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Egerci OF, Yapar A, Dogruoz F, Selcuk H, Kose O. Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05301-w. [PMID: 38635048 DOI: 10.1007/s00402-024-05301-w] [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: 11/12/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.
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Affiliation(s)
- Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey.
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de Araujo LCT, Westerholt A, Sandiford AN, Gursche A, Kendoff D. Periprosthetic joint infections in patients with rheumatoid arthritis are associated with higher complication and mortality rates. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05248-y. [PMID: 38502248 DOI: 10.1007/s00402-024-05248-y] [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: 09/02/2023] [Accepted: 02/17/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) remains the most devasting complication after total joint arthroplasty (TJA). There has been a significant focus on this topic in recently-published medical literature. However, relatively little has been published about PJI in patients with rheumatoid arthritis (RA), which are often physiologically frail and immunocompromised. A better understanding of PJI in this patient population is therefore crucial. The main aims of this paper are to (1) report complication and mortality rates in a cohort of PJI-RA patients; and (2) clinically characterize them. METHODS Medical and surgical records of all RA PJI patients treated surgically from 2003 to 2020 were retrospectively reviewed. Medical history, physical examination, reactive protein (CRP) level, procalcitonin, white blood cell (WBC) count, joint aspiration results, and cultures were used to determine PJI. RESULTS 54PJIs, 49 of them chronic, were treated in 53RA patients. Mean patient age was 65 yrs. (range = 32-88); 33females and 20 males (one bilateral hip). The overall mortality rate was 18.9%(n = 10), with five deaths directly attributed to PJI. Staphylococci accounted for 34 infections (63%), while 11(20.4%) had multiorganism infections and six culture-negative PJI. At the end of treatment 79.6%(n = 43) still had an implanted TJR, 7.4% (n = 4) had spacers, 5.6%(n = 3) had undergone resection arthroplasty, 3.7%(n = 2) arthrodesis, and one each amputation and exarticulation. CONCLUSIONS Mortality and specially complication rates were (are) high in this RA patients group presenting PJI. Delays to diagnosis and treatment may explain some of these poor outcomes. LEVEL OF EVIDENCE A cohort level III retrospective study.
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Affiliation(s)
- Lucio Cappelli Toledo de Araujo
- Department of Orthopaedic Surgery, ENDO Klinik Buch, Berlin, Germany.
- Regional Hospital Dr. Homero Miranda Gomes, São José, Santa Catarina, Brazil.
| | - Anette Westerholt
- Department of Orthopaedic Surgery, ENDO Klinik Buch, Berlin, Germany
| | | | - Angelika Gursche
- Department of Orthopaedic Surgery, ENDO Klinik Buch, Berlin, Germany
| | - Daniel Kendoff
- Department of Orthopaedic Surgery, ENDO Klinik Buch, Berlin, Germany
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Kheir M, Anderson C, Chiu YF, Carli A. Do one-stage indications predict success following two-stage arthroplasty for chronic periprosthetic joint infection? J Bone Jt Infect 2024; 9:75-85. [PMID: 38600996 PMCID: PMC11002939 DOI: 10.5194/jbji-9-75-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/14/2023] [Indexed: 04/12/2024] Open
Abstract
Introduction: The 2018 International Consensus Meeting (ICM) proposed criteria for one-stage exchange arthroplasty in treating periprosthetic joint infection (PJI). Our study aimed to determine what proportion of PJI patients met the 2018 ICM criteria and how this affected infection-free survivorship for patients. Methods: All chronic PJI patients treated with two-stage exchange within our institution between 2017-2020 were retrospectively reviewed. Included cases met 2011 Musculoskeletal Infection Society (MSIS) criteria for PJI and had a 2-year minimum follow-up. Treatment success was defined as Tier 1A in the 2019 MSIS working group definition. ICM one-stage criteria included non-immunocompromised host, absence of sepsis, adequate soft tissue for closure, known preoperative pathogen, and susceptibility. Immunocompromised host was analyzed as two separate definitions. Kaplan-Meier survivorship, Cox regression, and univariate analyses were performed. Results: A total of 293 chronic PJI patients were included. Overall, treatment failure occurred in 64 / 293 (21.8 %) patients. Only 13 % (n = 37 ) met ICM criteria definition no. 1 for one-stage exchange; 12 % (n = 33 ) met definition no. 2. In both definitions, infection-free survivorship at 2 years did not differ between patients who met and did not meet criteria (p > 0.05 ). Cox proportional hazard regression analyses demonstrated that the only variable predicting treatment failure was knee joint involvement (p = 0.01 ). Conclusions: We found that a very limited number of chronic PJI patients were suitable for a one-stage exchange. Furthermore, the supposition that healthier hosts with known pathogens (the basis of the ICM criteria) yield better PJI treatment outcomes was not observed. These results justify the ongoing multicenter randomized control trial comparing one-stage versus two-stage treatment for chronic PJI.
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Affiliation(s)
- Michael M. Kheir
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher G. Anderson
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Yu-Fen Chiu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Alberto V. Carli
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Alswerki MN, AlRaie LA, Aladwan D, Alabed Y, Ibrahim A, Aburumman R, Shaf'ei M, Sharayah M, Qaraqesh MA, Al-Juboori MA, Haddad BI, Alajlouni J. Total hip arthroplasty for adult patients with hip arthritis in Jordan: clinical profiles and patient characteristics. INTERNATIONAL ORTHOPAEDICS 2024; 48:71-78. [PMID: 38051384 DOI: 10.1007/s00264-023-06053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/26/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE Total Hip Arthroplasty (THA) is one of the most commonly performed orthopaedic surgeries, with hip arthritis being the main indication. This procedure is usually performed when other non-surgical methods fail to relieve patients' hip pain and improve their quality of life. However, limited information exists to identify and compare the demographics and clinical characteristics of patients undergoing this procedure in Jordan. This study aims to identify these demographic and clinical characteristics and compare the findings in terms of gender differences. METHODOLOGY This is a retrospective study that analysed the hospital records of 650 patients undergoing THA in tertiary referral hospital in Jordan over a four-year period from January 2019 to December 2022. The collected data were classified into three categories: demographic characteristics, perioperative variables, and patients' related health profiles. IBM's Statistical Package for the Social Sciences (SPSS) version 23 software (IBM, USA) and descriptive analysis were used for data analysis. RESULTS Two-thirds of the sample studied were female (63.4%). In terms of bleeding profiles, the mean intraoperative blood loss was 542 millilitres. The major indication for THA was degenerative hip arthritis (50.5%), followed by hip dysplasia (40.3%).. Comparing the findings of the two gender groups, females were more likely to have degenerative and dysplastic hip arthritis (221 and 157, p = 0.04 and p = 0.1, respectively) when compared to males. Although males were more likely to lose more blood during the surgery (557 ml vs. 533 ml, p = 0.33, females needed more blood transfusions both during (21 vs. 6 patients, p = 0.12) and after the surgery (57 vs. 16 patients, p = 0.006). Furthermore, females were more likely to have comorbidities such hypertension (293 vs. 179 patients, p = 0.20), and hypothyroidism (313 vs 187, p = 0.36), and diabetes (85 vs. 38 patients, p = 0.15), among many other health conditions. However, in the study sample, male smokers outnumbered female smokers (132 vs. 63). CONCLUSION Gender highly impacted the immediate surgical outcomes of patients who underwent THA. Females were more likely to need blood transfusions both during and after the surgery and had lower post-operative haemoglobin readings. In addition, females had more comorbidities and degenerative hip osteoarthritis. We believe that raising awareness about comorbidity management, preoperative smoking cessation, and perioperative blood transfusion management can improve medical and surgical outcomes.
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Affiliation(s)
- Mohammad N Alswerki
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: (13046), Amman, 11942, Jordan.
| | - Lana A AlRaie
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Deema Aladwan
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Yasmeen Alabed
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Alia Ibrahim
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Razan Aburumman
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Moayad Shaf'ei
- Jordan University Hospital, The University of Jordan, Amman, Jordan
| | | | | | | | - Bassem I Haddad
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: (13046), Amman, 11942, Jordan
| | - Jihad Alajlouni
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: (13046), Amman, 11942, Jordan
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Aljuhani WS, Alanazi AM, Saeed AI, Alhadlaq KH, Alhoshan YS, Aljaafri ZA. Patient-related risk factors of prosthetic joint infections following total hip and knee arthroplasty at King Abdulaziz Medical City, a 10-year retrospective study. J Orthop Surg Res 2023; 18:717. [PMID: 37736732 PMCID: PMC10514936 DOI: 10.1186/s13018-023-04210-9] [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: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA) can be associated with the development of periprosthetic joint infection (PJI). It is necessary to determine the modifiable and non-modifiable risk factors of PJI to provide optimum healthcare to TJA candidates. METHODS This single-center retrospective review investigated 1198 patients who underwent TJA from 2012 to 2022. The data analysis comprised two stages. The first stage was a descriptive analysis, while the second stage was a bivariate analysis. The sociodemographic data, medical history, operative details, and presence of PJI postoperatively were evaluated. RESULTS The study sample consisted of 1198 patients who underwent TJA. The mean patient age was 63 years. Among the patients, only 1.3% had PJI. No comorbidity was significantly related to PJI. General anesthesia was used in almost 21% of the patients and was significantly associated with a higher risk of infection (p = 0.049). An increased operative time was also significantly related to PJI (p = 0.012). Conversely, tranexamic acid (TXA) administration was a protective factor against PJI (p = 0.017). CONCLUSION Although PJI is not a common complication of TJA, multiple risk factors such as general anesthesia and prolonged operative time play a significant role in its development. In contrast, TXA administration is thought to reduce the risk of PJI effectively.
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Affiliation(s)
- Wazzan S Aljuhani
- Department of Orthopedic Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah I Saeed
- Department of Orthopedic Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Khalid H Alhadlaq
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yazeed S Alhoshan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ziad A Aljaafri
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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de Buys M, Moodley K, Cakic JN, Pietrzak JRT. Staphylococcus aureus colonization and periprosthetic joint infection in patients undergoing elective total joint arthroplasty: a narrative review. EFORT Open Rev 2023; 8:680-689. [PMID: 37655845 PMCID: PMC10548302 DOI: 10.1530/eor-23-0031] [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
Peri-prosthetic joint infections (PJIs) following total joint arthroplasty (TJA) are associated with higher treatment costs, longer hospital admissions and increased morbidity and mortality. Colonization with Staphylococcus aureus is an independent and modifiable risk factor for PJIs and carriers of S. aureus are ten times more likely than non-carriers for post-operative infections. Screening and targeted decolonization, vs universal decolonization without screening, remains a controversial topic. We recommend a tailored approach, based on local epidemiological patterns, resource availability and logistical capacity. Universal decolonization is associated with lower rates of SSI and may reduce treatment costs.
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Affiliation(s)
- Michael de Buys
- Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa
| | | | - Josip Nenad Cakic
- Department Orthopaedic Surgery, Life Fourways Hospital, Johannesburg, South Africa
| | - Jurek R T Pietrzak
- Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa
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Seutz Y, Bäcker H, Akgün D, Adelhoefer S, Kriechling P, Gonzalez MR, Karczewski D. Corynebacterium periprosthetic joint infection: a systematic review of 52 cases at 2.5 years follow-up. Arch Orthop Trauma Surg 2023; 143:5527-5538. [PMID: 36995473 PMCID: PMC10449657 DOI: 10.1007/s00402-023-04844-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/01/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION While large progress has been achieved in identifying and treating the most common pathogens involved in periprosthetic joint infections (PJI), there remains limited knowledge on atypical pathogens such as Corynebacterium. For that reason, we analyzed infection and diagnostical characteristics, as well as treatment outcome in Corynebacterium PJI. METHODS A systematic review was performed based on a structured PubMed and Cochrane Library analysis using the PRISMA algorithm. The search was performed by 2 independent reviewers, and articles from 1960 to 2022 considered eligible for inclusion. Out of 370 search results, 12 studies were included for study synthesis. RESULTS In total, 52 cases of Corynebacterium PJI were identified (31 knees, 16 hips, 4 elbows, 1 shoulder). Mean age was 65 years, with 53% females, and a mean Charlson Comorbidity Index of 3.9. The most common species was Corynebacterium striatum in 37 cases (71%). Most patients were treated with two-stage exchange (40%), isolated irrigation and debridement (21%), and resection arthroplasty (19%). Mean duration of antibiotic treatment was 8.5 weeks. At a mean follow-up of 2.5 years, there were 18 reinfections (33%), and 39% were for Corynebacterium. Initial infection by Corynebacterium striatum species was predictive of reoperation (p = 0.035) and reinfection (p = 0.07). CONCLUSION Corynebacterium PJI affects multimorbid and elderly patients, with one in three developing a reinfection at short term. Importantly, the relative majority of reinfections was for persistent Corynebacterium PJI.
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Affiliation(s)
- Yannick Seutz
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Henrik Bäcker
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Doruk Akgün
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Siegfried Adelhoefer
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Philipp Kriechling
- Department of OrthopaedicsBalgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Marcos R Gonzalez
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Daniel Karczewski
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany.
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Jeong S, Lee JW, Boucher HR. Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection-related Revisions After Primary THA. Clin Orthop Relat Res 2023; 482:00003086-990000000-01267. [PMID: 37458699 PMCID: PMC10723855 DOI: 10.1097/corr.0000000000002766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/12/2023] [Accepted: 06/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Symptomatic benign prostatic hyperplasia (sBPH) is a potential risk factor for periprosthetic joint infection (PJI), a leading cause of implant failure and revision THA. However, the available evidence is mixed on whether this is the case. QUESTIONS/PURPOSES (1) What is the prevalence of sBPH in male recipients of primary THA by age group? (2) Do patients with sBPH compared with those without sBPH have higher 30-day, 90-day, and 2-year odds of PJI and higher 30-day and 90-day odds of urinary catheterization, urinary tract infection (UTI), and sepsis after primary THA? (3) Do patients with sBPH compared with those without sBPH have lower survivorship free from PJI-related revision at 5 years after THA? METHODS The PearlDiver database was used as it provided the largest sample of patients across all payer types to perform longitudinal research. Between January 2010 and April 2021, 1,056,119 patients who underwent primary THA were identified. After applying the inclusion criteria (that is, male sex, minimum age of 18, and diagnosis of hip osteoarthritis) and exclusion criteria (that is, history of asymptomatic BPH or any other joint arthroplasty), 16% (172,866) of patients remained. A further 6% (59,500) of patients were excluded as they did not meet the minimum study follow-up of 2 years, leaving 11% (113,366) for analysis. Of those, patients with sBPH were matched to those without in a 1:4 ratio by age and comorbidities, including alcohol abuse, anemia, cardiovascular disorders, chronic pulmonary disease, diabetes mellitus, depression, obesity, peripheral vascular disorders, renal failure, and rheumatoid arthritis. Age and comorbidities of the two groups postmatch were balanced. Logistic regression was performed to analyze the odds for 30-day, 90-day, and 2-year postoperative complications. Survivorship free from PJI-related revision at 5 years after THA was estimated using the Kaplan-Meier method and compared with the log-rank test. RESULTS Among male recipients of primary THA ages 65 or older, 24% (11,319 of 47,426) had a medical history of sBPH. We found no difference in the odds of PJI at 30 days, 90 days, and 2 years after primary THA between the two groups. PJI occurred in 0.5% (62 of 11,819), 0.8% (97 of 11,819), and 1.3% (150 of 11,819) of patients with sBPH versus in 0.5% (227 of 47,103), 0.8% (360 of 47,103), and 1.2% (570 of 47,103) of those without sBPH within 30 days (OR 1.09 [95% CI 0.82 to 1.43]), 90 days (OR 1.07 [95% CI 0.85 to 1.34]), and 2 years (OR 1.05 [95% CI 0.87 to 1.25]) after THA, respectively. Patients with sBPH compared with those without had higher odds of 30-day and 90-day urinary catheterization (OR 5.00 [95% CI 3.64 to 6.88] and OR 5.36 [95% CI 4.04 to 7.13], respectively), 30-day and 90-day UTI (OR 2.18 [95% CI 1.88 to 2.54] and OR 2.55 [95% CI 2.26 to 2.87], respectively), and 30-day and 90-day sepsis (OR 1.55 [95% CI 1.11 to 2.13] and OR 1.43 [95% CI 1.10 to 1.83], respectively). We found no difference in survival free from PJI-related revision at 5 years after THA between patients with and without sBPH (98.3% [95% CI 98.1% to 98.6%] versus 98.1% [95% CI 98.1% to 98.2%]; p = 0.10). CONCLUSION sBPH is common among THA recipients, and surgeons should be aware of the added risk of postoperative urinary complications and sepsis in this subset that could lead to additional postoperative care requirements. Surgeons may consider perioperative measures such as preoperative use of short-form questionnaires to assess urinary symptoms, urology clearance or referral, and closer follow-up to improve care of sBPH patients undergoing THA. As currently available tools for assessing sBPH are limited and lack sensitivity as well as specificity, future studies may develop validated tools that can be used to quickly assess risk in sBPH patients before surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Suin Jeong
- Medstar Georgetown University, Washington, DC, USA
| | - Ji Won Lee
- MedStar Union Memorial Hospital, Baltimore, MD, USA
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Karczewski D, Bäcker H, Andronic O, Bedi A, Adelhoefer S, Müllner M, Gonzalez MR. Serratia marcescens prosthetic joint infection: two case reports and a review of the literature. J Med Case Rep 2023; 17:294. [PMID: 37386554 DOI: 10.1186/s13256-023-04021-w] [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: 02/22/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Despite some studies on Gram-negative bacteria as difficult to treat pathogens in periprosthetic joint infections, there are no detailed analyses on Serratia periprosthetic joint infections. As such, we present two cases of Serratia periprosthetic joint infections and summarize all known cases to date in the course of a PRISMA criteria-based systematic review. CASE PRESENTATION Case 1: a 72-year-old Caucasian female with Parkinson's disease and treated breast cancer developed periprosthetic joint infection caused by Serratia marcescens and Bacillus cereus, following multiple prior revisions for recurrent dislocations of her total hip arthroplasty. Two-stage exchange was performed, and the patient remained free of Serratia periprosthetic joint infection recurrence at 3 years. Case 2: an 82-year-old Caucasian female with diabetes and chronic obstructive pulmonary disease presented with a chronic parapatellar knee fistula after undergoing multiple failed infection treatments at external clinics. After performing two-stage exchange and gastrocnemius flap plastic for combined Serratia marcescens and Proteus mirabilis periprosthetic joint infection, the patient was released without any signs of infection, but was subsequently lost to follow-up. REVIEW a total of 12 additional Serratia periprosthetic joint infections were identified. Merged with our two cases, the mean age of 14 patients was 66 years and 75% were males. Mean length of antibiotic therapy was 10 weeks with ciprofloxacin most commonly used (50%). Mean follow-up was 23 months. There was a total of four reinfections (29%), including one case of Serratia reinfection (7%). CONCLUSIONS Serratia is a rare cause of periprosthetic joint infection affecting elderly with secondary diseases. While the overall reinfection rate was high, the risk of Serratia periprosthetic joint infection persistence was low. Treatment failure in patients may be attributable to the host, rather than the Serratia periprosthetic joint infection itself, thus challenging current concepts on Gram-negatives as a uniform class of difficult-to-treat pathogens. LEVEL OF EVIDENCE Therapeutic level IV.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany.
| | - Henrik Bäcker
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Angad Bedi
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Siegfried Adelhoefer
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Maximilian Müllner
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Marcos R Gonzalez
- Department of Orthopaedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Kelly JP, Bae AS, Taunton J, Jardaly A, Harris RM. Superficial Surgical Site Infections in Primary Total Joint Arthroplasty: A Retrospective Analysis of Topical Anti-Biofilm Therapy. Cureus 2023; 15:e39490. [PMID: 37362497 PMCID: PMC10290534 DOI: 10.7759/cureus.39490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Surgical site infections (SSI) following orthopedic procedures can cause significant morbidity and mortality, particularly in total joint arthroplasty. Biofilm formation in surgical wounds has made it difficult to prevent and treat these infections. SURGX® Antimicrobial Wound Gel (Next Science, Jacksonville, Florida, USA) was developed to disrupt biofilm formation but has not been evaluated in prophylactic use in total joint arthroplasty to prevent superficial SSI. Methods A retrospective chart review was performed at a single institution comparing the rate of SSI in patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). SSI data were collected from patients with standard postoperative dressings (Group A: Control) and patients with SURGX® applied as part of a standardized dressing following THA/TKA (Group B: Study). Rates of SSI were compared. Results SURGX® was administered to 120 patients, including 91 TKAs and 29 THAs. The overall infection rate in this cohort was 2.5%. No superficial site infections developed. The control group constituted 566 patients, with 386 TKAs and 180 THAs. The infection rate was 1.24%, which included one superficial infection. Binary logistic regression did not show different odds of developing infections with the use of SURGX® (OR = 2.23, 95% CI: 0.54-9.13, p = 0.27). Conclusion In our small retrospective study, Next Science SURGX® Antimicrobial Wound Gel did not demonstrate a statistically significant difference in the rate of superficial SSI in total joint arthroplasty; however, Group B did not have any superficial SSI.
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Affiliation(s)
- Joseph P Kelly
- Orthopaedic Surgery, The Hughston Foundation, Columbus, USA
- Orthopaedic Surgery, The Hughston Clinic, Columbus, USA
- Orthopaedic Surgery, Jack Hughston Memorial Hospital, Phenix City, USA
| | - Andrew S Bae
- Orthopaedic Surgery, Jack Hughston Memorial Hospital, Phenix City, USA
| | - Jacob Taunton
- Orthopaedic Surgery, The Hughston Clinic, Columbus, USA
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11
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Edmiston CE, Spencer M, Gunja NJ, Holy CE, Ruppenkamp JW, Leaper DJ. Longitudinal Rates, Patient Risk Factors, and Economic Impact of Superficial and Deep Incisional Surgical Site Infection After Primary and Revision Total Hip Arthroplasty: A U.S. Retrospective Commercial Claims Database Analysis. Surg Infect (Larchmt) 2023; 24:366-375. [PMID: 36940292 DOI: 10.1089/sur.2022.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Background: Longitudinal rates, risk factors, and costs of superficial and deep incisional surgical site infection (SSI) were evaluated six months after primary total hip arthroplasty (pTHA) and revision total hip replacement (rTHA). Patients and Methods: Patients who had pTHA or rTHA between January 1, 2016 and March 31, 2018 were identified using the IBM® MarketScan® administrative claims databases. Kaplan-Meier survival curves evaluated time to SSI over six months. Cox proportional hazard models evaluated SSI risk factors. Generalized linear models estimated SSI costs up to 12 months. Results: The total cohort included 17,514 pTHA patients (mean [standard deviation] age 59.6 [10.1] years, 50.2% female; 66.4% commercial insurance), and 2,954 rTHA patients (61.2 [12.0] years, 52.0% female; 48.6% commercial insurance). Deep and superficial post-operative SSI at six months affected 0.30% (95% confidence interval [CI], 0.22%-0.39%) and 0.67% (95% CI, 0.55%-0.79% of patients in the pTHA, and 8.9% (95%CI: 7.8%-10.0%) and 4.8% (95% CI, 4.0%-5.6%) of patients in the rTHA cohorts. Hazards for SSI were related to patient comorbidities that included diabetes mellitus, obesity, renal failure, pulmonary or circulatory disorders, and depression. The adjusted average all-cause incremental commercial costs associated with post-operative infection ranged from $21,434 to $42,879 for superficial incisional SSI and $53,884 to $76,472 for deep incisional SSI, over a 12-month post-operative assessment period. Conclusions: The SSI rate after revision total hip arthroplasty (rTHA) was nearly 9% compared with 1.0% after pTHA. The risk of infection was influenced by several comorbid risk factors. The incremental cost associated with SSIs was substantial.
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Affiliation(s)
- Charles E Edmiston
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maureen Spencer
- Infection Prevention Consultants, Boston, Massachusetts, USA
| | - Najmuddin J Gunja
- Health Economics and Market Access, Johnson & Johnson, Ontario, Canada
| | - Chantal E Holy
- MedTech Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - Jill W Ruppenkamp
- MedTech Epidemiology, Real-World Data Sciences, Johnson & Johnson, New Brunswick, New Jersey, USA
| | - David J Leaper
- Universities of Newcastle and Huddersfield, Newcastle upon Tyne and Huddersfield, United Kingdom
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12
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SIGURDARDOTTIR M, SIGURDSSON MI, OLAFSSON Y, SVERRISDOTTIR SH, GUNNARSDOTTIR I, SIGURDSSON EL, KARASON S. Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections. Acta Orthop 2023; 94:38-44. [PMID: 36727913 PMCID: PMC9893833 DOI: 10.2340/17453674.2023.8480] [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: 06/09/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND PURPOSE The aim of this study was to identify the prevalence of modifiable risk factors of surgical site infections (SSI) in patients undergoing primary elective total joint arthroplasty (TJA) receiving conventional preoperative preparation, and to explore their association with infectious outcomes. PATIENTS AND METHODS Information regarding modifiable risk factors (anemia, diabetes, obesity, nutritional status, smoking, physical activity) was prospectively gathered in patients undergoing primary TJA of hip or knee in 2018-2020 at a single institution with 6 weeks' follow-up time. RESULTS 738 patients (median age 68 years [IQR 61-73], women 57%) underwent TJA (knee 64%, hip 36%). Anemia was detected in 8%, diabetes was present in 9%, an additional 2% had undiagnosed diabetes (HbA1c > 47 mmol/mol), and 8% dysglycemia (HbA1c 42-47 mmol/mol). Obesity (BMI ≥ 30) was observed in 52%. Serum albumin, total lymphocyte count, and vitamin D below normal limits was identified in 0.1%, 18%, and 16%, respectively. Current smokers were 7%. Surgical site complications occurred in 116 (16%), superficial SSI in 57 (8%), progressing to periprosthetic joint infection in 7 cases. Univariate analysis identified higher odds of superficial SSI for BMI ≥ 30 (OR 2.1, 95%CI 1.2-3.8) and HbA1c ≥ 42 mmol/mol (OR 2.2, CI 1.1-4.2), but no association was found with other factors. CONCLUSION In a general population undergoing primary TJA an association was found between obesity (52%) and dysglycemia/diabetes (19%) and superficial SSI (8%), which progressed to PJI in 12% of cases, generating a 1% total rate of PJI. Modification of these risk factors might mitigate infectious adverse outcomes.
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Affiliation(s)
- Maria SIGURDARDOTTIR
- Department of Anaesthesia and Intensive Care, Landspitali, The National University Hospital of Iceland, Reykjavik,University of Iceland, Faculty of Medicine, Reykjavik
| | - Martin Ingi SIGURDSSON
- Department of Anaesthesia and Intensive Care, Landspitali, The National University Hospital of Iceland, Reykjavik,University of Iceland, Faculty of Medicine, Reykjavik
| | - Yngvi OLAFSSON
- Department of Orthopeadics, Landspitali, The National University Hospital of Iceland, Reykjavik
| | | | - Ingibjorg GUNNARSDOTTIR
- Department of Clinical Nutrition, Landspitali – The National University Hospital of Iceland, Reykjavik,University of Iceland, Faculty of Food Science and Nutrition
| | - Emil L SIGURDSSON
- University of Iceland, Faculty of Medicine, Reykjavik,Development Centre for Primary Health Care in Iceland
| | - Sigurbergur KARASON
- Department of Anaesthesia and Intensive Care, Landspitali, The National University Hospital of Iceland, Reykjavik,University of Iceland, Faculty of Medicine, Reykjavik
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13
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Salimi M, Mirghaderi P, Mosalamiaghili S, Mohammadi A, Salimi A. Joint replacement and human immunodeficiency virus. World J Virol 2023; 12:1-11. [PMID: 36743660 PMCID: PMC9896588 DOI: 10.5501/wjv.v12.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/19/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV)-infected cases that need total joint replacement (TJR) is generally rising. On the other hand, modern management of HIV-infected cases has enabled them to achieve longevity while increasing the need for arthroplasty procedures due to the augmented dege-nerative joint disease and fragility fractures, and the risk of osteonecrosis. Although initial investigations on joint replacement in HIV-infected cases showed a high risk of complications, the recent ones reported acceptable outcomes. It is a matter of debate whether HIV-infected cases are at advanced risk for adverse TJR consequences; however, the weak immune profile has been associated with an increased probability of complications. Likewise, surgeons and physicians should be aware of the complication rate after TJR in HIV-infected cases and include an honest discussion of the probable unwelcoming complication with their patients contemplating TJR. Therefore, a fundamental review and understanding of the interaction of HIV and arthroplasty are critical.
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Affiliation(s)
- Maryam Salimi
- Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz 71936-13311, Iran
| | - Peyman Mirghaderi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran 7138433608, Iran
| | | | - Ali Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 7136587666, Iran
| | - Amirhossein Salimi
- Department of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd 7156893040, Iran
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14
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Scholten DJ, Gwam CU, Recker AJ, Plate JF, Waterman BR. Shared and unique risk factors for readmission exist following upper and lower extremity arthroplasty in the 30-day postoperative period. J Orthop Surg (Hong Kong) 2023; 31:10225536231155749. [PMID: 36815584 DOI: 10.1177/10225536231155749] [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: 02/24/2023] Open
Abstract
PURPOSE Joint arthroplasty has become increasingly more common in the United States, and it is important to examine the patient-based risk factors and surgical variables associated with hospital readmissions. The purpose of this study was to identify stratified rates and risk factors for readmission after upper extremity (shoulder, elbow, and wrist) and lower extremity (hip, knee, and ankle) arthroplasty. METHODS All patients undergoing upper and lower extremity arthroplasty from 2008-2018 were identified using the National Surgical Quality Improvement Program dataset. Patient demographics, medical comorbidities and surgical characteristics were examined utilizing uni- and multi-variate analysis for significant predictors of 30-days hospital readmission. RESULTS A total of 523,523 lower and 25,215 upper extremity arthroplasty patients were included in this study. A number of 22,183 (4.2%) lower and 1072 (4.4%) upper extremity arthroplasty patients were readmitted within 30 days of discharge. Significant risk factors for 30-days readmission after lower extremity arthroplasty included age, Body Mass Index (BMI), operative time, dependent functional status, American Society of Anesthesiologists (ASA) score ≥3, increased length of stay, and various medical comorbidities such as diabetes, tobacco dependency, and chronic obstructive pulmonary disease (COPD). An overweight BMI was associated with a lower odds of 30-days readmission when compared to a normal BMI for lower extremity arthroplasty. Analysis for upper extremity arthroplasty revealed similar findings of significant risk factors for 30-days hospital readmission, although diabetes mellitus was not found to be a significant risk factor. CONCLUSION Nearly one in 25 patients undergoing upper and lower extremity arthroplasty experiences hospital readmission within 30-days of index surgery. There are several modifiable risk factors for 30-days hospital readmission shared by both lower and upper extremity arthroplasty, including tobacco smoking, COPD, and hypertension. Optimization of these medical comorbidities may mitigate the risk short-term readmission following joint arthroplasty procedures and improve overall cost effectiveness of perioperative surgical care.
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Affiliation(s)
- Donald J Scholten
- Department of Orthopaedics, 528756Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Chukwuweike U Gwam
- Department of Orthopaedics, 528756Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Andrew J Recker
- School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian R Waterman
- Department of Orthopaedics, 528756Wake Forest Baptist Health, Winston-Salem, NC, USA
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15
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Ekhtiari S, Gazendam A, Saidahmed A, Petruccelli D, Winemaker MJ, de Beer JD, Shah V, Wood TJ. Risk factors for recurrence of periprosthetic joint infection following operative management: a cohort study with average 5-year follow-up. ANNALS OF JOINT 2022; 8:2. [PMID: 38529229 PMCID: PMC10929461 DOI: 10.21037/aoj-22-4] [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: 01/19/2022] [Accepted: 09/08/2022] [Indexed: 03/27/2024]
Abstract
Background Periprosthetic joint infections (PJIs) remain challenging to eradicate even after surgical management, which in most cases involves either debridement, antibiotics and implant retention (DAIR) or single- or two-staged revision. The purpose of this study is to determine predictors of PJI recurrence after operative management for PJI, and to determine differences in recurrence-free survival between DAIR and staged revision. Methods This is a retrospective analysis of prospectively collected data of revision hip and knee arthroplasty surgeries due to PJI between 2011 and 2018 at an academic hospital. Any patient undergoing revision surgery for PJI was included except if the index surgery information was unknown. The primary outcome was confirmed PJI recurrence. Multivariable logistic regression analysis was utilized to determine the relationship between the predictor variables and outcome variable. Log rank testing was used to compare recurrence-free survival between DAIR and staged revision. Results A total of 89 patients (91 joints) underwent revision surgery due to PJI. Younger age and presence of a sinus tract were statistically significant for risk of PJI recurrence. A multivariable logistic regression model including both variables was significant for predicting recurrence of PJI (χ2=10.2, P=0.006). Survival was not significantly different between patients who underwent DAIR versus a staged revision. Conclusions Younger patients and those with a chronic sinus tract are at significantly higher risk of recurrent PJI. This study also demonstrated that PJI can be successfully managed in the majority of cases with DAIR or staged revision.
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Affiliation(s)
- Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ahmed Saidahmed
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Danielle Petruccelli
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mitchell J. Winemaker
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Justin D. de Beer
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vivek Shah
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Thomas J. Wood
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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16
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Diagnostic Value of CRP and Serum WBC Count during Septic Two-Stage Revision of Total Hip Arthroplasties. Antibiotics (Basel) 2022; 11:antibiotics11081098. [PMID: 36009968 PMCID: PMC9404910 DOI: 10.3390/antibiotics11081098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
The diagnostic value of C-reactive protein (CRP) and the serum white blood cell (WBC) count is still barely defined for decision making during septic two-stage revision surgery of hip arthroplasty. We, therefore, compared these values between stages as well as between the groups without and with reinfection in 117 patients. A total of 106 patients were reinfection-free (91%). The median follow-up was 51 months. With a ΔCRP of −10 mg/L and a ΔWBC count of −1000/µL, a significant decrease between stages (p = 0.001) could be observed. When comparing the CRP and WBC count values between groups, however, no significant difference was found at stage one, stage two and even the difference between these two time points (reinfection-free ΔCRP of −11 mg/L and ΔWBC count of −1000/µL vs. reinfection ΔCRP of −5 mg/L (p = 0.131) and ΔWBC count of −1100/µL) (p = 0.424). The diagnostic value was poor for the calculated parameters (area under the curve (AUC) 0.5–0.6). The courses of the mean CRP values of both groups were similar. We conclude that the CRP and WBC count are not helpful to guide the decision making in individual cases.
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17
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Treatment outcomes of patients with Cutibacterium acnes-positive cultures during total joint replacement revision surgery: a minimum 2-year follow-up. Arch Orthop Trauma Surg 2022; 143:2951-2958. [PMID: 35759014 DOI: 10.1007/s00402-022-04489-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/16/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) is a devastating complication following total joint replacement (TJR). Cutibacterium acnes (C. acnes) is a low virulent skin commensal, commonly found during TJR revision surgery for "aseptic" causes. The purpose of the present study was to report the treatment outcomes of patients with C. acnes contamination or infection in the presence of a TJR treated with a revision surgery ± implant exchange ± prolonged (≥ 8 weeks) postoperative antibiotics. METHODS Medical records of patients with at least one positive C. acnes culture in intraoperative tissue samples or sonication fluid from a TJR revision surgery between January 2005 and December 2014 were retrospectively evaluated. The primary endpoint was infection eradication according to Delphi criteria. The diagnostic accuracy of preoperative TJR aspiration regarding the diagnosis of C. acnes PJI was also investigated. RESULTS A total of 52 TJR (28 shoulders, 17 hips, 7 knees) in 52 patients (35 males, 17 females) with an average age of 63 ± 11 (33-86) years were included. At an average follow-up of 67 ± 33 (24-127) months, the infection eradication of C. acnes PJI was 97% regardless of the surgical treatment or administration of prolonged postoperative antibiotics. The incidence of unsuspected C. acnes PJI was 28.8%. The sensitivity and specificity of preoperative joint aspiration in detecting C. acnes PJI were 59% and 88%, whereas the PPV and NNV were 83% and 67%, respectively. CONCLUSION Infection eradication of C. acnes PJI was very high at a minimum follow-up of 24 months, suggesting that C. acnes PJI could be adequately treated with a combination of revision surgery and prolonged postoperative antibiotics. The preoperative diagnosis of C. acnes PJI might be challenging with more than one-quarter of patients presenting without suspicion of C. acnes PJI. The appropriate treatment of patients with a single positive culture remains still unclear. A negative TJR aspiration should not rule out a C. acnes PJI, especially in the presence of clinical correlates of infection. LEVEL OF EVIDENCE Retrospective case-control study, Level III. IRB APPROVAL Kantonale Ethikkommission Zürich, BASEC Nr.:2017-00567.
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18
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First report of a prosthetic joint infection with Fannyhessea (Atopobium) vaginae. Eur J Clin Microbiol Infect Dis 2022; 41:1023-1027. [PMID: 35610391 DOI: 10.1007/s10096-022-04461-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 11/03/2022]
Abstract
This case describes a 77-year-old woman with dysregulated type II diabetes, presenting with a prosthetic joint infection and bacteremia. Computed tomography (CT) of the pelvis and sacrum revealed manifest periprosthetic collections, suggestive of a septic arthritis with loosening of the hip prosthesis. Synovial fluid grew Fannyhessea vaginae, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). To our knowledge, this is the first report of a prosthetic joint infection due to this organism.
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Bruin MM, Deijkers RLM, Bus MPA, van Elzakker EPM, Bazuin R, Nelissen RG, Pijls BG. Inhaled Corticosteroids, Vitamin K Antagonists and Amlodipine Were Associated with an Increased Risk of Acute Periprosthetic Joint Infection in Patients with Total Hip Arthroplasty: A Retrospective Case–Cohort Study. J Clin Med 2022; 11:jcm11071842. [PMID: 35407449 PMCID: PMC8999352 DOI: 10.3390/jcm11071842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 01/03/2023] Open
Abstract
The perioperative use of certain medication may influence the risk of developing a periprosthetic joint infection (PJI). Inhaled corticosteroids (ICSs) and cardiovascular drugs are widely used against pulmonary and cardiovascular diseases. While oral corticosteroids and anticoagulants have been shown to increase the risk of developing PJI, this is not clear for ICSs. In contrast, some cardiovascular drugs, such as amlodipine, nifedipine and statins, have been documented to show an antimicrobial effect, suggesting a synergistic effect with antibiotics in the treatment of (multi-resistant) microorganisms. We performed a case–cohort study to assess the association between the occurrence of PJI after THA and the use of inhaled corticosteroids, anticoagulants, or previously mentioned cardiovascular agents. In a cohort of 5512 primary THAs, we identified 75 patients with a PJI (1.4%), and randomly selected 302 controls. A weighted Cox proportional hazard regression model was used for the study design and to adjust for potential confounders (age, sex, smoking, and cardiovascular/pulmonary disease). We found ICS use (HR 2.6 [95% CI 1.1–5.9]), vitamin K antagonist use (HR 5.3 [95% CI 2.5–11]), and amlodipine use (HR 3.1 [95% CI 1.4–6.9]) to be associated with an increased risk of developing PJI after THA. The effect remained after correction for the mentioned possible confounders. The underlying diseases for which the medications are prescribed could also play a role in the mentioned association; we believe, however, that the usages of ICSs, vitamin K antagonists and amlodipine appear to be potential modifiable risk factors for PJI, and therefore have to be questioned during preoperative screening and consultation.
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Affiliation(s)
- Maarten M. Bruin
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
| | - Ruud L. M. Deijkers
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
| | - Michaël P. A. Bus
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
| | | | - Roos Bazuin
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
| | - Rob G. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
| | - Bart G. Pijls
- Department of Orthopedic Surgery, Haga Ziekenhuis, 2545 AA The Hague, The Netherlands; (M.M.B.); (R.L.M.D.); (R.B.)
- Department of Orthopaedics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.A.B.); (R.G.N.)
- Correspondence:
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Nabergoj M, Denard PJ, Collin P, Trebše R, Lädermann A. Radiological changes, infections and neurological complications after reverse shoulder arthroplasty related to different design types and their rates: Part II. EFORT Open Rev 2021; 6:1109-1121. [PMID: 34909229 PMCID: PMC8631237 DOI: 10.1302/2058-5241.6.210040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Early reported complication rates with the Grammont-type reverse shoulder arthroplasty (RSA) were very high, up to 24%.A 'problem' is defined as an intraoperative or postoperative event that is not likely to affect the patient's final outcome, such as intraoperative cement extravasation and radiographic changes. A 'complication' is defined as an intraoperative or postoperative event that is likely to affect the patient's final outcome, including infection, neurologic injury and intrathoracic central glenoid screw placement.Radiographic changes around the glenoid or humeral components of the RSA are very frequently observed and described in the literature.High complication rates related to the Grammont RSA design led to development of non-Grammont designs which led to a dramatic fall in the majority of complications.The percentage of radiological changes after RSA is not negligible and remains unsolved, despite a decrease in its occurrence in the last decade. However, such changes should be now considered as simple problems because they rarely have a negative influence on the patient's final outcome, and their prevalence has dramatically decreased.With further changes in indications and designs for RSA, it is crucial to accurately track the rates and types of complications to justify its new designs and increased indications. Cite this article: EFORT Open Rev 2021;6:1109-1121. DOI: 10.1302/2058-5241.6.210040.
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Affiliation(s)
- Marko Nabergoj
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Collin
- Centre Hospitalier Privé Saint-Grégoire (Vivalto Santé), Saint- Grégoire, France
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Ren X, Ling L, Qi L, Liu Z, Zhang W, Yang Z, Wang W, Tu C, Li Z. Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BMC Musculoskelet Disord 2021; 22:776. [PMID: 34511099 PMCID: PMC8436433 DOI: 10.1186/s12891-021-04647-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. METHODS Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. RESULTS Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01-2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25-2.21)], AVN [1.65 (1.07-2.56)], femoral neck fracture [1.75 (1.39-2.20)], RA [1.37 (1.23-1.54)], CVD [1.34 (1.03-1.74)], chronic pulmonary disease (CPD) [1.22 (1.08-1.37)], neurological disease [1.19 (1.05-1.35)], opioid use [1.53 (1.35-1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13-1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45-0.93)], and OA [0.70 (0.62-0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. CONCLUSION Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.
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Affiliation(s)
- Xiaolei Ren
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Lin Ling
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Lin Qi
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhongyue Liu
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Wenchao Zhang
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhimin Yang
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Wanchun Wang
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Chao Tu
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
| | - Zhihong Li
- Department of Orthopaedics, Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
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22
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Bright R, Hayles A, Fernandes D, Visalakshan RM, Ninan N, Palms D, Burzava A, Barker D, Brown T, Vasilev K. In Vitro Bactericidal Efficacy of Nanostructured Ti6Al4V Surfaces is Bacterial Load Dependent. ACS APPLIED MATERIALS & INTERFACES 2021; 13:38007-38017. [PMID: 34374279 DOI: 10.1021/acsami.1c06919] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The demand for medical implants globally has increased significantly due to an aging population amongst other reasons. Despite the overall increase in the survivorship of Ti6Al4V implants, implant infection rates are increasing due to factors such as diabetes, obesity, and bacterial resistance to antibiotics. Two commonly found bacteria implicated in implant infections are Staphylococcus aureus and Pseudomonas aeruginosa. Based on prior work that showed nanostructured surfaces might have potential in passively killing these bacterial species, we developed a hierarchical, hydrothermally etched, nanostructured titanium surface. To evaluate the antibacterial efficacy of this surface, etched and as-received surfaces were inoculated with S. aureus or P. aeruginosa at concentrations ranging from 102 to 109 colony-forming units per disc. Live/dead staining revealed there was a 60% decrease in viability for S. aureus and greater than a 98% decrease for P. aeruginosa on etched surfaces at the lowest inoculum of 102 CFU/disc, when compared to the control surface. Bactericidal efficiency decreased with increasing bacterial concentrations in a stepwise manner, with decreases in bacterial viability noted for S. aureus above 105 CFU/disc and above 106 CFU/disc for P. aeruginosa. Surprisingly, biofilm depth analysis revealed a decrease in bacterial viability in the 2 μm layer furthest from the nanostructured surface. The nanostructured Ti6Al4V surface developed here holds the potential to reduce the rate of implant infections.
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Affiliation(s)
- Richard Bright
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Andrew Hayles
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Daniel Fernandes
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Rahul M Visalakshan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Neethu Ninan
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dennis Palms
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Anouck Burzava
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
| | - Dan Barker
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Toby Brown
- Corin Australia, Baulkham Hills, NSW 2153, Australia
| | - Krasimir Vasilev
- STEM, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
- Future Industries Institute, University of South Australia, Mawson Lakes, Adelaide, South Australia 5095, Australia
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23
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Steixner SJM, Spiegel C, Dammerer D, Wurm A, Nogler M, Coraça-Huber DC. Influence of Nutrient Media Compared to Human Synovial Fluid on the Antibiotic Susceptibility and Biofilm Gene Expression of Coagulase-Negative Staphylococci In Vitro. Antibiotics (Basel) 2021; 10:antibiotics10070790. [PMID: 34209737 PMCID: PMC8300679 DOI: 10.3390/antibiotics10070790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/23/2022] Open
Abstract
Bacterial antibiotic resistance and biofilm formation are mechanisms usually involved in the pathogeny of implant-related infections. Worldwide, antibiotic susceptibility tests are usually carried out using nutrient-rich media. Clinical routine laboratories and even research centers use for example EUCAST or CLSI for guidelines. In this study, we investigated the effect of different nutrient media on the antibiotic susceptibility and icaADBC gene expression of bacteria in biofilm. As media, Müller-Hinton Bouillon (MHB), Tryptic Soy Broth (TSB) and human synovial fluid (SF) diluted 1:4 in phosphate buffered saline (PBS), each also supplemented with 1% glucose, were used. The influence of different nutrient media on the antibiotic susceptibility of coagulase-negative staphylococci (CoNS) was evaluated by counting of colony-forming units (CFU) and by checking the metabolic activity of the bacteria. We used reverse transcriptase and real-time qPCR to investigate the influence of nutrient media on the biofilm gene expression. We used two-way analysis of variance (ANOVA). p < 0.05 was considered to be statistically significant. Significant differences in growth and antibiotic susceptibility were detected in all strains tested among the different media used. The nutrient media showed influence on the cell viability of all bacteria after antibiotic treatment. IcaADBC gene expression was significantly influenced by glucose and all nutrient media. The results highlight the influence of glucose on the antibiotic susceptibility, growth and gene expression of all strains tested. For all strains, a significant difference in bacterial recovery, viability and gene expression were found when compared to biofilm grown in SF.
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Affiliation(s)
- Stephan Josef Maria Steixner
- Research Laboratory for Biofilms and Implant Associated Infections (BIOFILM LAB), Experimental Orthopaedics, University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Peter-Mayr-Strasse 4b, Room 204, 6020 Innsbruck, Austria; (S.J.M.S.); (C.S.); (M.N.)
| | - Christopher Spiegel
- Research Laboratory for Biofilms and Implant Associated Infections (BIOFILM LAB), Experimental Orthopaedics, University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Peter-Mayr-Strasse 4b, Room 204, 6020 Innsbruck, Austria; (S.J.M.S.); (C.S.); (M.N.)
| | - Dietmar Dammerer
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.D.); (A.W.)
| | - Alexander Wurm
- University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.D.); (A.W.)
| | - Michael Nogler
- Research Laboratory for Biofilms and Implant Associated Infections (BIOFILM LAB), Experimental Orthopaedics, University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Peter-Mayr-Strasse 4b, Room 204, 6020 Innsbruck, Austria; (S.J.M.S.); (C.S.); (M.N.)
| | - Débora Cristina Coraça-Huber
- Research Laboratory for Biofilms and Implant Associated Infections (BIOFILM LAB), Experimental Orthopaedics, University Hospital for Orthopaedics and Traumatology, Medical University of Innsbruck, Peter-Mayr-Strasse 4b, Room 204, 6020 Innsbruck, Austria; (S.J.M.S.); (C.S.); (M.N.)
- Correspondence: ; Tel.: +43-512-9003-71697; Fax: +43-512-9003-73691
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24
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Figoni AM, Lalchandani GR, Markes AR, Sing D, Hansen EN. Infection and Mechanical Complications Are Risk Factors for New Diagnosis of a Mental Health Disorder After Total Joint Arthroplasty. Arthroplast Today 2021; 10:1-5. [PMID: 34195314 PMCID: PMC8239436 DOI: 10.1016/j.artd.2021.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/17/2021] [Accepted: 05/16/2021] [Indexed: 01/23/2023] Open
Abstract
Background Prior studies have demonstrated that depression is an independent risk factor for developing a prosthetic joint infection (PJI) after total joint arthroplasty (TJA). To our knowledge, there is no literature examining whether PJI or aseptic failure increases the risk of developing a new mental health diagnosis. Methods PearlDiver Patient Database (Colorado Springs, CO) was used to identify 80,826 patients who underwent TJA without a pre-existing diagnosis of depression, anxiety, a stress and/or adjustment disorder, and/or current use of a selective serotonin reuptake inhibitor within the year prior to surgery. The odds of developing a new mental health issue or being prescribed a selective serotonin reuptake inhibitor within 1 year of an uncomplicated TJA was compared to those who developed PJI or mechanical failure within 90 days after TJA as well as to those who subsequently underwent revision surgery within 30 days of either complication using Fisher’s exact test and Baptista-Pike. Results A total of 6474 (8%) patients were diagnosed with a new mental health issue after TJA. PJI or mechanical failure led to significantly higher odds of new diagnoses with an odds ratio of 1.67 (95% confidence interval = 1.26, 2.22) and 1.57 (1.24, 2.00), respectively. Undergoing revision surgery for PJI or mechanical failure increased the odds of developing a new mental health diagnosis to 2.10 (1.29, 3.42) and 2.24 (1.36, 3.72), respectively. There was no significant difference comparing those who developed PJI vs those who sustained mechanical complications. Conclusion Patients who sustain complications after TJA are at increased odds of receiving a new mental health diagnosis, an effect further amplified if revision surgery is required.
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Affiliation(s)
- Andrew Michael Figoni
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Gopal R Lalchandani
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Alexander R Markes
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - David Sing
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, USA
| | - Erik Nathan Hansen
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
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25
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Hypoalbuminaemia in orthopaedic trauma patients in a rural hospital in South Africa. INTERNATIONAL ORTHOPAEDICS 2021; 46:37-42. [PMID: 33834264 DOI: 10.1007/s00264-021-05022-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The deleterious effects of hypoalbuminaemia in the peri-operative period are well documented. We aimed to review serum albumin levels in a cohort of orthopaedic trauma patients to determine the prevalence of hypoalbuminaemia. Secondarily, we aimed to identify factors associated with an increased risk of hypoalbuminaemia. METHODS A retrospective cross-sectional study was performed of data collected prospectively at a regional hospital serving primarily a rural population in South Africa. RESULTS Two hundred ninety-five patients were included in the study. Twenty-nine per cent of the cohort was found to have hypoalbuminaemia. Femur neck fractures (p < 0.001), intertrochanteric fractures (p = 0.004), tibial plateau fractures (p = 0.034) and polytrauma (p = 0.013) were associated with hypoalbuminaemia. The mean albumin level was lower in HIV-positive patients when compared to HIV-negative patients (35.7 g/L vs 37.5 g/L, p = 0.007). The presence of comorbidities other than HIV, like diabetes mellitus (p = 0.001), previous pulmonary tuberculosis (p = 0.034) and chronic renal failure (p = 0.007) was associated with hypoalbuminaemia. CONCLUSION In this cohort of orthopaedic trauma patients from rural South Africa, we found a 29% prevalence of hypoalbuminaemia at the time of presentation. High-risk subgroups include patients with pre-existing comorbidities and increased age, as well as patients presenting with polytrauma, femoral neck, intertrochanteric femur or tibial plateau fractures.
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26
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Swiggett SJ, Vakharia AM, Ehiorobo JO, Vakharia RM, Roche MW, Mont MA, Choueka J. Impact of depressive disorders on primary total shoulder arthroplasties: a matched control analysis of 113,648 Medicare patients. Shoulder Elbow 2021; 13:181-187. [PMID: 33897849 PMCID: PMC8039756 DOI: 10.1177/1758573220916846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/09/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate whether patients with depressive disorders undergoing primary total shoulder arthroplasty have higher rates of (1) in-hospital lengths of stay, (2) readmission rates, (3) medical complications, and (4) implant-related complications. METHODS A retrospective query was performed using a national claims database. Study group patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 113,648 patients who were with (n = 18,953) and without (n = 94,695) depressive disorders. Pearson's χ2 analyses were used to compare patient demographics. Logistic regression analyses were used to calculate odds-ratios of complications and readmission rates. Welch's t-tests were used to test for significance for in-hospital lengths of stay. A p-value less than 0.003 was considered statistically significant. RESULTS Study group patients had significantly longer in-hospital lengths of stay (2.7 days versus 2.3 days; p < 0.0001). Patients who have depressive disorders had higher incidences and odds of readmissions (9.4 versus 6.15%; odds-ratio: 1.6, p < 0.0001), medical complications (2.7 versus 0.9%; odds-ratio: 3.0, p < 0.0001), and implant-related complications (6.1 versus 2.4%; odds-ratio: 2.59, p < 0.0001) compared to controls. CONCLUSION Depressive disorder patients have longer in-hospital lengths of stay and increased odds of readmissions and complications following primary total shoulder arthroplasty.
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Affiliation(s)
- Samuel J Swiggett
- Department of Orthopedic Surgery,
Maimonides Medical Center, Brooklyn, USA,Samuel J Swiggett, Maimonides Medical
Center, 4802, 10th Avenue Brooklyn, NY 11219, USA.
| | - Ajit M Vakharia
- Department of Orthopedic Surgery, Case
Western Reserve University Hospital, Cleveland, USA
| | - Joseph O Ehiorobo
- Department of Orthopedic Surgery,
Northwell Health, Lenox Hill Hospital, New York, USA
| | | | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research
Institute, Ft Lauderdale, USA
| | - Michael A Mont
- Department of Orthopedic Surgery,
Northwell Health, Lenox Hill Hospital, New York, USA,Department of Orthopaedic Surgery,
Cleveland Clinic Hospital, Cleveland, USA
| | - Jack Choueka
- Department of Orthopedic Surgery,
Maimonides Medical Center, Brooklyn, USA
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27
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Zeng YQ, Deng S, Zhu XY, Sun XB, Feng WJ, Zeng JC, Zhang HT, Zeng YR. Diagnostic Accuracy of the Synovial Fluid α-Defensin Lateral Flow Test in Periprosthetic Joint Infection: A Meta-analysis. Orthop Surg 2021; 13:708-718. [PMID: 33719221 PMCID: PMC8126937 DOI: 10.1111/os.12966] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/15/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives There is a controversy on the diagnostic reliability and accuracy of synovial fluid α‐defensin in periprosthetic joint infection (PJI). We performed this meta‐analysis to evaluate the diagnostic accuracy of the α‐defensin lateral flow test in PJI. Methods PubMed, Embase, and the Cochrane library were systematically searched, and articles (up to January 2020) on the diagnosis of hip and knee PJIs using the α‐defensin Synovasure lateral flow test were included. The diagnostic accuracy of the α‐defensin lateral flow test in PJI was evaluated using meta‐analysis. The pooled sensitivity, specificity, accuracy, positive and negative likelihood ratio, diagnostic odds ratio, and post‐test probabilities were calculated. Results Seventeen studies including 1443 cases were included. Meta‐analysis showed the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and a diagnostic odds ratio was 0.83 (95% CI 0.77, 0.88), 0.95 (95% CI 0.93, 0.97), 16.86 (95% CI 11.67, 24.37), 0.17 (95% CI 0.13, 0.24) and 85.30 (95% CI 47.76, 152.35), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.97 (95% CI 0.95, 0.98). Subgroup analysis also confirmed the high efficiency of α‐defensin Synovasure lateral flow test in diagnosing PJIs, irrespective of ethnicity. Fagan's nomogram analysis there was a high positive post‐test probability of 94% and a low negative post‐test probability of 15%. Conclusions We indicated that the α‐defensin lateral flow test had a high accuracy for diagnosing PJI. Large‐scale studies are needed to validate its significance in PJI diagnosis.
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Affiliation(s)
- Yu-Qing Zeng
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Shu Deng
- Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xing-Yang Zhu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Bo Sun
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Jun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian-Chun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hai-Tao Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi-Rong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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28
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Kamada S, Kise N, Kinoshita K, Shiota E, Yamamoto T. Femoral Neck Fracture in a Hemodialysis Patient after Liver Transplantation: A Case Report. Prog Rehabil Med 2021; 6:20210003. [PMID: 33490699 PMCID: PMC7817843 DOI: 10.2490/prm.20210003] [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: 10/07/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022] Open
Abstract
Background Surgical treatment of femoral neck fractures is usually performed as an urgent procedure so that restoration of the ability to stand and walk can be achieved as quickly as possible. However, orthopedic surgeons need to be aware of undertreated or untreated diseases in their patients. Organ transplant recipients require immunosuppressive agents and steroids postoperatively. Hemodialysis patients also exhibit immunological deterioration and are included among immunocompromised patients. We report a case in which conservative treatment was chosen for a hepatic transplant recipient on hemodialysis who suffered a femoral neck fracture because signs of inflammation of unknown etiology were intermittently seen. Case The patient was a 70-year-old man who had undergone liver transplantation from a living donor as treatment for hepatocellular cancer and hepatic failure with cirrhosis. Dialysis for end-stage renal failure was initiated at approximately 1 year postoperatively. Cyclosporine was administered as an immunosuppressive agent. The patient subsequently fell off a bicycle and was unable to walk because of right hip pain. He was brought to our hospital by ambulance, and a right hip radiograph revealed a femoral neck fracture. His white blood cell count and C-reactive protein levels were intermittently elevated with unknown etiology. Conservative treatment was finally adopted, although a bipolar hip arthroplasty was planned. At 5 months after the injury, the patient was able to walk alone in a stable manner using a pair of crutches and was discharged. Discussion Conservative treatment for a femoral neck fracture, which generally requires surgery, may be acceptable in organ transplant recipients on hemodialysis.
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Affiliation(s)
- Satoshi Kamada
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Naoki Kise
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Koichi Kinoshita
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Etsuji Shiota
- Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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29
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Hall JR, Metcalf R, Leisinger E, An Q, Bedard NA, Brown TS. Does Smoking Cessation Prior to Elective Total Joint Arthroplasty Result in Continued Abstinence? THE IOWA ORTHOPAEDIC JOURNAL 2021; 41:141-144. [PMID: 34552416 PMCID: PMC8259204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Smoking tobacco is a known modifiable risk factor for complications in total joint arthroplasty (TJA) patients. Patients are commonly required to quit smoking prior to TJA. After the early postoperative period, little is known about the long-term implications of this preoperative behavioral change. Our aims were to 1) identify TJA patients that had negative anabasine screen prior to elective TJA and 2) determine the long-term rates of continued smoking abstinence. METHODS At our institution, TJA patients identified as smokers undergo urine anabasine testing prior to surgery. Between 2009 - 2018 all patients that had elective primary TJA with pre-operative urine anabasine tests were queried. Patients were called post-operatively at mean 52 months (range 15 - 126 months) and surveyed regarding smoking status. Long-term smoking cessation rates were then analyzed along with relapse time frame. The use of quit aid and patient perspective on importance of quitting were also analyzed. RESULTS 249 smokers that had elective TJA were identified. 124 (50%) participated in the survey, and 93 quit to facilitate surgery. 21 (23%) never resumed smoking, and 32 (34%) were currently abstinent. Just over half of the patients relapsed in the three-month post-operative period (55%). There were no differences in quit aid or patient perspectives between these groups. CONCLUSION With an increased focus on smoking cessation prior to elective TJA, orthopedics contributes to an important public health initiative. Although national quit rates are in the single digits, 23% of patients were able to quit permanently.Level of Evidence: IV.
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Affiliation(s)
- James R.L. Hall
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Rory Metcalf
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Emma Leisinger
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Qiang An
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Nicholas A. Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Timothy S. Brown
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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30
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Günsche JL, Pilz V, Hanstein T, Skripitz R. The variation of arthroplasty procedures in the OECD Countries: analysis of possible influencing factors by linear regression. Orthop Rev (Pavia) 2020; 12:8526. [PMID: 33312485 PMCID: PMC7726828 DOI: 10.4081/or.2020.8526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/16/2020] [Indexed: 01/22/2023] Open
Abstract
Total hip and knee replacements (THR, TKR) are among the most common surgeries but incidence rates vary between OECD countries. Previous studies suggested economic factors to be most influential but did not take into account health care system related factors. Hence we analysed the possible influence of healthcare system related factors on the operation rate. We used OECD data for 27 countries and calculated Age-Standardized Incidence Rates (ASIR). In order to determine possible explanatory variables on the ASIRs we performed a stepwise blockwise linear regression. The ASIR of hip and knee replacement varies widely. We identified statistically significant determinants which influence the ASIR of THR in a positive manner: incidence and length of stay of coxarthrosis, ASIR of knee replacement, health expenditures, number of nurses and an etatistic social insurance. Diabetes prevalence, gross domestic product and number of doctor consultations, however, have a negative influence on the ASIR. TKR rate is positively influenced by health expenditures and incidence rate of gonarthrosis, negatively by the number of primary practitioners. We observed strong geographic disparities in the frequency of THR and THR that cannot be explained by age structure of the countries. Economic factors seem to play a secondary role while healthcare related factors have a greater influence.
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Affiliation(s)
- Jamie Lee Günsche
- Bavarian State Office for Statistics, Schweinfurt Office, Schweinfurt.,Heraeus Medical GmbH, Health Economics, Wehrheim
| | | | - Tim Hanstein
- Heraeus Medical GmbH, Health Economics, Wehrheim.,Rostock University Medical Center, Orthopedic Clinic and Policlinic; Rostock
| | - Ralf Skripitz
- Rostock University Medical Center, Orthopedic Clinic and Policlinic; Rostock.,Roland- Klinik, Centre forArthroplasty, Foot Surgery, Paediatric and General Orthopaedics, Bremen, Germany
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Ye Y, Pan B, Gu M, Xian G, Chen W, Zheng L, Zhang Z, Sheng P. Fluctuation of fasting blood glucose in patients who underwent primary or revision total joint arthroplasty: a retrospective review. J Orthop Surg Res 2020; 15:508. [PMID: 33153464 PMCID: PMC7643256 DOI: 10.1186/s13018-020-02029-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
Background Perioperative hyperglycemia is a risk factor for postoperative complications after total joint arthroplasty (TJA). However, the variability of fasting blood glucose (FBG) after TJA remains unknown. We aimed to assess the fluctuation and extent of elevation of FBG following primary or revision TJA. Methods We retrospectively evaluated the medical records of 1788 patients who underwent primary or revision TJA between 2013 and 2018. We examined FBG values collected during 6 days of the perioperative period. The findings for each time point were evaluated with descriptive statistics. Postoperative glycemic variability was assessed by the coefficient of variation (CV). Results The final cohort included the medical records of 1480 patients (1417 primary and 63 revision). FBG was highest on postoperative day 1 in the primary and revision groups (P < 0.001), which had the highest number of hyperglycemic patients (FBG > 100 mg/dL), with 66.4% and 75.5% in the primary and revision groups, respectively. The CV of diabetics in the primary group, and diabetics and non-diabetics in the revision group, was higher than that of non-diabetics in the primary group. Conclusion Postoperative day 1 showed the highest FBG levels and proportion of patients with hyperglycemia in the perioperative period. Primary group diabetics, and revision group diabetics and non-diabetics, had higher postoperative fluctuation of FBG than primary group non-diabetics. Frequent FBG monitoring may therefore be warranted in diabetic patients undergoing TJA, and all patients undergoing revision TJA.
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Affiliation(s)
- Yongyu Ye
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Baiqi Pan
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Minghui Gu
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Guoyan Xian
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Weishen Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Linli Zheng
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Ziji Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Puyi Sheng
- Department of Orthopedic Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
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Saidahmed A, Sarraj M, Ekhtiari S, Mundi R, Tushinski D, Wood TJ, Bhandari M. Local antibiotics in primary hip and knee arthroplasty: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:669-681. [PMID: 33104869 DOI: 10.1007/s00590-020-02809-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Infection is a truly devastating complication of total joint arthroplasty, causing most patients to undergo a revision surgery, and to bear significant psychological and financial burden. The purpose of this study is to systematically evaluate the literature to determine the efficacy and complication profile of local antibiotic application in primary total joint arthroplasty. METHODS All studies of primary total joint arthroplasty which assessed local antibiotics in any form other than antibiotic-impregnated cement as an intervention were included. Studies that reported at least one outcome related to infection and were available in full text in English were eligible for inclusion. Studies which included both primary and revision cases but did not report the stratified data for each type of surgery and studies on fracture populations were excluded. RESULTS A total of 9 studies involving 3,714 cases were included. The pooled deep infection rate was 1.6% in the intervention groups and 3.5% in the control groups. Meta-analysis revealed a RR of 0.53 (95%CI: 0.35-0.79, p = 0.002) with no heterogeneity (I2 = 0%) for infection in the intervention groups. Meta-analysis revealed a non-significant reduction in superficial infection rates in the intervention groups; however, there was a significant increase in aseptic wound complications in the intervention groups. CONCLUSION Local antibiotic application results in a moderate reduction in deep infection rates in primary total joint arthroplasty, with no significant impact on superficial infection rates. However, local antibiotic application may be associated with a moderate increase in aseptic wound complications.
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Affiliation(s)
- Ahmed Saidahmed
- Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada.
| | - Mohamed Sarraj
- Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada
| | - Raman Mundi
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Daniel Tushinski
- Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada
| | - Thomas J Wood
- Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, St. Joseph's Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada
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Abstract
Human immunodeficiency virus (HIV) is a pandemic affecting more than 35 million people worldwide. The aim of this review is to describe the association between HIV and total hip arthroplasty (THA) and assess patient risk factors to optimize functional outcomes and decrease rates of revision. Since the advent of highly active antiretroviral treatment (HAART), HIV-infected patients are living longer, which allows them to develop degenerative joint conditions. HIV and HAART act independently to increase the demand for THA. HIV-positive patients are also more predisposed to developing avascular necrosis (AVN) of the hip and femoral neck fractures due to decreased bone mineral density (BMD). Prior to the widespread implementation of access to HAART in homogenous cohorts of HIV-infected patients undergoing THA, reports indicated increased rates of complications. However, current literature describes equivocal functional outcomes and survival rates after THA in HIV-positive patients controlled on HAART when compared to HIV-negative controls. HIV-infected patients eligible for THA should be assessed for medical co-morbidities and serum markers of disease control should be optimized. Periprosthetic joint infection (PJI) is a leading cause of revision THA, and HIV is a modifiable risk factor. Importantly, the significance is negated once patients are placed on HAART and achieve viral suppression. THA should not be withheld in HIV-infected patients injudiciously. However, HIV is a burgeoning epidemic and all patients should be identified and started on HAART to avoid preventable peri-operative complications.
Cite this article: EFORT Open Rev 2020;5:164-171. DOI: 10.1302/2058-5241.5.190030
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Affiliation(s)
| | - Zia Maharaj
- Arthroplasty Unit, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa
| | - Lipalo Mokete
- Arthroplasty Unit, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa
| | - Nkhodiseni Sikhauli
- Arthroplasty Unit, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa
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Lespasio M, Mont M, Guarino A. Identifying Risk Factors Associated With Postoperative Infection Following Elective Lower-Extremity Total Joint Arthroplasty. Perm J 2020; 24:1-3. [PMID: 33482967 DOI: 10.7812/tpp/20.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article addresses the importance of identifying risk factors associated with postoperative infection following elective lower-extremity total joint arthroplasty. Specifically, this review discusses risk factors recognized by the American Academy of Orthopaedic Surgeons that should be carefully considered and assessed by the orthopaedic team in collaboration with the primary care provider before proceeding with surgery.
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Affiliation(s)
- Michelle Lespasio
- Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA
| | - Michael Mont
- Northwell Health Physician Partners Orthopaedic Institute at Lenox Hill, Lenox Hill Hospital, New York, NY
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Spitzmüller R, Gümbel D, Güthoff C, Zaatreh S, Klinder A, Napp M, Bader R, Mittelmeier W, Ekkernkamp A, Kramer A, Stengel D. Duration of antibiotic treatment and risk of recurrence after surgical management of orthopaedic device infections: a multicenter case-control study. BMC Musculoskelet Disord 2019; 20:184. [PMID: 31043177 PMCID: PMC6495646 DOI: 10.1186/s12891-019-2574-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Device-related infections in orthopaedic and trauma surgery are a devastating complication with substantial impact on morbidity and mortality. Systemic suppressive antibiotic treatment is regarded an integral part of any surgical protocol intended to eradicate the infection. The optimal duration of antimicrobial treatment, however, remains unclear. In a multicenter case-control study, we aimed at analyzing the influence of the duration of antibiotic exposure on reinfection rates 1 year after curative surgery. Methods This investigation was part of a federally funded multidisciplinary network project aiming at reducing the spread of multi-resistant bacteria in the German Baltic region of Pomerania. We herein used hospital chart data from patients treated for infections of total joint arthroplasties or internal fracture fixation devices at three academic referral institutions. Subjects with recurrence of an implant-related infection within 1 year after the last surgical procedure were defined as case group, and patients without recurrence of an implant-related infection as control group. We placed a distinct focus on infection of open reduction and internal fixation (ORIF) constructs. Uni- and multivariate logistic regression analyses were employed for data modelling. Results Of 1279 potentially eligible patients, 269 were included in the overall analysis group, and 84 contributed to an extramedullary fracture-fixation-device sample. By multivariate analysis, male sex (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.08 to 3.94, p = 0.029) and facture fixation device infections (OR 2.05, 95% CI 1.05 to 4.02, p = 0.036) remained independent predictors of reinfection. In the subgroup of infected ORIF constructs, univariate point estimates suggested a nearly 60% reduced odds of reinfection with systemic fluoroquinolones (OR 0.42, 95% CI 0.04 to 2.46) or rifampicin treatment (OR 0.41, 95% CI 0.08 to 2.12) for up to 31 days, although the width of confidence intervals prohibited robust statistical and clinical inferences. Conclusion The optimal duration of systemic antibiotic treatment with surgical concepts of curing wound and device-related orthopaedic infections is still unclear. The risk of reinfection in case of infected extramedullary fracture-fxation devices may be reduced with up to 31 days of systemic fluoroquinolones and rifampicin, although scientific proof needs a randomized trial with about 1400 subjects per group. Concerted efforts are needed to determine which antibiotics must be applied for how long after radical surgical sanitation to guarantee sustainable treatment success.
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Affiliation(s)
- Romy Spitzmüller
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Str 7, 12683, Berlin, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Str 7, 12683, Berlin, Germany
| | - Sarah Zaatreh
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Annett Klinder
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Matthias Napp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Axel Ekkernkamp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Axel Kramer
- Department of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str 49A, 17489, Greifswald, Germany
| | - Dirk Stengel
- BG Kliniken Group of Hospitals, Leipziger Pl 1, 10117, Berlin, Germany
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Löwik CAM, Zijlstra WP, Knobben BAS, Ploegmakers JJW, Dijkstra B, de Vries AJ, Kampinga GA, Mithoe G, Al Moujahid A, Jutte PC, Wouthuyzen-Bakker M. Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients. PLoS One 2019; 14:e0215035. [PMID: 30958847 PMCID: PMC6453483 DOI: 10.1371/journal.pone.0215035] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023] Open
Abstract
Background Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category. Methods We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2. Results A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018). Conclusions Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.
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Affiliation(s)
- Claudia A. M. Löwik
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Bas A. S. Knobben
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Joris J. W. Ploegmakers
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Baukje Dijkstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Astrid J. de Vries
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Greetje A. Kampinga
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Glen Mithoe
- Department of Medical Microbiology, Certe Medical Diagnostics and Advice, Groningen, the Netherlands
| | - Aziz Al Moujahid
- Center for Infectious Diseases Friesland, Izore, Leeuwarden, the Netherlands
| | - Paul C. Jutte
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
PURPOSE OF REVIEW The purpose of this review is to critically analyze and summarize recent studies in the area of penile prosthesis surgery outcomes with a focus on infection prevention in high-risk patients. RECENT FINDINGS Reduction of surgical time in complex prosthesis surgery may reduce infection risk. Concomitant implant surgery is not associated with increased infection risk. Certain immunocompromised patients may be more likely to have penile implant infections, but these may not include patients with well-controlled HIV, well-controlled diabetes, or transplant recipients. Substance abuse is correlated with increased risk of infection after penile implant surgery. Careful patient selection and preoperative optimization can reduce infection risk in spinal cord injury patients. In the last 5 years, there have been several important studies investigating the risk of penile prosthesis infection in complex patients, clarifying which patient categories are at increased risk and how that risk can be mitigated.
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Anatone AJ, Shah RP, Jennings EL, Geller JA, Cooper HJ. A risk-stratification algorithm to reduce superficial surgical site complications in primary hip and knee arthroplasty. Arthroplast Today 2018; 4:493-498. [PMID: 30560182 PMCID: PMC6287286 DOI: 10.1016/j.artd.2018.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Surgical site complications (SSCs) are the most common cause for readmission after total joint arthroplasty (TJA), increasing costs while predisposing to inferior long-term outcomes. Prophylactic use of closed-incision negative pressure therapy (ciNPT) may lower the risk of these complications, especially in high-risk populations, but appropriate-use guidelines are lacking for patients undergoing primary TJA. We sought to develop a risk-stratification algorithm to guide use of ciNPT dressings and test its use in normalizing the rate of superficial SSCs among high-risk groups. METHODS We reviewed 323 consecutive primary TJAs, where 38% of those patients considered at elevated risk were risk-stratified to receive ciNPT dressings. An individual risk score was developed, assigning points based on patient-specific risk factors. We identified a historical control population of 643 patients who all received the same postoperative dressing to test the impact of this risk score. RESULTS Compared with historical controls, we observed a modest but significant improvement in superficial SSCs after implementation of risk-stratification (12.0% vs 6.8%; P = .013). Among high-risk patients, there was a marked improvement in SSCs when treated prophylactically with ciNPT dressings as compared with historical controls (26.2% vs 7.3%; P < .001). Low-risk patients, who continued to be treated with standard postoperative dressings, demonstrated no significant improvement (8.6% vs 6.5%; P = .344). CONCLUSIONS ciNPT dressings are effective at reducing and normalizing risks of superficial SSCs among high-risk primary arthroplasty patients. The proposed risk-stratification algorithm may help identify those patients who benefit most from these dressings.
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Affiliation(s)
| | | | | | | | - H. John Cooper
- Department of Orthopedic Surgery, Columbia University Medical Center New York, NY, USA
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39
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Tsai YS, Kung PT, Ku MC, Wang YH, Tsai WC. Effects of pay for performance on risk incidence of infection and of revision after total knee arthroplasty in type 2 diabetic patients: A nationwide matched cohort study. PLoS One 2018; 13:e0206797. [PMID: 30388167 PMCID: PMC6214551 DOI: 10.1371/journal.pone.0206797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 10/19/2018] [Indexed: 12/31/2022] Open
Abstract
As the world's population ages, the number of people receiving total knee arthroplasty (TKA) has been on the rise. Although patients with diabetes mellitus are known to face greater risks of TKA postoperative infection and revision TKA owing to diabetic complications, studies on whether such patients' participation in pay for performance (P4P) programs influences the incidence rates of TKA postoperative infection or revision TKA are still lacking. This study examined the 2002-2012 data of Taiwan's National Health Insurance Research Database to conduct a retrospective cohort analysis of diabetic patients over 50 years old who have received TKA. To reduce any selection bias between patients joining and not joining the P4P program, propensity score matching was applied. The Cox proportional hazards model was used to examine the influence of the P4P program on TKA postoperative infection and revision TKA, and the results indicate that joining P4P lowered the risk of postoperative infection (HR = 0.91, 95% CI: 0.77-1.08), however, which was not statistically significant, and significantly lowered the risk of revision TKA (HR = 0.53, 95% CI: 0.39-0.72). Being younger and male, having multiple comorbid conditions or greater diabetic severity, receiving care at regional or public hospitals, and not having a diagnosis of degenerative or rheumatoid arthritis were identified as factors for higher risk of TKA postoperative infection for patients with diabetes. As for the risk of revision TKA, postoperative infection and being younger were identified as factors for a significantly higher risk (p < 0.05).
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Affiliation(s)
- Yi-Shiun Tsai
- Department of Orthopedics, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung, Taiwan, ROC
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Ming-Chou Ku
- Department of Orthopedics, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan, ROC
| | - Yeuh-Hsin Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
- * E-mail:
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Premkumar A, Morse K, Levack AE, Bostrom MP, Carli AV. Periprosthetic Joint Infection in Patients with Inflammatory Joint Disease: Prevention and Diagnosis. Curr Rheumatol Rep 2018; 20:68. [PMID: 30203376 DOI: 10.1007/s11926-018-0777-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Periprosthetic joint infection (PJI) is a devastating complication that can occur following total joint arthroplasty (TJA), causing significant morbidity and often requiring revision surgery. This goal of this manuscript is to review the current evidence for the prevention and diagnosis of PJI in patients with inflammatory arthritis. RECENT FINDINGS Patients with inflammatory arthritis have a higher risk of PJI after TJA; however, there are several preventive, diagnostic, and therapeutic measures that can be optimized to lower the burden of PJI in this population. This manuscript will review the current evidence and clinical practice recommendations that support specific features of preoperative evaluation, perioperative medication management, and surgical planning in inflammatory arthritis patients undergoing TJA. Evidence and recommendations for the diagnosis of PJI in this patient population will also be reviewed. Despite increased research efforts directed towards PJI, specific approaches directed at the inflammatory arthritis patient population remain surprisingly limited. Optimization strategies such as adequately managing disease-modifying medications, treating preoperative anemia, encouraging smoking cessation, and improving weight management are strongly encouraged before entering the perioperative period. If PJI does occur in the inflammatory arthritis patient, establishing the diagnosis is challenging, since guidelines were created from investigations of PJI in primarily patients without inflammatory arthritis. Future prospective research is required to better guide clinicians in preventing and diagnosing PJI in inflammatory arthritis patients undergoing TJA.
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Affiliation(s)
- Ajay Premkumar
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kyle Morse
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ashley E Levack
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Mathias P Bostrom
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alberto V Carli
- Department of Academic Training, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Compagnoni R, Gualtierotti R, Randelli P. Total Joint Arthroplasty in Patients with Inflammatory Rheumatic Diseases. Adv Ther 2018; 35:1133-1139. [PMID: 29995301 PMCID: PMC6097014 DOI: 10.1007/s12325-018-0750-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 02/05/2023]
Abstract
Since its introduction, total joint arthroplasty (TJA) has improved the quality of life of patients with degenerative joint disorders. In the last decades, a number of
conventional and biological disease-modifying antirheumatic drugs have become available for the treatment of patients with inflammatory rheumatic diseases (IRD), leading to a reduction in the need to undergo TJA. However, TJA is still frequently performed in IRD patients. Both rheumatologists and orthopedics should be aware that patients with IRD have a peculiar perioperative risk profile due to disease-related, patient-related, and surgery-related risk factors. On the basis of current evidence, TJA is a safe procedure for IRD patients as long as an accurate risk stratification and a multidisciplinary approach are applied. We here describe the current strategies for an appropriate surgical management of osteoarthritis in IRD patients and the fascinating opening perspectives that surgeons and clinicians may expect in the future.
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Affiliation(s)
- Riccardo Compagnoni
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - Roberta Gualtierotti
- Dipartimento di Reumatologia e Scienze Mediche, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Pietro Randelli
- Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Lum ZC, Monzon RA, Bosque J, Coleman S, Pereira GC, Di Cesare PE. Effects of fondaparinux on wound drainage after total hip and knee arthroplasty. J Orthop 2018; 15:388-390. [PMID: 29881160 DOI: 10.1016/j.jor.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/16/2018] [Indexed: 01/22/2023] Open
Abstract
Background The purpose of this investigation was to determine the effects of fondaparinux on postoperative wound drainage, length of hospital stay (LOS) and rate of surgical site infection in total joint patients. Methods 117 patients undergoing total joint arthroplasty treated with fondaparinux for venous thromboembolism (VTE) prophylaxis were prospectively studied. Results The average time to a dry wound was 3.4 days, with an average LOS of 3.77 days. Perioperative complications included 2 cases each of superficial cellulitis, deep vein thrombosis, and pulmonary embolism; there were no cases of deep infection. Multi-variate analysis showed increased patient BMI increased LOS (p = 0.0169). Conclusion Fondaparinux is an effective drug for VTE prophylaxis in total joint arthroplasty with wound drainage and LOS comparable to historical controls of enoxaparin, warfarin, and rivaroxaban.
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Affiliation(s)
- Zachary C Lum
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Rene A Monzon
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Jose Bosque
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Sheldon Coleman
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Gavin C Pereira
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Paul E Di Cesare
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
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Yao JJ, Maradit Kremers H, Abdel MP, Larson DR, Ransom JE, Berry DJ, Lewallen DG. Long-term Mortality After Revision THA. Clin Orthop Relat Res 2018; 476:420-426. [PMID: 29389795 PMCID: PMC6259686 DOI: 10.1007/s11999.0000000000000030] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term mortality after primary THA is lower than in the general population, but it is unknown whether this is also true after revision THA. QUESTIONS/PURPOSES We examined (1) long-term mortality according to reasons for revision after revision THA, and (2) relative mortality trends by age at surgery, years since surgery, and calendar year of surgery. METHODS This retrospective study included 5417 revision THAs performed in 4532 patients at a tertiary center between 1969 and 2011. Revision THAs were grouped by surgical indication in three categories: periprosthetic joint infections (938; 17%); fractures (646; 12%); and loosening, bearing wear, or dislocation (3833; 71%). Patients were followed up until death or December 31, 2016. The observed number of deaths in the revision THA cohort was compared with the expected number of deaths using standardized mortality ratios (SMRs) and Poisson regression models. The expected number of deaths was calculated assuming that the study cohort had the same calendar year, age, and sex-specific mortality rates as the United States general population. RESULTS The overall age- and sex-adjusted mortality was slightly higher than the general population mortality (SMR, 1.09; 95% CI, 1.05-1.13; p < 0.001). There were significant differences across the three surgical indication subgroups. Compared with the general population mortality, patients who underwent revision THA for infection (SMR, 1.35; 95% CI, 1.24-1.48; p < 0.001) and fractures (SMR, 1.23; 95% CI, 1.11-1.37; p < 0.001) had significantly increased risk of death. Patients who underwent revision THA for aseptic loosening, wear, or dislocation had a mortality risk similar to that of the general population (SMR, 1.01; 95% CI, 0.96-1.06; p = 0.647). The relative mortality risk was highest in younger patients and declined with increasing age at surgery. Although the relative mortality risk among patients with aseptic indications was lower than that of the general population during the first year of surgery, the risk increased with time and got worse than that of the general population after approximately 8 to 10 years after surgery. Relative mortality risk improved with time after revision THA for aseptic loosening, wear, or dislocation. CONCLUSIONS Shifting mortality patterns several years after surgery and the excess mortality after revision THA for periprosthetic joint infections and fractures reinforce the need for long-term followup, not only for implant survival but overall health of patients having THA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Jie J Yao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dirk R. Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeanine E. Ransom
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Daniel J. Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Self-Resolution of a Draining Sinus Tract in a Patient with Chronic Periprosthetic Hip Infection. Case Rep Orthop 2018; 2018:8657562. [PMID: 29670791 PMCID: PMC5836394 DOI: 10.1155/2018/8657562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/29/2018] [Indexed: 11/21/2022] Open
Abstract
We report a novel case of a patient who had a draining sinus soon after a total hip arthroplasty that spontaneously resolved. The patient voluntarily discontinued antibiotic suppressive therapy (AST) after 10 years of treatment and paradoxically experienced full resolution of signs of chronic prosthetic joint infection (PJI), including recovery of his left-sided draining sinus tract. Now 8 years after discontinuing AST, the patient has no pain, good function, and no major or minor criteria of joint infection according to the Musculoskeletal Infection Society (MSIS) workgroup. The authors have not identified literature describing a similar resolution of draining sinus tracts from around a prosthetic joint after discontinuing AST. Despite the resolution of this patient's sinus tract, the authors do not advocate for discontinuing AST in patients with a draining sinus tract. However, in spite of the fact that the MSIS consensus statement suggests that a draining sinus is a sure sign of PJI and that the assumption is that the infection will not go away until explant, this case was different.
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Cunningham DJ, Kavolus JJ, Bolognesi MP, Wellman SS, Seyler TM. Common Medical Comorbidities Correlated With Poor Outcomes in Hip Periprosthetic Infection. J Arthroplasty 2017; 32:S241-S245.e3. [PMID: 28438451 PMCID: PMC5572102 DOI: 10.1016/j.arth.2017.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/21/2017] [Accepted: 03/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Periprosthetic infection has been linked to risk factors such as diabetes, obesity, and smoking among others. This study examined the relationship between common patient comorbidities and hip periprosthetic infection outcomes. METHODS We retrospectively reviewed the records of 149 culture-positive periprosthetic hip infections at our tertiary care center that underwent treatment between 2005 and 2015. Baseline characteristics and common comorbidities were analyzed with relation to rates of successfully treated infection, total surgeries for infection, and cumulative length of hospitalization using multivariate analysis. RESULTS Patients with coronary artery disease or anemia had significantly lower rate of successfully treated infection. Patients with anemia or chronic pulmonary disease underwent significantly more surgery, and patients with chronic pulmonary disease, psychiatric disease, anemia, or diabetes spent significantly longer time in hospital. CONCLUSION Potentially modifiable cardiovascular, respiratory, and psychiatric diseases were associated with a decreased rate of successfully treated infection, more surgery, and longer hospitalization in treatment for hip periprosthetic infection in multivariate analysis.
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Affiliation(s)
- Daniel J Cunningham
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Joseph J Kavolus
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Anderson MB, Curtin K, Wong J, Pelt CE, Peters CL, Gililland JM. Familial Clustering Identified in Periprosthetic Joint Infection Following Primary Total Joint Arthroplasty: A Population-Based Cohort Study. J Bone Joint Surg Am 2017; 99:905-913. [PMID: 28590375 PMCID: PMC5452903 DOI: 10.2106/jbjs.16.00514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is estimated that the cost to treat periprosthetic joint infection in the United States will approach $1.62 billion by 2020. Thus, the need to better understand the pathogenesis of periprosthetic joint infection is evident. We performed a population-based, retrospective cohort study to determine if familial clustering of periprosthetic joint infection was observed. METHODS Analyses were conducted using software developed at the Utah Population Database (UPDB) in conjunction with the software package R. The cohort was obtained by querying the UPDB for all patients undergoing total joint arthroplasty and for those patients who had subsequent periprosthetic joint infection. The magnitude of familial risk was estimated by hazard ratios (HRs) from Cox regression models to assess the relative risk of periprosthetic joint infection in relatives and spouses. Using percentiles for age strata, we adjusted for sex, body mass index (BMI) of ≥30 kg/m, and a history of smoking, diabetes, and/or end-stage renal disease. Additionally, we identified families with excess clustering of periprosthetic joint infection above that expected in the population using the familial standardized incidence ratio. RESULTS A total of 66,985 patients underwent total joint arthroplasty and 1,530 patients (2.3%) had a periprosthetic joint infection. The risk of periprosthetic joint infection following total joint arthroplasty was elevated in first-degree relatives (HR, 2.16 [95% confidence interval (CI), 1.29 to 3.59]) and combined first and second-degree relatives (HR, 1.79 [95% CI, 1.22 to 2.62]). Further, 116 high-risk pedigrees with a familial standardized incidence ratio of >2 and a p value of <0.05 were identified and 9 were selected for genotyping studies based on the observed periprosthetic joint infection/total joint arthroplasty ratio and visual inspection of the pedigrees for lack of excessive comorbidities. CONCLUSIONS Although preliminary, these data may help to guide further genetic research associated with periprosthetic joint infections. An understanding of familial risks could lead to new discoveries in creating patient-centered pathways for infection prevention in patients at risk. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mike B. Anderson
- Departments of Orthopaedics (M.B.A., C.E.P., C.L.P, and J.M.G.) and Internal Medicine (K.C.), University of Utah, Salt Lake City, Utah
| | - Karen Curtin
- Departments of Orthopaedics (M.B.A., C.E.P., C.L.P, and J.M.G.) and Internal Medicine (K.C.), University of Utah, Salt Lake City, Utah,Pedigree and Population Resource, The University of Utah and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Jathine Wong
- Pedigree and Population Resource, The University of Utah and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Christopher E. Pelt
- Departments of Orthopaedics (M.B.A., C.E.P., C.L.P, and J.M.G.) and Internal Medicine (K.C.), University of Utah, Salt Lake City, Utah
| | - Christopher L. Peters
- Departments of Orthopaedics (M.B.A., C.E.P., C.L.P, and J.M.G.) and Internal Medicine (K.C.), University of Utah, Salt Lake City, Utah
| | - Jeremy M. Gililland
- Departments of Orthopaedics (M.B.A., C.E.P., C.L.P, and J.M.G.) and Internal Medicine (K.C.), University of Utah, Salt Lake City, Utah,E-mail address for J.M. Gililland:
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Lee GC. CORR Insights(®): Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty? Clin Orthop Relat Res 2016; 474:1607-9. [PMID: 26818598 PMCID: PMC4887350 DOI: 10.1007/s11999-016-4690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 01/04/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA.
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