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Dabert A, Runtz A, Leclerc G, Sergent P, Loisel F, Pluvy I, Fradin T, Garbuio P. Bone consolidation under septic condition and hardware retention: about 69 patients. Orthop Traumatol Surg Res 2024:103942. [PMID: 39030127 DOI: 10.1016/j.otsr.2024.103942] [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: 06/22/2023] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Management of infection on internal fixation hardware is particularly complex. The main aim of the present study was to assess bone consolidation rates under septic conditions in patients treated for bone and joint infection (BJI) with hardware retention. Secondary objectives were to determine a time limit beyond which it is unreasonable to retain hardware, and to assess risk factors for non-consolidation and functional results. The study hypothesis was that bone consolidation is possible under septic conditions without hardware exchange. MATERIAL AND METHOD A single-center retrospective observational study was conducted on 69 patients for the period January 1, 2009 to December 31, 2019. We included all patients aged over 15 years with infection after internal fixation or fusion whose files had been discussed in the multidisciplinary team meeting during the study period. Bone healing was screened for on X-ray or CT. Study data comprised type of fracture, smoking status, time to treatment for open fracture, initial surgery time, type of hardware, interval between fixation and revision, and type of irrigation. Functional results were assessed at follow-up: walking, pain, return to work and SF12 and QuickDASH scores. RESULTS The bone healing rate was 73.5% (50/68 patients) at a mean 24 weeks (range, 6-68 weeks). Time to revision did not significantly impact consolidation: 60% for 2 weeks (6/10 cases), 80% for 2-10 weeks (35/40 cases), and 64% for >10 weeks (9/14 cases) (p = 0.28). Smoking, longer initial surgery time and Gustilo type IIIb or IIIc were significant risks factors for non-consolidation. DISCUSSION Bone consolidation under septic conditions with hardware retention adhering to an established medical and surgical protocol was reliable and straightforward, without extra morbidity. These findings are encouraging, and in line with the literature. We were unable to determine a time limit beyond which hardware prevented healing. LEVEL OF EVIDENCE IV; descriptive epidemiological study.
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Affiliation(s)
- Alizé Dabert
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France.
| | - Adrien Runtz
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France
| | - Grégoire Leclerc
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France
| | - Pauline Sergent
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France
| | - François Loisel
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France; Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Isabelle Pluvy
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France; Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Thomas Fradin
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France
| | - Patrick Garbuio
- Service d'Orthopédie, de Traumatologie, de Chirurgie Plastique, Reconstructrice et Assistance Main, Université de Franche-Comté, Faculté de Médecine et CHU de Besançon LNIT (UR 4662), F-25000 Besançon, France
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Hammad M, Oktarina A, Suhardi VJ, Thomson A, Li Q, Döring K, Augustin EJ, Ivashkiv LB, Carli AV, Bostrom MPG, Yang X. Effects of antiseptic irrigation solutions on osseointegration in a cementless tibial implantation mouse model. J Orthop Res 2024. [PMID: 39017392 DOI: 10.1002/jor.25937] [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: 06/04/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024]
Abstract
Despite the success of standard antiseptic irrigation solutions in reducing periprosthetic joint infection (PJI) rates, there is still a need for more effective solutions. Synergistic use of povidone-iodine (PI) and hydrogen peroxide (H2O2) has shown promising results; however, the optimal solution concentration balancing bactericidal activity and osseointegration remains unknown. This study aims to evaluate the impact of these antiseptic irrigation solutions on osseointegration and the bone-implant interface strength in vivo. Forty C57BL/6 mice underwent bilateral tibial implantation surgery and were randomly allocated into three groups receiving 0.3% PI, 10% PI mixed with 3% H2O2, or saline as irrigation solutions intraoperatively. Assessments were performed on postoperative Days 1 and 28, including plain radiographs, microcomputed tomography (microCT) evaluation, histological analysis, immunohistochemistry, and biomechanical pull-out testing. No wound complications were observed. MicroCT scans revealed no differences in peri-implant trabecular bone parameters. Biomechanical pull-out testing showed no differences in the bone-implant interface strength across groups. Histological analysis indicated no differences in bone and bone marrow percentage areas among treatment groups. Immunohistochemical analysis demonstrated no differences among groups in peri-implant osteocalcin, osterix, or endomucin-positive cells. In conclusion, using either antiseptic irrigation solution showed no differences in osseointegration parameters compared to the control group, demonstrating safety and the absence of toxicity. CLINICAL RELEVANCE: Dilute 0.3% povidone-iodine and a 1:1 combination of 10% povidone-iodine mixed with 3% hydrogen peroxide can be safely used during primary and revision total joint arthroplasty without compromising osseointegration or causing wound complications.
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Affiliation(s)
- Mohammed Hammad
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Anastasia Oktarina
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Vincentius J Suhardi
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
| | - Andrew Thomson
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Qingdian Li
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, USA
| | - Kevin Döring
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Edouard J Augustin
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Lionel B Ivashkiv
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Alberto V Carli
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
- Department of Orthopedics, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, China
| | - Mathias P G Bostrom
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
- Department of Orthopedics, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, China
| | - Xu Yang
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, USA
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Wang Y, Li Z, Gao X, Lin J. The efficacy and safety of intra-articular injection of corticosteroids in multimodal analgesic cocktails in total knee arthroplasty-a historically controlled study. Front Surg 2024; 11:1279462. [PMID: 38919978 PMCID: PMC11196593 DOI: 10.3389/fsurg.2024.1279462] [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: 08/18/2023] [Accepted: 05/22/2024] [Indexed: 06/27/2024] Open
Abstract
Background Total knee arthroplasty (TKA) is a common and effective procedure. Optimizing pain control and reducing postoperative discomfort are essential for patient satisfaction. No studies have examined the safety and efficacy of intra-articular corticosteroid injections following TKA. This study aims to examine the safety and efficacy of corticosteroids in intra-articular multimodal analgesic injections. Materials and methods This was a historically controlled study conducted at a single academic institution. Before May 2019, patients received an intra-articular cocktail injection without corticosteroids during surgery, referred to as the non-corticosteroid (NC) group. After June 2019, intraoperatively, patients received an intra-articular cocktail injection containing corticosteroids, referred to as the corticosteroid (C) group. Finally, 738 patients were evaluated, 370 in the C cohort and 368 in the NC cohort. The mean follow-up duration was 30.4 months for the C group and 48.4 months for the NC group. Results The mean VAS scores at rest on postoperative day (POD) 1 (2.35) and POD3 (3.88) were significantly lower in the C group than those in the NC group, which were 2.86 (POD1) and 5.26 (POD3) (p < 0.05). Walking pain in the C group (4.42) was also significantly lower than that (5.96) in the NC group on POD3 (p < 0.05). Patients in the C group had a significantly higher mean range of motion (ROM) (92.55) on POD3 than that (86.38) in the NC group. The mean time to straight leg raise for group C (2.77) was significantly shorter than that (3.61) for the NC group (p < 0.05). The C group also had significantly fewer rescue morphine (1.9) and metoclopramide (0.21) uses per patient than the NC group, which were 3.1 and 0.24, respectively. No significant differences in fever or vomiting rates between groups were found. Patients in neither group developed periprosthetic joint infections or skin necrosis. One patient in the C group suffered from wound dehiscence, and the wound healed well after debridement. No patient died or had a re-operation in either group. Conclusions This pilot trial found that intra-articular injection of multimodal analgesia (including corticosteroids) reduced initial postoperative pain, increased ROM in the early postoperative days (up to POD3), and did not increase wound complications or infection rates in approximately 30 months of follow-up.
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Affiliation(s)
- Yixiong Wang
- Department of Orthopedic Diseases, Jincheng General Hospital, Jincheng, China
| | - Zhichang Li
- Arthritis Clinic & Research Center, Peking University People’s Hospital, Beijing, China
| | - Xuan Gao
- Department of Orthopedic Disease, Luanzhou People’s Hospital, Tangshan, Hebei, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People’s Hospital, Beijing, China
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Wu X, Chen W, Rong R, Pan B, Hu X, Zheng L, Alimu A, Chu C, Tu Y, Zhang Z, Ye Y, Gu M, Sheng P. Application of the New Irrigation Protocol to Reduce Recurrence Rate in the Management Of Periprosthetic Joint Infection. Orthop Surg 2024; 16:577-584. [PMID: 38238252 PMCID: PMC10925507 DOI: 10.1111/os.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Irrigation is a conventional treatment for acute and chronic periprosthetic joint infections (PJI). However, there has been no unified standard for irrigation during surgery for PJI in the past, and the efficacy is uncertain. The purpose of this study is to create a new irrigation protocol to enhance the infection control rate and reduce the postoperative recurrence rate of PJI patients. METHODS We conducted a single-institution retrospective review with a total of 56 patients who underwent revision total hip or knee arthroplasties due to PJI from January 2011 to January 2022. Conventional irrigation (CI) was used in 32 cases, and standard operating procedure of irrigation (SOPI) was used in 24. The CI protocol carries out an empirical irrigation after debridement, which is quite random. Our SOPI protocol clearly stipulates the soaking concentration and time of hydrogen peroxide and povidone-iodine. The irrigation is carried out three times, and tissue samples are taken from multiple parts before and after irrigation, which are sent for microbial culture. The important statistical indicators were the rate of positive microbiological culture and postoperative recurrence rate with an average follow-up of 24 average months. RESULTS The drainage volume was lower in the SOPI group than in the CI group on postoperative day 3 (p < 0.01) and 7 (p = 0.016). In addition, the percentage of positive microbiological cultures after the third irrigation was less than that before (p < 0.01) and after (p < 0.01) the first irrigation. The most common causative organism was Staphylococcus aureus, which was detected in 25.0% and 12.5% of the SOPI and CI groups, respectively. The failure rate at the final follow-up was 8.3% and 31.3% (p = 0.039) for the SOPI and CI groups, respectively. CONCLUSION Compared with the traditional CI method, SOPI standardized the soaking time of hydrogen peroxide and povidone-iodine, increased the frequency of and irrigation, and proved that microorganisms were almost completely removed through the microbial culture of multiple tissues. SOPI has the potential to become a standardized irrigation process worthy of promotion, effectively reducing the postoperative recurrence rate of PJI patients.
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Affiliation(s)
- Xiaoyu Wu
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Weishen Chen
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Rong Rong
- Department of Nosocomial InfectionThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Baiqi Pan
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Xuantao Hu
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Linli Zheng
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Aerman Alimu
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Chenghan Chu
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yucheng Tu
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Ziji Zhang
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Yongyu Ye
- Department of Spinal SurgeryGuangdong Provincial People's HospitalGuangzhouChina
| | - Minghui Gu
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Puyi Sheng
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Guangdong Provincial Key Laboratory of Orthopaedics and TraumatologyThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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Zhang L, Jin Z. Antibacterial activities of titanium dioxide (TiO 2) nanotube with planar titanium silver (TiAg) to prevent orthopedic implant infection. J Orthop Surg Res 2024; 19:144. [PMID: 38365803 PMCID: PMC10870603 DOI: 10.1186/s13018-024-04596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/28/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Orthopedic implant infection has become a common catastrophic complication after various orthopedic implants, which can lead to prolonged use of antibiotics and even surgical failure. The quality of care (QoC) of orthopedic implant infection is very important. METHODS Titanium dioxide (TiO2) nanotube array with planar TiAg was prepared, and their antibacterial rates were tested. 400 patients hospitalized in the Department of Orthopedics of Wuhan Fourth Hospital from May 2019 to May 2020 were selected as controls (before QoC evaluation system of orthopedics), and 400 patients hospitalized from June 2020 to June 2021 were selected as observation group (after QoC evaluation system of orthopedics). RESULTS Regardless of Staphylococcus aureus or Escherichia coli, the antibacterial rate of TiO2 nanotube array with planar TiAg was clearly higher than that of pure iron film on the 10th and 20th days (P < 0.05). The accuracy of hospitalization assessment, disease assessment, adverse event intervention, nursing record filing and nursing satisfaction in observation group were higher as against controls (P < 0.05). CONCLUSION The TiO2 nanotube array with planar TiAg has good antibacterial property, which can effectively prevent orthopedic implant infection. The construction of QoC evaluation system for orthopedic specialists can effectively improve the QoC of orthopedic specialists.
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Affiliation(s)
- Lihong Zhang
- Department of Surgery, Wuhan Fourth Hospital, Wuhan, 430030, Hubei Province, China
| | - Zhihui Jin
- Department of Orthopaedics, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei Province, China.
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Christodoulou N, Asimakopoulos D, Kapetanos K, Seah M, Khan W. Principles of management of hand fractures. J Perioper Pract 2023; 33:342-349. [PMID: 36408867 PMCID: PMC10623595 DOI: 10.1177/17504589221119739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The optimal management of hand fractures requires a multidisciplinary approach. Initial assessment should include a thorough medical history and clinical examination, followed by appropriate radiological imaging. These are crucial in determining the appropriate management. Following joint stabilisation to allow fractures to unite, early mobilisation is needed to maximise the functional restoration of the hand. In this review, the principles of operative and non-operative management of these injuries are discussed.
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Affiliation(s)
| | | | | | - Matthew Seah
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Cambridge, UK
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Schultz BV, Watt K, Rashford S, Wylie J, Bosley E. Epidemiology of open limb fractures attended by ambulance clinicians in the out-of-hospital setting: A retrospective analysis. Australas Emerg Care 2023; 26:216-220. [PMID: 36621412 DOI: 10.1016/j.auec.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/25/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Open limb fractures are a time-critical orthopaedic emergency that present to jurisdictional ambulance services. This study describes the demographic characteristics and epidemiological profile of these patients METHODS: We undertook a retrospective analysis of all patients that presented to Queensland Ambulance Service with an open limb fracture (fracture to the humerus, radius/ulna, tibia/fibula or femur) over a two-year period (January 2018 - December 2019). RESULTS Overall, 1020 patients were included. Patients were mainly male (65.9%) and middle-aged (age 41 years, IQR 22-59). Fractures predominately occurred in the lower extremities (64.9%) with transport crashes the primary mechanism of injury (47.8%). The location of the fracture varied depending on the cause of injury, with femur fractures associated with motorcycle crashes, and fractures to the radius/ulna attributed to falls of greater than one metre (p = 0.001). The median prehospital episode of care was 83 min (IQR 62-144) with aeromedical air ambulance involvement and the attendance of a critical care paramedic or emergency physician, both independent factors that increased this time interval. CONCLUSION Open limb fractures are a relatively infrequent injury presentation encountered by ambulance clinicians. The characteristics of these patients is consistent with previously described national and international out-of-hospital trauma cohorts.
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Affiliation(s)
- Brendan V Schultz
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, QLD, Australia.
| | - Kerrianne Watt
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, QLD, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Stephen Rashford
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, QLD, Australia
| | - James Wylie
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, QLD, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, QLD, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Martinez R, Chen AF. Outcomes in revision knee arthroplasty: Preventing reoperation for infection Keynote lecture - BASK annual congress 2023. Knee 2023; 43:A5-A10. [PMID: 37524637 DOI: 10.1016/j.knee.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Revision total knee arthroplasty (TKA) patients have a lower survival rate and lower post-surgical outcomes compared to primary TKA patients. Infection and aseptic loosening are the most common reasons for revision and re-revision TKAs, with infection accounting for nearly half of re-revision cases. To prevent infection, patient optimization addressing obesity, diabetes, malnutrition, and smoking cessation is crucial. Advancements in irrigation solutions, antibiotic-impregnated bone fillers, bacteriophage therapy, and electrochemical therapy hold promise for preventing infection. Technical strategies such as obtaining sufficient component fixation, joint line restoration, and using robot assistance may improve revision TKA outcomes. As the burden of revision TKA continues to rise, substantial efforts remain for mitigating future revision TKAs and their associated complications.
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Affiliation(s)
- Roxana Martinez
- Department of Orthopaedic Surgery & Rehabilitation, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Davies H, Russell J, Varghese A, Holmes H, Soares MO, Woods B, Puig-Peiro R, Evans S, Tierney R, Mealing S, Sculpher M, Robotham JV. Developing a Modeling Framework for Quantifying the Health and Cost Implications of Antibiotic Resistance for Surgical Procedures. MDM Policy Pract 2023; 8:23814683231152885. [PMID: 36755742 PMCID: PMC9900655 DOI: 10.1177/23814683231152885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 12/26/2022] [Indexed: 02/07/2023] Open
Abstract
Background. Antimicrobial resistance (AMR) is a global public health threat. The wider implications of AMR, such as the impact of antibiotic resistance (ABR) on surgical procedures, are yet to be quantified. The objective of this study was to produce a conceptual modeling framework to provide a basis for estimating the current and potential future consequences of ABR for surgical procedures in England. Design. A framework was developed using literature-based evidence and structured expert elicitation. This was applied to populations undergoing emergency repair of the neck of the femur and elective colorectal resection surgery. Results. The framework captures the implications of increasing ABR by allowing for higher rates of surgical site infection (SSI) as the effectiveness of antibiotic prophylaxis wanes and worsened outcomes following SSIs to reflect reduced antibiotic treatment effectiveness. The expert elicitation highlights the uncertainty in quantifying the impact of ABR, reflected in the results. A hypothetical SSI rate increase of 14% in a person undergoing emergency repair of the femur could increase costs by 39% (-2% to 108% credible interval [CI]) and decrease quality-adjusted life-years by 11% (0.4% to 62% CI) over 15 y. Conclusions. The modeling framework is a starting point for addressing the implication of ABR on the outcomes and costs of surgeries. Due to clinical uncertainty highlighted in the expert elicitation process, the numerical outputs of the case studies should not be focused on but rather the framework itself, illustration of the evidence gaps, the benefit of expert elicitation in quantifying parameters with limited data, and the potential magnitude of the impact of ABR on surgical procedures. Implications. The framework can be used to support research surrounding the health and cost burden of ABR in England. Highlights The modeling framework is a starting point for assessing the health and cost impacts of antibiotic resistance on surgeries in England.Formulating a framework and synthesizing evidence to parameterize data gaps provides targets for future research.Once data gaps are addressed, this modeling framework can be used to feed into overall estimates of the health and cost burden of antibiotic resistance and evaluate control policies.
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Affiliation(s)
- Heather Davies
- Davies H. MSc, York Health Economics
Consortium Ltd, Enterprise House, Heslington, York, North Yorkshire YO10 5NQ,
UK; ()
| | - Joel Russell
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Angel Varghese
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Hayden Holmes
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Marta O. Soares
- Centre for Health Economics, University of
York, York. North Yorkshire, UK
| | - B. Woods
- Centre for Health Economics, University of
York, York. North Yorkshire, UK
| | - Ruth Puig-Peiro
- Office for Health Improvement and Disparities,
Department of Health and Social Care, UK
| | - Stephanie Evans
- Modelling and Evaluations Unit, HCAI & AMR,
UK Health Security Agency
| | - Rory Tierney
- Office for Health Improvement and Disparities,
Department of Health and Social Care, UK
| | - Stuart Mealing
- York Health Economics Consortium Ltd (YHEC),
York, North Yorkshire, UK
| | - Mark Sculpher
- Centre for Health Economics, University of
York, York. North Yorkshire, UK
| | - Julie V. Robotham
- Modelling and Evaluations Unit, HCAI &
AMR, UK Health Security Agency
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He SY, Yu B, Jiang N. Current Concepts of Fracture-Related Infection. Int J Clin Pract 2023; 2023:4839701. [PMID: 37153693 PMCID: PMC10154639 DOI: 10.1155/2023/4839701] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/24/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023] Open
Abstract
Currently, fracture-related infection (FRI) still represents great challenges in front of orthopaedic surgeons, despite great advances that have been achieved regarding its diagnosis and treatment. Although both FRI and prosthetic joint infection (PJI) belong to osteoarticular infections and share similarities, FRI displays unique characteristics. Diagnosis of FRI is sometimes difficult owing to the nonspecific symptoms, and treatment is usually tricky, with a high risk of infection recurrence. In addition, the long disease course is associated with a significantly elevated risk of disability, both physically and psychologically. Moreover, such a disorder still poses heavy economic burdens to the patients, both personally and socially. Therefore, early diagnosis and reasonable treatment are the key issues for increasing the cure rate, decreasing the risks of infection relapse and disability, and improving the life quality and prognosis of the patients. In this review, we summarized the present concepts regarding the definition, epidemiology, diagnosis, and treatment of FRI.
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Affiliation(s)
- Si-ying He
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Bin Yu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
| | - Nan Jiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
- Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Southern Medical University Nanfang Hospital, Guangzhou 510515, China
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11
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One and a Half-Stage Revision With Prosthetic Articulating Spacer for Definitive Management of Knee Periprosthetic Joint Infection. Arthroplast Today 2022; 19:100993. [PMID: 36507285 PMCID: PMC9727150 DOI: 10.1016/j.artd.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/12/2022] Open
Abstract
This paper is a comprehensive review that describes indications, contraindications, clinical outcomes, and pearls and pitfalls of 1.5-stage revision total knee arthroplasty (TKA) utilizing a primary TKA femoral component, all-polyethylene tibial component, and hand-crafted antibiotic cement for the management of chronic periprosthetic joint infection. The 1.5-stage exchange TKA details placement of an articulating spacer for an indefinite period, prolonging revision until reinfection, deterioration of functional status, or construct failure. A 1.5-stage revision TKA technique is a viable option for treatment of chronic periprosthetic knee infections. The inherent advantages of decreased health-care costs, decreased morbidity and mortality, and improved emotional ease from having a single procedure is attractive, especially if reinfection rates are determined to be equivocal to 2-stage revision.
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12
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Lipson S, Pagani NR, Moverman MA, Puzzitiello RN, Menendez ME, Smith EL. The Cost-Effectiveness of Extended Oral Antibiotic Prophylaxis for Infection Prevention After Total Joint Arthroplasty in High-Risk Patients. J Arthroplasty 2022; 37:1961-1966. [PMID: 35472436 DOI: 10.1016/j.arth.2022.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Extended oral antibiotic prophylaxis may decrease rates of prosthetic joint infection (PJI) after total joint arthroplasty (TJA) in patients at high risk for infection. However, the cost-effectiveness of this practice is not clear. In this study, we used a break-even economic model to determine the cost-effectiveness of routine extended oral antibiotic prophylaxis for PJI prevention in high-risk TJA patients. METHODS Baseline PJI rates in high-risk patients, the cost of revision arthroplasty for PJI, and the costs of extended oral antibiotic prophylaxis regimens were obtained from the literature and institutional purchasing records. These variables were incorporated in a break-even economic model to calculate the absolute risk reduction (ARR) in infection rate necessary for extended oral antibiotic prophylaxis to be cost-effective. ARR was used to determine the number needed to treat (NNT). RESULTS Extended oral antibiotic prophylaxis with Cefadroxil in patients at high risk for PJI was cost-effective at an ARR in baseline infection rate of 0.187% (NNT = 535) and 0.151% (NNT = 662) for TKA and THA, respectively. Cost-effectiveness was preserved with varying costs of antibiotic regimens, PJI treatment costs, and infection rates. CONCLUSION The use of extended oral antibiotic prophylaxis may reduce PJI rates in patients at high risk for infection following TJA and appears to be cost-effective. However, the current evidence supporting this practice is limited in quality. The use of extended oral antibiotic prophylaxis should be weighed against the possible development of future antimicrobial resistance, which may change the value proposition.
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Affiliation(s)
- Sophie Lipson
- Tufts University School of Medicine, Boston, Massachusetts
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Mariano E Menendez
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Eric L Smith
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts
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13
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Warburton G, Mercuri LG. Alloplastic Reconstruction of the Temporomandibular Joint in Patients with Dentofacial Deformities. Atlas Oral Maxillofac Surg Clin North Am 2022; 30:223-233. [PMID: 36116882 DOI: 10.1016/j.cxom.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gary Warburton
- Oral & Maxillofacial Surgery, University of Maryland School of Dentistry, 650 West Baltimore Street, Room 1209, Baltimore, MD 21201, USA.
| | - Louis G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 W Harrison St, Chicago, IL 60612, USA
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14
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Pullen WM, Money AJ, Ray TE, Freehill MT, Sherman SL. Postoperative Infection: Prevention, Diagnosis, and Treatment Guidelines for the Sports Surgeon. Sports Med Arthrosc Rev 2022; 30:17-23. [PMID: 35113838 DOI: 10.1097/jsa.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postoperative infection remains a potentially devastating complication facing the sports medicine surgeon. Infection prevention begins with a thorough history and physical examination to identify patient specific risk factors and aid in risk stratification. Perioperative steroid injections should be used cautiously, with increased time prior to or following surgery being associated with lower infection risk. Sterile preparation with an alcohol containing solution is typically preferred, though there is limited evidence to identify which product is superior. Diagnosis can be challenging with a high index of suspicion needed to identify and appropriately manage patients. Treatment involves prompt irrigation and debridement with deep cultures. Antibiotic coverage should begin with empiric broad treatment and be tailored based on culture results. Early consultation with an infectious disease specialist is recommended to ensure appropriate antibiotic coverage and duration of treatment.
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Affiliation(s)
- W Michael Pullen
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
| | - Adam J Money
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA
| | - Taylor E Ray
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | | | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
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15
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Christopher ZK, Deckey DG, Pollock JR, Spangehl MJ. Antiseptic Irrigation Solutions Used in Total Joint Arthroplasty: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202203000-00005. [PMID: 35231016 DOI: 10.2106/jbjs.rvw.21.00225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» There are limited data that directly compare the efficacy of antiseptic irrigation solutions used for the prevention and treatment of periprosthetic joint infections in orthopaedic procedures; there is a notable lack of prospective data. » For prevention of periprosthetic joint infections, the strongest evidence supports the use of low-pressure povidone-iodine. » For the treatment of periprosthetic joint infections, delivering multiple solutions sequentially may be beneficial.
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16
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What Is the Duration of Irrigation? An In Vitro Study of the Minimum Exposure Time to Eradicate Bacteria With Irrigation Solutions. J Arthroplasty 2022; 37:385-389.e2. [PMID: 34740788 DOI: 10.1016/j.arth.2021.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Antiseptic irrigation solutions are commonly used by arthroplasty surgeons to reduce intraoperative bacterial colonization with the goal of reducing postoperative infections in the setting of primary total joint arthroplasty. Currently, the minimum irrigation time to eliminate common microbes implicated in periprosthetic joint infection is unknown. We sought to determine the minimum effective exposure time required to prevent growth of Staphylococcus aureus, Staphylococcus epidermidis, and Cutibacterium acnes with common antiseptic solutions. METHODS S aureus, S epidermidis, and C acnes cultures were treated with povidone-iodine (0.35%), chlorhexidine (0.05%), sodium hypochlorite (0.5%), polyhexamethylene biguanide, and an acetic acid-based solution for 15, 30, 60, 90, and 120 seconds in triplicate. Bacterial growth was quantified using the drop plate method. Failure to eliminate all bacteria was considered "not effective" at that time point. RESULTS Povidone-iodine 0.35% (Betadine), sodium hypochlorite 0.5% (HySept), and acetic acid (Bactisure) eradicated all bacterial growth after 90 seconds of treatment, and as low as 15 seconds in S aureus and C acnes (Betadine) or S epidermidis (Bactisure). Polyhexamethylene biguanide (Prontosan) required 90 seconds for elimination of S aureus and S epidermidis, and 120 seconds for C acnes. Chlorhexidine 0.05% (Irrisept) did eliminate S epidermidis at 120 seconds but did not effectively eradicate S aureus or C acnes. CONCLUSION All tested antiseptic solutions demonstrated successful eradication of all bacterial growth in under 2 minutes of treatment time except chlorhexidine. Povidone-iodine may require the shortest duration of treatment time to successfully eradicate common bacteria.
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17
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Use of Adjunct Antiseptic Agents in Periprosthetic Joint Infections. J Am Acad Orthop Surg 2021; 29:e1151-e1158. [PMID: 34520439 DOI: 10.5435/jaaos-d-21-00154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/05/2021] [Indexed: 02/01/2023] Open
Abstract
Periprosthetic joint infection is a leading cause for failure of contemporary total hip arthroplasty and total knee arthroplasty projected to nearly double in the next decade and reach an economic burden of $1.85 billion in the United Sates by 2030. Although multiple treatments for periprosthetic joint infection have been described, a thorough débridement and joint lavage to decrease bacterial bioburden and to remove biofilm remains a critical component of treatment. Various adjunct antiseptic agents such as chlorhexidine, povidone-iodine, hydrogen peroxide, acetic acid, and chlorine compounds are currently in off-label use in this capacity. Each antiseptic agent, however, has a distinct mechanism of action and targets different organisms, and some combinations of agents may lead to tissue toxicity. In this review, currently available adjunct antiseptic washes will be described in detail based on their mechanism of action and the evidence for their use will be reviewed. Furthermore, this review puts forward an evidence-based treatment algorithm based on the specific causative organism.
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18
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Siddiqi A, Abdo ZE, Rossman SR, Kelly MA, Piuzzi NS, Higuera CA, Schwarzkopf R, Springer BD, Chen AF, Parvizi J. What Is the Optimal Irrigation Solution in the Management of Periprosthetic Hip and Knee Joint Infections? J Arthroplasty 2021; 36:3570-3583. [PMID: 34127346 DOI: 10.1016/j.arth.2021.05.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Thorough irrigation and debridement using an irrigation solution is a well-established treatment for both acute and chronic periprosthetic joint infections (PJIs). In the absence of concrete data, identifying the optimal irrigation agent and protocol remains challenging. METHODS A thorough review of the current literature on the various forms of irrigations and their additives was performed to evaluate the efficacy and limitations of each solution as pertaining to pathogen eradication in the treatment of PJI. As there is an overall paucity of high-quality literature comparing irrigation additives to each other and to any control, no meta-analyses could be performed. The literature was therefore summarized in this review article to give readers concise information on current irrigation options and their known risks and benefits. RESULTS Antiseptic solutions include povidone-iodine, chlorhexidine gluconate, acetic acid, hydrogen peroxide, sodium hypochlorite, hypochlorous acid, and preformulated commercially available combination solutions. The current literature suggests that intraoperative use of antiseptic irrigants may play a role in treating PJI, but definitive clinical studies comparing antiseptic to no antiseptic irrigation are lacking. Furthermore, no clinical head-to-head comparisons of different antiseptic irrigants have identified an optimal irrigation solution. CONCLUSION Further high-quality studies on the optimal irrigation additive and protocol for the management of PJI are warranted to guide future evidence-based decisions.
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Affiliation(s)
- Ahmed Siddiqi
- A Division of Ortho Alliance NJ, Orthopaedic Institute of Central Jersey, Manasquan, NJ; Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ; Department of Orthopedic Surgery, Jersey Shore University Medical Center, Neptune, NJ
| | - Zuhdi E Abdo
- Department of Orthopedics, Rutgers New Jersey Medical School, Newark, NJ
| | - Stephen R Rossman
- Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Michael A Kelly
- Department of Orthopedic Surgery, Hackensack Meridian Health, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Carlos A Higuera
- Department of Orthopedic Surgery, Cleveland Clinic Florida, Weston, FL
| | - Ran Schwarzkopf
- Department of Orthopedics, New York University Langone Medical Center, New York, NY
| | - Bryan D Springer
- Department of Orthopedics, Atrium Musculoskeletal Institute, OrthoCarolina Hip and Knee Center, Charlotte, NC
| | - Antonia F Chen
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Javad Parvizi
- Department of Orthopedics, Rothman Orthopedics, Philadelphia, PA
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19
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Hashmi Y, Zhou AK, Jawaid A, Zhou AY, Shah V, Thahir A, Krkovic M. The role of acetic acid in orthopaedic surgery. J Perioper Pract 2021; 32:162-166. [PMID: 34310234 PMCID: PMC9149521 DOI: 10.1177/17504589211015629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acetic acid has become more commonly used in orthopaedic surgery. The purposed roles
include biofilm eradication and surgical debridement, postoperative scar reduction and
managing soft tissue injuries. Current research is scarce and does not provide conclusive
evidence behind acetic acid’s efficacy in orthopaedic procedures such as biofilm
eradication or acetic acid iontophoresis in soft tissue injuries. Current literature on
acetic acid’s effects on biofilm eradication is composed of in-vitro studies, which do not
demonstrate the potential clinical efficacy of acetic acid. Acetic acid iontophoresis is a
novel technique which is now more commonly accepted for soft tissues injuries. Our
literature search identified calcifying tendonitis of the shoulder, rotator cuff
tendinopathy, heel pain syndrome, plantar fasciitis, achilles tendonitis, calcifying
tendonitis of the ankle, myositis ossificans and cervical spondylosis as documented
clinical uses. In this narrative review, we present the current uses of acetic acid and
acetic acid iontophoresis, while evaluating the evidence revolving around its efficacy,
benefits and risks.
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Affiliation(s)
- Yousuf Hashmi
- College of Medical and Dental Sciences, University of Birmingham, School
of Medicine, Birmingham, UK
- Yousuf Hashmi, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, UK.
| | | | - Anam Jawaid
- College of Medical and Dental Sciences, University of Birmingham, School
of Medicine, Birmingham, UK
| | - Anli Yue Zhou
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Vianca Shah
- Natural Science Department, University of Cambridge, Cambridge, UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit,
Cambridge University Hospitals, Cambridge, UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit,
Cambridge University Hospitals, Cambridge, UK
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20
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Siddiqi A, Abdo ZE, Springer BD, Chen AF. Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections. J Bone Jt Infect 2021; 6:189-198. [PMID: 34109103 PMCID: PMC8182666 DOI: 10.5194/jbji-6-189-2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 12/23/2022] Open
Abstract
Irrigation and debridement in the treatment of periprosthetic joint infection
(PJI) serve an integral role in the eradication of bacterial burden and
subsequent re-infection rates. Identifying the optimal irrigation agent,
however, remains challenging, as there is limited data on superiority.
Direct comparison of different irrigation solutions remains difficult
because of variability in treatment protocols. While basic science studies
assist in the selection of irrigation fluids, in vitro results do not directly
translate into clinical significance once implemented in vivo. Dilute
povidone iodine, hydrogen peroxide, chlorhexidine gluconate, acetic acid,
sodium hypochlorite, hypochlorous acid, and preformed combination solutions
all have potential against a broad spectrum of PJI pathogens with their own
unique advantages and disadvantages. Future clinical studies are needed to
identify ideal irrigation solutions with optimal bactericidal properties and
low cytotoxicity for PJI treatment.
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Affiliation(s)
- Ahmed Siddiqi
- Orthopaedic Institute of Central Jersey, a division of Ortho Alliance NJ, 2315 Route 34 South Manasquan, NJ 08736, USA.,Hackensack Meridian School of Medicine, Department of Orthopedic Surgery, Hackensack, NJ, USA.,Jersey Shore University Medical Center, Department of Orthopedic Surgery, Neptune, NJ, USA
| | - Zuhdi E Abdo
- Rutgers New Jersey Medical School, Department of Orthopedics, Newark, NJ, 07103, USA
| | - Bryan D Springer
- OrthoCarolina Hip and Knee Center, Department of Orthopedics Atrium Musculoskeletal Institute, Charlotte, NC, 28207, USA
| | - Antonia F Chen
- Brigham & Women's Hospital, Department of Orthopedics, Boston, MA, 02115, USA
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21
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Cawthorne DP, Castillo TE, Sivakumar BS. Effect of commonly used surgical solutions on the tensile strength of absorbable sutures: an in-vitro study. ANZ J Surg 2021; 91:1451-1454. [PMID: 33928746 DOI: 10.1111/ans.16908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Within recent decades the use of various surgical solutions to prevent bleeding, ward off infection or decrease post-operative pain has become common-place in orthopaedic procedures. However, little work has been done to determine the effects that these solutions have on the tensile strength of various sutures, particularly those that are used for deep closures, which are often absorbable in nature. Whilst numerous authors have attempted to reach conclusions regarding the nature of these effects, a consensus has yet to be reached and this paper is designed with the aim to contribute to the current literature on the subject and improve surgical practice. METHODS This in-vitro study incubated three different surgical sutures in five commonly used surgical solutions at 37°C for 30 min, prior to applying a constant increase in force to determine the effects these solutions have on tensile strength. A control set was included. RESULTS No significant difference was found in the tensile strength of Vicryl and PDS-II sutures, whilst Monocryl incubated in chlorhexidine exhibited a borderline significant increase in tensile strength. CONCLUSIONS Common surgical solutions used on orthopaedic procedures can impact on the tensile strength of suture materials; however, further research is required on the subject.
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Affiliation(s)
- Donald P Cawthorne
- Department of Orthopaedic Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Tiana E Castillo
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia
| | - Brahman S Sivakumar
- Department of Orthopaedic Surgery, Hornsby Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia.,Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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22
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Hernandez CJ. Musculoskeletal microbiology: The utility of the microbiome in orthopedics. J Orthop Res 2021; 39:251-257. [PMID: 33245146 PMCID: PMC7855812 DOI: 10.1002/jor.24927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 02/04/2023]
Abstract
The past 15 years have witnessed a renaissance in the study of the microbes that colonize the human body. The vast majority of the human microbiome resides within the gut. Alterations to the gut microbiome have been associated with the pathogenesis and progression of wide-ranging diseases throughout the body-including atherosclerosis, depression, and obesity. Our understanding of the effects of the gut microbiome on the musculoskeletal system remains in its infancy, but preclinical work has demonstrated an effect of the gut microbiome on the success of orthopedic surgical procedures, osteoporosis, osteoarthritis, and muscle mass. In this perspective I review preclinical findings demonstrating that an impaired presurgical gut microbiome can increase the likelihood of developing periprosthetic joint infection and how alterations in the gut microbiome can reduce bone strength by impairing bone tissue material properties. In addition to discussing these examples, I review the hypothesis that many chronic non-communicable diseases have become more prevalent in modern industrialized societies as a result of changes in the composition of the gut microbiome resulting from changes in environment/lifestyle (diet, sanitation, antibiotic use). The most burdensome musculoskeletal disorders are chronic and non-communicable and may therefore be related to generational shifts in the composition of the gut microbiome, a possibility I illustrate by reviewing changes in the prevalence of osteoarthritis over the last century. Microbiome-based therapeutics are potentially innocuous, inexpensive, and have the potential to be effective with only occasional use, making them attractive for addressing the needs of chronic and/or slowly progressing musculoskeletal disorders.
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Affiliation(s)
- Christopher J Hernandez
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
- Hospital for Special Surgery, New York, New York, USA
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23
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Bloom GB, Mears SC, Edwards PK, Barnes CL, Stambough JB. Total Knee Periprosthetic Joint Infection in the Setting of Hematologic Malignancy: Considerations for Management. Arthroplast Today 2020; 6:309-315. [PMID: 32514420 PMCID: PMC7267679 DOI: 10.1016/j.artd.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/20/2022] Open
Abstract
Patients with malignancy are often profoundly immunocompromised due to chemotherapy, placing them at potential increased risk for periprosthetic joint infection (PJI). However, there is little information regarding PJI management in these patients. We describe 4 patients with a history of primary total knee arthroplasty followed by diagnosis of multiple myeloma or Waldenström macroglobulinemia who received chemotherapy within 4 months prior to PJI. The Musculoskeletal Infection Society major and minor criteria and either debridement, antibiotics, and implant retention or a 2-stage approach appear to be effective for acute or chronic PJI, respectively. We recommend an anticoagulant be administered concomitantly with antineoplastics that significantly increase deep vein thrombosis risk, and we recommend long-term oral suppressive antibiotics postoperatively, especially if chemotherapy will be resumed. Additional studies are needed to investigate risks and benefits of PJI prophylaxis during chemotherapy and long-term suppressive antibiotics after PJI treatment.
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Affiliation(s)
- G Barnes Bloom
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Paul K Edwards
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - C Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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