Success rate after Debridement-Irrigation, Antibiotic Therapy and Implant Retention (DAIR) for treatment of Acute Haematogenous (AH) and Early Post-surgical (EP) periprosthetic joint infection (PJI) varies widely among published studies. Prosthesis exchange is recommended to treat PJI after a failed DAIR. However, no early postoperative prognostic factors permitting to identify future failures have been described. Identify early prognostic factor of failure after DAIR in order to propose efficient treatment before onset of chronic PJI.Introduction
Aim
Laboratory records from January 2009 to January 2014 were searched for monomicrobial Aim
Methods
The frequency of arthroplasty among older people is increasing. Taking care of Prosthetic Joint infection (PJI) in this specific population is a challenge. The purpose of this multicentric retrospective study was to evaluate the bacterial epidemiology of hip and knee PJI in octogenarians and nonagenarians over ten years. Data were collected using two softwares* in each of the 4 Centers participating. Inclusion criteria: age ≥ 80 years PJI (knee or hip) between January 2007 and December 2016 microbiological data available (strains isolated from osteo-articular samples) Bacterial identification: biochemical methods, followed by Malditof since 2009. For Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacteriaceae, resistance profiles to antibiotics frequently used in PJI were collected. Antimicrobial susceptibility testing: disk diffusion (recommendations: French Society of Microbiology yearly updated).Aim
Method
According to Tsukuyama classification, late acute hematogenous prosthesis joint infections (PJI) should be treated with debridement and implant retention (DAIR). We report here a recurrent Salmonella Dublin hip prosthesis infection. Through this case, we show how a recurrence of chronic PJI may have an acute clinical presentation leading to an inadequate surgical treatment. Case report. On May 2011, a 74-year-old woman with bilateral hip prostheses (implanted in 1998 (right) and 2001 (left)), was admitted to intensive care for sepsis and pain of her left hip. Blood cultures and a joint aspiration of the left hip yielded pure cultures of S.Dublin. The patient had a recent history of febrile diarrhea after consuming dubious meat. The patient underwent DAIR followed by a six-week antibiotherapy. Three years later, she presented to the emergency room for an acute onset febrile PJI of the right hip. The patient underwent DAIR of the right hip. Blood cultures, joint aspiration fluid, and all intraoperative periprosthetic tissue samples yielded S.Dublin. Colonoscopy and abdomen ultrasound were negative. The patient received two weeks of intravenous combined antibiotherapy followed by oral antibiotics for further 10 weeks. Six weeks post operatively, the surgical wound was healed and the patient walked normally. One year later, the patient was referred by her primary care practitioner for night fevers without local signs or dysfunction of her prostheses. Radioleucoscintigraphy showed right hip inflammation. Bilateral hip biopsies were nevertheless performed, yet S. Dublin was recovered solely from the right hip biopsy. A one-stage exchange of the right hip was performed. All intraoperative periprosthetic tissue samples yielded S.Dublin. A six-week-combined antibiotherapy was undertaken. One year later, the patient appeared free of infection and walked normally.Aim
Method
We retrospectively selected all cases of microbiologically documented monomicrobial PJI caused by Aim
Method
The diagnosis of prosthetic joint infections (PJI) represents a critical challenge for orthopedic surgeons and infectious disease specialists. The diagnosis of PJI is often delayed because non-invasive assays lack sensitivity and specificity. A novel multiplex immunoassay detecting antibodies against Staphylococci, Propionibacteria and Streptococcus agalactiae was developed and its performance evaluated in a prospective, multicenter, non-interventional study. The Luminex-based assay measures serum IgG against a proprietary panel of recombinant purified antigens from Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus agalactiae and Propionibacterium acnes. Patients undergoing revision arthroplasty were included over a 2-year period (from 2012 up to 2014) in two French reference centers in compliance with IRB and French regulations. PJI cases were defined microbiologically (≥2 intraoperative samples yielding the same microorganism) for confrontation of microbiological and immunoassay data. 455 patients were eligible for study analyses. 149 patients (32.7%) were found to be infected. Among the most frequent infecting species recovered were S. aureus (30%), S. epidermidis (26%), P. acnes (9%), S. lugdunensis (6%), and S. agalactiae (4%). The sensitivity and specificity values of the test were, respectively, 75.9% (63/83) and 82.2% (180/219) for staphylococci (S. aureus, S. epidermidis, S. lugdunensis), 38.5% (5/13) and 81.9% (190/232) for P. acnes, and 66.7% (4/6) and 92.4% (208/225) for S. agalactiae. Interestingly, all cases (9/9) involving S. lugdunensis were detected by the test and the sensitivity for S. epidermidis reached 79.4% in patients more than three months after joint replacement. In a similar fashion, 89.5% (17/19) in the subpopulation with elevated inflammatory markers (ESR>30 and CRP>10). The assay correctly identified 67% of the microbiologically positive patients that were negative by ESR or CRP screening. This novel multiplex serological test allows the rapid and non-invasive diagnosis of the most frequent PJI pathogens, showing a good correlation with microbiological culture. and appears to be a new promising tool in the management of PJI, adding sensitivity to the current serological assays and enhancing the management of patients with pauci-inflammatory PJI.
Modular femoral necks have shown promising clinical results in total hip arthroplasty (THA) to optimize offset, rotation, and leg length. Given the wide variety of proximal femoral morphology, fine-tuning these kinematic parameters can help decrease femoroacetabular impingement, decrease wear rates and help prevent dislocations. Yet, additional implant junctions introduce additional mechanisms of failure. We present two patients who developed an abnormal soft tissue reaction consistent with a metal hypersensitivity reaction at a modular femoral neck/stem junction requiring revision arthroplasty. Two patients underwent THA for primary osteoarthritis with the same series of components: 50 mm shell, a 36 mm highly-crosslinked polyethylene liner, uncemented titanium alloy modular stem with a 130 degree Cobalt Chromium (CoCr) modular femoral neck, and 36 mm CoCr head with a +5-mm offset. Patient 1 was a 63 year-old female who had an uneventful post-operative course but presented seven months later with progressive pain in the left hip. Patient 2 was an 80 year-old female who did well post-operatively, but presented with limp and persistent pain at 10 months post-op. An initial evaluation of a painful THA to rule out aseptic loosening, infection, mal-positioning, loosening and osteolysis included radiographs, lab work (CBC, ESR, CRP, Cobalt & Chromium levels) and Metal Artifact Reduction Sequence (MARS) MRI.Introduction
Methods
Both from experimental studies and the large arthroplasty registries there is evidence that bacteria are more often involved in implant loosening then is currently reported. To further elucidate this potential problem, the current study investigated the hypothesis that many total hip arthroplasty revisions, classified as aseptic, are in fact low-grade infections missed with routine diagnostics. In 7 Dutch hospitals, 176 patients with the preoperative diagnosis of aseptic loosening of their total hip arthroplasty were enrolled. From each patient, the preoperative history was obtained. During surgery, between 14 and 20 tissue samples were obtained for routine culture, pathology analysis and broad range 16S rRNA PCR with reverse line blot hybridization (PCR-RLB). Samples were taken from the (neo-) capsule and acetabular and femoral interface tissue. Cultures were performed locally according to similar protocols. One specialized pathologist, blinded for all other results, analyzed all pathology samples. The PCR-RLB analysis was performed centrally, using a technique previously validated for orthopedic use. Patients were classified as not infected, suspect for infection or infected, according to strict, predefined criteria. Each patient had a follow-up visit after 1 year.Background
Methods
The purpose of this study was to evaluate trabecular bone response to four different synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model. The group with the highest HA/TCP proportion (and the lowest CaSO4 proportion) had the greatest amount of residual graft material and total mineralized material (p<
0.05). Increasing the proportion of HA/TCP reduces the rate of dissolution, and appears to have little effect on bone formation. This study suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications. Calcium sulfates and phosphates have become popular clinically for use as bone graft substitutes, however, their in-vivo performance has not been well characterized. The purpose of this study was to evaluate trabecular bone response to four synthetic graft materials (CaSO4 and CaSO4 – HA/TCP composites) as compared to autograft in a canine defect model. Both 100% CaSO4 and the 3 CaSO4– HA/TCP formulations showed good bone formation. The group with the highest proportion of HA/TCP lasted longer than the other formulations, suggesting increased HA/TCP proportions reduce the rates of dissolution, without compromising bone formation in the current model. Results suggests that a range of composites could be created to match the spectrum of resorption rates demanded by clinical applications. In this REB-approved RCT, bilateral humeral and femoral cylindrical defects were filled with one of four types of pellets with varying proportions of CaSO4 – HA/TCP, autograft bone, or left unfilled. After sacrifice at six or twelve weeks, defect sites were evaluated histologically for tissue and inflammatory response, area fractions of residual graft material, and bone ingrowth in the defects. The area of the defect occupied by residual graft material in the group with the highest percentage of HA/TCP was greater than in other composite groups (p<
0.0006). At twelve weeks, this group contained more total mineralized material (graft material + bone) (p<
0.005). The extent of new bone formation was not different among the composite groups at either time-point, but all showed more bone formation than the empty defect.