Streptococcus bovis Hip and Knee Periprosthetic Joint Infections: A Series of 9 Cases

Incidence, functional outcomes and cure rate of hematogenous infection in a 2,498 Total Knee Arthroplasties cohort

PURPOSE

The primary aim of the present study is to report the late acute hematogenous (LAH) prosthetic joint infection (PJI) cure rate following Total knee arthroplasty (TKA) treated by means of debridement, antibiotics, and implant retention (DAIR) in a long-term follow-up. The secondary purpose is to report the functional outcomes at that follow-up and to compare them with a non-infected group.

MATERIAL AND METHODS

This study cohort consists of 2,498 TKA performed from September 2005 to April 2010 that had a minimum follow-up of 10 years. The diagnosis of PJI and classification into LAH was done in accordance with the Zimmerli criteria. The primary outcome was the failure rate, defined as death before the end of antibiotic treatment, a further surgical intervention for treatment of infection, life-long antibiotic suppressive treatment or chronic infection. The Knee Society Score (KSS) was used to evaluate clinical outcomes.

RESULTS

Ten patients were diagnosed with acute hematogenous PJI during the study period (0.4%). All of them were managed with DAIR, which was performed by a knee surgeon and/or PJI surgeon. The failure rate was 0% at the 8.5-year (SD, 2.4) follow-up mark. The KSS score was 82.1 vs. 84.1 (p n.s.) at final follow-up.

CONCLUSION

Although the literature suggests that TKA DAIR for LAH periprosthetic joint infection is associated with high rates of failure, the results presented here suggest a high cure rate with good functional outcomes.

LEVEL OF EVIDENCE

Level II, prospective cohort study.

Enhancing Antibacterial Performance and Biocompatibility of Pure Titanium by a Two-Step Electrochemical Surface Coating

A two-step electrochemical surface treatment has been developed to modify the CP Ti surface on commercially pure titanium grade 2 (CP Ti): (1) anodic oxidation to form TiO₂ nanotube precoatings loaded with silver (Ag) and (2) microarc oxidation (MAO) to produce a porous Ca-P-Ag coating in an electrolyte containing Ag, Ca, and P. One-step MAO in the same electrolyte has also been used to produce porous Ca-P-Ag coatings without anodic oxidation and preloaded Ag as a control. Surface morphologies and alloying chemistry of the two coatings were characterized by SEM, EDS, and XPS. Biocompatibility and antimicrobial properties have been evaluated by the MTT method and co-culture of Staphylococcus aureus, respectively. It is demonstrated that porous coatings with high Ag content can be achieved on the CP Ti by the two-step treatment. The optimized MAO voltage for excellent comprehensive properties of the coating is 350 V, in which a suitable chemical equilibrium between Ag, Ca, and P contents and a Ca/P ratio of 1.67 similar to HA can be obtained, and the Ag particles are in the size of less than 100 nm and embedded into the underneath of the coating surface. After being contacted with S. aureus for 1 and 7 days, the average bactericidal rates were 99.53 and 89.27% and no cytotoxicity was detected. In comparison, the one-step MAO coatings contained less Ag, had a lower Ca/P ratio, and showed lower antimicrobial ability than the two-step treated samples.