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Brenner JD, Atallah M, Yatsonsky D, Casabianca A, Hanna M. Higher Onset of Periprosthetic Joint Infections in Patients With Teeth Compared to Those Without Teeth. Cureus 2024; 16:e63696. [PMID: 39092322 PMCID: PMC11293887 DOI: 10.7759/cureus.63696] [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] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION Bacteria can enter the bloodstream through simple actions such as brushing teeth, flossing, and even chewing food, increasing the chance of hematogenous seeding of prosthetic joints. Antibiotics before dental work in patients with orthopedic hardware is a topic of debate because of concerns for antibiotic resistance. Patients with dentures theoretically avoid this risk due to the lack of teeth and their maintenance. Most periprosthetic joint infections (PJIs) that occur in the first six months after surgery are due to wound infection, whereas late PJIs are more commonly caused by hematogenous seeding. MATERIALS AND METHODS Charts from patients who received primary total joint arthroplasty were interrogated for the condition of their teeth at the time of operation. If the patient had a PJI, the time from surgery and the organism responsible were noted. Multivariate linear regressions were performed for statistical analysis to compare rates of dental status, infection, comorbidities, and demographics. RESULTS From the 1,500 charts reviewed, patients with teeth and edentulous had similar rates of comorbidities. PJI patients had higher rates of chronic kidney disease than patients who did not have the infection. The overall rate of infections in patients with teeth was 2.14%, close to the national average. The rate of infection in patients without teeth was 0.78%. Patients with teeth have a higher rate of infection one month or longer from surgery than edentulous patients. CONCLUSIONS There was an increased infection rate in patients with teeth at six months and greater since the primary total joint arthroplasty. The organisms responsible for many of the PJIs are commonly found in the mouth of humans. Having teeth is a potential risk factor for late PJI.
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Affiliation(s)
- Joseph D Brenner
- College of Medicine and Life Sciences, The University of Toledo, Toledo, USA
| | - Marina Atallah
- College of Medicine and Life Sciences, The University of Toledo, Toledo, USA
| | - David Yatsonsky
- Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
| | | | - Maged Hanna
- Orthopedic Surgery, The University of Toledo Medical Center, Toledo, USA
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Shihabul Hassan M, Stevenson J, Gandikota G, Veeratterapillay A, Bhamidipaty K, Botchu R. Current updates in MSK infection imaging: A narrative review. J Clin Orthop Trauma 2024; 51:102396. [PMID: 38585385 PMCID: PMC10998214 DOI: 10.1016/j.jcot.2024.102396] [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: 01/23/2024] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.
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Affiliation(s)
- M. Shihabul Hassan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J. Stevenson
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK
| | - G. Gandikota
- Department of Radiology, University of North Carolina, USA
| | | | | | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Glenn GT, Apple AE, Mears SC, Barnes CL, Stronach BM, Siegel ER, Stambough JB. Articulating Hip Spacers with a Constrained Acetabular Liner: Effect of Acetabular Bone Loss and Cementation Quality. Antibiotics (Basel) 2023; 12:1384. [PMID: 37760681 PMCID: PMC10526049 DOI: 10.3390/antibiotics12091384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Articulating hip spacers for periprosthetic joint infection (PJI) offer numerous advantages over static spacers such as improved patient mobilization, hip functionality, and soft tissue tension. Our study aimed to determine complication rates of a functional articulating spacer using a constrained liner to determine the role of acetabular cementation mantle and bone loss on the need for second-stage surgery. A retrospective review of 103 patients was performed and demographic information, spacer components and longevity, spacer-related complications, reinfection rates, and grade of bone loss and acetabular cement mantle quality were determined. There was no significant difference in spacer-related complications or reinfection rate between PJI and native hip infections. 33 of 103 patients (32.0%) elected to retain their spacers. Between patients who retained their initial spacer and those who underwent reimplantation surgery, there was not a significant difference in cement mantle grade (p = 0.52) or degree of bone loss (p = 0.78). Functional articulating antibiotic spacers with cemented constrained acetabular liners demonstrate promising early results in the treatment of periprosthetic and native hip infections. The rate of dislocation events was low. Further efforts to improve cement fixation may help decrease the need for second-stage reimplantation surgery.
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Affiliation(s)
- Grayson T. Glenn
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; (G.T.G.); (S.C.M.); (C.L.B.); (B.M.S.)
| | - Andrew E. Apple
- Department of Orthopaedic Surgery, Tulane University, 1430 Tulane Avenue, New Orleans, LA 70112, USA;
| | - Simon C. Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; (G.T.G.); (S.C.M.); (C.L.B.); (B.M.S.)
| | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; (G.T.G.); (S.C.M.); (C.L.B.); (B.M.S.)
| | - Benjamin M. Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; (G.T.G.); (S.C.M.); (C.L.B.); (B.M.S.)
| | - Eric R. Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA;
| | - Jeffrey B. Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA; (G.T.G.); (S.C.M.); (C.L.B.); (B.M.S.)
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Toirac B, Garcia-Casas A, Monclús MA, Aguilera-Correa JJ, Esteban J, Jiménez-Morales A. Influence of Addition of Antibiotics on Chemical and Surface Properties of Sol-Gel Coatings. MATERIALS 2022; 15:ma15144752. [PMID: 35888219 PMCID: PMC9317242 DOI: 10.3390/ma15144752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 01/30/2023]
Abstract
Infection is one of the most common causes that leads to joint prosthesis failure. In the present work, biodegradable sol-gel coatings were investigated as a promising controlled release of antibiotics for the local prevention of infection in joint prostheses. Accordingly, a sol-gel formulation was designed to be tested as a carrier for 8 different individually loaded antimicrobials. Sols were prepared from a mixture of MAPTMS and TMOS silanes, tris(tri-methylsilyl)phosphite, and the corresponding antimicrobial. In order to study the cross-linking and surface of the coatings, a battery of examinations (Fourier-transform infrared spectroscopy, solid-state 29Si-NMR spectroscopy, thermogravimetric analysis, SEM, EDS, AFM, and water contact angle, thickness, and roughness measurements) were conducted on the formulations loaded with Cefoxitin and Linezolid. A formulation loaded with both antibiotics was also explored. Results showed that the coatings had a microscale roughness attributed to the accumulation of antibiotics and organophosphites in the surface protrusions and that the existence of chemical bonds between antibiotics and the siloxane network was not evidenced.
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Affiliation(s)
- Beatriz Toirac
- Materials Science and Engineering and Chemical Engineering Department, Carlos III University of Madrid, 28911 Madrid, Spain; (A.G.-C.); (A.J.-M.)
- Correspondence:
| | - Amaya Garcia-Casas
- Materials Science and Engineering and Chemical Engineering Department, Carlos III University of Madrid, 28911 Madrid, Spain; (A.G.-C.); (A.J.-M.)
- CIDETEC, Basque Research and Technology Alliance (BRTA), 20014 Donostia-San Sebastián, Spain
| | - Miguel A. Monclús
- Micro- and Nano-Mechanics Department, Madrid Institutes for Advanced Studies (IMDEA)—Materials, 28906 Madrid, Spain;
| | - John J. Aguilera-Correa
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain; (J.J.A.-C.); (J.E.)
- CIBERINFEC, ISCIII—CIBER de Enfermedades Infecciosas, Instituto Carlos III, 28029 Madrid, Spain
| | - Jaime Esteban
- Clinical Microbiology Department, IIS-Fundación Jiménez Díaz, UAM, 28040 Madrid, Spain; (J.J.A.-C.); (J.E.)
- CIBERINFEC, ISCIII—CIBER de Enfermedades Infecciosas, Instituto Carlos III, 28029 Madrid, Spain
| | - Antonia Jiménez-Morales
- Materials Science and Engineering and Chemical Engineering Department, Carlos III University of Madrid, 28911 Madrid, Spain; (A.G.-C.); (A.J.-M.)
- CIBERINFEC, ISCIII—CIBER de Enfermedades Infecciosas, Instituto Carlos III, 28029 Madrid, Spain
- Alvaro Alonso Barba Technological Institute of Chemistry and Materials, Carlos III University of Madrid, 28911 Madrid, Spain
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Nikolaev NS, Malyuchenko LI, Karpukhin AS, Yakovlev VV, Maksimov AL, Grigor'eva EV, Rozhkov NI. The use of an antibacterial implant in the treatment of periprosthetic infection in an HIV-positive patient. INNOVATIVE MEDICINE OF KUBAN 2022:59-66. [DOI: https:/doi.org/10.35401/2541-9897-2022-25-2-59-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Background: The frequency of occurrence of infectious complications after hip arthroplasty in HIV-infected patients is extremely high. Revision arthroplasty for periprosthetic infection is the leader (64%) among the causes of early revision interventions. The search for ways to increase the efficiency of the sanitizing stage of treatment due to antibacterial coatings of the endoprosthesis components continues.Objective: Demonstration of a clinical case of treatment of periprosthetic infection in an HIV-positive patient using a spacer and a femoral component of a hip joint endoprosthesis coated with linear Sp1 carbon chains and silver. 123 months after hip arthroplasty for stage 3 dysplastic coxarthrosis in HIV-positive patient of 42 years old developed an instability of the acetabular component with the growth of Staphylococcus aureus in punctates. A revision was performed with the removal of the endoprosthesis and the installation of an articulating spacer with the addition of antibiotics. 12 weeks later, a recurrence of periprosthetic infection occurred, and Enterococcus faecalis was detected in punctates. During re-endoprosthetics, there was an installation of an articulating spacer covered with a two-dimensionally ordered linear-chain carbon doped with silver, based on the Zimmer CPT femoral component and bone cement with antibiotics addition. After 3 months, the second stage of revision arthroplasty was performed with implantation of an individual acetabular component and a femoral component coated with two-dimensionally ordered linear-chain carbon doped with silver.Conclusion: 4 months after the operation the patient returned to work, 12 months later the functional results were satisfactory. The use of components coated with two-dimensionally ordered linear-chain carbon doped with silver in an HIV-positive patient with recurrent periprosthetic infection made it possible to stop the infectious process, improve limb function and the quality of life.
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Affiliation(s)
- N. S. Nikolaev
- Federal Center of Traumatology, Orthopedics and Arthroplasty; Chuvash State University named after I.N. Ulyanov
| | | | - A. S. Karpukhin
- Federal Center of Traumatology, Orthopedics and Arthroplasty
| | - V. V. Yakovlev
- Federal Center of Traumatology, Orthopedics and Arthroplasty
| | - A. L. Maksimov
- Federal Center of Traumatology, Orthopedics and Arthroplasty
| | | | - N. I. Rozhkov
- National Ilizarov Medical Research Centre for Traumatology and Orthopedics
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6
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Nikolaev NS, Malyuchenko LI, Karpukhin AS, Yakovlev VV, Maksimov AL, Grigor'eva EV, Rozhkov NI. The use of an antibacterial implant in the treatment of periprosthetic infection in an HIV-positive patient. INNOVATIVE MEDICINE OF KUBAN 2022:59-66. [DOI: 10.35401/2541-9897-2022-25-2-59-66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background: The frequency of occurrence of infectious complications after hip arthroplasty in HIV-infected patients is extremely high. Revision arthroplasty for periprosthetic infection is the leader (64%) among the causes of early revision interventions. The search for ways to increase the efficiency of the sanitizing stage of treatment due to antibacterial coatings of the endoprosthesis components continues.Objective: Demonstration of a clinical case of treatment of periprosthetic infection in an HIV-positive patient using a spacer and a femoral component of a hip joint endoprosthesis coated with linear Sp1 carbon chains and silver. 123 months after hip arthroplasty for stage 3 dysplastic coxarthrosis in HIV-positive patient of 42 years old developed an instability of the acetabular component with the growth of Staphylococcus aureus in punctates. A revision was performed with the removal of the endoprosthesis and the installation of an articulating spacer with the addition of antibiotics. 12 weeks later, a recurrence of periprosthetic infection occurred, and Enterococcus faecalis was detected in punctates. During re-endoprosthetics, there was an installation of an articulating spacer covered with a two-dimensionally ordered linear-chain carbon doped with silver, based on the Zimmer CPT femoral component and bone cement with antibiotics addition. After 3 months, the second stage of revision arthroplasty was performed with implantation of an individual acetabular component and a femoral component coated with two-dimensionally ordered linear-chain carbon doped with silver.Conclusion: 4 months after the operation the patient returned to work, 12 months later the functional results were satisfactory. The use of components coated with two-dimensionally ordered linear-chain carbon doped with silver in an HIV-positive patient with recurrent periprosthetic infection made it possible to stop the infectious process, improve limb function and the quality of life.
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Affiliation(s)
- N. S. Nikolaev
- Federal Center of Traumatology, Orthopedics and Arthroplasty; Chuvash State University named after I.N. Ulyanov
| | | | - A. S. Karpukhin
- Federal Center of Traumatology, Orthopedics and Arthroplasty
| | - V. V. Yakovlev
- Federal Center of Traumatology, Orthopedics and Arthroplasty
| | - A. L. Maksimov
- Federal Center of Traumatology, Orthopedics and Arthroplasty
| | | | - N. I. Rozhkov
- National Ilizarov Medical Research Centre for Traumatology and Orthopedics
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7
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[Experimental study of silkworm larvae plasma colorimetry based on immune cascade reaction in accurate diagnosis of periprosthetic joint infection]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:203-208. [PMID: 35172406 PMCID: PMC8863539 DOI: 10.7507/1002-1892.202109046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the diagnostic efficacy of silkworm larvae plasma (SLP) colorimetry in the accurate diagnosis of periprosthetic joint infection (PJI). METHODS Ninety healthy male New Zealand white rabbits were used for knee arthroplasty with Swanson prosthesis. Then they were randomly divided into 3 groups according to different pathogenic bacteria: group A ( Staphylococcus aureus group), group B ( Staphylococcus epidermidis group) and group C ( Escherichia coli group), with 30 rats in each group. The PJI model was prepared by knee injection with 1 mL of pathogenic bacteria of different concentrations. Samples were taken before inoculation and at 7, 14, and 21 days after inoculation, and based on the 2018 PJI Philadelphia International Consensus diagnostic criteria, the success rate of modeling among 3 groups of experimental animals was determined. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic efficiency of SLP colorimetry were calculated. RESULTS At 21 days after inoculation, 26, 18, and 23 rabbits in groups A, B, and C were diagnosed as infection, respectively. The success rates of modeling were 86.7%, 60.0%, and 76.7%, respectively, showing no significant difference among the 3 groups ( χ 2=5.724, P=0.073). The results of PJI colorimetry showed that 1 false-positive animal (specificity 75.0%) appeared in group A at 7 days, and the specificity of SLP increased to 100.0% over time (on 14 and 21 days); on 14 and 21 days, another animal appeared false-negative results (sensitivity decreased from 100.0% to 96.2%). One false-positive animal appeared in group B at 7 days (specificity 91.7%), the specificity returned to 100.0% over time; 1 and 4 false-negative animals appeared at 14 and 21 days, respectively (sensitivity 94.4% and 83.3%, respectively). In group C, two false-positive animals (specificity 71.4%) were found at 7 days, and then returned to 100.0%. The diagnostic efficiency of groups A and C was very high at 21 days (96.7% and 100.0%), even for the low virulence Staphylococcus epidermidis in group B, the diagnostic efficiency could be maintained at 90.0% (21 days), and the overall diagnostic efficiency was very good (95.6%). CONCLUSION SLP colorimetry has high sensitivity, specificity, and diagnostic efficiency in the diagnosis of PJI, which is a potential diagnostic method.
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Hao L, Wu Y, Zhang Y, Ma T, Weng P, Zhang B, Wang J, Pei Q. SdrG gene activated joint surface membrane protein PTPRJ to induce periprosthetic joint infection after total hip arthroplasty. J Clin Pharm Ther 2022; 47:517-522. [PMID: 35014055 DOI: 10.1111/jcpt.13573] [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: 07/13/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Up to now, no study focused on the role of SdrG in PJI after THA. To explore the mechanism of periprosthetic joint infection (PJI) after total hip arthroplasty (THA). METHODS Joint fluid and blood were collected from patients with PJI after THA, aseptic loosening of the joints or bacterial infection after traumatic fractures of the extremities alone. The expression of SdrG in the 3 groups was determined by agarose gel electrophoresis. The expression of protein tyrosine phosphatase receptor J (PTPRJ) was measured by immunohistochemistry method. The platelet adhesion rate was determined by biochemical analysis. The content of D-dimer, CRP and ESR in blood was determined by latex agglutination method. Multiple linear correlation analysis was used to analyse the correlation between PJI and the expression of PTPRJ protein, platelet adhesion rate, D-dimer content, CRP and ESR. RESULTS AND DISCUSSION The expression of SdrG and PTPRJ in PJI group was markedly increased compared to the other 2 groups. The platelet adhesion rate in PJI group was markedly larger compared to aseptic loosening and simple wound infection group, and the rate in simple wound infection group was larger than aseptic loosening group. The level of D-dimer, CRP and ESR in PJI group was higher than that of the other groups. The expression of PTPRJ protein, D-dimer content, CRP and ESR was all closely related to PJI, while platelet adhesion rate had no correlation with PJI. WHAT IS NEW AND CONCLUSION SDRG gene around joint prosthesis was over-expressed, which activated joint surface membrane protein PTPRJ and then induced platelet aggregation to reduce joint function.
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Affiliation(s)
- Linjie Hao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yanjie Wu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yumin Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Ma
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Pengfei Weng
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Binfei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Junwei Wang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Pei
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Karachalios T, Komnos GA. Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes. EFORT Open Rev 2021; 6:727-734. [PMID: 34667643 PMCID: PMC8489477 DOI: 10.1302/2058-5241.6.210008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies. Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance. DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy. Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision. It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon’s responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies.
Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008
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Affiliation(s)
- Theofilos Karachalios
- Department of Orthopaedics and Musculoskeletal Trauma, University General Hospital of Larissa, Greece.,School of Health Sciences, Faculty of Medicine, University of Thessalia, Larissa, Greece
| | - George A Komnos
- Department of Orthopaedics and Musculoskeletal Trauma, University General Hospital of Larissa, Greece
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Frank BJH, Aichmair A, Simon S, Schwarz GM, Dominkus M, Hofstaetter JG. Analysis of Culture Positive First and Second Stage Procedures in Periprosthetic Knee and Hip Joint Infections. J Arthroplasty 2021; 36:2158-2164. [PMID: 33608181 DOI: 10.1016/j.arth.2021.01.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/24/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A positive microbiological result at reimplantation may lead to a failed 2-stage revision arthroplasty in the treatment of periprosthetic joint infections. Little is known about changes in microbiological spectrum and resistance pattern between culture positive first and second stage procedures in revision knee and hip arthroplasty. METHODS Between January 2011 and December 2019, we performed 327 two-stage revision arthroplasties on 312 patients. There were 37 of 312 (11.9%) patients (20 hips/17 knees) who had a positive microbiological culture during the first and second stage procedure. We analyzed the microbiological spectrum, antimicrobial resistance pattern, and clinical outcome of culture positive first and second stage procedures as well as subsequent re-revisions. RESULTS Re-revision was necessary in 40.5% (15/37) of patients with culture positive first and second stage procedure at a median follow-up of 3.5 years. We found microbiological changes in 83.8% (31/37) of patients between the first and second stage and in 88.9% (8/9) between the second stage and subsequent culture positive re-revision. Polymicrobial infections were found in 21.6% (8/37) of first and in 16.2% (6/37) of second stage procedures. In 27% (10/37) of patients, microorganisms persisted between the first and second stage procedure. The antimicrobial resistance pattern changed in 60% of persistent microorganisms between the first and second stage procedure. CONCLUSION Changes in microbiological spectrum and resistance pattern are common between culture positive first and second stage procedures as well as subsequent re-revisions. This has to be considered in the antimicrobial treatment of periprosthetic joint infections.
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Affiliation(s)
- Bernhard J H Frank
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Alexander Aichmair
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; 2nd Department, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Sebastian Simon
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; 2nd Department, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
| | - Gilbert M Schwarz
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; Department of Orthopaedics and Trauma-Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Dominkus
- 2nd Department, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria; 2nd Department, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
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11
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Hashimoto A, Miyamoto H, Kii S, Kobatake T, Shobuike T, Noda I, Sonohata M, Mawatari M. Time-dependent efficacy of combination of silver-containing hydroxyapatite coating and vancomycin on methicillin-resistant Staphylococcus aureus biofilm formation in vitro. BMC Res Notes 2021; 14:81. [PMID: 33653399 PMCID: PMC7927400 DOI: 10.1186/s13104-021-05499-7] [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: 12/11/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We developed a silver-containing hydroxyapatite (Ag-HA) coating to prevent periprosthetic joint infection (PJI). Methicillin-resistant Staphylococcus aureus (MRSA) is the main PJI-causing bacteria. Previously, we had reported the combined effect of Ag-HA coating and vancomycin (VCM) on MRSA biofilm formation 24 h after MRSA inoculation. In this study, we investigated the time-dependent efficacy of Ag-HA coating and VCM on MRSA biofilm formation on Ti discs in vitro by three-dimensional confocal laser scanning microscopic analysis. RESULTS For the Ti VCM and HA VCM groups, the total biofilm volumes per area at 96 h after MRSA inoculation were significantly larger than those at 48 h after MRSA inoculation, respectively (p < 0.001). In contrast, for the Ag-HA VCM group, the total biofilm volume per area at 96 h was significantly smaller than that at 48 h (p < 0.0001). Moreover, 96 h after MRSA inoculation, the total biofilm volume per area of the Ag-HA VCM groups was significantly smaller than those of the Ti VCM and HA VCM groups (p < 0.0001). Thus, the combination of Ag-HA and VCM might be useful for the prevention of MRSA-associated PJI.
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Affiliation(s)
- Akira Hashimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.
| | - Hiroshi Miyamoto
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Sakumo Kii
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Tomoki Kobatake
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Takeo Shobuike
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Iwao Noda
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan.,Research Section, Medical Division, KYOCERA Corporation, 800 Ichimiyake, Yasu City, Shiga, 530-2362, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga, 849-8501, Japan
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Schiavi P, Pogliacomi F, Calderazzi F, Domenichini M, Ceccarelli F, Vaienti E. Dair approach in 7 infected total hip arthroplasties: our experience and current concepts of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021572. [PMID: 35604248 PMCID: PMC9437696 DOI: 10.23750/abm.v92is3.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) is one of the most challenging complications following total hip arthroplasty. In early infection, within four to twelve weeks from surgery, debridement, antibiotics and implant retention (DAIR) can be the initial treatment. The aim of this study is to report our case series and review current concepts reported in the literature about this topic. MATERIALS AND METHODS This was an observational cohort study that included 7 patients managed with DAIR for PJI following primary total hip replacement (THR) between 2014 and 2020. Inclusion criteria were a primary THR, direct anterior or lateral approach, DAIR procedure, and PJI. Exclusion criteria were a PJI following a revision total hip replacement or hemiarthroplasty, posterolateral approach, 1-stage revision, 2-stage revision, and Girdlestone procedure without prior DAIR. For each patient demographic characteristics, laboratory values, microorganisms involved, antibiotic therapy and outcome at one-year follow-up were registered. RESULTS The mean duration between THR and DAIR was 19 days. In all cases only one DAIR procedure was performed. Most infections were caused by Staphylococcus aureus (4 cases) [one methicillin resistant (MRSA)]. The other infections were caused by Streptococcus agalactiae, Staphylococcus coagulase negative and Escherichia coli. At the final follow-up, the procedure was considered as successful in 6 out of 7 patients (85%). The one with unsuccessful outcome underwent to a two-stage revision. DISCUSSION Our results were comparable with those of a recent systematic review of the literature. Factors that have been postulated to influence the outcome of DAIR in the management of PJIs include the timing and numbers of debridement, the exchange of components, the responsible microorganism and the duration of antibiotic treatment. In conclusion, the outcomes following DAIR are better as the indications are refined and risk factors identified. PJI prevention remains the key but the current literature still lacks well documented and effective PJI prevention protocols. (www.actabiomedica.it).
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Affiliation(s)
| | - Francesco Pogliacomi
- PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
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Deijkers RL, van Elzakker EPM, Pijls BG. Debridement, Antibiotics, and Implant Retention with the Direct Anterior Approach for Acute Periprosthetic Joint Infection Following Primary THA. JB JS Open Access 2020; 5:e0062. [PMID: 33123664 PMCID: PMC7418914 DOI: 10.2106/jbjs.oa.19.00062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Periprosthetic joint infection (PJI) is a devastating complication following
total hip replacement. The direct anterior approach for total hip
replacement is becoming increasingly popular. However, little is known about
the success rate of treatment with debridement, antibiotics, and implant
retention (DAIR) using the direct anterior approach. The aim of this study
was to analyze the effectiveness of DAIR using this approach and identify
patient and surgical factors that influence the results. Methods: Seventy-four patients (75 hips) in whom DAIR had been performed were
identified from the records of the weekly multidisciplinary infection
meeting and the laboratory information management systems. In 4% (3 hips),
modular components were exchanged. To consider competing risks (death), we
used competing risk models. Results: The competing risk analysis showed a successful outcome after DAIR of 82% at
4 years of follow-up; this rate was 89% at 4 years follow-up when excluding
patients managed with gentamicin beads. The sensitivity analysis revealed
that obesity (body mass index [BMI] of ≥30 kg/m2), use of
gentamicin beads, and an erythrocyte sedimentation rate (ESR) of >40
mm/hr increased the risk of failure. Conclusions: DAIR using the direct anterior approach without the routine exchange of
modular components offers a success rate that is comparable with other
approaches for eradicating acute PJI following primary hip arthroplasty. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for
a complete description of levels of evidence.
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Affiliation(s)
- R L Deijkers
- Departments of Orthopaedic Surgery (R.L.D. and B.G.P.) and Microbiology (E.P.M.v.E.), Haga Hospital, The Hague, the Netherlands
| | - E P M van Elzakker
- Departments of Orthopaedic Surgery (R.L.D. and B.G.P.) and Microbiology (E.P.M.v.E.), Haga Hospital, The Hague, the Netherlands
| | - B G Pijls
- Departments of Orthopaedic Surgery (R.L.D. and B.G.P.) and Microbiology (E.P.M.v.E.), Haga Hospital, The Hague, the Netherlands
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Abstract
PURPOSE OF REVIEW Prosthetic joint infections (PJIs) represent one of the most disastrous complications in prosthetic surgery, requiring long hospitalization, prolonged antimicrobial treatment and repeated surgical interventions. No gold standard test to formulate diagnosis exist. A combination of high index of suspicion, physical examination, microbiological and biohumoral investigations is required. Therapeutical approach should be based on a multidisciplinary team. In our center, a two-stage approach is preferred. As regards the choice of the empirical antibiotic backbone, individual risk factors for multiple-drug resistant (MDR) pathogens should be considered. Several studies enhance the possibility to shorten the length of antibiotic couses. RECENT FINDINGS Some interesting improvements have been made in the setting of PJIs management. As regards diagnosis, novel biomarkers and nuclear imaging are acquiring more importance. Molecular biology techniques also offer the possibility to formulate rapid microbiological identification. The pattern of PJIs is evolving towards higher rates of MDR causes. During the last decade, a number of new antibiotic molecules with activity against MDRs have been approved. Some of them are also available either in oral formulation or as long-acting compounds, offering the opportunity for early patient's discharge, with expected healthcare costs saving. SUMMARY Management of PJIs still represents a major threat for clinicians. Improvements in surgical techniques and antibiotic pipeline promise to revolutionize the approach in next years. Despite data from our experience confirm the efficacy of shorter antibiotic courses and the value of new molecules, randomized clinical trials are lacking. More data are needed in order to modify the routine clinical practice.
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Loosening of total knee arthroplasty - always aseptic? J Clin Orthop Trauma 2020; 11:S234-S238. [PMID: 32189947 PMCID: PMC7068007 DOI: 10.1016/j.jcot.2019.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE When revision surgery is needed in total knee arthroplasty (TKA) the most frequent reasons are aseptic loosening (AL) and periprosthetic joint infection (PJI). However preoperative distinction between AL and PJI remains challenging. Aim of this study is to determine the incidence of PJI in patients with suspected AL after TKA and to evaluate a diagnostic algorithm for reliable differential diagnosis. METHODS In this study a total of 149 symptomatic patients with radiographic signs of prosthetic loosening and suspected AL were included. Preoperatively all patients underwent a standardized diagnostic algorithm. For each patient demographics, as well as the results of laboratory and microbiological testing were collected from the medical records. RESULTS Of the included patients 117 (78.5%) were diagnosed with AL and 32 (21.5%) with PJI. The latency period from primary arthroplasty to the presentation with symptomatic implant loosening was significantly shorter for PJI compared to AL (p < 0.05). The initial CRP values were significantly higher in patients with PJI compared to patients with AL (p < 0.05). Elevated count of white blood cells or percentage of neutrophils within the synovial fluid support the diagnosis of PJI. The sensitivity of synovial cell count (CC) count for PJI in patients with radiographic signs of loosening was 0.84 (CI 0.81-0.87) with a specificity of 0.96 (CI 0.92-0.98). The single best measure for the diagnosis of PJI was synovial fluid cultures with a specificity of 1, however this measure provides poor sensitivity. CONCLUSION Patients with radiographic signs of loosening in TKA need thorough diagnostics. Information about primary TKA, serological testing, and results of joint aspiration can rule out a PJI in most cases.
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