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Riehakainen L, Mota-Silva E, Kusmic C, Panetta D, Petroni D, Fragnito D, Salvadori S, Menichetti L. Assessment of tissue response in vivo: PET-CT imaging of titanium and biodegradable magnesium implants. Acta Biomater 2024:S1742-7061(24)00310-6. [PMID: 38871201 DOI: 10.1016/j.actbio.2024.06.005] [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: 01/19/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
To study in vivo the bioactivity of biodegradable magnesium implants and other possible biomaterials, we are proposing a previously unexplored application of PET-CT imaging, using available tracers to follow soft tissue and bone remodelling and immune response in the presence of orthopaedic implants. Female Wistar rats received either implants (Ti6Al7Nb titanium or WE43 magnesium) or corresponding transcortical sham defects into the diaphyseal area of the femurs. Inflammatory response was followed with [18F]FDG and osteogenesis with [18F]NaF, over the period of 1.5 months after surgery. An additional pilot study with [68Ga]NODAGA-RGD tracer specific to αvβ3 integrin expression was performed to follow the angiogenesis for one month. [18F]FDG tracer uptake peaked on day 3 before declining in all groups, with Mg and Ti groups exhibiting overall higher uptake compared to sham. This suggests increased cellular activity and tissue response in the presence of Mg during the initial weeks, with Ti showing a subsequent increase in tracer uptake on day 45, indicating a foreign body reaction. [18F]NaF uptake demonstrated the superior osteogenic potential of Mg compared to Ti, with peak uptake on day 7 for all groups. [68Ga]NODAGA-RGD pilot study revealed differences in tracer uptake trends between groups, particularly the prolonged expression of αvβ3 integrin in the presence of implants. Based on the observed differences in the uptake trends of radiotracers depending on implant material, we suggest that PET-CT is a suitable modality for long-term in vivo assessment of orthopaedic biomaterial biocompatibility and underlying tissue reactions. STATEMENT OF SIGNIFICANCE: The study explores the novel use of positron emission tomography for the assessment of the influence that biomaterials have on the surrounding tissues. Previous related studies have mostly focused on material-related effects such as implant-associated infections or to follow the osseointegration in prosthetics, but the use of PET to evaluate the materials has not been reported before. The approach tests the feasibility of using repeated PET-CT imaging to follow the tissue response over time, potentially improving the methodology for adopting new biomaterials for clinical use.
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Affiliation(s)
- Leon Riehakainen
- The Sant'Anna School of Advanced Studies, Pisa, Italy; Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy.
| | - Eduarda Mota-Silva
- The Sant'Anna School of Advanced Studies, Pisa, Italy; Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Claudia Kusmic
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Daniele Panetta
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Debora Petroni
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Davide Fragnito
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
| | - Luca Menichetti
- Institute of Clinical Physiology, National Research Council (IFC-CNR), Pisa, Italy
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Flanagan W, Becraft K, Warren H, Stavrakis AI, Bernthal NM, Hardin TJ, Clites TR. Prosthetic Limb Attachment via Electromagnetic Attraction Through a Closed Skin Envelope. IEEE Trans Biomed Eng 2024; 71:1552-1564. [PMID: 38090864 DOI: 10.1109/tbme.2023.3342652] [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: 04/23/2024]
Abstract
OBJECTIVE Current socket-based methods of prosthetic limb attachment are responsible for many of the dominant problems reported by persons with amputation. In this work, we introduce a new paradigm for attachment via electromagnetic attraction between a bone-anchored ferromagnetic implant and an external electromagnet. Our objective was to develop a design framework for electromagnetic attachment, and to evaluate this framework in the context of transfemoral amputation. METHODS We first used inverse dynamics to calculate the forces required to suspend a knee-ankle-foot prosthesis during gait. We then conducted cadaveric dissections to inform implant geometry and design a surgical methodology for covering the implant. We also developed an in silico framework to investigate how electromagnet design affects system performance. Simulations were validated against benchtop testing of a custom-built electromagnet. RESULTS The physical electromagnet matched simulations, with a root-mean-square percentage error of 4.2% between measured and predicted forces. Using this electromagnet, we estimate that suspension of a prosthesis during gait would require 33 W of average power. After 200 and 1000 steps of simulated walking, the temperature at the skin would increase 2.3 °C and 15.4 °C relative to ambient, respectively. CONCLUSION Our design framework produced an implant and electromagnet that could feasibly suspend a knee-ankle-foot prosthesis during short walking bouts. Future work will focus on optimization of this system to reduce heating during longer bouts. SIGNIFICANCE This work demonstrates the initial feasibility of an electromagnetic prosthetic attachment paradigm that has the potential to increase comfort and improve residual limb health for persons with amputation.
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Xiang S, Zhang C, Guan Z, Li X, Liu Y, Feng G, Luo X, Zhang B, Weng J, Xiao D. Preparation of a novel antibacterial magnesium carbonate coating on a titanium surface and its in vitro biocompatibility. RSC Adv 2024; 14:10516-10525. [PMID: 38567331 PMCID: PMC10985587 DOI: 10.1039/d4ra00399c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Magnesium-based coatings have attracted great attention in surface modification of titanium implants due to their superior angiogenic and osteogenic properties. However, their biological effects as a carbonate-based constituent remain unrevealed. In this study, magnesium carbonate coatings were prepared on titanium surfaces under hydrothermal conditions and subsequently treated with hydrogen peroxide. Also, their antibacterial activity and in vitro cell biocompatibility were evaluated. The obtained coatings consisted of nanoparticles without cracks and exhibited excellent adhesion to the substrate. X-ray diffraction (XRD) results indicated pure magnesium carbonate coatings formed on the Ti surface after hydrothermal treatment. After hydrogen peroxide treatment, the phase composition of the coatings had no obvious change. Compared to the untreated coatings, the hydrogen peroxide-treated coatings showed increased surface roughness and hydrophilicity. Co-culture with Staphylococcus aureus (S. aureus) demonstrated that the obtained coatings had good antibacterial activity. In vitro cell culture results showed that the hydrogen peroxide-treated coatings enhanced the viability, proliferation, and osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). These findings suggest that this MgCO3-based coating exhibits excellent antibacterial performance and osteogenic potential. Based on the above, this study provides a simple method for preparing titanium implants with dual antibacterial and osteogenic capabilities, holding great promise in clinical applications.
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Affiliation(s)
- Shougang Xiang
- Department of Orthopaedics, Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical College of North Sichuan Medical College Nanchong Sichuan 637000 China
| | - Chengdong Zhang
- Key Laboratory of Advanced Technologies of Materials (MOE), School of Materials Science and Engineering, Southwest Jiaotong University Chengdu Sichuan 610031 China
| | - Zhenju Guan
- Department of Orthopaedics, Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical College of North Sichuan Medical College Nanchong Sichuan 637000 China
| | - Xingping Li
- Department of Orthopaedics, Chengfei Hospital Chengdu Sichuan 610091 China
| | - Yumei Liu
- Collaboration Innovation Center for Tissue Repair Material Engineering Technology, China West Normal University Nanchong Sichuan 637002 China
| | - Gang Feng
- Department of Orthopaedics, Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical College of North Sichuan Medical College Nanchong Sichuan 637000 China
| | - Xuwei Luo
- Department of Orthopaedics, Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical College of North Sichuan Medical College Nanchong Sichuan 637000 China
| | - Bo Zhang
- Department of Orthopaedics, Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical College of North Sichuan Medical College Nanchong Sichuan 637000 China
| | - Jie Weng
- Key Laboratory of Advanced Technologies of Materials (MOE), School of Materials Science and Engineering, Southwest Jiaotong University Chengdu Sichuan 610031 China
| | - Dongqin Xiao
- Department of Orthopaedics, Research Institute of Tissue Engineering and Stem Cells, Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), The Second Clinical College of North Sichuan Medical College Nanchong Sichuan 637000 China
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Samet JD, Alizai H, Chalian M, Costelloe C, Deshmukh S, Kalia V, Kamel S, Mhuircheartaigh JN, Saade J, Walker E, Wessell D, Fayad LM. Society of skeletal radiology position paper - recommendations for contrast use in musculoskeletal MRI: when is non-contrast imaging enough? Skeletal Radiol 2024; 53:99-115. [PMID: 37300709 DOI: 10.1007/s00256-023-04367-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/01/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
The following White Paper will discuss the appropriateness of gadolinium administration in MRI for musculoskeletal indications. Musculoskeletal radiologists should consider the potential risks involved and practice the judicious use of intravenous contrast, restricting administration to cases where there is demonstrable added value. Specific nuances of when contrast is or is not recommended are discussed in detail and listed in table format. Briefly, contrast is recommended for bone and soft tissue lesions. For infection, contrast is reserved for chronic or complex cases. In rheumatology, contrast is recommended for early detection but not for advanced arthritis. Contrast is not recommended for sports injuries, routine MRI neurography, implants/hardware, or spine imaging, but is helpful in complex and post-operative cases.
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Affiliation(s)
- Jonathan D Samet
- Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Hamza Alizai
- CHOP Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Majid Chalian
- Department of Radiology, University of Washington, Seattle, USA
| | | | | | - Vivek Kalia
- Children's Scottish Rite Hospital, Dallas, USA
| | - Sarah Kamel
- Thomas Jefferson University Hospital, Philadelphia, USA
| | | | - Jimmy Saade
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, USA
| | - Eric Walker
- Penn State Health Milton S Hershey Medical Center, Hershey, USA
| | - Daniel Wessell
- Mayo Clinic Jacksonville Campus: Mayo Clinic in Florida, Jacksonville, USA
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, Baltimore, USA.
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Spronk T, Kraff O, Schaefers G, Quick HH. Numerical approach to investigate MR imaging artifacts from orthopedic implants at different field strengths according to ASTM F2119. MAGMA (NEW YORK, N.Y.) 2023; 36:725-735. [PMID: 36933090 PMCID: PMC10504103 DOI: 10.1007/s10334-023-01074-2] [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: 07/26/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE This study presents an extended evaluation of a numerical approach to simulate artifacts of metallic implants in an MR environment. METHODS The numerical approach is validated by comparing the artifact shape of the simulations and measurements of two metallic orthopedic implants at three different field strengths (1.5 T, 3 T, and 7 T). Furthermore, this study presents three additional use cases of the numerical simulation. The first one shows how numerical simulations can improve the artifact size evaluation according to ASTM F2119. The second use case quantifies the influence of different imaging parameters (TE and bandwidth) on the artifact size. Finally, the third use case shows the potential of performing human model artifact simulations. RESULTS The numerical simulation approach shows a dice similarity coefficient of 0.74 between simulated and measured artifact sizes of metallic implants. The alternative artifact size calculation method presented in this study shows that the artifact size of the ASTM-based method is up to 50% smaller for complex shaped implants compared to the numerical-based approach. CONCLUSION In conclusion, the numerical approach could be used in the future to extend MR safety testing according to a revision of the ASTM F2119 standard and for design optimization during the development process of implants.
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Affiliation(s)
- Tobias Spronk
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany.
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
- MRI-STaR Magnetic Resonance Institute for Safety GmbH, Technology and Research GmbH, Gelsenkirchen, Germany.
| | - Oliver Kraff
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany
| | - Gregor Schaefers
- MRI-STaR Magnetic Resonance Institute for Safety GmbH, Technology and Research GmbH, Gelsenkirchen, Germany
- MR:Comp GmbH, Testing Services for MR Safety and Compatibility, Gelsenkirchen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Kokereiallee 7, Building C84, 45141, Essen, Germany
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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6
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Lützelberger J, Arneth P, Franck A, Drese KS. Ultrasonic Interferometric Procedure for Quantifying the Bone-Implant Interface. SENSORS (BASEL, SWITZERLAND) 2023; 23:5942. [PMID: 37447790 DOI: 10.3390/s23135942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
The loosening of an artificial joint is a frequent and critical complication in orthopedics and trauma surgery. Due to a lack of accuracy, conventional diagnostic methods such as projection radiography cannot reliably diagnose loosening in its early stages or detect whether it is associated with the formation of a biofilm at the bone-implant interface. In this work, we present a non-invasive ultrasound-based interferometric measurement procedure for quantifying the thickness of the layer between bone and prosthesis as a correlate to loosening. In principle, it also allows for the material characterization of the interface. A well-known analytical model for the superposition of sound waves reflected in a three-layer system was combined with a new method in data processing to be suitable for medical application at the bone-implant interface. By non-linear fitting of the theoretical prediction of the model to the actual shape of the reflected sound waves in the frequency domain, the thickness of the interlayer can be determined and predictions about its physical properties are possible. With respect to determining the layer's thickness, the presented approach was successfully applied to idealized test systems and a bone-implant system in the range of approx. 200 µm to 2 mm. After further optimization and adaptation, as well as further experimental tests, the procedure offers great potential to significantly improve the diagnosis of prosthesis loosening at an early stage and may also be applicable to detecting the formation of a biofilm.
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Affiliation(s)
- Jan Lützelberger
- Institute of Sensor and Actuator Technology (ISAT), Coburg University of Applied Sciences and Arts, Am Hofbräuhaus 1b, 96450 Coburg, Germany
| | - Philipp Arneth
- Institute of Sensor and Actuator Technology (ISAT), Coburg University of Applied Sciences and Arts, Am Hofbräuhaus 1b, 96450 Coburg, Germany
| | - Alexander Franck
- Department of Trauma Surgery and Orthopedics, REGIOMED Clinical Center Coburg, Ketschendorfer Str. 33, 96450 Coburg, Germany
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Klaus Stefan Drese
- Institute of Sensor and Actuator Technology (ISAT), Coburg University of Applied Sciences and Arts, Am Hofbräuhaus 1b, 96450 Coburg, Germany
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Hirano M, Muto Y, Kuroda M, Fujiwara Y, Sasaki T, Kuroda K, Kamizaki R, Imajoh S, Tanabe Y, Al-Hammad WE, Nakamitsu Y, Shimizu Y, Sugimoto K, Oita M, Sugianto I, Bamgbose BO. Quantitative evaluation of the reduction of distortion and metallic artifacts in magnetic resonance images using the multiacquisition variable‑resonance image combination selective sequence. Exp Ther Med 2023; 25:109. [PMID: 36793326 PMCID: PMC9922940 DOI: 10.3892/etm.2023.11808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Magnetic resonance imaging (MRI) is superior to computed tomography (CT) in determining changes in tissue structure, such as those observed following inflammation and infection. However, when metal implants or other metal objects are present, MRI exhibits more distortion and artifacts compared with CT, which hinders the accurate measurement of the implants. A limited number of reports have examined whether the novel MRI sequence, multiacquisition variable-resonance image combination selective (MAVRIC SL), can accurately measure metal implants without distortion. Therefore, the present study aimed to demonstrate whether MAVRIC SL could accurately measure metal implants without distortion and whether the area around the metal implants could be well delineated without artifacts. An agar phantom containing a titanium alloy lumbar implant was used for the present study and was imaged using a 3.0 T MRI machine. A total of three imaging sequences, namely MAVRIC SL, CUBE and magnetic image compilation (MAGiC), were applied and the results were compared. Distortion was evaluated by measuring the screw diameter and distance between the screws multiple times in the phase and frequency directions by two different investigators. The artifact region around the implant was examined using a quantitative method following standardization of the phantom signal values. It was revealed that MAVRIC SL was a superior sequence compared with CUBE and MAGiC, as there was significantly less distortion, a lack of bias between the two different investigators and significantly reduced artifact regions. These results suggested the possibility of utilizing MAVRIC SL for follow-up to observe metal implant insertions.
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Affiliation(s)
- Masaki Hirano
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Radiology, Osaka Red Cross Hospital, Osaka 543-8555, Japan
| | - Yuki Muto
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Radiology, Oomoto Hospital, Okayama 700-0924, Japan
| | - Masahiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Correspondence to: Professor Masahiro Kuroda, Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan
| | - Yuta Fujiwara
- Division of Clinical Radiology Service, Okayama Central Hospital, Okayama 700-0017, Japan
| | - Tomoaki Sasaki
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - Kazuhiro Kuroda
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan,Department of Health and Welfare Science, Graduate School of Health and Welfare Science, Okayama Prefectural University, Okayama 719-1197, Japan
| | - Ryo Kamizaki
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Satoshi Imajoh
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yoshinori Tanabe
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Wlla E. Al-Hammad
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-0017, Japan
| | - Yuki Nakamitsu
- Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, Okayama 700-8558, Japan
| | - Yudai Shimizu
- Department of Oral and Maxillofacial Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-0017, Japan
| | - Kohei Sugimoto
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama, 770-8558, Japan
| | - Masataka Oita
- Graduate School of Interdisciplinary Sciences and Engineering in Health Systems, Okayama University, Okayama, 770-8558, Japan
| | - Irfan Sugianto
- Department of Oral Radiology, Faculty of Dentistry, Hasanuddin University, Makassar, Sulawesi 90245, Indonesia
| | - Babatunde O. Bamgbose
- Department of Oral Diagnostic Sciences, Faculty of Dentistry, Bayero University, Kano 00234, Nigeria
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8
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Boero M, Allocca M, Pisu N, Sanna S, Ruggiero A, Pung BLJ, Margotti S, Dessì G. Management of periprosthetic knee joint infections: focus on the role of Nuclear Medicine (v2). Orthop Rev (Pavia) 2022; 14:39646. [PMID: 36381502 PMCID: PMC9662607 DOI: 10.52965/001c.39646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND When faced with a painful knee replacement, ruling out infection is mandatory to set the correct therapeutic approach. However, it is not always easy, especially in subclinical/chronic infections. A multidisciplinary approach is necessary to assess in the most correct way each case of suspected periprosthetic knee joint infection. This review explores the role of nuclear medicine investigations in the management of periprosthetic knee infections and their proper use within a multidisciplinary pathway. METHODS A PubMed search was conducted selecting studies from the past 10 years. RESULTS Triphasic bone scintigraphy has high sensitivity (93%) but poor specificity (56%) for periprosthetic joint infections of the knee, with a high negative predictive value (NPV), ranging from 96% to 100%. Consequently, a negative bone scan is useful in ruling out infection. In contrast, radiolabeled leukocyte scintigraphy is characterized by a sensitivity of 85.7-93%, specificity of 93.6-100%, diagnostic accuracy of 92.6-98%, NPV of 93-97.8%, and positive predictive value (PPV) of 66.7-100%. By adding a tomographic acquisition with hybrid single-photon emission computed tomography combined with computed tomography technique (SPECT/CT), the diagnostic accuracy increases. Because 18F-fluorodeoxyglucose (FDG) accumulates at both sites of inflammation and infection, FDG positron emission tomography (PET/CT) shows low specificity. CONCLUSIONS A common decision-making process in the diagnosis of periprosthetic joint infection is not yet validated and multidisciplinary integration is mandatory. In this context, nuclear medicine can contribute decisively.
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Affiliation(s)
| | | | - Nicola Pisu
- Nuclear Medicine, Brotzu Hospital, Cagliari (Italy)
| | - Silvia Sanna
- Nuclear Medicine, Brotzu Hospital, Cagliari (Italy)
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Atkin B, Dupley L, Chakravorty P, Zafar K, Boden R. Approach to patients with a potential prosthetic joint infection. BMJ 2022; 376:e069502. [PMID: 35314426 DOI: 10.1136/bmj-2021-069502] [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: 11/03/2022]
Affiliation(s)
- B Atkin
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - L Dupley
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - P Chakravorty
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - K Zafar
- New Collegiate Medical Centre, Cheetham Hill and Crumpsall Primary Care Network, Manchester, UK
| | - R Boden
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
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10
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Gamma camera imaging (bone scan) in orthopedics: Foot, ankle, knees, and hip. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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11
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Ronin D, Boyer J, Alban N, Natoli RM, Johnson A, Kjellerup BV. Current and novel diagnostics for orthopedic implant biofilm infections: a review. APMIS 2021; 130:59-81. [PMID: 34862649 DOI: 10.1111/apm.13197] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
Biofilm infections involving orthopedic implants are a global problem. They contribute to severe complications and mortality, as well as increased use of antibiotic treatments and development of antibiotic-resistant microorganisms. More than 1 million hip and knee arthroplasties are performed each year in the United States. These hard-to-treat infections lead to patient distress, increased morbidity, and high financial costs to both patients and healthcare systems. There is a need to improve the diagnosis of such biofilm infections to allow for earlier detection and treatment. Current diagnostics rely on clinical signs for infections such as loss of function, fever, rubor, patient history of the predisposing condition, persisting infection, failure of antibiotic treatment, and documentation of antibiotic failure. Below, we present a framework which outlines the data gaps in the conventional laboratory techniques used in clinical diagnostics; we also discuss promising novel diagnostic methods which are currently used solely in research. It is critical to assess these novel infection diagnostic techniques and address the data gaps and clinical hesitance preventing application in a clinical setting. Additionally, the combination of conventional and novel diagnostic technologies would streamline the diagnostic process of biofilm infections associated with orthopedic implants.
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Affiliation(s)
- Dana Ronin
- Department of Civil and Environmental Engineering, University of Maryland, College Park, Maryland, USA.,Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Jessica Boyer
- Department of Civil and Environmental Engineering, University of Maryland, College Park, Maryland, USA.,Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Nathan Alban
- Department of Civil and Environmental Engineering, University of Maryland, College Park, Maryland, USA.,Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aaron Johnson
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Birthe Veno Kjellerup
- Department of Civil and Environmental Engineering, University of Maryland, College Park, Maryland, USA.,Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
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12
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Genovese N, Auld T, Dever LL, Rossman SR. Mycobacterium abscessus Periprosthetic Hip Infection Complicated by Superimposed Polymicrobial Infection: A Case Report. JBJS Case Connect 2021; 11:01709767-202112000-00055. [PMID: 34798649 DOI: 10.2106/jbjs.cc.21.00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 79-year-old man developed Mycobacterium abscessus prosthetic joint infection (PJI) after hip hemiarthroplasty that was complicated by polymicrobial infection. He was ultimately treated with resection arthroplasty and chronic suppressive therapy. He has had no evidence of recurrent infection after 2 years of follow-up. CONCLUSION As far as we know, this is the first reported case of M. abscessus hip PJI complicated by superimposed polymicrobial infection. This case demonstrates the challenge of treating M. abscessus infection, the need for a multidisciplinary approach with aggressive surgical intervention, and prolonged combination antimicrobial therapy for a successful outcome.
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Affiliation(s)
- Nicholas Genovese
- Rutgers New Jersey Medical School, Department of Orthopaedic Surgery, Newark, New Jersey
| | - Thomas Auld
- Rutgers New Jersey Medical School, Department of Orthopaedic Surgery, Newark, New Jersey
| | - Lisa L Dever
- Rutgers New Jersey Medical School, Department of Infectious Disease, Newark, New Jersey
| | - Stephen R Rossman
- Hackensack University Medical Center, Department of Orthopaedic Surgery, Hackensack, New Jersey
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13
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Ong N, Zailan I, Tandon A. Imaging update in arthroplasty. J Clin Orthop Trauma 2021; 23:101649. [PMID: 34777990 PMCID: PMC8577440 DOI: 10.1016/j.jcot.2021.101649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 11/20/2022] Open
Abstract
Imaging of metal implants has historically been difficult, regardless of the applied modality. The number of primary arthroplasties is increasing over the years. With it, we expect the number of symptomatic complications to increase as well. Acquiring accurate imaging for diagnosis and treatment planning for these cases is of paramount importance. Significant advancements have been made to reduce artifacts, leading to better imaging representation of arthroplasty. This review article would give a background on the current ways of imaging arthroplasty and metal implants, covering recent advances in imaging techniques.
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Affiliation(s)
| | | | - Ankit Tandon
- Tan Tock Seng Hospital, Singapore
- Corresponding author.
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14
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Thippeswamy PB, Nedunchelian M, Rajasekaran RB, Riley D, Khatkar H, Rajasekaran S. Updates in postoperative imaging modalities following musculoskeletal surgery. J Clin Orthop Trauma 2021; 22:101616. [PMID: 34660193 PMCID: PMC8502706 DOI: 10.1016/j.jcot.2021.101616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Postoperative imaging following orthopaedic surgeries is essential in assessing complications post-surgery and also helps plan further treatment. Combining a high degree of clinical insight with appropriate imaging can guide the treating clinician to the correct diagnosis. Imaging is quite challenging because of surgery-related soft tissue changes, especially in the early postoperative period and the presence of metal implants resulting in image scatter and metal artifacts. Newer modalities and advances in imaging have helped overcome shortcomings and assess better, especially in procedures that involve implants. Collaborative decision-making involving radiologists and clinicians has shown to be beneficial and is the way forward. This narrative review discusses the utility of imaging in evaluating postoperative complications following musculoskeletal surgeries with specific relation to trauma, arthroplasty, and tumour by discussing commonly encountered clinical scenarios.
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Affiliation(s)
- Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Meena Nedunchelian
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Raja Bhaskara Rajasekaran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
- Corresponding author. 17, Horwood Close, Headington, Oxford, OX3 7RF, UK.
| | - Dylan Riley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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15
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Wijayaratna U, Kiridena S, Adams JD, Behrend CJ, Anker JN. Synovial fluid pH sensor for early detection of prosthetic hip infections. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2104124. [PMID: 36478668 PMCID: PMC9725744 DOI: 10.1002/adfm.202104124] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 05/11/2023]
Abstract
We describe an implantable sensor developed to measure synovial fluid pH for noninvasive early detection and monitoring of hip infections using standard-of-care plain radiography. The sensor was made of a pH responsive polyacrylic acid-based hydrogel, which expands at high pH and contracts at low pH. A radiodense tantalum bead and a tungsten wire were embedded in the two ends of the hydrogel in order to monitor the change in length of the hydrogel sensor in response to pH via plain radiography. The effective pKa of the hydrogel-based pH sensor was 5.6 with a sensitivity of 3 mm/pH unit between pH 4 and 8. The sensor showed a linear response and reversibility in the physiologically relevant pH range of pH 6.5 and 7.5 in both buffer and bovine synovial fluid solutions with a 30-minute time constant. The sensor was attached to an explanted prosthetic hip and the pH response determined from the X-ray images by measuring the length between the tantalum bead and the radiopaque wire. Therefore, the developed sensor would enable noninvasive detection and studying of implant hip infection using plain radiography.
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Affiliation(s)
- Uthpala Wijayaratna
- Department of Chemistry, Clemson University, 102 BRC, 105 Collings St., Clemson, SC 29634, USA
| | - Sachindra Kiridena
- Department of Chemistry, Clemson University, 102 BRC, 105 Collings St., Clemson, SC 29634, USA
| | - John D Adams
- Prisma Health-Upstate, Department of Orthopedic Surgery, Second Floor Support Tower, 701 Grove Road, Greenville, SC 29605, USA
| | | | - Jeffrey N Anker
- Departments of Chemistry and BioEngineering, and Center for Optical Materials Science and Engineering Technology (COMSET), Clemson University, 102 BRC, 105 Collings St., Clemson, SC 29634, USA
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16
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Nwawka OK, Tischler B, Lin B, Ko L, Schneider R, Miller TT. Utility of lavage in addition to native fluid collection during fluoroscopically guided joint aspiration in infection diagnosis. J Orthop Res 2021; 39:1884-1888. [PMID: 33251626 DOI: 10.1002/jor.24929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
Image-guided prosthetic joint aspirations have been criticized in the literature as having poor sensitivity and specificity. Native fluid is typically analyzed for the presence of infection. Joint lavage during fluoroscopically guided aspiration of prosthetic joints is not routinely performed, and the lavage aspirate is not typically analyzed unless native fluid could not be aspirated for culture. This study aims to determine if concordance of culture results from native fluid and an additional joint lavage sample improves sensitivity and specificity in the diagnosis of prosthetic joint infection by fluoroscopically guided joint aspiration. A retrospective review of the fluoroscopically guided joint aspirations at our institution between December 2007 and December 2009 was performed. Data collected from the electronic medical record included culture results for both native fluid and lavage aspirate, histopathology results, final clinical diagnosis, as well as clinical/surgical management. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio for infection were calculated for the following culture analysis scenarios: native fluid alone; lavage aspirate alone; native fluid; and lavage aspirate. Five hundred sixty-three aspirations, mostly prosthetic joints, were identified in the reviewed time period, of which 397 were sent for both native fluid and lavage aspirate analysis. Concordance between positive culture results from native fluid and joint lavage aspirate markedly increased the likelihood ratio for infection from 23.8 to 138.7 and improved specificity and PPV of fluoroscopically guided joint aspiration, with similar sensitivity and NPV to that of native fluid culture alone.
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Affiliation(s)
- O Kenechi Nwawka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Brian Tischler
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Bin Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Lydia Ko
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA
| | - Robert Schneider
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Theodore T Miller
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York, USA.,Department of Radiology, Weill Cornell Medical College of Cornell University, New York, New York, USA
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17
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Bright R, Hayles A, Fernandes D, Visalakshan RM, Ninan N, Palms D, Burzava A, Barker D, Brown T, Vasilev K. In Vitro Bactericidal Efficacy of Nanostructured Ti6Al4V Surfaces is Bacterial Load Dependent. ACS APPLIED MATERIALS & INTERFACES 2021; 13:38007-38017. [PMID: 34374279 DOI: 10.1021/acsami.1c06919] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for medical implants globally has increased significantly due to an aging population amongst other reasons. Despite the overall increase in the survivorship of Ti6Al4V implants, implant infection rates are increasing due to factors such as diabetes, obesity, and bacterial resistance to antibiotics. Two commonly found bacteria implicated in implant infections are Staphylococcus aureus and Pseudomonas aeruginosa. Based on prior work that showed nanostructured surfaces might have potential in passively killing these bacterial species, we developed a hierarchical, hydrothermally etched, nanostructured titanium surface. To evaluate the antibacterial efficacy of this surface, etched and as-received surfaces were inoculated with S. aureus or P. aeruginosa at concentrations ranging from 102 to 109 colony-forming units per disc. Live/dead staining revealed there was a 60% decrease in viability for S. aureus and greater than a 98% decrease for P. aeruginosa on etched surfaces at the lowest inoculum of 102 CFU/disc, when compared to the control surface. Bactericidal efficiency decreased with increasing bacterial concentrations in a stepwise manner, with decreases in bacterial viability noted for S. aureus above 105 CFU/disc and above 106 CFU/disc for P. aeruginosa. Surprisingly, biofilm depth analysis revealed a decrease in bacterial viability in the 2 μm layer furthest from the nanostructured surface. The nanostructured Ti6Al4V surface developed here holds the potential to reduce the rate of implant infections.
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Affiliation(s)
- Richard Bright
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Andrew Hayles
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Daniel Fernandes
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Rahul M Visalakshan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Neethu Ninan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dennis Palms
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Anouck Burzava
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dan Barker
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Toby Brown
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Krasimir Vasilev
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
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18
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In Vivo Imaging of Biodegradable Implants and Related Tissue Biomarkers. Polymers (Basel) 2021; 13:polym13142348. [PMID: 34301105 PMCID: PMC8309526 DOI: 10.3390/polym13142348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/12/2021] [Indexed: 01/10/2023] Open
Abstract
Non-invasive longitudinal imaging of osseointegration of bone implants is essential to ensure a comprehensive, physical and biochemical understanding of the processes related to a successful implant integration and its long-term clinical outcome. This study critically reviews the present imaging techniques that may play a role to assess the initial stability, bone quality and quantity, associated tissue remodelling dependent on implanted material, implantation site (surrounding tissues and placement depth), and biomarkers that may be targeted. An updated list of biodegradable implant materials that have been reported in the literature, from metal, polymer and ceramic categories, is provided with reference to the use of specific imaging modalities (computed tomography, positron emission tomography, ultrasound, photoacoustic and magnetic resonance imaging) suitable for longitudinal and non-invasive imaging in humans. The advantages and disadvantages of the single imaging modality are discussed with a special focus on preclinical imaging for biodegradable implant research. Indeed, the investigation of a new implant commonly requires histological examination, which is invasive and does not allow longitudinal studies, thus requiring a large number of animals for preclinical testing. For this reason, an update of the multimodal and multi-parametric imaging capabilities will be here presented with a specific focus on modern biomaterial research.
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19
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Ramalhete R, Brown R, Blunn G, Skinner J, Coathup M, Graney I, Sanghani-Kerai A. A novel antimicrobial coating to prevent periprosthetic joint infection. Bone Joint Res 2020; 9:848-856. [PMID: 33275031 PMCID: PMC9021900 DOI: 10.1302/2046-3758.912.bjr-2020-0157.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aims Periprosthetic joint infection (PJI) is a debilitating condition with a substantial socioeconomic burden. A novel autologous blood glue (ABG) has been developed, which can be prepared during surgery and sprayed onto prostheses at the time of implantation. The ABG can potentially provide an antimicrobial coating which will be effective in preventing PJI, not only by providing a physical barrier but also by eluting a well-known antibiotic. Hence, this study aimed to assess the antimicrobial effectiveness of ABG when impregnated with gentamicin and stem cells. Methods Gentamicin elution from the ABG matrix was analyzed and quantified in a time-dependent manner. The combined efficiency of gentamicin and ABG as an anti-biofilm coating was investigated on titanium disks. Results ABG-gentamicin was bactericidal from 10 μg/ml and could release bactericidal concentrations over seven days, preventing biofilm formation. A concentration of 75 μg/ml of gentamicin in ABG showed the highest bactericidal effect up to day 7. On titanium disks, a significant bacterial reduction on ABG-gentamicin coated disks was observed when compared to both uncoated (mean 2-log reduction) and ABG-coated (mean 3-log reduction) disks, at days 3 and 7. ABG alone exhibited no antimicrobial or anti-biofilm properties. However, a concentration of 75 μg/ml gentamicin in ABG sustains release over seven days and significantly reduced biofilm formation. Its use as an implant coating in patients with a high risk of infection may prevent bacterial adhesion perioperatively and in the early postoperative period. Conclusion ABG’s use as a carrier for stem cells was effective, as it supported cell growth. It has the potential to co-deliver compatible cells, drugs, and growth factors. However, ABG-gentamicin’s potential needs to be further justified using in vivo studies. Cite this article: Bone Joint Res 2020;9(12):848–856.
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Affiliation(s)
- Rita Ramalhete
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
| | - Robyn Brown
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
| | - Gordon Blunn
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
| | - Melanie Coathup
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK.,College of Medicine, University of Central Florida, Orlando, Florida, USA
| | | | - Anita Sanghani-Kerai
- Institute of Orthopaedics and Musculoskeletal Science, Department of Materials & Tissue, University College London, London, UK
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20
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YİĞİT Ş, AKAR MS, ÖZBEK E. Ortopedik Enfeksiyonların Tedavisinde Sodyum Hipoklorit’in Yeri Var mıdır? DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.755778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Prosthetic joint infections: diagnosis, management, and complications of the two-stage replacement arthroplasty. Skeletal Radiol 2020; 49:847-859. [PMID: 32040604 DOI: 10.1007/s00256-020-03389-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Despite improved strategies to prevent prosthetic joint infection, as the total number of joint replacements increases, so does the absolute number of infections. Radiography serves as the first-line imaging modality for the assessment of a suspected prosthetic joint infection. Additionally, serial radiographs acquired after a surgery to eradicate a prosthetic joint infection are an important clinical tool. Prosthetic joint infections are often treated with a 2-stage replacement arthroplasty utilizing a prosthesis with antibiotic-loaded acrylic cement. While complications are uncommon with this procedure, imaging may demonstrate periprosthetic fractures, as well as spacer migration, joint dislocation, and spacer fracture. We describe the classification of prosthetic joint infections, the clinical and imaging diagnosis, and treatment strategies. Familiarity with the hardware utilized in the management of the prosthetic joint infection, and its potential complications is fundamental to accurate imaging interpretation.
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22
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Galley J, Sutter R, Stern C, Filli L, Rahm S, Pfirrmann CWA. Diagnosis of Periprosthetic Hip Joint Infection Using MRI with Metal Artifact Reduction at 1.5 T. Radiology 2020; 296:98-108. [PMID: 32396046 DOI: 10.1148/radiol.2020191901] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background MRI with metal artifact reduction has gained importance in assessment of pain with total hip arthroplasty (THA). However, its role in diagnosis of periprosthetic joint infection (PJI) has not been well defined. Purpose To evaluate findings of PJI after THA and to determine the diagnostic performance of 1.5-T MRI with metal artifact reduction. Materials and Methods Dedicated compressed sensing-based slice encoding for metal artifact correction 1.5-T MRI examinations (from January 2015 to April 2018) in patients with THA PJI (infection group) and noninfected THA (control group) were retrospectively evaluated by two musculoskeletal radiologists. Fisher exact test was used to compare the groups. Sensitivity, specificity, and accuracy were evaluated for each finding. Interobserver reliability was assessed with κ statistics. Results Forty patients (mean age, 69 years ± 11 [standard deviation]; 26 men) in the infection group and 100 patients (mean age, 67 years ± 11; 42 men) in the control group were evaluated. Periosteal reaction, capsule edema, and intramuscular edema differed between the two groups (P < .001 for each finding). Periosteal reaction was found in 31 of 40 patients with infection and 10 of 100 participants in the control group (sensitivity, 78%; specificity, 90%; accuracy, 86%); capsule edema was found in 33 of 40 (infection group) and five of 100 (control group) (sensitivity, 83%; specificity, 95%; accuracy, 91%); and intramuscular edema was found in 38 of 40 (infection group) and 14 of 100 (control group) (sensitivity, 95%; specificity, 86%; accuracy, 89%). Interobserver agreement was almost perfect, with κ values between 0.88 and 0.92. No difference between the two groups was found regarding the presence of osteolysis (infection group, 23 of 40; control group, 60 of 100), bone marrow edema (39 of 40 vs 87 of 100), effusion (20 of 40 vs 26 of 100), abductor tendon lesion (22 of 40 vs 62 of 100), or bursitis (14 of 40 vs 34 of 100) (P > .05 for each finding). Conclusion The presence of periosteal reaction, capsule edema, and intramuscular edema after total hip arthroplasty at 1.5-T MRI with metal artifact reduction had a high accuracy in evaluation of periprosthetic joint infection. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Zanetti in this issue.
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Affiliation(s)
- Julien Galley
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Reto Sutter
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Christoph Stern
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Lukas Filli
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Stefan Rahm
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
| | - Christian W A Pfirrmann
- From the Departments of Radiology (J.G., R.S., C.S., L.F., C.W.A.P.) and Orthopedic Surgery (S.R.), Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland; and Department of Radiology, HFR, University of Fribourg, Fribourg, Switzerland (J.G.)
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23
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Seltzer A, Xiao R, Fernandez M, Hasija R. Role of nuclear medicine imaging in evaluation of orthopedic infections, current concepts. J Clin Orthop Trauma 2019; 10:721-732. [PMID: 31316245 PMCID: PMC6611848 DOI: 10.1016/j.jcot.2019.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alexandra Seltzer
- NYC H/H Elmhurst, Department of Nuclear Medicine, USA
- Icahn School of Medicine at Mount Sinai, Department of Nuclear Medicine, USA
- Corresponding author. Dept. of Nuclear Medicine, NYC H/H Elmhurst, 79-01 Broadway, Elmhurst, USA.
| | - Ryan Xiao
- Icahn School of Medicine at Mount Sinai, Department of Orthopedics, USA
| | - Michelle Fernandez
- NYC H/H Elmhurst, Department of Nuclear Medicine, USA
- Icahn School of Medicine at Mount Sinai, Department of Nuclear Medicine, USA
| | - Rohit Hasija
- NYC H/H Elmhurst, Department of Nuclear Medicine, USA
- Icahn School of Medicine at Mount Sinai, Department of Orthopedics, USA
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24
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Sconfienza LM, Signore A, Cassar-Pullicino V, Cataldo MA, Gheysens O, Borens O, Trampuz A, Wörtler K, Petrosillo N, Winkler H, Vanhoenacker FMHM, Jutte PC, Glaudemans AWJM. Diagnosis of peripheral bone and prosthetic joint infections: overview on the consensus documents by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur Radiol 2019; 29:6425-6438. [PMID: 31250170 DOI: 10.1007/s00330-019-06326-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/27/2019] [Accepted: 06/12/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Peripheral bone infection (PBI) and prosthetic joint infection (PJI) are two different infectious conditions of the musculoskeletal system. They have in common to be quite challenging to be diagnosed and no clear diagnostic flowchart has been established. Thus, a conjoined initiative on these two topics has been initiated by the European Society of Radiology (ESR), the European Association of Nuclear Medicine (EANM), the European Bone and Joint Infection Society (EBJIS), and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The purpose of this work is to provide an overview on the two consensus documents on PBI and PJI that originated by the conjoined work of the ESR, EANM, and EBJIS (with ESCMID endorsement). METHODS AND RESULTS After literature search, a list of 18 statements for PBI and 25 statements for PJI were drafted in consensus on the most debated diagnostic challenges on these two topics, with emphasis on imaging. CONCLUSIONS Overall, white blood cell scintigraphy and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities for the diagnosis of PBI and PJI. However, the choice of which advanced diagnostic modality to use first depends on several factors, such as the benefit for the patient, local experience of imaging specialists, costs, and availability. Since robust, comparative studies among most tests do not exist, the proposed flowcharts are based not only on existing literature but also on the opinion of multiple experts involved on these topics. KEY POINTS • For peripheral bone infection and prosthetic joint infection, white blood cell and magnetic resonance imaging have individually demonstrated the highest diagnostic performance over other imaging modalities. • Two evidence- and expert-based diagnostic flowcharts involving variable combination of laboratory tests, biopsy methods, and radiological and nuclear medicine imaging modalities are proposed by a multi-society expert panel. • Clinical application of these flowcharts depends on several factors, such as the benefit for the patient, local experience, costs, and availability.
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Victor Cassar-Pullicino
- Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire, UK
| | - Maria Adriana Cataldo
- Infectious Disease Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Borens
- Division of Orthopaedic Surgery and Traumatology, Septic surgical unit, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Musculoskeletal Surgery (CMSC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus Wörtler
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Nicola Petrosillo
- Infectious Disease Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Heinz Winkler
- Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
| | - Filip M H M Vanhoenacker
- Department of Radiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.,AZ Sint-Maarten, Belgium, Mechelen, Belgium.,University of Ghent, Ghent, Belgium
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Mushtaq N, To K, Gooding C, Khan W. Radiological Imaging Evaluation of the Failing Total Hip Replacement. Front Surg 2019; 6:35. [PMID: 31275942 PMCID: PMC6591276 DOI: 10.3389/fsurg.2019.00035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023] Open
Abstract
Total hip replacements (THR) have been performed in the UK from the 1960s and since then we have seen surgical techniques, the design of implants, and imaging modalities rapidly develop. This paper will aim to review the different complications and imaging appearance which help to evaluate each problem. As for all investigations for bone and joints, a radiograph is the first imaging to be performed for any patient with a THR and can detect a majority of complications. CT is relatively low-cost, simple to perform and easily available making it an excellent tool to supplement radiographs when trying to evaluate a hip prosthesis. Single photon emission computed tomography with CT (SPECT-CT) is an emerging modality which has shown to combine the sensitivity that bone scintigraphy offers with the high specificity of CT. SPECT imaging also has the advantage of showing the bone's metabolic activity and is less prone to metal artifact than Magnetic resonance imaging (MRI). MRI has evolved to become an important diagnostic tool for the evaluation of THR in the post-operative period. Optimized pulse sequences and metal artifact reduction techniques have made MRI a useful tool in diagnosis of soft tissue abnormalities and is particularly useful in identifying adverse local tissue reactions in metal on metal implants. CT and MRI are accurate in identifying the diagnosis of most causes of THR complications except infection. Research confirms that leukocyte-marrow scintigraphy is the modality of choice for accurately diagnosing prosthetic joint infection and reassures us of its superiority over other nuclear medicine imaging. However, due to the limited availability and increased costs when performing leukocyte-marrow scintigraphy, CT and SPECT-CT would be a more preferred option when suspecting prosthesis infection. Ultrasound (US) has a limited role in the assessment of most THR complications but can be useful to identify peri-prosthetic fluid collections and the presence of soft tissue sinus tracts. Being aware of the imaging modalities that are available to orthopedic surgeons, and discussing these challenging cases with specialist radiologists will enable optimal management of THR complications.
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Affiliation(s)
- Nida Mushtaq
- Department of Trauma and Orthopaedics, Walsall Manor Hospital, Walsall, United Kingdom
| | - Kendrick To
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Chris Gooding
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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Tardy M, Montecucco V, Botelho-Nevers E, Sahi B, Cazorla C. [Prosthetic joint infections: Practice evaluation in Hôpital du Gier, France]. Presse Med 2019; 48:593-603. [PMID: 31155433 DOI: 10.1016/j.lpm.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 03/13/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Marin Tardy
- Hôpital du Gier, centre de rééducation, 62, rue Léon-Marrel, 42800 Rive-de-Gier, France.
| | - Vincent Montecucco
- Hôpital du Gier, centre de rééducation, 62, rue Léon-Marrel, 42800 Rive-de-Gier, France
| | - Elisabeth Botelho-Nevers
- CHU de Saint-Étienne, service des maladies infectieuses, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Bachir Sahi
- Hôpital du Gier, centre de rééducation, 62, rue Léon-Marrel, 42800 Rive-de-Gier, France
| | - Céline Cazorla
- CHU de Saint-Étienne, service des maladies infectieuses, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
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Diaz-Ledezma C, Espinosa-Mendoza R, Gallo J, Glaudemans A, Gómez-García F, Goodman S, Kaminek M, Le Roux TLB, Llinás A, Nieslanikova E, Quinn L, Sculco P, Svoboda M. General Assembly, Diagnosis, Imaging: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S215-S223. [PMID: 30360979 DOI: 10.1016/j.arth.2018.09.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Glaudemans AWJM, Jutte PC, Cataldo MA, Cassar-Pullicino V, Gheysens O, Borens O, Trampuz A, Wörtler K, Petrosillo N, Winkler H, Signore A, Sconfienza LM. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging 2019; 46:957-970. [PMID: 30675635 PMCID: PMC6450853 DOI: 10.1007/s00259-019-4262-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 01/15/2023]
Abstract
Introduction In adults with a suspicion of peripheral bone infection, evidence-based guidelines in choosing the most accurate diagnostic strategy are lacking. Aim and methods To provide an evidence-based, multidisciplinary consensus document on the diagnostic management of adult patients with PBIs, we performed a systematic review of relevant infectious, microbiological, orthopedic, radiological, and nuclear medicine literature. Delegates from four European societies (European Bone and Joint Infection Society, European Society of Microbiology and Infectious Diseases, European Society or Radiology, and European Association of Nuclear Medicine) defined clinical questions to be addressed, thoroughly reviewed the literature pertinent to each of the questions, and thereby evaluated the diagnostic accuracy of each diagnostic technique. Inclusion of the papers per statement was based on a PICO (Population/problem – Intervention/indicator – Comparator – Outcome) question following the strategy reported by the Oxford Centre for Evidence-based Medicine. For each statement, the level of evidence was graded according to the 2011 review of the Oxford Centre for Evidence-based Medicine. All approved statements were addressed taking into consideration the available diagnostic procedures, patient acceptance, tolerability, complications, and costs in Europe. Finally, a commonly agreed-upon diagnostic flowchart was developed. Electronic supplementary material The online version of this article (10.1007/s00259-019-4262-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Paul C Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Adriana Cataldo
- Clinical and Research Department on of Infectious Diseases, "L. Spallanzani", IRCCS-Rome, Rome, Italy
| | - Victor Cassar-Pullicino
- Department of Diagnostic Imaging, Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Trust, Oswestry, Shropshire, UK
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Borens
- Division of Orthopaedic Surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Andrej Trampuz
- Center for Muskuloskeletal Surgery, Charité - Universitätsmedicin Berlin, Berlin, Germany
| | - Klaus Wörtler
- 69 Division Institut für Diagnostische und Interventionelle Radiologie, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Nicola Petrosillo
- Clinical and Research Department on of Infectious Diseases, "L. Spallanzani", IRCCS-Rome, Rome, Italy
| | - Heinz Winkler
- Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
| | - Alberto Signore
- Nuclear Medicine Unit, Faculty of Medicine and Psychology, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Luca Maria Sconfienza
- Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Di Benedetto P, Niccoli G, Magnanelli S, Beltrame A, Gisonni R, Cainero V, Causero A. Arthroscopic treatment of iliopsoas impingement syndrome after hip arthroplasty. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:104-109. [PMID: 30715007 PMCID: PMC6503398 DOI: 10.23750/abm.v90i1-s.8076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Groin pain after hip arthroplasty (HA) ranges from 0.4% to 18.3%. Defining the cause of groin pain after HA can be difficult. Iliopsoas impingement (IPI) has been reported to be the underlying cause of groin pain in up to 4.4% of cases. The purpose of this study is to present arthroscopic surgical outcomes in the treatment of IPI after HA. METHODS Between September 2013 and March 2018, 13 patients, 11 total hip arthroplasty (THA), 1 hip endoprosthesis and 1 total hip resurfacing affected by groin pain due to unceasing iliopsoas tendinopathy for impingement after HA were treated arthroscopically. The patients underwent to physical examination, blood analysis, hip X-rays, bone scintigraphy and CT assessment. We performed the arthroscopic OUT-IN access to hip joint in all patients. VAS scale, Harris Hip Score (HHS) and Medical Research Council (MRC) scale were performed before surgery and during follow up at 1-3-6-12 months. RESULTS After 10 months of mean follow-up, average HHS and MRC scale improved significantly from preoperatively to postoperatively. No complications arose in our case series. CONCLUSIONS Hip arthroscopy after hip arthroplasty is supported in the literature for a variety of indications. Hip arthroscopy is a viable and reproducible technique in treatment of IPI, being less invasive than the classic open technique. This simple arthroscopic release provides satisfactory results and preserves HA function. Moreover an arthroscopic OUT-IN access proves good clinical outcomes, few complications and iatrogenic lesions.
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Van den Wyngaert T, Paycha F, Strobel K, Kampen WU, Kuwert T, van der Bruggen W, Gnanasegaran G. SPECT/CT in Postoperative Painful Hip Arthroplasty. Semin Nucl Med 2018; 48:425-438. [PMID: 30193649 DOI: 10.1053/j.semnuclmed.2018.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Consecutive milestones in hip arthroplasty design and surgical technique have contributed to the successful and cost-effective intervention this procedure has become today in maintaining mobility and quality of life in patients with osteoarthritis, fracture, or other hip conditions. With the increasing prevalence of hip joint replacements, the need for improved diagnostic imaging tools to guide revision surgery has risen in parallel. Over the last few years, promising data have emerged on the potential role of bone SPECT/CT imaging in the assessment of patients with recurrent pain after arthroplasty. This review summarizes the trends in hip arthroplasty surgery (partial vs total arthroplasty; cemented vs cementless arthroplasty; resurfacing arthroplasty) and prosthesis design (bearing materials; stem designs) over the last decade. In particular, the impact on the biomechanics and interpretation of bone SPECT/CT findings is discussed, with emphasis on integrative reporting in the following frequently encountered conditions: lysis/aseptic loosening, septic loosening, heterotopic ossification, periprosthetic fracture, tendinopathies, and adverse local tissue reactions. Based on the available literature data, bone SPECT/CT is increasingly being used as second-line imaging modality when conventional investigations are nondiagnostic. Further outcome research is warranted to examine whether this technique could be used earlier in patient management.
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Affiliation(s)
- Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium..
| | - Frédéric Paycha
- Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Wouter van der Bruggen
- Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands
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31
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The Importance of Antibacterial Surfaces in Biomedical Applications. ADVANCES IN BIOMEMBRANES AND LIPID SELF-ASSEMBLY 2018. [DOI: 10.1016/bs.abl.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Niccoli G, Mercurio D, Cortese F. Bone scan in painful knee arthroplasty: obsolete or actual examination? ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:68-77. [PMID: 28657567 DOI: 10.23750/abm.v88i2 -s.6516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
ptic loosening, instability and infection are the major causes of TKA failure. For many years, nuclear medicine (NM) imaging was helpful to frame a painful total joint arthroplasty. The differentiation of septic from aseptic prosthetic loosening is critical. The latest AAOS guidelines to detect periprosthetic joint infection (PJI) restrict the role of NM scintigraphy. On the other hand, several studies suggest that NM imaging plays an important role in the evaluation of patients with painful prosthesis, but its specificity in differentiating aseptic loosening from infection is low. Moreover, scintigraphic exams showed different diagnostic accuracy in TKA compared to total hip arthroplasty (THA). PURPOSE To assess and discuss current knowledges about the diagnostic value of the various scans in TKA failure alone. METHODS We perform a pubmed/medline search to identify all papers published in the literature matching the following key words: "total knee arthroplasty", "bone", "scintigraphy", "imaging", "three-phase", "triple-phase", "99mTc-HDP", "99mTc-MDP", "99mTc-hydroxymethane diphosphonate", and "99m Tc-methylenediphosphonate", "leukocyte scanning", "labeled leukocyte scintigraphy", "antigranulocyte", "nuclear medicine", "septic loosening", "aseptic loosening" and "infection". RESULTS Three phases bone scintigraphy results an early diagnostic screening test or part of the preoperative tests for painful TKA and when PJI is suspected. Instead, leukocyte/bone marrow scintigraphy is superior to other scintigraphic tools in diagnosis of TKA infections. Granulocyte scintigraphy, seems to be an excellent choice when the diagnosis is unclear. Moreover, nuclear diagnostic tests showed different diagnostic accuracy between TKA and THA. CONCLUSIONS Although nuclear diagnostic tests for THA failure are superior in diagnostic accuracy compared to TKA, NM scintigraphy is still an effective tool in the identification of chronic, low grade PJI. To date, scintigraphic exams have an higher levels of sensitivity, specificity and accuracy. Currently, leukocyte/bone marrow scintigraphy is considered the gold standard for this aim. Nevertheless, further studies are needed to assess and improve the accuracy of the scintigraphic exams in order to discriminate the causes of failure for painful TKA.
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Pedicle Screw Fluid Sign: An Indication on Magnetic Resonance Imaging of a Deep Infection After Posterior Spinal Instrumentation. Clin Spine Surg 2017; 30:169-175. [PMID: 28437330 DOI: 10.1097/bsd.0000000000000040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A single-center case-referent study. OBJECTIVE To assess whether the "pedicle screw (PS) fluid sign" on magnetic resonance imaging (MRI) can be used to diagnose deep surgical site infection (SSI) after posterior spinal instrumentation (PSI). SUMMARY OF BACKGROUND DATA MRI is a useful tool for the early diagnosis of a deep SSI. However, the diagnosis is frequently difficult with feverish patients with clear wounds after PSI because of artifacts from the metallic implants. There are no reports on MRI findings that are specific to a deep SSI after PSI. We found that fluid collection outside the head of the PS on an axial MRI scan (PS fluid sign) strongly suggested the possibility of an abscess. METHODS The SSI group comprised 17 patients with a deep SSI after posterior lumbar spinal instrumentation who had undergone an MRI examination at the onset of the SSI. The non-SSI group comprised 64 patients who had undergone posterior lumbar spinal instrumentation who did not develop an SSI and had an MRI examination within 4 weeks after surgery. The frequency of a positive PS fluid sign was compared between both groups. RESULTS The PS fluid sign had a sensitivity of 88.2%, specificity of 89.1%, positive predictive value of 68.1%, and negative predictive value of 96.6%. The 2 patients with a false-negative PS fluid sign in the SSI group had an infection at the disk into which the interbody cage had been inserted. Three of the 7 patients with a false-positive PS fluid sign in the non-SSI group had a dural tear during surgery. CONCLUSIONS The PS fluid sign is a valuable tool for the early diagnosis of a deep SSI. The PS fluid sign is especially useful for diagnosing a deep SSI in difficult cases, such as feverish patients without wound discharge.
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Fang C, Wong TM, Lau TW, To KK, Wong SS, Leung F. Infection after fracture osteosynthesis - Part I. J Orthop Surg (Hong Kong) 2017; 25:2309499017692712. [PMID: 28215118 DOI: 10.1177/2309499017692712] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Bone and surgical site infections after osteosynthesis are notoriously difficult to manage and pose a tremendous burden in fracture management. In this article, we use the term osteosynthesis-associated infection (OAI) to refer to this clinical entity. While relatively few surgically treated fractures become infected, it is challenging to perform a rapid diagnosis. Optimal management strategies are complex and highly customized to each scenario and take into consideration the status of fracture union, the presence of hardware and the degree of mechanical stability. At present, a high level of relevant evidence is unavailable; most findings presented in the literature are based on laboratory work and non-randomized clinical studies. We present this overview of OAI in two parts: an examination of recent literature concerning OAI pathogenesis, diagnosis and classification and a review of treatment options.
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Affiliation(s)
- Christian Fang
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Tak-Man Wong
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.,3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Tak-Wing Lau
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Kelvin Kw To
- 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Samson Sy Wong
- 2 Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Frankie Leung
- 1 Department of Orthopaedics and Traumatology, Queen Mary Hospital, University of Hong Kong, Pokfulam, Hong Kong, China.,3 Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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Bone scan usefulness in patients with painful hip or knee prosthesis: 10 situations that can cause pain, other than loosening and infection. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 27:147-156. [DOI: 10.1007/s00590-016-1884-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
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Blum A, Gondim-Teixeira P, Gabiache E, Roche O, Sirveaux F, Olivier P, Coudane H, Raymond A, Louis M, Grandhaye M, Meyer JB, Mainard D, Molé D. Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm. Diagn Interv Imaging 2016; 97:735-47. [PMID: 27452630 DOI: 10.1016/j.diii.2016.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several imaging modalities can be used to diagnose complications of hip prosthesis placement. Despite progress in these imaging techniques, there are, as yet, no guidelines as to their respective indications. METHODS We formed a panel of experts in fields related to prosthesis imaging (radiology, nuclear medicine, orthopedic surgery) and conducted a review of the literature to determine the value of each modality for diagnosing complications following hip replacement. RESULTS Few recent studies have investigated the benefits related to the use of the latest technical developments, and studies comparing different methods are extremely rare. CONCLUSIONS We have developed a diagnostic tree based on the characteristics of each imaging technique and recommend its use. Computed topography was found to be the most versatile and cost-effective imaging solution and therefore a key tool for diagnosing the complications of hip replacement surgery.
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Affiliation(s)
- A Blum
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - P Gondim-Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - E Gabiache
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - O Roche
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - F Sirveaux
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - P Olivier
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - H Coudane
- Chirurgie traumatologique et arthroscopique de l'appareil locomoteur (ATOL), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | | | - A Raymond
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Louis
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Grandhaye
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - J-B Meyer
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Mainard
- Chirurgie orthopédique et traumatologique (COT), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Molé
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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Blum A, Meyer JB, Raymond A, Louis M, Bakour O, Kechidi R, Chanson A, Gondim-Teixeira P. CT of hip prosthesis: New techniques and new paradigms. Diagn Interv Imaging 2016; 97:725-33. [DOI: 10.1016/j.diii.2016.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
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Dillenseger JP, Molière S, Choquet P, Goetz C, Ehlinger M, Bierry G. An illustrative review to understand and manage metal-induced artifacts in musculoskeletal MRI: a primer and updates. Skeletal Radiol 2016; 45:677-88. [PMID: 26837388 DOI: 10.1007/s00256-016-2338-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/13/2016] [Accepted: 01/17/2016] [Indexed: 02/02/2023]
Abstract
This article reviews and explains the basic physical principles of metal-induced MRI artifacts, describes simple ways to reduce them, and presents specific reduction solutions. Artifacts include signal loss, pile-up artifacts, geometric distortion, and failure of fat suppression. Their nature and origins are reviewed and explained though schematic representations that ease the understanding. Then, optimization of simple acquisition parameters is detailed. Lastly, dedicated sequences and options specifically developed to reduce metal artifacts (VAT, SEMAC, and MAVRIC) are explained.
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Affiliation(s)
- J P Dillenseger
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France.,Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France
| | - S Molière
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France
| | - P Choquet
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France.,Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France
| | - C Goetz
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France.,Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France
| | - M Ehlinger
- Icube, CNRS, University of Strasbourg, Strasbourg, France.,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France.,Department of orthopedic surgery, University Hospital of Strasbourg, Strasbourg, France
| | - G Bierry
- Medical imaging department, University Hospital of Strasbourg, 10 Av. Molière, F- 67098, Strasbourg, France. .,Icube, CNRS, University of Strasbourg, Strasbourg, France. .,Translational Medicine Research Federation, Strasbourg Medical School, University of Strasbourg, Strasbourg, France.
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Sinogram utilization revisited. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang Y, Cheung JPY, Cheung KMC. Use of PET/CT in the early diagnosis of implant related wound infection and avoidance of wound debridement. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25 Suppl 1:38-43. [DOI: 10.1007/s00586-015-4044-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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Biomimetic approaches in bone tissue engineering: Integrating biological and physicomechanical strategies. Adv Drug Deliv Rev 2015; 84:1-29. [PMID: 25236302 DOI: 10.1016/j.addr.2014.09.005] [Citation(s) in RCA: 265] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/01/2014] [Accepted: 09/05/2014] [Indexed: 02/06/2023]
Abstract
The development of responsive biomaterials capable of demonstrating modulated function in response to dynamic physiological and mechanical changes in vivo remains an important challenge in bone tissue engineering. To achieve long-term repair and good clinical outcomes, biologically responsive approaches that focus on repair and reconstitution of tissue structure and function through drug release, receptor recognition, environmental responsiveness and tuned biodegradability are required. Traditional orthopedic materials lack biomimicry, and mismatches in tissue morphology, or chemical and mechanical properties ultimately accelerate device failure. Multiple stimuli have been proposed as principal contributors or mediators of cell activity and bone tissue formation, including physical (substrate topography, stiffness, shear stress and electrical forces) and biochemical factors (growth factors, genes or proteins). However, optimal solutions to bone regeneration remain elusive. This review will focus on biological and physicomechanical considerations currently being explored in bone tissue engineering.
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Berber R, Henckel J, Khoo M, Wan S, Hua J, Skinner J, Hart A. Clinical Usefulness of SPECT-CT in Patients with an Unexplained Pain in Metal on Metal (MOM) Total Hip Arthroplasty. J Arthroplasty 2015; 30:687-94. [PMID: 25583682 DOI: 10.1016/j.arth.2014.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 10/27/2014] [Accepted: 11/08/2014] [Indexed: 02/06/2023] Open
Abstract
SPECT-CT is increasingly used to assess painful knee arthroplasties. The aim of this study was to evaluate the clinical usefulness of SPECT-CT in unexplained painful MOM hip arthroplasty. We compared the diagnosis and management plan for 19 prosthetic MOM hips in 15 subjects with unexplained pain before and after SPECT-CT. SPECT-CT changed the management decision in 13 (68%) subjects, Chi-Square=5.49, P=0.24. In 6 subjects (32%) pain remained unexplained however the result reassured the surgeon to continue with non-operative management. SPECT-CT should be reserved as a specialist test to help identify possible causes of pain where conventional investigations have failed. It can help reassure surgeons making management decisions for patients with unexplained pain following MOM hip arthroplasty.
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Affiliation(s)
- Reshid Berber
- Institute of Orthopaedics and Musculoskeletal Science (University College London) and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science (University College London) and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Michael Khoo
- Institute of Orthopaedics and Musculoskeletal Science (University College London) and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Simon Wan
- Institute of Nuclear Medicine, T5, University College Hospital, London
| | - Jia Hua
- School of Science and Technology, Natural Sciences Department, Middlesex University London, The Burroughs, London
| | - John Skinner
- Institute of Orthopaedics and Musculoskeletal Science (University College London) and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
| | - Alister Hart
- Institute of Orthopaedics and Musculoskeletal Science (University College London) and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex
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Predictors of Diagnostic Efficacy of Tagged White Blood Cell Scans in the Evaluation of Occult Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deep Infection With Candida albicans Following Total Hip Replacement. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a1eeae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Makarov C, Berdicevsky I, Raz-Pasteur A, Gotman I. In vitro antimicrobial activity of vancomycin-eluting bioresorbable β-TCP-polylactic acid nanocomposite material for load-bearing bone repair. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:679-687. [PMID: 23224936 DOI: 10.1007/s10856-012-4832-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
Release of antimicrobial agents from bone healing devices can dramatically reduce the risk of implant-associated infection. Here we report the fabrication and antimicrobial activity of a multifunctional load-bearing bioresorbable material that can provide mechanical support to the healing bone all while slowly releasing an antibiotic drug. Dense beta-tricalcium phosphate (β-TCP)-40 vol% polylactic acid (PLA) nanocomposite containing 1 wt% vancomycin (VH) was high pressure consolidated at 2.5 GPa, at room temperature, or at 120 °C. Over the course of 5 weeks in TRIS solution, the β-TCP-PLA-VH nanocomposite released approximately 90 % of its drug load. Specimens consolidated at 120 °C had the highest initial mechanical properties and maintained 85 % of their compressive strength and 30 % of their bending strength after 5 weeks release. In vitro growth inhibition study showed significant antimicrobial efficacy of VH-impregnated β-TCP-PLA against methicillin-resistant Staphylococcus aureus when exposed to both high (2 × 10(5) CFU/mL) and very high (1 × 10(8) CFU/mL) bacterial concentrations. After 1 week, total eradication of the microorganisms was achieved. The results suggest that the developed high-strength antibiotic-eluting β-TCP-PLA nanocomposite can be a promising material for orthopedic surgical devices.
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Affiliation(s)
- C Makarov
- Department of Materials Science and Engineering, Technion-Israel Institute of Technology, Haifa, Israel
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