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Al-Jabri T, Ridha M, Wood MJ, Kayani B, Jayadev C, McCulloch RA, Schemitsch E. An overview of the current diagnostic approach to Periprosthetic Joint Infections. Orthop Rev (Pavia) 2024; 16:120308. [PMID: 38957745 PMCID: PMC11218870 DOI: 10.52965/001c.120308] [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: 11/13/2023] [Accepted: 03/24/2024] [Indexed: 07/04/2024] Open
Abstract
The diagnosis of periprosthetic joint infections (PJI) presents a formidable challenge to orthopaedic surgeons due to its complex and diverse manifestations. Accurate diagnosis is of utmost importance, as even mild pain following joint replacement surgery may indicate PJI in the absence of a definitive gold standard diagnostic test. Numerous diagnostic modalities have been suggested in the literature, and international societies have continually updated diagnostic criteria for this debilitating complication. This review article aims to comprehensively examine the latest evidence-based approaches for diagnosing PJI. Through a thorough analysis of current literature, we explore promising diagnostic strategies that have demonstrated effectiveness in identifying PJI. These strategies encompass the utilization of laboratory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), alongside imaging techniques such as magnetic resonance imaging (MRI) and leukocyte scintigraphy. Additionally, we highlight the importance of synovial fluid analysis, including the potential role of alpha-defensin as a biomarker, and examine evolving international diagnostic criteria to standardize and improve diagnostic accuracy.
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Affiliation(s)
- Talal Al-Jabri
- Department of Surgery and Cancer Imperial College London
| | | | | | | | - Chethan Jayadev
- Joint Reconstruction Unit Royal National Orthopaedic Hospital NHS Trust
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Sax FH, Hoyka M, Blersch BP, Fink B. Diagnostics in Late Periprosthetic Infections-Challenges and Solutions. Antibiotics (Basel) 2024; 13:351. [PMID: 38667027 PMCID: PMC11047502 DOI: 10.3390/antibiotics13040351] [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: 01/31/2024] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024] Open
Abstract
The rising number of arthroplasties is combined with a rising number of periprosthetic joint infections, which leads to life-concerning consequences for the patients, including extended antibiotic treatment, further surgery and increased mortality. The heterogeneity of the symptoms and inflammatory response of the patients due to, e.g., age and comorbidities and the absence of a single diagnostic test with 100% accuracy make it very challenging to choose the right parameters to confirm or deny a periprosthetic joint infection and to establish a standardized definition. In recent years, additional diagnostic possibilities have emerged primarily through the increasing availability of new diagnostic methods, such as genetic techniques. The aim of the review is to provide an overview of the current state of knowledge about the various tests, including the latest developments. The combination of different tests increases the accuracy of the diagnosis. Each physician or clinical department must select the tests from the available methods that can be best implemented for them in organizational and technical terms. Serological parameters and the cultivation of the samples from aspiration or biopsy should be combined with additional synovial tests to create an accurate figure for the failure of the prosthesis, while imaging procedures are used to obtain additional information for the planned therapeutic procedure.
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Affiliation(s)
- Florian Hubert Sax
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (F.H.S.); (M.H.); (B.P.B.)
| | - Marius Hoyka
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (F.H.S.); (M.H.); (B.P.B.)
| | - Benedikt Paul Blersch
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (F.H.S.); (M.H.); (B.P.B.)
| | - Bernd Fink
- Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany; (F.H.S.); (M.H.); (B.P.B.)
- Orthopaedic Department, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Abstract
IMPORTANCE Approximately 0.5% to 3% of patients undergoing surgery will experience infection at or adjacent to the surgical incision site. Compared with patients undergoing surgery who do not have a surgical site infection, those with a surgical site infection are hospitalized approximately 7 to 11 days longer. OBSERVATIONS Most surgical site infections can be prevented if appropriate strategies are implemented. These infections are typically caused when bacteria from the patient's endogenous flora are inoculated into the surgical site at the time of surgery. Development of an infection depends on various factors such as the health of the patient's immune system, presence of foreign material, degree of bacterial wound contamination, and use of antibiotic prophylaxis. Although numerous strategies are recommended by international organizations to decrease surgical site infection, only 6 general strategies are supported by randomized trials. Interventions that are associated with lower rates of infection include avoiding razors for hair removal (4.4% with razors vs 2.5% with clippers); decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures (0.8% with decolonization vs 2% without); use of chlorhexidine gluconate and alcohol-based skin preparation (4.0% with chlorhexidine gluconate plus alcohol vs 6.5% with povidone iodine plus alcohol); maintaining normothermia with active warming such as warmed intravenous fluids, skin warming, and warm forced air to keep the body temperature warmer than 36 °C (4.7% with active warming vs 13% without); perioperative glycemic control (9.4% with glucose <150 mg/dL vs 16% with glucose >150 mg/dL); and use of negative pressure wound therapy (9.7% with vs 15% without). Guidelines recommend appropriate dosing, timing, and choice of preoperative parenteral antimicrobial prophylaxis. CONCLUSIONS AND RELEVANCE Surgical site infections affect approximately 0.5% to 3% of patients undergoing surgery and are associated with longer hospital stays than patients with no surgical site infections. Avoiding razors for hair removal, maintaining normothermia, use of chlorhexidine gluconate plus alcohol-based skin preparation agents, decolonization with intranasal antistaphylococcal agents and antistaphylococcal skin antiseptics for high-risk procedures, controlling for perioperative glucose concentrations, and using negative pressure wound therapy can reduce the rate of surgical site infections.
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Affiliation(s)
- Jessica L Seidelman
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Christopher R Mantyh
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
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Romanò CL, Petrosillo N, Argento G, Sconfienza LM, Treglia G, Alavi A, Glaudemans AW, Gheysens O, Maes A, Lauri C, Palestro CJ, Signore A. The Role of Imaging Techniques to Define a Peri-Prosthetic Hip and Knee Joint Infection: Multidisciplinary Consensus Statements. J Clin Med 2020; 9:jcm9082548. [PMID: 32781651 PMCID: PMC7466174 DOI: 10.3390/jcm9082548] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Diagnosing a peri-prosthetic joint infection (PJI) remains challenging despite the availability of a variety of clinical signs, serum and synovial markers, imaging techniques, microbiological and histological findings. Moreover, the one and only true definition of PJI does not exist, which is reflected by the existence of at least six different definitions by independent societies. These definitions are composed of major and minor criteria for defining a PJI, but most of them do not include imaging techniques. This paper highlights the pros and cons of available imaging techniques—X-ray, ultrasound, computed tomography (CT), Magnetic Resonance Imaging (MRI), bone scintigraphy, white blood cell scintigraphy (WBC), anti-granulocyte scintigraphy, and fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), discusses the added value of hybrid camera systems—single photon emission tomography/computed tomography (SPECT/CT), PET/CT and PET/MRI and reports consensus answers on important clinical questions that were discussed during the Third European Congress on Inflammation/Infection Imaging in Rome, December 2019.
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Affiliation(s)
- Carlo Luca Romanò
- Gruppo di Studio SIOT Infezioni-Clinica San Gaudenzio-Novara-Gruppo Policlinico di Monza, University of Milan, 20100 Milan, Italy;
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infective Diseases “L. Spallanzani”, 00144 Rome, Italy;
| | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy;
- Department of Biomedical Sciences for Health, University of Milan, 20123 Milan, Italy
| | - Giorgio Treglia
- Nuclear Medicine and PET/CT Center, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale Via Lugano 4F, CH-6500 Bellinzona, Switzerland;
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 1904, USA;
| | - Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Olivier Gheysens
- Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk Belgium and Department of Imaging and Pathology @ KULAK, KU Leuven campus Kulak, 8500 Kortrijk, Belgium;
| | - Chiara Lauri
- Nuclear Medicine Unit Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Christopher J. Palestro
- Department of Radiology Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA;
| | - Alberto Signore
- Nuclear Medicine Unit Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, “Sapienza” University of Rome, 00161 Rome, Italy;
- Correspondence:
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Chu L, Ren YL, Yang JS, Yang J, Zhou H, Jiang HT, Shi L, Hao DJ, Deng ZL. The combinations of multiple factors to improve the diagnostic sensitivity and specificity after artificial joint infection. J Orthop Surg Res 2020; 15:161. [PMID: 32334610 PMCID: PMC7183659 DOI: 10.1186/s13018-020-01669-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/03/2020] [Indexed: 11/11/2022] Open
Abstract
Objective To discuss the sensitivity and specificity of the combinations of multiple factors that work on bone infection after artificial joint, and provide evidence-based medical basis for the early diagnosis of infection after artificial joint. Methods A retrospective review was conducted on 35 patients diagnosed with periprosthetic joint infections (PJI) or aseptic loosening (AL) who both received revision operation from January 2011 to January 2015. Analyzing and comparing their epidemiology indexes and expounded a series of auxiliary examinations corresponding positive diagnosis ratio. Results Thirty-five patients were divided into two groups. One is called group PJI which includes 16 patients, and the other is called group AL which contains 19 patients. There was no statistical difference between in age (p = 0.536), gender ratio (p = 0.094), and the time of catching infection or getting loose (p = 0.055). Swelling was statistical significant (p = 0.0435 < 0.05). AUC of CRP = 0.947, ESR = 0.893, IL-6 = 0.893, PCT = 0.781, WBC = 0.839, and PMN = 0.755, respectively, CRP has a high diagnostic value to PJI, ESR, IL-6, PCT, WBC, and PMN% possess a moderate diagnostic value. There were 3 cases of PJI whose pathological paraffin section showed infectious inflammatory cells (100%). three PJI patients and one AL patient whose 99mTc-MDP examination presented 100% infection or looseness rate. Conclusion CRP has a high diagnostic value to PJI. Histopathology HE staining, Gram staining, and 99mTc-MDP provide a highly accurate diagnosis for PJI. Therefore, the results suggest combining the unique clinical symptoms of PJI patients with relevant laboratory indexes, histopathologic characteristics, and imageological examinations that can improve diagnostic sensitivity and specificity of PJI in its early stage.
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Affiliation(s)
- Lei Chu
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China
| | - You-Liang Ren
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China
| | - Jun-Song Yang
- Department of spinal surgery, Honghui hospital, Xi'an Jiaotong University, No.76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Jin Yang
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China
| | - Hang Zhou
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China
| | - Hai-Tao Jiang
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China
| | - Lei Shi
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China
| | - Ding-Jun Hao
- Department of spinal surgery, Honghui hospital, Xi'an Jiaotong University, No.76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Zhong-Liang Deng
- Department of Orthopedic Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 40010, China.
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Bengtzen RR, Lee J. Point-of-Care Ultrasound and the Septic Prosthetic Hip Joint. J Emerg Med 2019; 57:701-704. [PMID: 31677979 DOI: 10.1016/j.jemermed.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/07/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022]
Abstract
Septic joints can have an insidious onset and are difficult to diagnosis. Diagnosis can be more complicated in the setting of a distant prosthetic joint. Plain films and inflammatory markers are not specific and magnetic resonance imaging (MRI) is not a timely test in the emergency department. Computed tomography (CT) scan is quick and useful to evaluate for bony changes or signs of inflammation, but lacks the details of MRI, and the prosthetic joint may cause significant artifact. Point-of-care ultrasound (POCUS) is often used in the pediatric population to evaluate for an effusion when there is a concern for a septic native hip joint and is finding a role in adult emergency medicine to evaluate for an effusion in painful native adult hip joints. Even so, ultrasound is not currently included in diagnostic algorithms for diagnosing prosthetic hip joint infections (PJIs). POCUS is, however, readily available in the emergency department. We present a case where POCUS aided in identifying a periprosthetic synovitis and changed the course of the patient's management from previous physical therapy to an investigation toward the final diagnosis of a septic prosthetic hip joint.
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Affiliation(s)
- Rachel R Bengtzen
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon; Department of Family Medicine (Sports), Oregon Health and Science University, Portland, Oregon
| | - Jesse Lee
- Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon
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Abstract
Fungal periprosthetic joint infection (PJI) is a devastating complication because it can be difficult to diagnose, manage, and eradicate. Fungal PJI treatment requires a systematic approach. Increased awareness is essential when patients with painful arthroplasties present with immunosuppression, significant comorbidities, multiple surgeries, and history of drug use. Every suspected fungal PJI should be promptly diagnosed using readily available serum and synovial fluid markers. Surgical management involves débridement, antibiotics, and implant retention, one-stage exchange arthroplasty, prosthetic articulating spacers, and two-stage exchange arthroplasty. Because mycotic infections develop robust biofilms, the utility of débridement, antibiotics, and implant retention and one-stage revisions seem limited. A thorough irrigation and débridement is essential to decrease infection burden. Adjunctive local and systemic antifungal therapy is critical, although the agent choice and duration should be tailored appropriately. Future high-quality studies are needed to develop standardized guidelines for the management of fungal PJI.
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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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Amanatullah D, Dennis D, Oltra EG, Marcelino Gomes LS, Goodman SB, Hamlin B, Hansen E, Hashemi-Nejad A, Holst DC, Komnos G, Koutalos A, Malizos K, Martinez Pastor JC, McPherson E, Meermans G, Mooney JA, Mortazavi J, Parsa A, Pécora JR, Pereira GA, Martos MS, Shohat N, Shope AJ, Zullo SS. Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S329-S337. [PMID: 30348576 DOI: 10.1016/j.arth.2018.09.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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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Effectiveness and safety of 5% lidocaine-medicated plaster on localized neuropathic pain after knee surgery: a randomized, double-blind controlled trial. Pain 2019; 160:1186-1195. [DOI: 10.1097/j.pain.0000000000001502] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Zajonz D, Behrens J, Brand AG, Höch A, Fakler JKM, Roth A, Josten C, Ghanem M. Femoral neck fractures in old age treated with hemiarthroplasty. DER ORTHOPADE 2018; 48:224-231. [DOI: 10.1007/s00132-018-03664-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Menendez MI, Hettlich B, Wei L, Knopp MV. Preclinical Multimodal Molecular Imaging Using 18F-FDG PET/CT and MRI in a Phase I Study of a Knee Osteoarthritis in In Vivo Canine Model. Mol Imaging 2018; 16:1536012117697443. [PMID: 28654381 PMCID: PMC5472233 DOI: 10.1177/1536012117697443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to use a multimodal molecular imaging approach to serially assess regional metabolic changes in the knee in an in vivo anterior cruciate ligament transection (ACLT) canine model of osteoarthritis (OA). Five canine underwent ACLT in one knee and the contralateral knee served as uninjured control. Prior, 3, 6, and 12 weeks post-ACLT, the dogs underwent 18F-fluoro-d-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and magnetic resonance imaging (MRI). The MRI was coregistered with the PET/CT, and 3-dimensional regions of interest (ROIs) were traced manually and maximum standardized uptake values (SUVmax) were evaluated. 18F-fluoro-d-glucose SUVmax in the ACLT knee ROIs was significantly higher compared to the uninjured contralateral knees at 3, 6, and 12 weeks. Higher 18F-FDG uptake observed in ACLT knees compared to the uninjured knees reflects greater metabolic changes in the injured knees over time. Knee 18F-FDG uptake in an in vivo ACLT canine model using combined PET/CT and MRI demonstrated to be highly sensitive in the detection of metabolic alterations in osseous and nonosteochondral structures comprising the knee joint. 18F-fluoro-d-glucose appeared to be a capable potential imaging biomarker for early human knee OA diagnosis, prognosis, and management.
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Affiliation(s)
- Maria I Menendez
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - Bianca Hettlich
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA.,2 Vetsuisse Faculty Bern, Bern, Switzerland
| | - Lai Wei
- 3 Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Michael V Knopp
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
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Van den Wyngaert T, Palli SR, Imhoff RJ, Hirschmann MT. Cost-Effectiveness of Bone SPECT/CT in Painful Total Knee Arthroplasty. J Nucl Med 2018; 59:1742-1750. [DOI: 10.2967/jnumed.117.205567] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/15/2018] [Indexed: 12/15/2022] Open
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Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss - a pilot study of 34 patients. BMC Musculoskelet Disord 2017; 18:383. [PMID: 28865425 PMCID: PMC5581473 DOI: 10.1186/s12891-017-1742-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 08/28/2017] [Indexed: 02/02/2023] Open
Abstract
Background Hip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of aseptic implants as an infection prophylaxis is already proven; however, the significance of these coatings in septic reimplantation of large implants is still not sufficiently investigated. Methods In a retrospective analysis, 34 patients who have been treated with a modular mega-endoprosthesis after a cured bone infection of the lower limb (femur or tibia) have been evaluated. One group with 14 patients (NSCG: non silver- coated group) was supplied with the non silver- coated implants: MML München- Lübeck™ modular endoprosthesis system (AQ Implants, Ahrensburg, Germany) or MUTARS® Modular Universal Tumor And Revision System (Implantcast GmbH, Buxtehude, Germany). The other group with 20 patients (SCG: silver- coated group) was supplied with the silver- coated system of MUTARS®. In addition to the clinical findings and the patients’ histories, specifically the reinfection rates, the patients’ mobility was assessed using the New Mobility Score (NMS, by Parker and Palmer). Results The median follow-up period was 72 months, ranging from 6 to 267 months. The dropout rate was 5.8%. The reinfection rate after healed reinfection in SCG was 40% (8/20), in NSCG 57% (8/14), p = 0.34; α =0.05. The time for reinfection was, on average, 14 months (1–72 months) in SCG and 8 months (1–48 months) in the NSCG (p = 0.61; α =0.05). The two groups showed no differences in the NMS. Conclusion With this retrospective analysis, it can be determined that the rate of reinfection of modular mega-endoprostheses on the hip and knee joint after healed periprosthetic joint infection (PJI) can be reduced by the use of silver coated implants. The time until reinfection can also be delayed by utilizing silver coated implants. Due to the low number of cases of this highly specific patient population, no statistical significance could be determined. A positive effect, however, can be assumed through the use of silver coatings in mega-endoprostheses after an infectious situation.
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Göçer H, Dabak N. Periprosthetic joint infection treated via bone cement and without the removal of hardware. Niger Med J 2016; 57:139-41. [PMID: 27226691 PMCID: PMC4872493 DOI: 10.4103/0300-1652.182079] [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] [Indexed: 11/16/2022] Open
Abstract
Periprosthetic joint infection (PJI) is a challenging complication with a frequency of 0.5–3%. The patient's age, recurrent surgeries, and comorbid systemic diseases increase the risk of infection. Although the current approach in the treatment of PJI is a two-stage revision; sometimes, removing all the implants can lead to more serious complications. PJI's complications are increase in the time of surgery, loss of blood volume, and increase in the amount of bone loss. Infected soft tissue and dead bone tissue debridement must be made in all cases. One of our cases had bone defects due to recurrent hip arthroplasty revisions. Our case that was given PJI treatment by covering the well-fixed components with bone cement and removing only the mobile parts was discussed in line with the literature.
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Affiliation(s)
- Hasan Göçer
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Nevzat Dabak
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Zajonz D, Zieme A, Prietzel T, Moche M, Tiepoldt S, Roth A, Josten C, von Salis-Soglio GF, Heyde CE, Ghanem M. Periprosthetic joint infections in modular endoprostheses of the lower extremities: a retrospective observational study in 101 patients. Patient Saf Surg 2016; 10:6. [PMID: 26865860 PMCID: PMC4748625 DOI: 10.1186/s13037-016-0095-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/03/2016] [Indexed: 02/08/2023] Open
Abstract
Background Modular mega-endoprosthesis systems are used to bridge very large bone defects and have become a widespread method in orthopaedic surgery for the treatment of tumours and revision arthroplasty. However, the indications for the use of modular mega-endoprostheses must be carefully considered. Implanting modular endoprostheses requires major, complication-prone surgery in which the limited salvage procedures should always be borne in mind. The management of periprosthetic infection is particularly difficult and beset with problems. Given this, the present study was designed to gauge the significance of periprosthetic infections in connection with modular mega-implants in the lower extremities among our own patients. Methods Patients who had been fitted with modular endoprosthesis on a lower extremity at our department between September 1994 and December 2011 were examined retrospectively. A total of 101 patients with 114 modular prostheses were identified. Comprising 30 men (29.7 %) and 71 women (70.3 %), their average age at the time of surgery was 67 years (18–92 years). Results The average follow-up period was 27 months (5 months and 2 weeks to 14 years and 11 months) and the drop-out rate was about 8.8 %. Altogether, there were 19 (17.7 %) endoprosthesis infections: 3 early infections and 16 late or delayed infections. The pathogen spectrum was dominated by coagulase-negative staphylococci (36 %) and Staphylococcus aureus (16 %), including 26 % multi-resistant pathogens. Reinfection occurred in 37 % of cases of infection. Tumours were followed by significantly fewer infections than the other indications. Infections were twice as likely to occur after previous surgery. Conclusion In our findings modular endoprostheses (18 %) are much more susceptible to infection than primary endoprostheses (0.5–2,5 %). Infection is the most common complication alongside the dislocation of proximal femur endoprostheses. Consistent, radical surgery is essential – although even with an adequate treatment strategy, the recurrence rate is very high. Unfortunately, the functional results are frequently unsatisfactory, with amputation often being the last resort. Therefore, the indication for implantation must be carefully considered and discussed in great detail, especially in the case of multimorbid patients with previous joint infections.
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Affiliation(s)
- Dirk Zajonz
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Almut Zieme
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Torsten Prietzel
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Solveig Tiepoldt
- Department of Nuclear medicine, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Roth
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Christoph Josten
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Georg Freiherr von Salis-Soglio
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Mohamed Ghanem
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
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17
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García-Gareta E, Davidson C, Levin A, Coathup MJ, Blunn GW. Biofilm formation in total hip arthroplasty: prevention and treatment. RSC Adv 2016. [DOI: 10.1039/c6ra09583f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This review assesses the current knowledge on treatments, pathogenesis and the prevention of infections associated with orthopaedic implants, with a focus on total hip arthroplasty.
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Affiliation(s)
| | - Christopher Davidson
- John Scales Centre for Biomedical Engineering
- Institute of Orthopaedics and Musculoskeletal Science
- Division of Surgery and Interventional Science
- University College London
- Royal National Orthopaedic Hospital
| | - Alexandra Levin
- RAFT Institute of Plastic Surgery
- Mount Vernon Hospital
- Northwood HA6 2RN
- UK
| | - Melanie J. Coathup
- John Scales Centre for Biomedical Engineering
- Institute of Orthopaedics and Musculoskeletal Science
- Division of Surgery and Interventional Science
- University College London
- Royal National Orthopaedic Hospital
| | - Gordon W. Blunn
- John Scales Centre for Biomedical Engineering
- Institute of Orthopaedics and Musculoskeletal Science
- Division of Surgery and Interventional Science
- University College London
- Royal National Orthopaedic Hospital
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