Aim. Dissolvable antibiotic-loaded calcium sulphate beads have been utilized for management of periprosthetic joint infection (PJI) and for
Prosthetic joint infection (PJI) is a devastating and costly complication of total joint arthroplasty (TJA). Use of extended oral antibiotic prophylaxis (EOAP) has become increasingly popular in the United States following a highly publicized study (Inabathula et al) from a single center demonstrating a significant protective effect (81% reduction) against PJI in ‘high-risk’ patients. However, these results have not been reproduced elsewhere and EOAP use directly conflicts with current antibiotic stewardship efforts. In order to study the role of EOAP in PJI prevention, consensus is needed for what defines ‘high-risk’ patients. The revision TJA (rTJA) population is an appropriate group to study due to having a higher incidence of PJI. The purpose of the current study was to rigorously determine which preoperative conditions described by Inabathula et al. (referred to as Inabathula criteria (IBC)) confer a higher rate of PJI in patients undergoing aseptic rTJA. 2,256 patients that underwent aseptic rTJA at a single high-volume institution between 2016–2022 were retrospectively reviewed. Patient demographics and comorbidities were recorded to determine if they had 1 or more ‘IBC’, a long list of preoperative conditions including autoimmune diseases, active smoking, body mass index (BMI)>35, diabetes mellitus, and chronic kidney disease (CKD). Reoperation for PJI at 90-days and 1-year was recorded. Chi-squared or Fischer's exact tests were calculated to determine the association between preoperative presence/absence of IBC and PJI. Multivariable logistic regressions were conducted to determine if specific comorbidities within the IBC individually conferred an increased PJI risk.Aim
Method
Aims. The outcomes of patients with unexpected positive cultures (UPCs) during revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unknown. The objectives of this study were to establish the prevalence and infection-free implant survival in UPCs during presumed aseptic single-stage revision THA and TKA at mid-term follow-up. Methods. This study included 297 patients undergoing presumed aseptic single-stage revision THA or TKA at a single treatment centre. All patients with at least three UPCs obtained during revision surgery were treated with minimum three months of oral antibiotics following revision surgery. The prevalence of UPCs and causative microorganisms, the recurrence of periprosthetic joint infections (PJIs), and the infection-free implant survival were established at minimum five years’ follow-up (5.1 to 12.3). Results. Of the 297 patients undergoing aseptic revisions, 37 (12.5%) had at least three UPCs obtained during surgery. The UPC cohort included 23 males (62.2%) and 14 females (37.8%), with a mean age of 71.2 years (47 to 82). Comorbidities included smoking (56.8%), hypertension (48.6%), diabetes mellitus (27.0%), and chronic renal impairment (13.5%). The causative microorganisms included Staphylococcus epidermidis (49.6%), Bacillus species (18.9%), Micrococcus species (16.2%), and Cutibacterium acnes (16.2%). None of the study patients with UPCs developed further PJIs or required further surgical intervention during follow-up. Conclusion. The prevalence of UPCs during presumed aseptic revision THA and TKA was 12.5%. The most common causative microorganisms were of low virulence, and included S. epidermidis, Bacillus species, Micrococcus species, and C. acnes. Microorganism-specific antibiotic treatment for minimum three months’ duration of UPCs in presumed
Aim. Culture-based conventional methods are still the gold standard to identify microorganisms in hip and knee PJIs diagnosis. However, such approach presents some limitations due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range polymerase chain reaction (PCR), are available for diagnostic use in a suspected PJI. However, limited data is available on their sensitivity and specificity. This study aimed to evaluate the performance of a rapid and simple Investigational Use Only (IUO) version of the BioFire® JI multiplex PCR panel when compared to traditional microbiological procedures. Method. Fifty-eight native synovial fluid samples were recovered from 49 patients (female n=26; male =23) who underwent one or multiple septic or
Early and/or prolonged wound discharge after total knee arthroplasty often raises the question whether this is a sign of an early infection or if the prolonged discharge leads to a secondary deep wound infection from migrating skin bacteria. Confronted with the dilemma of what to do with early PWC our department implemented a new treatment protocol in 2002 to deal with early PWC after TKA in order to standardize decision-making. The aim of this study was to report our long-term results using this protocol on a prospective cohort primary TKA and revision TKA performed for other reasons than infection. This report focuses on the results of DAIR (debridement, antibiotics and implant retention) performed for early PPJI and/or early wound complications without clinical signs of infection. After implementing our treatment algorithm regarding postoperative wound complications in early 2002, we initiated a quality registration including every primary and non infected revision TKA performed. Between January 2002 and August 2012 1439 consecutive primary knee arthroplasties were performed at our institution. During the same period a total of 120 knee revisions for reasons not related to infection were performed. All patients undergoing DAIR within three months of the index procedure where divided into two groups: successful and unsuccessful. Successful DAIR didn't require any more surgery and the implant could be retained with a minimum follow up time of two years. Unsuccessful DAIR required at least one more surgical intervention. Treatment with DAIR was successful in 47 of 62 patients operated with primary and revision TKA as index operation. Those patients had no signs of infection and no antimicrobial therapy after a minimum of one year follow up time. The remaining 15 patients were in need of further surgery. Positive cultures could be obtained in 41 of 62 patients including those operated for
Current diagnostic tools are not always able to effectively identify periprosthetic joint infections (PJIs). Recent studies suggest that circulating microRNAs (miRNAs) undergo changes under pathological conditions such as infection. The aim of this study was to analyze miRNA expression in hip arthroplasty PJI patients. This was a prospective pilot study, including 24 patients divided into three groups, with eight patients each undergoing revision of their hip arthroplasty due to aseptic reasons, and low- and high-grade PJI, respectively. The number of intraoperative samples and the incidence of positive cultures were recorded for each patient. Additionally, venous blood samples and periarticular tissue samples were collected from each patient to determine miRNA expressions between the groups. MiRNA screening was performed by small RNA-sequencing using the miRNA next generation sequencing (NGS) discovery (miND) pipeline.Aims
Methods
Aims: The aim of this study was to investigate the functional results and complications of the total femur prosthesis Endo-Model?. Material and methods:100 total femurs implanted between 3/89 and 9/97 during
Introduction and Aims: Functional results following revision total hip arthroplasty (THA) for infection may be inferior to those done for aseptic causes. This cross-sectional study compared the results of patients who had two-stage revision for infection using an articulating spacer device, with those of a control group who had revision for aseptic causes. Method: Patients admitted between December 1997 and December 2000 for two-stage revision of an infected hip replacement using the PROSTALAC articulating spacer were included. They were compared to patients who had revision of both components for aseptic causes over the same time period. Patients with periprosthetic fractures were excluded. Pre-operative function was assessed using the Charnley score and bone loss was determined from pre-operative radiographs using the Paprowsky femoral and acetabular classifications. At a minimum two years follow-up, quality of life (QOL) was assessed using the WOMAC, Oxford-12 and SF-12 questionnaires. Patient satisfaction and co-morbidity data were also collected. Results: There were 44 septic and 105
Total knee arthroplasty is an established and successful operation. In up to 13% of patients who undergo total knee arthroplasty continue to complain of pain. Recently computerised tomography (CT) has been used to assess the rotational profile of both the tibial and femoral components in painful total knee arthroplasty. We reviewed 56 painful total knee replacements and compared these to 56 matched patients with pain free total knee replacements. Patients with infection,
We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision hip arthroplasty, the changes in risk over time, and the overall burden created by PJI. We analysed revision total hip arthroplasties (THAs) performed due to a diagnosis of PJI and the linked index procedures recorded in the NJR between 2003 and 2014. The cohort analysed consisted of 623 253 index primary hip arthroplasties, 63 222 index revision hip arthroplasties and 7585 revision THAs performed due to a diagnosis of PJI. The prevalence, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression.Objectives
Methods