1
|
Huo S, Lyu Z, Wang X, Liu S, Chen X, Yang M, Liu Z, Yin X. Engineering mesoporous polydopamine-based potentiate STING pathway activation for advanced anti-biofilm therapy. Biomaterials 2025; 312:122739. [PMID: 39096840 DOI: 10.1016/j.biomaterials.2024.122739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/07/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
The biofilm-induced "relatively immune-compromised zone" creates an immunosuppressive microenvironment that is a significant contributor to refractory infections in orthopedic endophytes. Consequently, the manipulation of immune cells to co-inhibit or co-activate signaling represents a crucial strategy for the management of biofilm. This study reports the incorporation of Mn2+ into mesoporous dopamine nanoparticles (Mnp) containing the stimulator of interferon genes (STING) pathway activator cGAMP (Mncp), and outer wrapping by M1-like macrophage cell membrane (m-Mncp). The cell membrane enhances the material's targeting ability for biofilm, allowing it to accumulate locally at the infectious focus. Furthermore, m-Mncp mechanically disrupts the biofilm through photothermal therapy and induces antigen exposure through photodynamic therapy-generated reactive oxygen species (ROS). Importantly, the modulation of immunosuppression and immune activation results in the augmentation of antigen-presenting cells (APCs) and the commencement of antigen presentation, thereby inducing biofilm-specific humoral immunity and memory responses. Additionally, this approach effectively suppresses the activation of myeloid-derived suppressor cells (MDSCs) while simultaneously boosting the activity of T cells. Our study showcases the efficacy of utilizing m-Mncp immunotherapy in conjunction with photothermal and photodynamic therapy to effectively mitigate residual and recurrent infections following the extraction of infected implants. As such, this research presents a viable alternative to traditional antibiotic treatments for biofilm that are challenging to manage.
Collapse
Affiliation(s)
- Shicheng Huo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Zhuocheng Lyu
- Department of Bone and Joint Surgery, Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoyuan Wang
- Physical Examination Center, Xi'an International Medical Center Hospital, Xi'an, China
| | - Shichang Liu
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Xuxu Chen
- Department of Sports Medicine, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ming Yang
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhongkai Liu
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.
| | - Xinhua Yin
- Department of Spine Surgery, Hong Hui Hospital, Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
2
|
Bhanushali A, Tran L, Nairne-Nagy J, Bereza S, Callary SA, Atkins GJ, Ramasamy B, Solomon LB. Patient-Related Predictors of Treatment Failure After Two-Stage Total Hip Arthroplasty Revision for Periprosthetic Joint Infection: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:2395-2402.e14. [PMID: 38677343 DOI: 10.1016/j.arth.2024.04.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) treatment has high failure rates even after 2-stage revision. Risk factors for treatment failure (TF) after staged revision for PJI are not well defined, nor is it well established how they correlate with the risks of developing an index PJI. Identifying modifiable risk factors may allow preoperative optimization, while identifying nonmodifiable risk factors can influence surgical options or advise against further surgery. We performed a systematic review and meta-analysis to better define predictors of TF in 2-stage revision for PJI. METHODS The PubMed, Embase, and Scopus databases were searched from their inception in December 1976 to April 15, 2023. Studies comparing patient-related variables between patients successfully treated who had 2-staged revision total hip arthroplasty (THA) and patients with persistent infections were included. Studies were screened, and 2 independent reviewers extracted data, while a third resolved discrepancies. Meta-analysis was performed on these data. There were 10,052 unique studies screened, and 21 studies met the inclusion criteria for data extraction. RESULTS There was good-quality evidence that obesity, liver cirrhosis, and previous failed revisions for PJI are nonmodifiable risk factors, while intravenous drug use (IVDU) and smoking are modifiable risk factors for TF after 2-stage revision for hip PJI. Reoperation between revision stages was also significantly associated with an increased risk of TF. Interestingly, other risk factors for an index PJI including male gender, American Society of Anesthesiology score, diabetes mellitus, and inflammatory arthropathy did not predict TF. Evidence on Charlson Comorbidity Index was limited. CONCLUSIONS Patients with a smoking history, obesity, IVDU, previous failed revision for PJI, reoperation between stages, and liver cirrhosis are more likely to experience TF after 2-stage revision THA for PJI. Modifiable risk factors include smoking and IVDU and these patients should be referred to services for cessation as early as possible before 2-stage revision THA.
Collapse
Affiliation(s)
- Ameya Bhanushali
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Liem Tran
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jaiden Nairne-Nagy
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Samuel Bereza
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Gerald J Atkins
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Boopalan Ramasamy
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| | - Lucian B Solomon
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
Prats-Peinado L, Fernández-Fernández T, Márquez-Gómez M, Matas-Diaz JA, Sánchez-Somolinos M, de la Villa-Martínez S, Vaquero-Martín J, Sanz-Ruiz P. Do High Doses of Multiple Antibiotics Loaded into Bone Cement Spacers Improve the Success Rate in Staphylococcal Periprosthetic Joint Infection When Rifampicin Cannot Be Employed? Antibiotics (Basel) 2024; 13:538. [PMID: 38927204 PMCID: PMC11200406 DOI: 10.3390/antibiotics13060538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Rifampicin is one of the mainstays in treating staphylococcal prosthetic joint infection (PJI). However, discontinuation due to intolerance, drug interactions, and adverse events is common. Two-stage revision surgery remains the gold standard, with the number of revision arthroplasties steadily increasing. This study aims to evaluate the effectiveness and safety of a novel two-stage revision protocol for staphylococcal prosthetic joint infection (PJI) utilizing bone cement spacers loaded with multiple high doses of antibiotics. Additionally, it seeks to analyze outcomes in patients ineligible for rifampicin treatment. A retrospective review of 43 cases of staphylococcal hip and knee prosthetic joint infections (PJIs) from 2012 to 2020 was conducted. In all instances, a commercial cement containing 1 g of gentamicin and 1 g of clindamycin, augmented with 4 g of vancomycin and 2 g of ceftazidime, was employed to cast a spacer manually after thorough surgical debridement. We report an eradication rate of 82%, with no significant differences observed (p = 0.673) between patients treated with (84%, n = 19) and without rifampicin (79%, n = 24). There were no disparities in positive culture rates (7%), spacer replacement (18%), or survival analysis (p = 0.514) after an average follow-up of 68 months (range 10-147) in the absence of systemic toxicity and surgical complications superimposable to those previously reported. In conclusion, two-stage revision with local high doses of ceftazidime, vancomycin, gentamicin, and clindamycin demonstrates high effectiveness in treating staphylococcal PJIs. Notably, systemic rifampicin does not influence the outcomes. This protocol, with multiple high doses of antibiotics loaded into the bone cement spacer, is presented as a viable and safe alternative for patients unsuitable for rifampicin treatment.
Collapse
Affiliation(s)
- Lourdes Prats-Peinado
- Department of Orthopedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (L.P.-P.); (T.F.-F.); (M.M.-G.); (J.A.M.-D.); (J.V.-M.)
| | - Tanya Fernández-Fernández
- Department of Orthopedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (L.P.-P.); (T.F.-F.); (M.M.-G.); (J.A.M.-D.); (J.V.-M.)
| | - Miguel Márquez-Gómez
- Department of Orthopedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (L.P.-P.); (T.F.-F.); (M.M.-G.); (J.A.M.-D.); (J.V.-M.)
| | - José Antonio Matas-Diaz
- Department of Orthopedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (L.P.-P.); (T.F.-F.); (M.M.-G.); (J.A.M.-D.); (J.V.-M.)
| | - Mar Sánchez-Somolinos
- Department of Microbiology, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (M.S.-S.); (S.d.l.V.-M.)
| | - Sofía de la Villa-Martínez
- Department of Microbiology, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (M.S.-S.); (S.d.l.V.-M.)
| | - Javier Vaquero-Martín
- Department of Orthopedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (L.P.-P.); (T.F.-F.); (M.M.-G.); (J.A.M.-D.); (J.V.-M.)
- Surgery Department, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Pablo Sanz-Ruiz
- Department of Orthopedic Surgery, General University Hospital Gregorio Marañón, 28007 Madrid, Spain; (L.P.-P.); (T.F.-F.); (M.M.-G.); (J.A.M.-D.); (J.V.-M.)
- Surgery Department, School of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| |
Collapse
|
4
|
Jackson J. Triple Encapsulation and Controlled Release of Vancomycin, Rifampicin and Silver from Poly (Methyl Methacrylate) or Poly (Lactic-Co-Glycolic Acid) Nanofibers. Bioengineering (Basel) 2024; 11:529. [PMID: 38927765 PMCID: PMC11200951 DOI: 10.3390/bioengineering11060529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/14/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Although the incidence of infections in orthopedic surgeries, including periprosthetic surgeries, remains low at approximately 1-2%, the number of surgeries and the incidence of drug-resistant bacteria is increasing. The cost and morbidity associated with revision surgeries are huge. More effective drug combinations and delivery methods are urgently needed. In this paper, three anti-infective drugs (vancomycin, rifampicin, and silver sulfadiazine) have been jointly and effectively electrospun in thin (0.1 mm) flexible nanofiber mats of either poly (methyl methacrylate) (PMMA) or poly (lactic-co-glycolic acid) (PLGA). The inclusion of poly (ethylene glycol) (PEG) enabled optimal drug release with a reduced water contact angle for wetting. The controlled release of these three agents from 20% PEG (w/w to polymer)-blended PMMA or PLGA nanofiber mats may allow for the prophylactical prevention of implant-related infections or provide methods to treat orthopedic infections at the time of revision surgeries. These combinations of drugs provide excellent additive or synergistic antibiotic action against a broader spectrum of bacteria than each drug alone.
Collapse
Affiliation(s)
- John Jackson
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, UBC, Vancouver, BC V6T 1Z3, Canada
| |
Collapse
|
5
|
Ascione T, Balato G, Pagliano P. Upcoming evidence in clinical practice of two-stage revision arthroplasty for prosthetic joint infection. J Orthop Traumatol 2024; 25:26. [PMID: 38761247 PMCID: PMC11102413 DOI: 10.1186/s10195-024-00767-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024] Open
Abstract
Total joint arthroplasty is the recommended treatment for patients with end-stage osteoarthritis, as it reduces disability and pain and restores joint function. However, prosthetic joint infection is a serious complication of this procedure, with the two-stage exchange being the most common treatment method. While there is consensus on diagnosing prosthetic joint infection, there is a lack of agreement on the parameters that can guide the surgeon in performing definitive reimplantation in a two-stage procedure. One approach that has been suggested to improve the accuracy of microbiologic investigations before definitive reimplantation is to observe a holiday period from antibiotic therapy to improve the accuracy of cultures from periprosthetic tissues, but these cultures report some degree of aspecificity. Therefore, several pieces of evidence highlight that performing reimplantation using continuous antibiotic therapy should be considered a safe and effective approach, leading to higher cure rates and a shorter period of disability. Dosage of C-reactive protein (CRP), erythrocyte sedimentation rate (ERS) and D-dimer are helpful in diagnosing prosthetic joint infection, but only D-dimer has shown sufficient accuracy in predicting the risk of infection recurrence after a two-stage procedure. Synovial fluid analysis before reimplantation has been shown to be the most accurate in predicting recurrence, and new cutoff values for leukocyte count and neutrophil percentage have shown a useful predictive rule to identify patients at risk of unfavourable outcome. A new scoring system based on a numerical score calculated from the beta coefficient derived through multivariate analysis of D-dimer levels, synovial fluid leukocytes and relative neutrophils percentage has demonstrated high accuracy when it comes to guiding the second step of two-stage procedure. In conclusion, reimplantation may be a suitable option for patients who are on continuous therapy without local symptoms, and with CRP and ERS within the normal range, with low synovial fluid leukocytes (< 952/mL) and a low relative neutrophil percentage (< 52%) and D-dimer below 1100 µg/mL. A numerical score derived from analysing these three parameters can serve as a valuable tool in determining the feasibility of reimplantation in these patients.
Collapse
Affiliation(s)
- Tiziana Ascione
- Service of Infectious Diseases, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Giovanni Balato
- Department of Public Health, Orthopedic Unit, "Federico II" University, Naples, Italy
| | - Pasquale Pagliano
- Unit of Infectious Diseases, Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
- Clinica Malattie Infettive, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| |
Collapse
|
6
|
Sabater-Martos M, Boadas L, Trebše R, Grenho A, Sanz-Ruiz P, Marais LC, Vaznaisiene D, Ferrari M, Soriano A. Impact of Positive Cultures During the Second Stage of a Two-Stage Exchange: Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:839-845.e15. [PMID: 37757980 DOI: 10.1016/j.arth.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Two-stage exchange is a frequently performed procedure in patients who have a periprosthetic joint infection. Positive cultures when performing the second stage are perceived as a risk factor for reinfection. This study aimed to determine the impact of positive cultures during the second stage on the outcome of patients undergoing a 2-stage septic exchange and the impact of stopping the antibiotic treatment before reimplantation. METHODS We systematically searched four databases. We performed a meta-analysis on the risk of complications after positive cultures during second stage and a subgroup analysis by antibiotic holiday period. We included 24 studies. RESULTS Failure in the positive group was 37.0% and in the negative group was 13.7% with an odds ratio (OR) of 4.05. In the subgroup analysis by antibiotic holidays, failure rate without holidays was 15% and with holidays was 17.3% (P = .21). Failure in each group was higher when cultures were positive (without holidays, 25 versus 12.2%, P = .0003, and with holidays 41.1 versus 12.7%, P < .0001), but the risk of failure when cultures were positive was higher in the holiday group (OR 4.798) than in the nonholiday group (OR 2.225) in comparison to those patients who were culture negative at the second stage. CONCLUSIONS Microbiological eradication at second stage was not obtained in 18% of cases and it was associated with a higher failure rate. In patients with positive cultures, withholding antibiotic treatment was associated with lower failure rate. Further studies to define the antibiotic strategy in 2-stage exchange procedure are necessary.
Collapse
Affiliation(s)
- Marta Sabater-Martos
- Orthopedic and Traumatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laia Boadas
- Orthopedic and Traumatology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rihard Trebše
- Faculty of Medicine, Valdoltra Orthopedic Hospital, Akaran Slovenija, University of Ljubljana, Ljubljana, Slovenija
| | - André Grenho
- CHULC - Hospital de Curry Cabral Orthopaedics Department, Lisbon, Portugal
| | - Pablo Sanz-Ruiz
- Orthopedic and Traumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Leonard C Marais
- Department of Orthopaedics, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Danguole Vaznaisiene
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic of Barcelona, Barcelona, Spain; University of Barcelona, CIBERINF, Barcelona, Spain
| |
Collapse
|
7
|
Carbonell-Rosell C, Lakhani K, Lung M, Nadal P, Rodriguez-Pardo D, Corona PS. Etiology and antimicrobial resistance patterns in chronic osteomyelitis of the tibia: an 11-year clinical experience. Arch Orthop Trauma Surg 2024; 144:773-781. [PMID: 38133804 DOI: 10.1007/s00402-023-05095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/27/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To analyze changes in tendency of etiology and of antimicrobial resistance patterns to most common local and systemic antibiotics in chronic osteomyelitis of the tibia (COM-T) in a Level I trauma center over an 11-year period. METHODS A retrospective review including all patients with COM-T who were surgically treated from January 2009 to December 2019. Patients were divided into two period groups: 2009-2014 and 2015-2019. Microbiologic etiology was analyzed. Bacterial resistance patterns evaluation was based on the Magiorakos et al. classification, including proportions of multidrug-resistant organisms (MDROs, acquired non-susceptibility to at least one agent in three or more antimicrobial categories), extensively drug-resistant (XDR) and pan drug-resistant (PDR) organisms encountered. RESULTS A total of 173 episodes of COM-T were identified. Monomicrobial infections represented 47.4% of all cases, while 28.3% had polymicrobial infections. Negative deep-bone cultures were identified in 24.3% of the patients. The most commonly isolated microorganisms were coagulase-negative Staphylococci (24.5%) and S. aureus (20.5%). No differences were found when comparing Gram-positive infections between periods (58.3% for 2009-2014 vs. 46.7% for 2015-2019; p = 0.10). Findings were similar for Gram-negative infections (37% vs. 33.7%; p = 0.62), although more polymicrobial infections were detected (24.7% vs. 33.3%, respectively; p = 0.359). MDROs were involved in 15% of the cases, with an upward trend when comparing both periods (12.8% vs. 23.6%; p = 0.07). The most-used combination of local antibiotics-glycopeptide (vancomycin) plus aminoglycoside (gentamicin or tobramycin)-was met with low rates of resistance in the most frequently isolated microorganisms. CONCLUSION According to the results of the present study, rates of Gram-positive and Gram-negative infections remained consistent during the two study periods, but with an upward trend in MDRO and polymicrobial infections detected. The local combination of a glycopeptide plus an aminoglycoside was effective in treating the most frequently isolated microorganisms.
Collapse
Affiliation(s)
- Carla Carbonell-Rosell
- Orthopaedic Surgery and Traumatology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - Kushal Lakhani
- Orthopaedic Surgery and Traumatology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery and Traumatology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, Barcelona, Spain.
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain.
| | - Mayli Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, Barcelona, Spain
- CIBERINFEC, Madrid, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - Patricia Nadal
- Microbiology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - Dolors Rodriguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, Barcelona, Spain
- CIBERINFEC, Madrid, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| | - Pablo S Corona
- Orthopaedic Surgery and Traumatology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery and Traumatology Department, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Department of Surgery, Universitat Autònoma de Barcelona, 08193, Barcelona, Spain
| |
Collapse
|
8
|
Corona PS, Pérez M, Vicente M, Pujol O, Amat C, Carrera L. Sequential repeated tibial tubercle osteotomy in a two-stage exchange strategy: a superior approach to treating a chronically infected knee arthroplasty? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3347-3355. [PMID: 37079110 PMCID: PMC10651709 DOI: 10.1007/s00590-023-03548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE Surgical approach can impact the reliability of the debridement after a chronic total knee periprosthetic joint infection (PJI), a factor of utmost importance to eradicate the infection. The most adequate knee surgical approach in cases of PJI is a matter of debate. The purpose of this study was to determine the influence of performing a tibial tubercle osteotomy (TTO) in a two-stage exchange protocol for knee PJI treatment. METHODS Retrospective cohort study examining patients managed with two-stage arthroplasty due to chronic knee PJI (2010-2019). Performance and timing of the TTO were collected. Primary end-point was infection control with a minimum FU of 12 months and according to internationally accepted criteria. Correlation between TTO timing and reinfection rate was reviewed. RESULTS Fifty-two cases were finally included. Overall success (average follow-up: 46.2 months) was 90.4%. Treatment success was significantly higher among cases addressed using TTO during the second stage (97.1% vs. 76.5%, p value 0.03). Only 4.8% of the patients relapsed after performing a sequential repeated TTO, that is, during both first and second stages, compared to 23.1% cases in which TTO was not done (p value 0.28). No complications were observed among patients in the TTO group with a significant decrease in soft tissue necrosis (p: 0.052). CONCLUSION Sequential repeated tibial tubercle osteotomy during a two-stage strategy is a reasonable option and offers high rates of infection control in complex cases of knee PJI with a low rate of complications.
Collapse
Affiliation(s)
- Pablo S Corona
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marta Pérez
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
- Surgery Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Matías Vicente
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Oriol Pujol
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carles Amat
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Lluís Carrera
- Universitat Autònoma de Barcelona (UAB), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Septic and Reconstructive Surgery Unit (UCSO), Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Surgery Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| |
Collapse
|
9
|
Dmitrov IA, Zagorodniy NV, Obolenskiy VN, Leval' PS, Zakharyan NG, Apresyan VS, Panin MA, Samkovich DA, Aliev RN, Grigoryan AA. Diagnosis and treatment of periprosthetic infection after hip replacement (a review). BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction. The frequency of hip arthroplasty is steadily increasing throughout the world and, although this operation has become routine, the likelihood of postoperative complications reaches 4.3 % [1]. The most dangerous of them are infectious lesions in the area of the endoprosthesis and adjacent tissues. At the same time, in addition to the threat of generalization of the infectious process, there are functional disorders in the joint area and a general deterioration in the quality of life of the patient. Timely diagnosis and treatment of the infectious process and related disorders can minimize the adverse effects of infection.Target. The purpose of this review is to analyze modern methods for diagnosing and treating periprosthetic infection resulting from hip replacement.Materials and methods. The subject literature was searched using the PubMed and Google Sholar databases.Results. The main methods for diagnosing periprosthetic infection include histological and bacteriological examination of the biopsy specimen, determination of sensitivity to antibiotics, blood, and synovial fluid analysis for the content of leukocytes, IL-6, CRP, PCR diagnostics of infectious agents. Treatment consists of re-intervention and/or antibiotic therapy.Conclusion. The most optimal method for diagnosing periprosthetic infection is a bacteriological study of biopsy specimens taken intraoperatively. The preferred method of treatment is determined by the severity of the infection, the degree of involvement of tissues adjacent to the prosthesis, the comorbid background, the nature of the infectious agent, and includes repeated revision surgery.
Collapse
Affiliation(s)
| | - N. V. Zagorodniy
- RUDN University; Pirogov Russian National Research Medical University
| | - V. N. Obolenskiy
- Pirogov Russian National Research Medical University; City Clinical Hospital No. 13
| | - P. Sh. Leval'
- City Clinical Hospital No. 13; European Clinic of Traumatology and Orthopedics (ECSTO)
| | | | | | - M. A. Panin
- RUDN University; City Clinical Hospital No. 17
| | | | | | | |
Collapse
|
10
|
Vicente M, Vilar I, Soriano RF, Capó I, Corona PS. Two-stage strategy in end-stage hip periprosthetic joint infection: utility of industrially prefabricated custom-made antibiotic spacers. Hip Int 2022:11207000221075356. [PMID: 35438009 DOI: 10.1177/11207000221075356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Use of prefabricated mobile spacers in end-stage cases of hip periprosthetic joint infection (HPJI) is hindered when large bone defects exist. In such cases, prefabricated custom-made antibiotic spacers (P-CMAS) offer an alternative. Such spacers are individually designed according to the size and anatomical characteristics of the bone defect. The purpose of this study is to describe and evaluate the use of such patient-specific spacers in a two-stage strategy to treat end-stage HPJI cases, and to report on clinical outcomes. METHODS A retrospective study identified all patients with end-stage HPJIs from January 2015 through December 2019, treated using a P-CMAS. Primary outcome: infection eradication rate. Secondary outcomes: spacer-related complications and patient satisfaction. Minimum follow-up: 12 months after the second-stage surgery. RESULTS A total of 7 end-stage cases (mean of 6.7 previous surgical procedures) were included. Mean bone defect size was 191.57 (range 47-304) mm. Polymicrobial infection was detected in 42.86% of these cases. During the spacer stage there were no periprosthetic fractures, spacer dislocations or breakages, nor spacer-drug-related complications. All patients proceeded with the second stage uneventfully, with an average time between stages of 178 (range 119-326) days. In 5 cases a total femur arthroplasty was the reconstructive procedure performed. After a mean follow-up of 27.29 (range 14-49) months the infection was clinically eradicated in all patients, despite their difficult-to-treat scenarios. CONCLUSIONS Industrially custom-made spacers offer an effective and safe option in performing 2-stage exchange arthroplasty in cases of end-stage HPJI with extensive bone defects.
Collapse
Affiliation(s)
- Matías Vicente
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Inca Vilar
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Rosa Fraile Soriano
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain.,Surgical nurse team, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Spain
| | - Irina Capó
- Orthopaedic Surgery Department, Francesc de Borja Hospital, Gandía, Spain
| | - Pablo S Corona
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| |
Collapse
|
11
|
Liu Z, Yang X, Zhao EZ, Wan X, Cao G, Zhou Z. The use of cell salvage during second-stage reimplantation for the treatment of chronic hip periprosthetic joint infection: a retrospective cohort study. J Orthop Surg Res 2022; 17:85. [PMID: 35148802 PMCID: PMC8832772 DOI: 10.1186/s13018-022-02955-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/21/2022] [Indexed: 02/08/2023] Open
Abstract
Introduction Given the possibility of inadvertent bacterial contamination of salvaged blood, the use of cell salvage is relatively contraindicated in cases of reimplantation for chronic hip periprosthetic joint infection (PJI). However, there are no published data supporting this assertion. The purpose of the current study was to compare the reinfection rate and rate of postoperative allogeneic blood transfusion (ABT) in second-stage reimplantation for PJI with or without intraoperative cell salvage reinfusion. Materials and methods We identified 125 patients who underwent two-stage exchange for chronic hip PJI between November 2012 and April 2019. The groups of patients who had (n = 61) and had not (n = 64) received intraoperative cell salvage reinfusion were compared with respect to the curative infection-free rate. Moreover, we compared the need for postoperative ABT and identified independent factors associated with ABT using multiple regression analysis. Results The log-rank survival curve with an endpoint of infection eradication failure was not significantly different between the cell salvage group (98.4%, 95% CI 95.3–99.9%) and the control group (95.3%, 95% CI 90.2–99.9%) at one year (log rank, P = .330). The rates of postoperative ABT in the cell salvage group were significantly lower than those in the control group (11.5% vs 26.6%, P = .041). In multivariable models, patient age, body mass index, preoperative hemoglobin level, and intraoperative cell salvage were independent predictors of ABT exposure (P < .05). Conclusions The use of cell salvage during reimplantation in two-stage exchange for chronic hip PJI did not appear to increase the reinfection rate, while it significantly reduced the rate of postoperative allogeneic red blood transfusion. Greater age, lower BMI, lower preoperative hemoglobin, and non-intraoperative cell salvage reinfusion were associated with higher rate of allogeneic red blood transfusion.
Collapse
Affiliation(s)
- Zunhan Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xuetao Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - En-Ze Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Xufeng Wan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Guorui Cao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
| |
Collapse
|
12
|
Maliuchenko LI, Nikolaev NS, Pchelova NN, Nikolaevich Efimov D, Preobrazhenskaia EV, Emelianov VU. Linear-Chain Nanostructured Carbon with a Silver Film Plated on Metal Components Has a Promising Effect for the Treatment of Periprosthetic Joint Infection. OSTEOLOGY 2021; 1:238-246. [DOI: https:/doi.org/10.3390/osteology1040022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Background: Due to the aging of the world population, the number of joint diseases, along with the number of arthroplasties, has increased, simultaneously increasing the amount of complications, including periprosthetic joint infection (PPI). In this study, to combat a PPI, we investigated the antimicrobial properties of the new composite cover for titanium implants, silver-doped carbyne-like carbon (S-CLC) film. Methods: The first assay investigated the antimicrobial activity against Pseudomonas aeruginosa and releasing of silver ions from S-CLC films into growth media covered with S-CLC with a thickness of 1, 2, and 4 mm. The second assay determined the direct antibacterial properties of the S-CLC film’s surface against Staphylococcus aureus, Enterococcus faecalis, or P. aeruginosa. The third assay studied the formation of microbial biofilms of S. aureus or P. aeruginosa on the S-CLC coating. Silver-doped carbyne-like carbon (S-CLC)-covered or titanium plates alone were used as controls. Results: S-CLC films, compared to controls, prevented P. aeruginosa growth on 1 mm thickness agar; had direct antimicrobial properties against S. aureus, E. faecalis, and P. aeruginosa; and could prevent P. aeruginosa biofilm formation. Conclusions: S-CLC films on the Ti surface could successfully fight the most common infectious agent in PPI, and prevented biofilm formation.
Collapse
|
13
|
Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of bacterial colonisation of vancomycin-gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1661-1669. [PMID: 34677662 DOI: 10.1007/s00590-021-03151-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In two-stage replacements for septic loosening, some studies have suggested an association between bacterial colonisation of spacers and a higher number of complications after implantation of the definitive prosthesis. Our study aimed to determine the reoperation rate of patients undergoing two-stage revision surgery according to the culture results of spacer sonication. METHODS A retrospective observational study was conducted in which hip or knee spacers implanted at our institution with a diagnosis of periprosthetic joint infection from 2010 to 2018 were analysed. Patients were grouped into three categories: A. Patients with positive spacer sonication fluid culture, with or without positive cultures of the rest of the samples. B. Patients with negative spacer sonication culture and negative cultures of the rest of intraoperative samples. C. Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples. RESULTS A total of 45 spacers were analysed: 10 were included in group A, 24 in group B and 11 in group C. The reoperation rate during the first year after the 2-stage revision surgery was 20%, 29.2% and 54.5% for each group, respectively, due to an infection in 10%, 20.8% and 45.5%. Spacers were colonised in all cases by low virulent micro-organisms. CONCLUSION In our study, bacterial colonisation of the spacer is not associated with a higher rate of reoperation. The group of patients with positive intraoperative cultures during the second-stage had the highest reoperation rate.
Collapse
Affiliation(s)
- Sandra Huguet
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain.
- Department of Traumatology and Orthopaedics, Consorci Sanitari de l'Alt Penedès - Garraf, Barcelona, Spain.
| | - Martí Bernaus
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lucía Gómez
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Eva Cuchí
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Department of Microbiology, CATLAB, Viladecavalls, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases - Osteoarticular Infections Unit, Hospital Clínic, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| |
Collapse
|
14
|
Hipfl C, Carganico T, Leopold V, Perka C, Müller M, Hardt S. Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency. J Arthroplasty 2021; 36:2575-2585. [PMID: 33750632 DOI: 10.1016/j.arth.2021.02.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a nonspacer two-stage revision. This study reports on the clinical course of a contemporary two-stage exchange for periprosthetic hip infection without spacer insertion. METHODS We reviewed 141 infected THAs with extensive bone loss or abductor damage who underwent two-stage exchange without spacer placement. The mean duration from resection arthroplasty to reimplantation was 9 weeks (2-29). Clinical outcomes included interim revision, reinfection, and aseptic revision rates. Restoration of leg-length and offset was assessed radiographically. Modified Harris hip scores were calculated. Mean follow-up was 5 years (3-7). Treatment success was defined using the modified Delphi consensus criteria. RESULTS Thirty-four patients (24%) had treatment failure, including 13 reinfections, 16 interim redebridements for persistent infection, 2 antibiotic suppressive therapies, and 3 prosthetic joint infection-related deaths. Aseptic rerevision after reimplantation was necessary in 14 patients (10%). Dislocation accounted for most aseptic complications, with 20 dislocations occurring in 15 patients (11%). Leg-length and offset were restored to preoperative measures. Mean modified Harris hip scores significantly improved from 35 points to 67 points. CONCLUSION A nonspacer two-stage exchange is a viable option for managing chronically infected THA with severe bone loss or abductor deficiency, showing comparable rates of interim revision and recurrence of infection. Cementless reimplantation demonstrates good midterm survivorship with comparable functional outcomes and leg-length restoration. However, dislocation continues to be a major concern.
Collapse
Affiliation(s)
- Christian Hipfl
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Teresa Carganico
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Vincent Leopold
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Carsten Perka
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Michael Müller
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| | - Sebastian Hardt
- Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany
| |
Collapse
|
15
|
Cai YQ, Fang XY, Huang CY, Li ZM, Huang ZD, Zhang CF, Li WB, Zhang ZZ, Guan ZP, Zhang WM. Destination Joint Spacers: A Similar Infection-Relief Rate But Higher Complication Rate Compared with Two-Stage Revision. Orthop Surg 2021; 13:884-891. [PMID: 33768722 PMCID: PMC8126900 DOI: 10.1111/os.12996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/21/2021] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluated the clinical outcomes of periprosthetic joint infection (PJI) patients with destination joint spacer compared with that of two‐stage revision. Methods From January 2006 to December 2017, data of PJI patients who underwent implantation with antibiotic‐impregnated cement spacers in our center due to chronic PJI were collected retrospectively. The diagnosis of PJI was based on the American Society for Musculoskeletal Infection (MSIS) criteria for PJI. One of the following must be met for diagnosis of PJI: a sinus tract communicating with the prosthesis; a pathogenis isolated by culture from two separate tissue or fluid samples obtained from the affected prosthetic joint; four of the following six criteria exist: (i) elevated ESR and CRP; (ii) elevate dsynovial fluid white blood cell (WBC) count; (iii) elevated synovial fluid neutrophil percentage (PMN%); (iv) presence of purulence in the affected joint; (v) isolation of a microorganism in one periprosthetic tissue or fluid culture; (vi) more than five neutrophilsper high‐power fields in five high‐power fields observed from histological analysis of periprosthetic tissue at ×400 magnification. Age, sex, body mass index (BMI), and laboratory test results were recorded. All patients were followed up regularly after surgery, the infection‐relief rates were recorded, Harris hip score (HHS) and knee society score (KSS) were used for functional evaluation, a Doppler ultrasonography of the lower limb veins was performed for complication evaluation. The infection‐relief rates and complications were compared between destination joint spacer group and two‐stage revision group. Results A total of 62 patients who were diagnosed with chronic PJI were enrolled, with an age of 65.13 ± 9.94 (39–88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group, namely, two‐stage revision group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group, and this might be the primary reason for joint spacer retainment. As for infection‐relief rate, there were three cases of recurrent infection (14.29%) in the destination joint spacer group and four cases of recurrent infection (9.76%) in the two‐stage revision group, there were no significant differences with regard to infection‐relief rate. Moreover, there two patients who suffered from spacer fractures, three cases of dislocation, one case of a periarticular fracture, and three cases of deep venous thrombosis in destination joint spacer group, while there was only one case of periprosthetic hip joint fracture, one case of dislocation, and one patient suffered from deep venous thrombosis of the lower extremity in two‐stage revision. The incidence of complications in the destination joint spacer group was higher than that of two‐stage revision. Conclusions In summary, the present work showed that a destination joint spacer might be provided as a last resort for certain PJI patients due to similar infection‐relief rate compared with two‐stage revision.
Collapse
Affiliation(s)
- Yuan-Qing Cai
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yu Fang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chang-Yu Huang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-Ming Li
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zi-da Huang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chao-Fan Zhang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhen-Zhen Zhang
- Department of Pathology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhen-Peng Guan
- Department of Orthopaedic Surgery, Peking University Shougang Hospital, Beijing, China
| | - Wen-Ming Zhang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| |
Collapse
|
16
|
Reconstruction of infected post-traumatic bone defects of the distal femur with the Compress Ⓡ implant. Preliminary results of a staged non-biological strategy. Injury 2021; 52:606-615. [PMID: 33066985 DOI: 10.1016/j.injury.2020.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/18/2020] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Infected post-traumatic distal femur defects remain a therapeutic challenge. Non-biological reconstruction offers an option for avoiding complex biological knee arthrodesis procedures. The CompressⓇ implant is an alternative to the traditional distal femur stemmed megaprosthesis. The aim of this study is to analyse the first patients treated with a distal femur CompressⓇ prosthesis to manage massive infected post-traumatic defects of the distal femur with joint involvement. METHODS We retrospectively reviewed all patients with massive infected defects of the distal femur where this implant was used in a two-stage strategy, together with an antibacterial coating hydrogel (DACⓇ). The specific protocol, microbiological data, clinical and radiological results, complications, functional results and prosthesis survivorship were determined. Follow-up was for a minimum of 12 months, or until implant removal. RESULTS Ten patients (11 CompressⓇ implants) with a mean age of 52 years (range 35-73) were included. On average, patients had undergone 4.4 previous surgical procedures before index surgery. The mean bone defect was 14 cm (range 8-21). After a median follow-up of 27 months (range 12-50 months) no patient had presented with recurrence of the infection, and limb salvage was achieved in all cases. Two patients suffered aseptic loosening which required revision of the femoral component. The short-term survivorship of the implant in our series was 81.8% at 4 years, with all failures occurring in the first 7 months. After this 7-month time threshold, we encountered no further loosening. Regarding functional outcomes, patients had a mean knee ROM of -4/86, expressed high overall satisfaction with the procedure according to the SAPS scale, and had an average LEFS of 52.5% (40-72.5%). CONCLUSION Non-biological reconstruction of the distal femur with the CompressⓇ implant is a valid option in selected patients with massive infected defects with joint involvement. Survivorship was high, with all loosening occurring in the first months after surgery-representing a failure in the osseointegration of the implant.
Collapse
|
17
|
Seyler TM, Moore C, Kim H, Ramachandran S, Agris PF. A New Promising Anti-Infective Agent Inhibits Biofilm Growth by Targeting Simultaneously a Conserved RNA Function That Controls Multiple Genes. Antibiotics (Basel) 2021; 10:41. [PMID: 33406640 PMCID: PMC7824582 DOI: 10.3390/antibiotics10010041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 12/11/2022] Open
Abstract
Combating single and multi-drug-resistant infections in the form of biofilms is an immediate challenge. The challenge is to discover innovative targets and develop novel chemistries that combat biofilms and drug-resistant organisms, and thwart emergence of future resistant strains. An ideal novel target would control multiple genes, and can be inhibited by a single compound. We previously demonstrated success against Staphylococcus aureus biofilms by targeting the tRNA-dependent regulated T-box genes, not present in the human host. Present in Gram-positive bacteria, T-box genes attenuate transcription with a riboswitch-like element that regulates the expression of aminoacyl-tRNA synthetases and amino acid metabolism genes required for cell viability. PKZ18, the parent of a family of compounds selected in silico from 305,000 molecules, inhibits the function of the conserved T-box regulatory element and thus blocks growth of antibiotic-resistant S. aureus in biofilms. The PKZ18 analog PKZ18-22 was 10-fold more potent than vancomycin in inhibiting growth of S. aureus in biofilms. In addition, PKZ18-22 has a synergistic effect with existing antibiotics, e.g., gentamicin and rifampin. PKZ18-22 inhibits the T-box regulatory mechanism, halts the transcription of vital genes, and results in cell death. These effects are independent of the growth state, planktonic or biofilm, of the bacteria, and could inhibit emergent strains.
Collapse
Affiliation(s)
- Thorsten M. Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 277010, USA;
| | - Christina Moore
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 277010, USA;
| | - Haein Kim
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; (H.K.); (S.R.)
| | - Sheetal Ramachandran
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; (H.K.); (S.R.)
| | - Paul F. Agris
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA; (H.K.); (S.R.)
| |
Collapse
|
18
|
Corona PS, Vicente M, Carrera L, Rodríguez-Pardo D, Corró S. Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection. Bone Joint J 2020; 102-B:1682-1688. [PMID: 33249903 DOI: 10.1302/0301-620x.102b12.bjj-2020-0792.r1] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup. METHODS A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better. RESULTS A total of 162 chronic PJIs were included in the study. After a mean follow-up of 57.3 months (12.1 to 115.7), 18 patients (11.1%) did not undergo reimplantation, due either to medical issues (10), the patient's choice (4), or death (4). When only considering those who underwent reimplantation, the success rate was 80.6%. However, when those who did not undergo reimplantation were included, the success rate dropped to 71.6%. Advanced age, American Society of Anesthesiologists grade ≥ III, McPherson's C host, and Gram-negative related PJI were independent risk factors for retention of the spacer. The mortality was higher in the non-reimplanted group. CONCLUSION The real success rate of two-stage revision may not be as high as previously reported. The exclusion of patients who do not undergo reimplantation resulted in a 9% overestimation of the success rate in this series. Many comorbidity-related risk factors for retention of the spacer were identified, as well as higher death rates in this group. Efforts should be made to optimize these patients medically in order to increase reimplantation and success rates, while decreasing mortality. Cite this article: Bone Joint J 2020;102-B(12):1682-1688.
Collapse
Affiliation(s)
- Pablo S Corona
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matías Vicente
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Carrera
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dolors Rodríguez-Pardo
- Vall d´Hebron Official Multidisciplinary Committee on Musculoskeletal Infections, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Infectious Diseases Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sebastián Corró
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
19
|
Fink B, Schlumberger M. Antibiotic therapy alone does not have a high success rate in cases of unexpected positive cultures in intraoperative samples from hip and knee prosthesis revision. BMC Musculoskelet Disord 2020; 21:786. [PMID: 33248455 PMCID: PMC7700714 DOI: 10.1186/s12891-020-03799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Unexpectedly positive bacterial cultures during prosthesis revision surgery still occur on occasion despite good preoperative diagnostics. In such cases a six-week antibiotic therapy without further surgical intervention is recommended. The aim of this study was to find out how successful this procedure is. METHODS In a study of 508 patients, who required revision surgery of total hip (THA, n = 231) or knee arthroplasties (TKA, n = 277) because of component loosening, biopsy was carried out before their surgery. The collected tissue samples (5) from the biopsy and the revision surgery procedure itself were analyzed according the criteria of the International Consensus Meeting (ICM). Tests revealed 11 patients (7 THA, 4 TKA) with unexpectedly positive bacterial cultures from tissue samples obtained during the revision surgery due to false negative preoperative diagnostic results. These 11 patients were treated with 6 weeks antibiotic therapy and examined with a follow-up of at least 2 years (42.2 ± 16.5 months). RESULTS Five patients (2 TKA, 3 THA) became reinfected, resulting in a success rate of 54.5%. CONCLUSION Antibiotic therapy alone of an unexpected positive intraoperative bacterial culture in prosthesis revision surgery seems to be less successful than previously assumed.
Collapse
Affiliation(s)
- Bernd Fink
- Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany.
- Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20251, Germany.
| | - Michael Schlumberger
- Department for Joint Replacement, Rheumatoid and General Orthopaedics, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany
| |
Collapse
|
20
|
Schauberger A, Klug A, Hagebusch P, Kemmerer M, Hoffmann R, Gramlich Y. Explantation, Followed by Serial Debridement Without Antibiotic Spacers and Subsequent Revision With Cementless Components, Is Associated With High Remission Rates and Low Mortality in Periprosthetic Hip Joint Infections. J Arthroplasty 2020; 35:3274-3284. [PMID: 32624380 DOI: 10.1016/j.arth.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In difficult-to-treat cases, it is necessary to add debridement steps in prosthesis-free interval of 2-stage exchange. We aimed to analyze the functional and clinical outcome of patients treated with a multistage exchange of total hip arthroplasty without the use of spacers, rather only cementless implants. METHODS Between 2009 and 2018, 84 patients (mean age: 67.3 [39-90] years) suffering chronic late-onset periprosthetic joint infection (PJI) were treated using a multistage prosthesis exchange without spacers. The mean follow-up was 70 ± 45.3 [14-210] months. The treatment included prosthesis exchange and at least 1 additional revision step before a reimplantation, owing to ongoing acute infection in the prosthesis-free interval. High-efficiency antimicrobial therapy was administered in between, which was discontinued after cementless revision implantation. RESULTS The mean number of revisions between explantation and implantation was 2.6 (1-9). The most common microorganism was Staphylococcus epidermidis (53.6%) followed by Staphylococcus aureus (16.7%) and Cutibacterium acnes (11.9%). The bacterial load was more than one bacterium per patient in 38% of cases. All patients could be treated using a cementless implant. PJI remission was achieved in 92% of cases. Overall, 9 prostheses (11%) were replaced because of an ongoing PJI or fracture. The mean modified Harrison Hip Score was 63.4 (22-88) points. No patient died. CONCLUSION Multistage total hip arthroplasty exchange showed high remission rates and low mortality in difficult-to-treat cases. Spacer-free and multistage treatment had no negative effect on the success rate or functional outcome, consistent with the results of published 2-stage exchange studies. Implantation of an uncemented press-fit prosthesis was possible in all patients with no elevated periprosthetic fracture rate.
Collapse
Affiliation(s)
- Alice Schauberger
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Paul Hagebusch
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias Kemmerer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
21
|
Lehner B, Omlor GW, Schwarze M. [Periprosthetic joint infections : Latest developments, strategies and treatment algorithms]. DER ORTHOPADE 2020; 49:648-659. [PMID: 32642942 DOI: 10.1007/s00132-020-03950-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to their multidimensional consequences, periprosthetic joint infections are a serious complication in arthroplasty. There are disagreements in the literature regarding their classification. At the same time, a consequence for the practical procedure cannot always be derived. THERAPEUTIC PROCEDURES In addition to debridement with antibiotics and implant retention, there are options for a one or two-stage change in the therapeutic procedure. Although the preservation of implants is only possible in the case of acute infections with a short duration of symptoms, prosthesis changes are indicated with a longer symptom duration. For both procedures, there are interinstitutional deviating indication criteria, weighing pros and cons. Both have specific problems, such as, in particular, the duration of the antibiotics course, the question of anchoring the prosthesis and, in the case of a two-stage procedure, the shape of the spacer.
Collapse
Affiliation(s)
- B Lehner
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - G-W Omlor
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - M Schwarze
- Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| |
Collapse
|
22
|
Zhang X, Li Z, Wang W, Liu T, Peng W. Mid-term results of revision surgery using double-trabecular metal cups alone or combined with impaction bone grafting for complex acetabular defects. J Orthop Surg Res 2020; 15:301. [PMID: 32762720 PMCID: PMC7412805 DOI: 10.1186/s13018-020-01828-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Revision surgery for complex acetabular defects is still technically challenging. In this study, we discussed and compared the clinical and radiological outcomes of revision surgery between two methods using double-trabecular metal (TM) cups alone or combined with impacting bone grafting (IBG). METHODS The records of 18 patients (18 hips) who underwent revision surgery using double-trabecular metal (double-TM) cups between 2008 and 2016 were retrospectively reviewed. All the patients were diagnosed with Paprosky III acetabular defects. The acetabular defects were reconstructed by double-TM cups alone or in combination with IBG. We used the modified Harris Hip Score (mHHS), University of California, Los Angeles (UCLA), and Short Form 36 (SF-36) to evaluate the clinical outcomes. Pelvis plain X-ray was used to assess hip center of rotation (COR), abduction angle and anteversion angle of acetabular cup, and incorporation of the bone graft to host bone. RESULTS The median follow-up time was 61.0 (IQR 56.0 to 65.8) months. No patients underwent re-revision for loosening or any other reasons. Complications included 3 patients (16.7%) with early dislocation and 3 patients (16.7%) with delayed wound healing. The average mHHS and UCLA preoperatively were 44.1 ± 4.0 (range 35 to 50) and 2.6 ± 0.7 (range 2 to 4), respectively and at the last follow-up were 73.7 ± 4.2 (range 68 to 85) and 7.3 ± 0.5 (range 7 to 8), respectively. The mean SF-36 scores at the last follow-up were improved significantly than preoperative scores, especially in bodily pain category (P < 0.05). The average limb-length discrepancy (LLD) decreased significantly from 24.2 ± 2.6 (range 20 to 32) mm preoperatively to 5.8 ± 1.8 (range 3 to 9) mm at the last follow-up, respectively. However, there was no significant difference between two methods at the last follow-up in terms of mHHS, UCLA, SF-36, LLD, and hip COR (P > 0.05). Radiographic evaluation demonstrated bone graft incorporation in all hips in the follow-up. CONCLUSIONS Defect reconstruction using double-TM cups alone or combined with IBG are practical and reliable treatment options for Paprosky III acetabular defects without pelvic discontinuity. Nevertheless, high postoperative complication rate, especially in terms of dislocation, remains a challenge.
Collapse
Affiliation(s)
- Xianghong Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.,Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, 545000, Guangxi, People's Republic of China
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Wanchun Wang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, 410011, Hunan, People's Republic of China.
| | - Weiqiu Peng
- Department of Orthopedics, Liuzhou General Hospital of Guangxi Medical University, Liuzhou, 545000, Guangxi, People's Republic of China
| |
Collapse
|