirurgia Plastica e Ricostruttiva, IRCCS AOU San Martino-IST , Genoa, Italy
| | - Serena Savaia
- 1 SC Chirurgia Plastica e Ricostruttiva, IRCCS AOU San Martino-IST , Genoa, Italy
| | - Anna Marchese
- 2 Sezione di Microbiologia DISC, University of Genoa , Genoa, Italy
| | - Ramona Barbieri
- 2 Sezione di Microbiologia DISC, University of Genoa , Genoa, Italy
| | - Ilaria Baldelli
- 3 Department of Health Sciences DISC, University of Genoa , Genoa, Italy
| | - Andrea De Maria
- 3 Department of Health Sciences DISC, University of Genoa , Genoa, Italy .,4 UOS Infettivologia dell'Ospite Immunocompromesso IRCCS AOU San Martino-IST , Genoa, Italy
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105
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Puhto AP, Puhto T, Niinimäki T, Ohtonen P, Leppilahti J, Syrjälä H. Predictors of treatment outcome in prosthetic joint infections treated with prosthesis retention. INTERNATIONAL ORTHOPAEDICS 2015; 39:1785-91. [DOI: 10.1007/s00264-015-2819-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/08/2015] [Indexed: 01/27/2023]
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106
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Jiranek WA, Waligora AC, Hess SR, Golladay GL. Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms? J Arthroplasty 2015; 30:912-8. [PMID: 25922125 DOI: 10.1016/j.arth.2015.03.014] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/26/2015] [Accepted: 03/13/2015] [Indexed: 02/07/2023] Open
Abstract
Prosthetic joint infection (PJI) of the hip and knee remains one of the most common and feared arthroplasty complications. The impact and cost of PJI is significant, both to the patient and to the health care system. Recent reports of results of different treatment strategies have led many surgeons to modify their approach to management of PJI. This paper will explore apparent paradigm shifts, both to indications and technique, including the importance of waiting for bacterial identification, the decreasing role for irrigation and debridement (I&D) with retention of components, the increased utilization of single stage revision, and conversely a decreasing role for two-stage exchange. Strategies for treating drug-resistant organisms and management of failed treatment will also be examined.
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Affiliation(s)
- William A Jiranek
- Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia
| | - Andrew C Waligora
- Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia
| | - Shane R Hess
- Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia
| | - Gregory L Golladay
- Department of Orthopaedic Surgery, VCU School of Medicine, Richmond, Virginia
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107
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Periprosthetic knee infections treated with irrigation and debridement: outcomes and preoperative predictive factors. J Arthroplasty 2015; 30:649-57. [PMID: 25466169 DOI: 10.1016/j.arth.2014.10.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/12/2014] [Accepted: 10/22/2014] [Indexed: 02/01/2023] Open
Abstract
The role of irrigation and debridement (I&D) in the treatment of periprosthetic joint infections (PJI) of the knee remains controversial. Our purpose was to identify the success rate and factors determining outcome of I&D in those patients. Clinical characteristics of 78 patients with PJI of the knee treated with I&D were retrospectively reviewed. Implant retention at final follow-up was achieved in 43 patients (55.1%). Logistic regression analysis revealed that duration of symptoms >5days and thyroid disease were independent predictors of I&D failure. Patients with methicillin-resistant staphylococcal infections had a success rate of 45.5% and significantly lower odds of success compared to patients with negative cultures. In selected patients, I&D is a reasonable option in the context of acute PJI of the knee.
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108
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Triantafyllopoulos GK, Poultsides LA, Sakellariou VI, Zhang W, Sculco PK, Ma Y, Sculco TP. Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome. INTERNATIONAL ORTHOPAEDICS 2015; 39:1203-9. [PMID: 25820839 DOI: 10.1007/s00264-015-2753-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/10/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE Our purpose was to identify the success rate and factors predicting outcome of irrigation and debridement (I&D) in patients with deep periprosthetic joint infection (PJI) of the hip. METHODS We retrospectively reviewed clinical characteristics of patients with deep PJI after primary/revision total hip arthroplasty (THA) between January 2000 and May 2013 treated with I&D. Implant retention was the outcome of interest. Sixty patients (29 men and 31 women; mean age 64.9 years) were identified. Mean follow-up was 59 months (range, 12-168). RESULTS The implants were retained in 42 patients (70%). Failure of I&D treatment correlated with duration of symptoms >five days (p <0.001) and obesity [body mass index (BMI) ≥ 30)] (p = 0.0289). Treatment outcome was affected by the type of pathogen (p = 0.0482), with patients with methicillin-resistant staphylococci having significantly lower odds of success. CONCLUSIONS I&D can be a feasible option in THA patients presenting with acute deep PJI. Duration of symptoms >five days, isolation of methicillin-resistant staphylococci and obesity should be taken into consideration in pre-operative decision making.
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Affiliation(s)
- Georgios K Triantafyllopoulos
- Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th street, New York, NY, 10021, USA,
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109
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Holmberg A, Thórhallsdóttir VG, Robertsson O, W-Dahl A, Stefánsdóttir A. 75% success rate after open debridement, exchange of tibial insert, and antibiotics in knee prosthetic joint infections. Acta Orthop 2015; 86:457-62. [PMID: 25753311 PMCID: PMC4513601 DOI: 10.3109/17453674.2015.1026756] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 02/03/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Prosthetic joint infection (PJI) is a leading cause of early revision after total knee arthroplasty (TKA). Open debridement with exchange of tibial insert allows treatment of infection with retention of fixed components. We investigated the success rate of this procedure in the treatment of knee PJIs in a nationwide material, and determined whether the results were affected by microbiology, antibiotic treatment, or timing of debridement. PATIENTS AND METHODS 145 primary TKAs revised for the first time, due to infection, with debridement and exchange of the tibial insert were identified in the Swedish Knee Arthroplasty Register (SKAR). Staphylococcus aureus was the most common pathogen (37%) followed by coagulase-negative staphylococci (CNS) (23%). Failure was defined as death before the end of antibiotic treatment, revision of major components due to infection, life-long antibiotic treatment, or chronic infection. RESULTS The overall healing rate was 75%. The type of infecting pathogen did not statistically significantly affect outcome. Staphylococcal infections treated without a combination of antibiotics including rifampin had a higher failure rate than those treated with rifampin (RR = 4, 95% CI: 2-10). In the 16 cases with more than 3 weeks of symptoms before treatment, the healing rate was 62%, as compared to 77% in the other cases (p = 0.2). The few patients with a revision model of prosthesis at primary operation had a high failure rate (5 of 8). INTERPRETATION Good results can be achieved by open debridement with exchange of tibial insert. It is important to use an antibiotic combination including rifampin in staphylococcal infections.
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Affiliation(s)
- Anna Holmberg
- Division of Infection Medicine, Department of Clinical Sciences, Lund University , Lund
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110
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Kim JG, Bae JH, Lee SY, Cho WT, Lim HC. The parameters affecting the success of irrigation and debridement with component retention in the treatment of acutely infected total knee arthroplasty. Clin Orthop Surg 2015; 7:69-76. [PMID: 25729521 PMCID: PMC4329535 DOI: 10.4055/cios.2015.7.1.69] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/14/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The aims of our study were to evaluate the success rate of irrigation and debridement with component retention (IDCR) for acutely infected total knee arthroplasty (TKA) (< 4 weeks of symptom duration) and to analyze the factors affecting prognosis of IDCR. METHODS We retrospectively reviewed 28 knees treated by IDCR for acutely infected TKA from 2003 to 2012. We evaluated the success rate of IDCR. All variables were compared between the success and failure groups. Multivariable logistic regression analysis was also used to examine the relative contribution of these parameters to the success of IDCR. RESULTS Seventeen knees (60.7%) were successfully treated. Between the success and failure groups, there were significant differences in the time from primary TKA to IDCR (p = 0.021), the preoperative erythrocyte sedimentation rate (ESR; p = 0.021), microorganism (p = 0.006), and polyethylene liner exchange (p = 0.017). Multivariable logistic regression analysis of parameters affecting the success of IDCR demonstrated that preoperative ESR (odds ratio [OR], 1.02; p = 0.041), microorganism (OR, 12.4; p = 0.006), and polyethylene liner exchange (OR, 0.07; p = 0.021) were significant parameters. CONCLUSIONS The results show that 60.7% of the cases were successfully treated by IDCR for acutely infected TKA. The preoperative ESR, microorganism, and polyethylene liner exchange were factors that affected the success of IDCR in acutely infected TKA.
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Affiliation(s)
- Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ji Hoon Bae
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung Yup Lee
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Tae Cho
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hong Chul Lim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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111
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Peng Z, Ao H, Wang L, Guo S, Tang T. Quaternised chitosan coating on titanium provides a self-protective surface that prevents bacterial colonisation and implant-associated infections. RSC Adv 2015. [DOI: 10.1039/c5ra07540h] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The Ti rod-treated group showed radiographic signs of osseous destruction, osteolytic lesions and consecutive deformity after 14 days, while the HTi rod-treated group were free of radiographic signs of infection.
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Affiliation(s)
- Zhaoxiang Peng
- Shanghai Key Laboratory of Orthopedic Implants
- Department of Orthopedic Surgery
- Shanghai Ninth People's Hospital
- Shanghai Jiao Tong University School of Medicine
- Shanghai 200011
| | - Haiyong Ao
- Shanghai Key Laboratory of Orthopedic Implants
- Department of Orthopedic Surgery
- Shanghai Ninth People's Hospital
- Shanghai Jiao Tong University School of Medicine
- Shanghai 200011
| | - Ling Wang
- School of Pharmacy
- Shanghai Jiao Tong University
- Shanghai 200240
- China
| | - Shengrong Guo
- School of Pharmacy
- Shanghai Jiao Tong University
- Shanghai 200240
- China
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopedic Implants
- Department of Orthopedic Surgery
- Shanghai Ninth People's Hospital
- Shanghai Jiao Tong University School of Medicine
- Shanghai 200011
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112
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Kuiper JWP, Willink RT, Moojen DJF, Bekerom MPJVD, Colen S. Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts. World J Orthop 2014; 5:667-676. [PMID: 25405096 PMCID: PMC4133475 DOI: 10.5312/wjo.v5.i5.667] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/28/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
Periprosthetic joint infection (PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively (4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one or more positive culture results. Debridement, antibiotics and implant retention (DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro’s and con’s should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus (aureus or coagulase negative). If DAIR treatment is unsuccessful, the following treatment option should be based on the patient health status and his or her expectations. For the best functional outcome, one- or two-stage revision should be performed after DAIR failure. In conclusion, DAIR is the obvious choice for treatment of acute PJI, with good success rates in selected patients.
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113
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Betz M, Abrassart S, Vaudaux P, Gjika E, Schindler M, Billières J, Zenelaj B, Suvà D, Peter R, Uçkay I. Increased risk of joint failure in hip prostheses infected with Staphylococcus aureus treated with debridement, antibiotics and implant retention compared to Streptococcus. INTERNATIONAL ORTHOPAEDICS 2014; 39:397-401. [DOI: 10.1007/s00264-014-2510-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 08/12/2014] [Indexed: 01/18/2023]
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114
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Nair PK, Bhat VG, Vaz MS. Prosthetic joint infections-a clinico-microbiological perspective: Review article. World J Clin Infect Dis 2014; 4:9-15. [DOI: 10.5495/wjcid.v4.i3.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/21/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Prosthetic joint infections (PJIs), although not very common, currently pose a very significant threat since they are associated with severe complications, high morbidity rates and substantial costs. PJIs are most commonly caused by Staphylococcus aureus and coagulase-negative staphylococci. The diagnosis of implant-associated infections is very challenging since no single routinely used laboratory or clinical test has been shown to demonstrate adequate results with respect to sensitivity, specificity and accuracy. In most cases, a sum of clinical signs and symptoms, histopathology, blood tests, radiography, bone scans and microbiological testing is considered to arrive at an accurate diagnosis. Treatment of PJIs is also very difficult since most of the infections are caused by biofilm-producing microorganisms which are significantly more resistant to the hosts natural defense mechanisms and antibiotic treatment. For successful management, a combination of both antibiotic and surgical treatment is most often required, and early diagnosis is of the utmost importance. Thus, a multidisciplinary approach is potentially the best option in dealing with PJI, and should include the involvement of microbiologists, orthopedic specialists, clinicians, pathologists and radiologists in order to improve decision-making processes and ensure overall success. The following review aims at briefly outlining the microbiology, diagnostic and treatment options, and preventive measures associated with such infections.
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115
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Moojen DJF, Zwiers JH, Scholtes VAB, Verheyen CCPM, Poolman RW. Similar success rates for single and multiple debridement surgery for acute hip arthroplasty infection. Acta Orthop 2014; 85:383-8. [PMID: 24930545 PMCID: PMC4105769 DOI: 10.3109/17453674.2014.927729] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Treatment of an acute total hip arthroplasty (THA) infection aims at control of the infection with retention of the implant by surgical debridement and antibiotic treatment. There is no clear evidence whether a single surgical debridement is sufficient or whether multiple procedures are necessary for optimal treatment. METHODS From a prospective database of patients with acute THA infection, we retrospectively reviewed 68 patients treated in 2 large teaching hospitals. Hospital S used a protocol in which each patient received a single surgical debridement and only additional surgery if infectious symptoms persisted (group S; n = 33). In hospital M, patients always received multiple surgical debridements (group M; n = 35). Both groups received systemic antibiotic treatment. Removal of the implant or persistent infection at follow-up was considered failure of treatment. Mean follow-up of the patients was 5 (2-11) years. RESULTS Mean time between implantation and debridement was 19 days. 4 patients in group S were considered failure, as opposed to 10 patients in group M (p = 0.09). 9 patients in group S had additional surgery, which resulted in 3 of the 4 failures. At final follow-up, 30 patients in group S and 33 patients in group M had a good clinical result (p = 0.6). INTERPRETATION In patients with acute THA infection, a single debridement with only additional surgery on indication appears to be at least as successful for retention of the primary implant and control of infection as a strategy with multiple surgical debridements.
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Affiliation(s)
- Dirk Jan F Moojen
- Department of Orthopaedic Surgery and Traumatology, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Jasper H Zwiers
- Department of Orthopaedic Surgery and Traumatology, Isala Clinics, Zwolle, the Netherlands.
| | - Vanessa AB Scholtes
- Department of Orthopaedic Surgery and Traumatology, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam
| | - Cees CPM Verheyen
- Department of Orthopaedic Surgery and Traumatology, Isala Clinics, Zwolle, the Netherlands.
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery and Traumatology, Joint Research, Onze Lieve Vrouwe Gasthuis, Amsterdam
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116
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Anagnostakos K, Schmitt C. Can periprosthetic hip joint infections be successfully managed by debridement and prosthesis retention? World J Orthop 2014; 5:218-224. [PMID: 25035823 PMCID: PMC4095013 DOI: 10.5312/wjo.v5.i3.218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/02/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
To evaluate the current literature about how successfully periprosthetic hip joint infections can be managed by debridement and prosthesis retention. A literature search was performed through PubMed until September 2013. Search terms were “DAIR (debridement, antibiotics, irrigation, and retention)” alone and in combination with “hip” as well as “hip infection + prosthesis retention”. A total of 11 studies reporting on 292 cases could be identified. Five different treatment modalities have been described with varying success rates (debridement-21% infection eradication rate; debridement + lavage-75% infection eradication rate; debridement, lavage, with change of modular prosthesis components-70.4% infection eradication rate; debridement, lavage, change of modular prosthesis components + vacuum-assisted closure-92.8% infection eradication rate; acetabular cup removal + spacer head onto retained stem-89.6% infection eradication rate). With regard to the postoperative antibiotic therapy, no general consensus could be drawn from the available data. Debridement, antibiotic therapy, irrigation, and prosthesis retention is an acceptable solution in the management of early and acute hematogenous periprosthetic hip joint infections. The current literature does not allow for generalization of conclusions with regard to the best treatment modality. A large, multi-center study is required for identification of the optimal treatment of these infections.
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117
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Low-grade periprosthetic knee infection: diagnosis and management. J Orthop Traumatol 2014; 16:1-7. [PMID: 24821631 PMCID: PMC4348503 DOI: 10.1007/s10195-014-0294-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/29/2014] [Indexed: 12/19/2022] Open
Abstract
Diagnosis and management of low-grade periprosthetic knee infection are still controversial and debatable. The diagnosis of low-grade infection after total knee arthroplasty is often complex, as clinical symptomatology and diagnostic studies are highly conflicting and knees often exhibit well-fixed components. Although the criterion standard for staged reimplantation is interim placement of an antibiotic-loaded spacer, less-invasive surgical procedures have been advocated for managing infections caused by low-virulence bacteria. Debridement with polyethylene exchange and single-stage reimplantation could offer advantages, such as fewer surgeries, reduced potential for intraoperative complications, and lower direct social costs. The aim of this narrative review was to analyze the literature to evaluate the effectiveness of different surgical procedures in managing low-grade periprosthetic knee infections. Additionally, the most reliable investigations for diagnosing total knee infection caused by low-virulence bacteria were reviewed. Level of evidence Level V.
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