Non-elective and revision arthroplasty are independently associated with hip and knee prosthetic joint infection caused by Acinetobacter baumannii: a Brazilian single center observational cohort study of 98 patients

Epidemiology and Risk Factors for Revision Total Knee Arthroplasty in Chinese Patients: A Retrospective Study in Changchun, Jilin Province, China

BACKGROUND Over the past decades, total knee arthroplasty (TKA) in China has increased substantially. Owing to a lack of a joint registry, there is restricted information concerning the epidemiology of TKA failures in China. We aimed to (1) investigate the etiology of TKA failures in a cohort of Chinese patients and (2) determine the related demographic and anthropometric risk factors in Jilin, China, to have a look at the actual situation. MATERIAL AND METHODS A total of 1927 primary and 109 revision TKAs performed between April 2014 and May 2022 were analyzed in this retrospective study. Patient demographics and anthropometric measures, the interval from primary TKA to revision procedures, and the mechanisms for primary TKA failure were evaluated. A chi-square test, unpaired t test, and multivariate logistic regression were used to investigate the relationships between different factors and TKA failures. RESULTS The leading failure mechanism was infection (53.3%), followed by aseptic loosening (21.5%), stiffness (15.0%), instability (3.7%), malposition (2.8%), periprosthetic fractures (2.8%), and extensor mechanism disruption (0.9%). Infection (59.7%) was the main reason for early revision. Aseptic loosening (43.3%) was the leading cause of late revision. The male ratio in infection patients was higher (35.1% vs 20.6%). The smoking rate in patients with revision and infection was higher (18.9%, 23.9% vs 7%) than in primary patients. There was no difference in BMI between groups. CONCLUSIONS The leading cause of revision TKA in Jilin, China, was infection, followed by aseptic loosening and stiffness. Sex and smoking history were associated with TKA failures in this region.

Promising applications of D-amino acids in periprosthetic joint infection

Due to the rise in our aging population, a disproportionate demand for total joint arthroplasty (TJA) in the elderly is forecast. Periprosthetic joint infection (PJI) represents one of the most challenging complications that can occur following TJA, and as the number of primary and revision TJAs continues to rise, an increasing PJI burden is projected. Despite advances in operating room sterility, antiseptic protocols, and surgical techniques, approaches to prevent and treat PJI remain difficult, primarily due to the formation of microbial biofilms. This difficulty motivates researchers to continue searching for an effective antimicrobial strategy. The dextrorotatory-isoforms of amino acids (D-AAs) are essential components of peptidoglycan within the bacterial cell wall, providing strength and structural integrity in a diverse range of species. Among many tasks, D-AAs regulate cell morphology, spore germination, and bacterial survival, evasion, subversion, and adhesion in the host immune system. When administered exogenously, accumulating data have demonstrated that D-AAs play a pivotal role against bacterial adhesion to abiotic surfaces and subsequent biofilm formation; furthermore, D-AAs have substantial efficacy in promoting biofilm disassembly. This presents D-AAs as promising and novel targets for future therapeutic approaches. Despite their emerging antibacterial efficacy, their role in disrupting PJI biofilm formation, the disassembly of established TJA biofilm, and the host bone tissue response remains largely unexplored. This review aims to examine the role of D-AAs in the context of TJAs. Data to date suggest that D-AA bioengineering may serve as a promising future strategy in the prevention and treatment of PJI.

Functionalized Self-Assembled Monolayers: Versatile Strategies to Combat Bacterial Biofilm Formation

Bacterial infections due to biofilms account for up to 80% of bacterial infections in humans. With the increased use of antibiotic treatments, indwelling medical devices, disinfectants, and longer hospital stays, antibiotic resistant infections are sharply increasing. Annual deaths are predicted to outpace cancer and diabetes combined by 2050. In the past two decades, both chemical and physical strategies have arisen to combat biofilm formation on surfaces. One such promising chemical strategy is the formation of a self-assembled monolayer (SAM), due to its small layer thickness, strong covalent bonds, typically facile synthesis, and versatility. With the goal of combating biofilm formation, the SAM could be used to tether an antibacterial agent such as a small-molecule antibiotic, nanoparticle, peptide, or polymer to the surface, and limit the agent’s release into its environment. This review focuses on the use of SAMs to inhibit biofilm formation, both on their own and by covalent grafting of a biocidal agent, with the potential to be used in indwelling medical devices. We conclude with our perspectives on ongoing challenges and future directions for this field.