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Kürüm H, Key S, Tosun HB, Yılmaz E, Kürüm KO, İpekten F, Akcan A. Relationship between the clinical outcomes and the systemic inflammatory response index and systemic immune inflammation index after total knee arthroplasty. Musculoskelet Surg 2024:10.1007/s12306-024-00825-1. [PMID: 38898343 DOI: 10.1007/s12306-024-00825-1] [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: 03/15/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is an extremely damaging complication that can occur after total knee arthroplasty (TKA). There is no study in the literature investigating the relationship between systemic inflammatory response index (SIRI) and systemic inflammation immune index (SII) values and prognosis and infection in patients who have undergone TKA. The aim of the study was to determine the relationship between the inflammatory index values and the rate of PJI in patients who had previously had TKA. METHODS A total of 187 patients who underwent TKA between 2015 and 2023 years were retrospectively analyzed. RESULTS The median value of the postoperative SII index was 1862.3 (1146.6-2630.4) in the infected group, while it was 1058.2 (605.0-1762.8) in the non-infected group (p < 0.001). In the infected group, the median value of preoperative SIRI was observed as 2.3 (1.7-3.5), while in the non-infected group it was 0.9 (0.7-1.5) (p < 0.001). The cutoff value for postoperative SIRI was observed to be 2.19, with a sensitivity value of 95%, a specificity value of 46%, the AUC value observed was 65%. The cutoff value for the postoperative SII index was observed to be 1058.96, with a sensitivity value of 100%, a specificity value of 50%. CONCLUSIONS Our study has associated the inflammatory markers SIRI, SII, neutrophil lymphocyte ratio, and platelet lymphocyte ratio with PJI, which are easy and inexpensive to obtain. There is no widely recognized serum biomarker that can be used alone with good sensitivity and specificity. This study contributes to finding the gold standard inflammatory marker for diagnosing PJI.
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Affiliation(s)
- H Kürüm
- Department of Orthopaedics and Traumatology, Ergani State Hospital, Diyarbakır, Turkey.
| | - S Key
- Department of Orthopedics and Traumatology, Firat University Hospital, Firat University Elazığ, Elazığ, Turkey
| | - H B Tosun
- Department of Orthopaedics and Traumatology, Elazığ Fethi Sekin Training and Research Hospital, Elazığ, Turkey
| | - E Yılmaz
- Department of Orthopedics and Traumatology, Firat University Hospital, Firat University Elazığ, Elazığ, Turkey
| | - K O Kürüm
- Department of Physiotherapy and Rehabilitation, İnönü University, Malatya, Turkey
| | - F İpekten
- Department of Biostatistics, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
| | - A Akcan
- Department of Orthopaedics and Traumatology, Ergani State Hospital, Diyarbakır, Turkey
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Spece H, Khachatryan A, Phillips FM, Lanman TH, Andersson GB, Garrigues GE, Bae H, Jacobs JJ, Kurtz SM. Presentation and management of infection in total disc replacement: A review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100320. [PMID: 38590972 PMCID: PMC10999484 DOI: 10.1016/j.xnsj.2024.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
Background Total disc replacement (TDR) is widely used in the treatment of cervical and lumbar spine pathologies. Although TDR infection, particularly delayed infection, is uncommon, the results can be devastating, and consensus on clinical management remains elusive. In this review of the literature, we asked: (1) What are the reported rates of TDR infection; (2) What are the clinical characteristics of TDR infection; and (3) How has infection been managed for TDR patients? Methods We performed a search of the literature using PubMed and Embase to identify studies that reported TDR infection rates, the identification and management of TDR infection, or TDR failures with positive cultures. Twenty database studies (17 focusing on the cervical spine and 3 on the lumbar spine) and 10 case reports representing 15 patients were reviewed along with device Summary of Safety and Effectiveness Data reports. Results We found a lack of clarity regarding how infection was diagnosed, indicating a variation in clinical approach and highlighting the need for a standard definition of TDR infection. Furthermore, while reported infection rates were low, the absence of a clear definition prevented robust data analysis and may contribute to underreporting in the literature. We found that treatment strategy and success rely on several factors including patient symptoms and time to onset, microorganism type, and implant positioning/stability. Conclusions Although treatment strategies varied throughout the extant literature, common practices in eliminating infection and reconstructing the spine emerged. The results will inform future work on the creation of a more robust definition of TDR infection and as well as recommendations for management.
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Affiliation(s)
- Hannah Spece
- Drexel University Implant Research Core, 3401 Market St., Suite 345, Philadelphia, PA, 19104, USA
| | - Armen Khachatryan
- The Disc Replacement Center, 3584 W 9000 S Suite 209, Salt Lake City, UT 84088, USA
| | - Frank M. Phillips
- Division of Spine Surgery, Rush University Medical Center, 1611 W Harrison St. #400, Chicago, IL 60612, USA
| | - Todd H. Lanman
- Lanman Spinal Neurosurgery, 450 N Roxbury Dr., 3rd Floor, Beverly Hills, CA 90210, USA
| | - Gunnar B.J. Andersson
- Department of Orthopedic Surgery, Rush University, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Grant E. Garrigues
- Department of Orthopedic Surgery, Rush University, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Hyun Bae
- Cedars-Sinai Spine Center, 444 S San Vicente Blvd, Los Angeles, CA 90048, USA
| | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University, 1611 W Harrison St., Chicago, IL 60612, USA
| | - Steven M. Kurtz
- Drexel University Implant Research Core, 3401 Market St., Suite 345, Philadelphia, PA, 19104, USA
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Erivan R, Villatte G, Haverlan A, Roullet CA, Ouchchane L, Descamps S, Boisgard S. Does a sign restricting operating room access reduce staff traffic in the surgical department? Orthop Traumatol Surg Res 2024:103843. [PMID: 38387645 DOI: 10.1016/j.otsr.2024.103843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Infections following orthopedic surgery are rare but difficult to treat. Among the prevention measures reviewed during the Musculoskeletal Infection Society's (MSIS) 2023 international consensus meeting, the only strategy to obtain 100% agreement was the control of traffic in and out of the operating room (OR). Although this recommendation makes good sense, to our knowledge, it has not been previously investigated in a comparative study. We, therefore, conducted a prospective, observational, before-and-after study of the implementation of an informational sign designed to limit traffic in and out of the OR to (1) determine its impact on door openings and the number of people present during orthopedic surgery and (2) assess the risk of surgical site infection after the institution of this sign. HYPOTHESIS This type of sign reduces the number of door openings. MATERIALS AND METHODS This prospective, observational study included all patients operated on in one of our ORs over a 6-week period. The number of entrances and exits from the OR and how long the doors were kept open were recorded during the entire study period. After 3 weeks, an informational sign was posted on the OR doors warning people that unnecessary traffic in and out of the OR increases the risk of infection. During this period, we also recorded the type of procedure, operative time, the number of people in the OR at the time of the incision, and the number of entrances and exits. Patients underwent a follow-up at 2 years to check for postoperative infection. The primary endpoint was the number of OR door openings, and the secondary endpoint was the number of infections at 2 years postoperatively. RESULTS The 2 groups (before and after the implementation of the sign) were homogeneous. The average total number of door openings for all ORs was 28.9±19.6 [2-90]. In the no sign group, it was 33.3±20.9 [3-90], and in the sign group, it was 21.0±14.7 [2-50] (p=0.011). The maximum number of people in the OR at one time was 8.32±1.84 [4-12] in the no sign group and 8.44±1.98 [5-12] in the sign group (p=0.8). There were 3 postoperative infections at the 2-year follow-up, all occurring in the no sign group. The infection rate was 6.4% (3/47) in the no sign group versus 0% (0/25) in the sign group (p=0.197). DISCUSSION Our prospective study demonstrated a simple strategy to reduce the number of entrances and exits, the number of people in the OR, and potentially the risk of surgery-related infection. Another larger-scale study is needed to assess the exact impact of this type of sign, particularly on the risk of infection. LEVEL OF EVIDENCE III; prospective non-randomized comparative study.
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Affiliation(s)
- Roger Erivan
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Arthur Haverlan
- CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Claude Alain Roullet
- CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Lemlih Ouchchane
- CNRS, SIGMA Clermont, institut Pascal, université Clermont Auvergne, 63000 Clermont-Ferrand, France; Unité de biostatistique-informatique médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
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Mangin M, Aouzal Z, Leclerc G, Sergent AP, Bouiller K, Patry I, Garbuio P. One-stage revision hip arthroplasty for infection using primary cementless stems as first-line implants: About 35 cases. Orthop Traumatol Surg Res 2023; 109:103642. [PMID: 37302525 DOI: 10.1016/j.otsr.2023.103642] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 02/19/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION During infected total hip arthroplasty revisions (THAR), the need for systematic antibiotic cementation remains undefined. HYPOTHESIS Implantation of a primary cementless stem as first-line implant in 1-stage septic THAR provides results as good as those from a stem cemented with antibiotics in terms of infection resolution. MATERIALS AND METHODS We retrospectively examined 35 patients operated on for septic THAR with Avenir® cementless stem placement - between 2008 and 2018 at Besançon University Hospital - with a minimum follow-up of 2 years to define healing in the absence of infectious recurrence. Clinical outcomes were assessed using the Harris, Oxford, and Merle D'Aubigné scores. Osseointegration was analyzed by the Engh radiographic score. RESULTS The median follow-up was 5±2.6 years (2-11). The infection was cured in 32 of 35 (91.4%) patients. The median scores of the following were: Harris 77/100, Oxford 47.5/60 and Merle d'Aubigné 15/18. Of 32 femoral stems, 31 (96.8%) had radiographically stable osseointegration. Age greater than 80 years was a risk factor for failure to cure the infection during septic THAR. DISCUSSION A primary cementless stem as first-line implant plays a role in 1-stage septic THAR. It confers good results in terms of infection resolution and stem integration in the setting of loss of femoral bone substances rated Paprosky 1. LEVEL OF EVIDENCE IV; retrospective case series.
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Affiliation(s)
- Matthieu Mangin
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France.
| | - Zouhair Aouzal
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Grégoire Leclerc
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Anne Pauline Sergent
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Kévin Bouiller
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Isabelle Patry
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
| | - Patrick Garbuio
- Orthopaedic and Traumatology Surgery Service, University Hospital of Besançon, 3 boulevard A. Fleming, 25000 Besançon, France
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Which Patients with Chronic Periprosthetic Joint Infection Are Less Suitable to Successful Two Stage Exchange Arthroplasty Surgery? A Retrospective Clinical Trial. Clin Pract 2023; 13:190-199. [PMID: 36826159 PMCID: PMC9954882 DOI: 10.3390/clinpract13010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Two-stage exchange (TSE) arthroplasty is currently considered the gold standard for chronic periprosthetic joint infections (PJIs), despite a failure rate reported in up to 10% of patients. Little is known about the risk factors that may compromise successful TSE arthroplasty management in such patients. The main purpose of the current study was to highlight the potential risk factors of patients with chronic PJIs after THA managed by implant removal, outlining the differences between reimplanted patients and those that were never reimplanted because of a non-eradicated infection. METHODS We conducted a retrospective observational study of patient candidates for TSE arthroplasty surgery, managed at the authors' institution, over a four-year timeframe. The data were retrieved from the hospital's information database. The enrolled population was divided into two Groups: A, reimplanted; B, non-reimplanted because of a non-eradicated infection within one year. For each Group, demographic information, PJI-related risk factors, type of pathogen and presence of single or polymicrobial infection, were collected and analyzed. RESULTS In total, 21 patients were included in the study, 14 patients in Group A and 7 in Group B. Major Depression (p = 0.049) and polymicrobial infection (p = 0.04) were more commonly observed in patients that were not reimplanted in the study period. No differences between the two groups were observed when other characteristics were compared. CONCLUSIONS Patients with major depression, or those hosting polymicrobial periprosthetic hip infections, are more susceptible to failure of TSE arthroplasty procedures for chronic PJIs, hampering THA reimplantation. Current findings may drive further research and contribute to the understanding of the role of these risk factors in chronic PJI patients.
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Benhenneda R, Le Nail LR, Druon J, Saad M, Rosset P, Samargandi R. Knee arthrodesis using a compression clamp and a single-plane external fixator to treat infection. Orthop Traumatol Surg Res 2022; 108:103330. [PMID: 35597544 DOI: 10.1016/j.otsr.2022.103330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In patients with knee infection, arthrodesis by external fixation is a limb-salvage procedure appropriate in highly selected patients. No hardware that might lead to infection is left in situ. However, the fusion rate is limited. Use of a device that applies compression in the coronal plane has been suggested in combination with sagittal external fixation to increase the fusion rate but has not been the focus of published studies. The objectives of this retrospective study were to determine: 1) the fusion rate and, 2) the rate of infection eradication. HYPOTHESIS Knee arthrodesis using an external fixator and a compression clamp provides higher fusion rates compared to reports of external fixation without compression. MATERIAL AND METHODS We retrospectively studied 30 patients who underwent knee arthrodesis using external fixation and a compression clamp. The reason for arthrodesis was recurrent infection after total knee arthroplasty in 18 patients and septic arthritis in 12 patients. There were 16 females and 14 males with a mean age of 66.0±11.6 years (range, 30-83 years). Mean follow-up was 42.5±23.6 months (range, 24-106 months). RESULTS Fusion was achieved in 25 (83%) patients, after a mean of 7.5 months (range, 6-12 months). Of the 8 patients with severe bone loss (≤25% bone contact), 4 experienced non-union, compared to 1 of the 22 patients whose bone loss was moderate or mild (50% and >50% bone contact, respectively) (p=0.01). After at least 2 years of follow-up, the infection was eradicated in 28 (93%) patients. Complications occurred in 9 patients and consisted of pin-site infection managed by lavage (n=3), recurrent infection requiring revision surgery for debridement and lavage combined with material exchange and antibiotic therapy (n=2), and femoral shaft fracture (n=3) or traumatic fracture of the arthrodesis (n=1) treated by changing the clamp and fixator assembly. DISCUSSION The fusion rate achieved using this combined technique is high and better than obtained with external fixation alone. Our results confirm that infection eradication is obtained more often than with nailing. This one-stage, simple, reproducible procedure does not leave any foreign material in situ. LEVEL OF EVIDENCE IV, retrospective observational cohort study.
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Affiliation(s)
- Rayane Benhenneda
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France.
| | - Louis-Romée Le Nail
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Jérôme Druon
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Maxime Saad
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Philippe Rosset
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
| | - Ramy Samargandi
- Service de chirurgie orthopédique, hôpital Trousseau, CHRU de Tours, avenue de la République, Chambray-lès-Tours, 37044 Tours cedex 9, France; Faculté de Médecine, Université de Tours, Tours, France
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Saade A, Urvoy JM, Luque Paz D, Baldeyrou M, Common H, Ropars M, Tattevin P, Jolivet-Gougeon A, Arvieux C. Microbiology and antibiotics after second-stage revision of periprosthetic joint infections: A two-year follow-up cohort. Infect Dis Now 2022; 52:358-364. [DOI: 10.1016/j.idnow.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
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Mainard N, Saab M, Dartus J, Martinot P, Loiez C, Titecat M, Dezeque H, Putman S, Senneville E, Migaud H. The benefits of systematic intraoperative sampling during lower limb arthroplasties due to sequelae from prior osteoarticular infections: A retrospective study of 92 cases. Orthop Traumatol Surg Res 2022; 108:103189. [PMID: 34933132 DOI: 10.1016/j.otsr.2021.103189] [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] [Received: 05/16/2021] [Revised: 08/08/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Osteoarticular infections (OAIs) of native joints lead to cartilage damage which may require subsequent arthroplasty. There is no consensus on systematic intraoperative microbiological sampling when performing an arthroplasty on a native joint with a history of OAI. We carried out a retrospective study to: (1) identify the frequency of the persistence of the microorganism(s) involved during the initial, presumed cured OAI, when performing an arthroplasty for sequelae of osteoarthritis, (2) to find an association between the length of time between the OAI and arthroplasty, and the recurrence of bacterial infection, (3) to assess the influence of the presence of hardware on the risk of infectious recurrence. HYPOTHESIS Systematic sampling is justified during a subsequent arthroplasty after an OAI, even after a prolonged period. MATERIAL AND METHOD This single-center, retrospective descriptive study included all patients whose indication for arthroplasty resulted from osteoarthritis, osteitis or bacterial osteomyelitis of a native joint, or in the aftermath of an infection post osteosynthesis. All patients were considered to have recovered from the initial infection at the time of the arthroplasty. Between 2008 and 2019, 92 patients were included in the study, with an average age of 56.5years (range: 21-97years). OAI occurred at a mean age of 35years (range: 1-84years). The average time from OAI to implantation was 15years (range: 1-65years). The bacteria most frequently found in the initial OAI was Staphylococcus aureus, involved in 35.8% of cases (n=33/92). RESULTS The intraoperative samples came back positive in 17% of cases (n=16/92), including 9 positive for the same bacteria as the OAI (56%, n=9/16). For these 16 cases, the time between the OAI and the arthroplasty was 1year for 5 patients, between 1 and 15years for 5 patients and greater than 15years for 6 patients. For 3 positive patients, the information on the initial microorganism was not known and 4 patients were positive for a bacterium different from the initial one. The time from the initial OAI to the arthroplasty was not associated with positive results (p=0.38). There was no significant difference between a positive culture at the time of arthroplasty and the initial type of OAI [native joint versus presence of hardware and/or open fracture (p=0.41)]. CONCLUSION The results of this work suggest there is value in microbiological sampling when performing an arthroplasty on a previously infected joint, regardless of the duration of the infection. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Nicolas Mainard
- Département de chirurgie pédiatrique, hôpital Jeanne-de-Flandre, CHU Lille, avenue Eugène-Avinée, 59000 Lille, France; Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France.
| | - Marc Saab
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Julien Dartus
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Pierre Martinot
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Caroline Loiez
- Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Service de bactériologie-hygiène, institut de microbiologie, centre de biologie pathologie, CHU Lille, boulevard du Pr-Jules-Leclercq, 59000 Lille, France
| | - Marie Titecat
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Service de bactériologie-hygiène, institut de microbiologie, centre de biologie pathologie, CHU Lille, boulevard du Pr-Jules-Leclercq, 59000 Lille, France
| | - Henri Dezeque
- Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Sophie Putman
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
| | - Eric Senneville
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire des maladies infectieuses et du voyageur, hôpital Gustave-Dron, 135, rue du Président-Coty, 59200 Tourcoing, France
| | - Henri Migaud
- Université de Lille Haut-de-France, 59037 Lille, France; Centre de Référence pour le traitement des Infections Ostéo-Articulaires Complexes (CRIOAC) de Lille-Tourcoing, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France; Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHU Lille, place de Verdun, 59000 Lille, France
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Zhang R, Lin J, Chen F, Liu W, Chen M. Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review. J Orthop Surg Res 2021; 16:495. [PMID: 34389036 PMCID: PMC8362243 DOI: 10.1186/s13018-021-02646-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study investigates whether three-dimensional (3D) printing-assisted revision total hip/knee arthroplasty could improve its clinical and radiological outcomes and assess the depth and breadth of research conducted on 3D printing-assisted revision total hip and knee arthroplasty. METHODS A literature search was carried out on PubMed, Web of Science, EMBASE, and the Cochrane Library. Only studies that investigated 3D printing-assisted revision total hip and knee arthroplasty were included. The author, publication year, study design, number of patients, patients' age, the time of follow-up, surgery category, Coleman score, clinical outcomes measured, clinical outcomes conclusion, radiological outcomes measured, and radiological outcomes conclusion were extracted and analyzed. RESULTS Ten articles were included in our review. Three articles investigated the outcome of revision total knee arthroplasty, and seven investigated the outcome of revision total hip arthroplasty. Two papers compared a 3D printing group with a control group, and the other eight reported 3D printing treatment outcomes alone. Nine articles investigated the clinical outcomes of total hip/knee arthroplasty, and eight studied the radiological outcomes of total hip/knee arthroplasty. CONCLUSION 3D printing is being introduced in revision total hip and knee arthroplasty. Current literature suggests satisfactory clinical and radiological outcomes could be obtained with the assistance of 3D printing. Further long-term follow-up studies are required, particularly focusing on cost-benefit analysis, resource availability, and, importantly, the durability and biomechanics of customized prostheses using 3D printing compared to traditional techniques.
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Affiliation(s)
- Rui Zhang
- Department of Orthopaedics, Fujian Medical University Union Hospital, Xinquan Road No.29, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Jiajun Lin
- Department of Orthopaedics, Fujian Medical University Union Hospital, Xinquan Road No.29, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Fenyong Chen
- Department of Orthopaedics, Fujian Medical University Union Hospital, Xinquan Road No.29, Gulou District, Fuzhou, 350001, Fujian Province, China
| | - Wenge Liu
- Department of Orthopaedics, Fujian Medical University Union Hospital, Xinquan Road No.29, Gulou District, Fuzhou, 350001, Fujian Province, China.
| | - Min Chen
- Department of Orthopaedics, Fujian Medical University Union Hospital, Xinquan Road No.29, Gulou District, Fuzhou, 350001, Fujian Province, China.
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Praz C, Gubbiotti L, Buia G, Chapus V, Dunet J, Grandhomme F, Michon J, Rochcongar G, Hulet C. Value of the synovial C-reactive protein test in the diagnosis of total hip and knee periprosthetic joint infections: A case-control study. Orthop Traumatol Surg Res 2021; 107:102903. [PMID: 33775885 DOI: 10.1016/j.otsr.2021.102903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI. MATERIALS AND METHODS In total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria. RESULTS The serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%). CONCLUSION This study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- César Praz
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - Laura Gubbiotti
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Geoffrey Buia
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Valentin Chapus
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Julien Dunet
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Frederique Grandhomme
- Secteurs biochimie et hormonologie, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Jocelyn Michon
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Goulven Rochcongar
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - Christophe Hulet
- Unit Inserm COMETE, UMR U1075, département de chirurgie orthopédique et traumatologique, centre hospitalo-universitaire de Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
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Zheng QY, Zhang GQ. Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-precision strips. ARTHROPLASTY 2020; 2:34. [PMID: 35236471 PMCID: PMC8796411 DOI: 10.1186/s42836-020-00053-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
Periprosthetic joint infection (PJI) represents one of the most challenging complications after total joint arthroplasty (TJA). Despite the availability of a variety of diagnostic techniques, the diagnosis of PJI remains a challenge due to the lack of well-established diagnostic criteria. The leucocyte esterase (LE) strips test has been proved to be a valuable diagnostic tool for PJI, and its weight in PJI diagnostic criteria has gradually increased. Characterized by its convenience, speed and immediacy, leucocyte esterase strips test has a prospect of broad application in PJI diagnosis. Admittedly, the leucocyte esterase strips test has some limitations, such as imprecision and liability to interference. Thanks to the application of new technologies, such as machine reading, quantitative detection and artificial intelligence, the LE strips test is expected to overcome the limitations and improve its accuracy.
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