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Luo H, He C, Zhao Y, Yang G, Hong H. Outcomes of single- vs two-stage primary joint arthroplasty for septic arthritis: a systematic review and meta-analysis. EFORT Open Rev 2023; 8:672-679. [PMID: 37655848 PMCID: PMC10548305 DOI: 10.1530/eor-22-0142] [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] [Indexed: 09/02/2023] Open
Abstract
Purpose Septic arthritis (SA) is an intra-articular infection caused by purulent bacteria and the only effective method is surgical intervention. Two-stage arthroplasty is considered the gold standard treatment for SA, but recent studies have found that single-stage arthroplasty can achieve the same efficacy as two-stage arthroplasty. This study aimed to compare the efficacy of single- vs two-stage arthroplasty in the treatment of (acute or quiescent) SA. Methods The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, EMBASE, Medline, and Cochrane Library databases to identify all literature on the treatment of SA using single- and two-stage arthroplasty from the date of database inception to November 10, 2022. Data on reinfection rates were expressed as odds ratios and 95% CIs. Results Seven retrospective studies with a total of 413 patients were included. Pooled analysis showed no difference in the reinfection rate between single- and two-stage arthroplasty. Subgroup analysis found no difference between the single- and two-stage arthroplasty groups in the incidence of purulent infection of the hip and knee. Cumulative meta-analysis showed gradual stabilization of outcomes. Conclusions Based on our meta-analysis of available retrospective studies, we found no significant difference in reinfection rates between single- and two-stage arthroplasty for SA. Further prospective cohort studies are needed to confirm our results, although our meta-analysis provides important insights into the current literature on this topic.
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Affiliation(s)
- Hua Luo
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Congcong He
- Department of Psychology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Yong Zhao
- Department of Orthopedics, Shanghai Fengxian District Central Hospital, Shanghai, China
| | - Guangyong Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Hainan Hong
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China
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Campbell DG, Poonnoose PM, Oommen AT, Natesan R. Perception of Perioperative Risk for Arthroplasty Patients: A Poll of Indian Orthopedic Surgeons. J Arthroplasty 2023:S0883-5403(23)00095-5. [PMID: 36773665 DOI: 10.1016/j.arth.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND A survey of the American Association of Hip and Knee Surgeons (AAHKS) reported that 95% of respondents attempted to modify risk factors prior to arthroplasty. This study investigated Indian arthroplasty surgeons' approach to patients who have modifiable risk factors. METHODS The AAHKS survey tool was adapted for Indian surgeons and distributed to the membership of the Indian Society of Hip and Knee Surgeons and Indian Arthroplasty Association via a Survey Monkey. A total of 92 survey responses were received, representing a response rate of 12%. RESULTS Overall, 87% of respondents restricted access to arthroplasty surgery for patients who have modifiable risk factors, but only 51% of respondents reported delays or restricted treatment because of risk factors. Respondents reported that financial implications were more likely to delay or restrict treatment in 97% and social/family reasons in 66%. Poor diabetic control (81%), previous infection (57%), and malnutrition/hypoalbuminemia (47%) were the most frequent modifiable risk factors. There were 82% of surgeons reporting that the patient's socioeconomic status influenced treatment including: 71% of patients who have low socioeconomic status, 57% who do not have insurance, and 45% who have limited social supports. Most surgeons (92%) reported that funding influenced the type of care provided and the choice of implants. CONCLUSION Over 97% of Indian arthroplasty surgeons thought socioeconomic factors impaired access to orthopaedic treatment. Only half the surgeons restricted access for comorbidities and these were more often related to infection risks and diabetes. These findings contrast dramatically to the practice patterns of American AAHKS members.
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Affiliation(s)
- David G Campbell
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
| | - Pradeep M Poonnoose
- Department of Orthopaedics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anil T Oommen
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Rajkumar Natesan
- Department of Joint Replacement Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Dubin JA, Chen Z, Bains SS, Hameed D, Mont MA, Delanois RE, Nace J. Less Than 1-Year Quiescent Period After Septic Arthritis of the Hip is Associated With High Risk of Periprosthetic Joint Infection Following Total Hip Arthroplasty. J Arthroplasty 2022; 38:930-934.e1. [PMID: 36436706 DOI: 10.1016/j.arth.2022.11.004] [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: 09/02/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Approximately 20,000 patients are diagnosed with septic arthritis annually, with 15% specifically affecting the hip joint. These cases exacerbate arthritic changes, often warranting a total hip arthroplasty (THA). Given their prior history of infection, these patients are predisposed to subsequent periprosthetic joint infections (PJIs). Multiple studies suggest delaying THA after a native septic hip, but no study utilizing a large cohort examined the specific timing to mitigate post-THA PJI risk within a short (<1 year) quiescent period after septic arthritis. We sought to compare patients who were diagnosed with septic hip arthritis at time intervals (0-6, or 6-12 months) prior to an ipsilateral primary THA to a cohort of THA patients who never had a septic hip history. Specifically, we assessed: from 90 days to 2 years (1) revisions due to PJI and (2) associated risk factors for PJI at 2-years. METHODS A national, all-payer database was queried to identify all patients who underwent a primary THA between 2010 and 2021 and patients who had prior ipsilateral septic hip arthritis were characterized using International Classification of Disease and Current Practice Terminology codes (n = 1,052). A randomized sample of patients who never had a history of septic arthritis prior to undergoing THA was used as a nonseptic group comparison (n = 5,000). The incidences of PJI at 90 days through two years were then identified and compared using bivariate chi-square analyses. Risk factors for post-THA PJIs were then analyzed using multivariate regression models. RESULTS The septic arthritis cohorts were more likely to require revisions due to PJIs, as compared to the non-septic group at 90 days, 1 year, and 2 years (all P < .0001). Patients who were diagnosed with septic arthritis between 0 and 6 months prior to THA were at greater PJI risk at both one-year (odds ratio (OR) of 43.1 versus 29.6, P < .0001) and two years (OR of 38.3 versus 22.1, P < .0001) compared to patients who had diagnoses between 6 and 12 months. Diabetes mellitus, obesity, and tobacco use were associated risk factors for PJIs at 2 years in the septic hip cohort in comparison to the cohort without a septic hip history. CONCLUSION Less than a 1-year quiescent period after septic arthritis is associated with a 38 times increased risk and a 22 times risk for post-THA PJI, at 0 and 6 months and 6 and 12 months, respectively. Though patients who undergo THA greater than 6 months after their septic arthritis treatment have a decreased risk compared to those between 0 and 6 months the risks are still high. Orthopaedic surgeons should be aware of the increased risks of PJIs when considering performing a THA in patients with a history of septic arthritis.
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Affiliation(s)
- Jeremy A Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Portier E, Zeller V, Kerroumi Y, Heym B, Marmor S, Chazerain P. Arthroplasty after septic arthritis of the native hip and knee: retrospective analysis of 49 joints. J Bone Jt Infect 2022; 7:81-90. [PMID: 35464147 PMCID: PMC9022469 DOI: 10.5194/jbji-7-81-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/26/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract. Background: Arthroplasty after septic arthritis (SA) treatment raises
diagnostic and therapeutic questions. The main objective was to evaluate
infection-free survival of patients undergoing total knee arthroplasty (TKA) or total hip
arthroplasty (THA) post-SA. Other objectives were to describe the
population's characteristics, surgical strategies, results of preoperative
examinations and cultures of intraoperative samples taken at implantation,
and postoperative antibiotic therapy.
Methods: This is a retrospective, observational, monocenter study, from January 2005 to May 2019, including all patients undergoing TKA or THA with prior or ongoing SA
in the same joint. Infection–free survival was analyzed and reported.
Results: Forty-seven patients, 29 men, 49 joints operated on (30 knees, 19 hips),
were included. Median SA-to-arthroplasty interval was 32 [1–216] weeks. It
was <2 years for 43 joints and <6 months for 19 joints. Six
patients underwent arthroplasty while still on SA treatment. One-stage
arthroplasty was done for 43 joints and two-stage arthroplasty for 6 joints. Eight (16 %)
cultures of intraoperative specimens were positive. Median durations of
postoperative antibiotic therapy were 10 d for sterile cultures and 82 d for those that were positive. At 2 years, infection-free survival rate was
95.9 % (±0.02). After a median follow-up of 47 [18–142] months, no SA
relapse was observed, but five patients developed new periprosthetic joint infections (PJIs) with a different
microorganism.
Conclusion: Arthroplasty may be a post-SA option, even within a short period of time.
One-stage arthroplasty can be done if synovectomy is thorough,
intraoperative samples are taken and antibiotics are administered until those
culture results become available. We observed no SA relapse, but new PJIs
occurred.
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Affiliation(s)
- Elodie Portier
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Rhumatologie, Groupe Hospitalier Diaconesses Croix
Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Médecine interne et Infectiologie, Groupe
Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier
Diaconesses Croix Saint-Simon, Paris, France
| | - Beate Heym
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier
Diaconesses Croix Saint-Simon, Paris, France
| | - Pascal Chazerain
- Centre de Référence des Infections Ostéo-Articulaires
Complexes (CRIOAC), Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris,
France
- Service de Rhumatologie, Groupe Hospitalier Diaconesses Croix
Saint-Simon, Paris, France
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Fontalis A, Berry DJ, Shimmin A, Slullitel PA, Buttaro MA, Li C, Malchau H, Haddad FS. Prevention of early complications following total hip replacement. SICOT J 2021; 7:61. [PMID: 34851264 PMCID: PMC8634898 DOI: 10.1051/sicotj/2021060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/29/2021] [Indexed: 01/01/2023] Open
Abstract
Total hip arthroplasty (THA) has been quoted as "the operation of the century", owing to its efficacy and the substantial improvements evidenced with respect to functional patient outcomes and quality of life. However, early postoperative complications are often inevitable, hence it is imperative to take every step to prevent them and minimise morbidity and mortality. This manuscript focuses on the most common early complications following THA, namely venous thromboembolism (VTE), prosthetic joint infection, periprosthetic fracture, instability, and leg length inequality. It aims to outline effective risk stratification strategies and prevention measures that could apply to the wider Orthopaedic community.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK - University College London, Division of Surgery and Interventional Science, Gower Street, London, WC1E 6BT, UK
| | | | - Andrew Shimmin
- Melbourne Orthopaedic Group, Windsor, Victoria 3181, Australia - Monash University, Windsor, Ontario N9B 3P4, Australia
| | - Pablo A Slullitel
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Martin A Buttaro
- Institute of Orthopaedics "Carlos E. Ottolenghi", Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Cao Li
- Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, 137 South LiYuShan Road, Urumqi, Xinjiang 830054, China
| | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK - University College London, Division of Surgery and Interventional Science, Gower Street, London, WC1E 6BT, UK
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