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Shu HT, Ghanem D, Covarrubias O, Elsabbagh Z, Hughes AJ, Sotsky RB, Conway JD, Ferguson J, Osgood GM, Shafiq B. Poor Outcomes of Girdlestone Resection Arthroplasty in Injection Drug Users: A Retrospective Study. Antibiotics (Basel) 2024; 13:782. [PMID: 39200082 PMCID: PMC11352147 DOI: 10.3390/antibiotics13080782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
This retrospective cohort study aims to investigate the clinical outcomes of Girdlestone resection arthroplasty (GRA) in injection drug users with septic hip arthritis. Patients who underwent primary GRA for septic hip arthritis secondary to injection drug use at two academic trauma centers from 2015 to 2023 were retrospectively reviewed. Patient demographics, surgical details, and follow-up outcomes, including patient-reported outcome measures, were collected and analyzed. The cohort included 15 patients, with a mean age of 44 ± 11 years and a mean follow-up period of 25 ± 20 months. Among the 15 patients, overall mortality was 27%, and only 4 patients underwent total hip arthroplasty (THA) following GRA. Infection resolution rates were significantly higher in patients who received an antibiotic spacer (75% vs. 0%, p = 0.048). GRA in injection drug users is associated with high mortality and low conversion rates to THA. The use of an antibiotic spacer during GRA significantly improves infection resolution rates. Larger studies are required to determine the optimal management strategies for this patient population.
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Affiliation(s)
- Henry T. Shu
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (D.G.); (O.C.); (Z.E.); (G.M.O.); (B.S.)
| | - Diane Ghanem
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (D.G.); (O.C.); (Z.E.); (G.M.O.); (B.S.)
| | - Oscar Covarrubias
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (D.G.); (O.C.); (Z.E.); (G.M.O.); (B.S.)
| | - Zaid Elsabbagh
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (D.G.); (O.C.); (Z.E.); (G.M.O.); (B.S.)
| | - Alice J. Hughes
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA; (A.J.H.); (R.B.S.)
| | - Rachel B. Sotsky
- Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA; (A.J.H.); (R.B.S.)
| | - Janet D. Conway
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopaedics, Sinai Hospital, Baltimore, MD 21215, USA;
| | - Jamie Ferguson
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford OX3 7LD, UK;
| | - Greg M. Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (D.G.); (O.C.); (Z.E.); (G.M.O.); (B.S.)
| | - Babar Shafiq
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA; (D.G.); (O.C.); (Z.E.); (G.M.O.); (B.S.)
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Incze MA, Stolebarger L. On Her Own Two Feet. N Engl J Med 2024; 391:105-107. [PMID: 38973745 DOI: 10.1056/nejmp2402086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Affiliation(s)
- Michael A Incze
- From the Division of General Internal Medicine (M.A.I.), and the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Division of Epidemiology (M.A.I., L.S.), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Laura Stolebarger
- From the Division of General Internal Medicine (M.A.I.), and the Program for Addiction Research, Clinical Care, Knowledge, and Advocacy, Division of Epidemiology (M.A.I., L.S.), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Pagani NR, Grant A, Bamford M, Peterman N, Smith EL, Gordon MR. Socioeconomic Disadvantage Predicts Decreased Likelihood of Maintaining a Functional Knee Arthroplasty Following Treatment for Prosthetic Joint Infection. J Arthroplasty 2024; 39:1828-1833. [PMID: 38220025 DOI: 10.1016/j.arth.2024.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) carries major morbidity and mortality as well as a complicated and lengthy treatment course. In patients who have high degrees of socioeconomic disadvantage, this may be a particularly devastating complication. Our study sought to evaluate the impact of socioeconomic deprivation on outcomes following treatment for PJI of the knee. METHODS We conducted a retrospective review of revision total knee arthroplasty (TKA) procedures performed for the treatment of initial PJI between 2008 and 2020 at a single tertiary care center in the United States. The Area Deprivation Index (ADI) was used to quantify socioeconomic deprivation. The primary outcome measure was presence of a functional knee joint at the time of most recent follow-up defined as TKA components or an articulating spacer. A total of 96 patients were included for analysis. The median follow-up duration was 26.5 months. RESULTS There was no significant difference in the rate of treatment failure (P = .63). However, the proportion of patients who had a functional knee arthroplasty (in contrast to having undergone arthrodesis, amputation, or retention of a static spacer) declined significantly with increasing ADI index (81.8% for the least disadvantaged group, 58.7% for the middle group, 42.9% for the most disadvantaged group, P = .021). CONCLUSIONS Patients who have a higher socioeconomic disadvantage as measured by ADI are less likely to maintain a functional knee arthroplasty following treatment for TKA PJI. These findings support continued efforts to improve access to care and optimize treatment plans for patients who have socioeconomic disadvantage.
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Affiliation(s)
- Nicholas R Pagani
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Andrew Grant
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | | | - Nicholas Peterman
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Eric L Smith
- Department of Orthopaedics, New England Baptist Hospital, Boston, Massachusetts
| | - Matthew R Gordon
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts
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Pinkney JA, Davis JB, Collins JE, Shebl FM, Jamison MP, Acosta Julbe JI, Bogart LM, Ojikutu BO, Chen AF, Nelson SB. Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study. Antibiotics (Basel) 2023; 12:1629. [PMID: 37998831 PMCID: PMC10668943 DOI: 10.3390/antibiotics12111629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/05/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16-3.89; p = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI.
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Affiliation(s)
- Jodian A. Pinkney
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
| | - Joshua B. Davis
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Jamie E. Collins
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Fatma M. Shebl
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
| | - Matthew P. Jamison
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Jose I. Acosta Julbe
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Laura M. Bogart
- RAND Corporation, Santa Monica, CA 90401, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Bisola O. Ojikutu
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
- Boston Public Health Commission, Boston, MA 02118, USA
| | - Antonia F. Chen
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
- Brigham and Women’s Hospital, Boston, MA 02115, USA; (J.B.D.); (M.P.J.); (J.I.A.J.)
| | - Sandra B. Nelson
- Massachusetts General Hospital, Boston, MA 02114, USA; (F.M.S.)
- Harvard Medical School, Boston, MA 02115, USA; (J.E.C.)
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Tidd JL, Pasqualini I, McConaghy K, Higuera CA, Deren ME, Visperas A, Klika AK, Piuzzi NS. The Use of Oral Antibiotics After Total Joint Arthroplasty: A Critical Analysis Review. JBJS Rev 2023; 11:01874474-202310000-00004. [PMID: 37812675 DOI: 10.2106/jbjs.rvw.23.00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
» There is conflicting and insufficient evidence that extended oral antibiotic (EOA) therapy prevents infection in high-risk patients undergoing primary total joint arthroplasty (TJA), limiting recommendation for or against the practice.» In the case of aseptic revision TJA, the evidence is also conflicting and limited by underlying confounders, preventing recommendation for use of EOA.» There is fair evidence that use of EOA after debridement antibiotic therapy and implant retention of the prosthesis prolongs infection-free survival, but randomized controlled trials are needed. On the other hand, there is strong evidence that patients undergoing 2-stage revision should receive a period of suppressive oral antibiotics after the second stage.» The optimal duration of EOA in primary TJA, aseptic revision, and debridement antibiotic therapy and implant retention of the prosthesis is unknown. However, there is strong evidence that 3 months of EOA suppression may be appropriate after reimplantation as part of 2-stage exchange arthroplasty.» Complications secondary to EOA are reported to be between 0% and 13.7%, yet are inconsistently reported and poorly defined. The risks associated with antibiotic use, including development of antimicrobial resistance, must be weighed against a possible decrease in infection rate.
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Affiliation(s)
- Joshua L Tidd
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | | | - Kara McConaghy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carlos A Higuera
- Levitetz Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Matthew E Deren
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anabelle Visperas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
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Affiliation(s)
- Robin Patel
- From the Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and the Division of Public Health, Infectious Diseases, and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
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