Aims. There is little information regarding the risk of a patient developing
Objectives. 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
Objectives.
Objectives.
Aims.
Aims. Fungal
Aims. The aim of this study was to evaluate the performance of metagenomic next-generation sequencing (mNGS) in detecting pathogens from synovial fluid of
Aims. Positive cultures are not uncommon in cases of revision total
knee and hip arthroplasty (TKA and THA) for presumed aseptic causes.
The purpose of this study was to assess the incidence of positive
intra-operative cultures in presumed aseptic revision of TKA and
THA, and to determine whether the presence of intra-operative positive cultures
results in inferior survival in such cases. Patients and Methods. A retrospective cohort study was assembled with 679 patients
undergoing revision knee (340 cases) or hip arthroplasty (339 cases)
for presumed aseptic causes. For all patients three or more separate
intra-operative cultures were obtained. Patients were diagnosed
with a previously unsuspected
Aims. In 2013, we introduced a specialized, centralized, and interdisciplinary team in our institution that applied a standardized diagnostic and treatment algorithm for the management of
Aims.
Aims. This pilot study tested the performance of a rapid assay for diagnosing
Aims. The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent
Objectives. The optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of
Objectives. The optimal protocol for antibiotic loading in the articulating cement spacers for the treatment of
Aims. Biopsy of the periprosthetic tissue is an important diagnostic tool for
Aims. In the absence of an identified organism, single-stage revision is contraindicated in
Aims. This study aimed to explore whether serum combined with synovial interleukin-6 (IL-6) measurement can improve the accuracy of
Aims. The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of
Aims. Failure of irrigation and debridement (I&D) for
Aims. Preoperative diagnosis is important for revision surgery after
Aims. The aim of this study was to establish the diagnostic accuracy
of culture of joint aspirate with and without saline injection-reaspiration. Patients and Methods. This is a retrospective analysis of 580 hip and knee aspirations
in patients who were deemed to have a moderate to high risk of infection,
and who subsequently proceeded to revision arthroplasty over a period
of 12 years. It was carried out at a large quaternary referral centre
where preoperative aspiration is routine. Results. Fluid was aspirated primarily in 313 (54%) cases and after saline
injection-reaspiration of a ‘dry tap’ in 267 (46%) cases. Overall
sensitivity and specificity of the diagnostic aspirate were 84%
(78% to 89%) and 85% (81% to 88%), respectively. Sensitivity and
specificity of saline injection-reaspiration after ‘dry tap’ were
87% (79% to 92%) and 79% (72% to 84%) compared with 81% (71% to
88%) and 90% (85% to 93%) for direct aspiration. Conclusion. Preoperative joint aspiration and culture is a sensitive and
specific test for the confirmation of diagnosis in patients at a
moderate to high risk of
Aims. The aim of this study was to determine the prevalence and characteristics of C-reactive protein (CRP)-negative
Aim. Prosthetic joint replacement is more commonly done in the elderly group of patients due to an increase pathology related to joint degeneration that comes with age. In this age group is also more frequent having underling condition that may predispose to a
Aim. Culture negative (CN)
Aims. Two-stage exchange arthroplasty is the most common definitive treatment for
Aims. This study aimed to evaluate calprotectin in synovial fluid for diagnosing chronic
Introduction. A proportion of patients with hip and knee
Aim.
Introduction. Gram-negative
Aims. To investigate the experience and emotional impact of
Introduction. The burden of
Gram-negative
Aim.
Aim. To provide proof of concept in an in vivo animal model for the prevention of
The management of
Background. Treatment of staphylococcal
Listeria monocytogenes is usually thought of as a bacterial pathogen that causes invasive disease including meningitis and bacteraemia in susceptible hosts. It remains a rare cause of bone and joint infection; there is therefore potential for clinical and laboratory delay in diagnosis and for uncertainty over optimal management. We describe our experience of two such cases of L. monocytogenes
Background. In the UK, over 160,000 total joint replacements are performed annually. About 1% of patients subsequently develop a deep bacterial infection and, if untreated, this can result in severe pain, disability, and death. Costs to the NHS are substantial. The INFORM (Infection Orthopaedic Management) programme aims to address gaps in knowledge relating to treatment of deep
Aims.
Aims. Current treatments of
INTRODUCTION. Deep infection is a potentially catastrophic complication of joint replacement surgery. Early intervention in suspected
This study aimed to identify the success rate of debridement, antibiotics and implant retention (DAIR) for
Aims. The aim of this study was to compare the results of 16S/28S rRNA sequencing with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and synovial fluid analysis in the diagnosis of
Introduction. The infection rate after total joint arthroplasty (TJA) has been shown to be 1–2% in multiple series and registry data. Irrigation, debridement, and polyethylene exchange (IDPE) is a common first line treatment in many cases of acute
Aim. The aim of this study was to gain insight into the in vivo expression of virulence and metabolic genes of Staphylococcus aureus in a
The infection rate after total joint arthroplasty (TJA) has been shown to be 1–2% in multiple series and registry data. Irrigation, debridement, and polyethylene exchange (IDPE) is a common first line treatment in many cases of acute
Introduction. In the last couple of years, several synovial biomarkers have been introduced in the diagnostic algorithm for a
Aims. The aim of this study was to determine if the local delivery of vancomycin and tobramycin in primary total knee arthroplasty (TKA) can achieve intra-articular concentrations exceeding the minimum inhibitory concentration thresholds for bacteria causing acute
Aims. We studied the impact of direct anterior (DA) versus non-anterior (NA) surgical approaches on
Aim. We aimed to compare the in vitro antibacterial activity of Bioactive Glass (BAG) S53P4, which is a compound showing local antibacterial activity, to that of antibiotic-loaded polymethylmethacrylate (PMMA) against multidrug resistant bacteria from osteomyelitis (OM) and
Aim. European population is ageing concurrently with an increase number of arthroplasties.
Cut-off values with highest sensitivity and specificity
for the synovial fluid white cell and differential count will facilitate
the accurate diagnosis of infection in total knee (TKR) and total
hip replacement (THR). All patients undergoing revision TKR or THR
for suspected
Total hip arthroplasty (THA) is one of the most successful and effective treatments for advanced hip osteoarthritis (OA). Over the last 5 years, Canada has seen a 17.8% increase in the number of hip replacements performed annually, and that number is expected to grow along with the aging Canadian population. However, the rise in THA surgery is associated with an increased number of patients at risk for the development of an infection involving the joint prosthesis and adjacent deep tissue – periprosthetic joint infections (PJI). Despite improved hygiene protocols and novel surgical strategies, PJI remains a serious complication. No previous population-based studies has investigated PJI risk factors using a time-to-event approach and none have focused exclusively on patients undergoing THA for primary hip OA. The purpose of this study is to determine risk factors for PJI after primary THA for OA using a large population-based database collected over 15 years. Our secondary objective is to determine the incidence of PJI, the time to PJI following primary THA, and if PJI rates have changed in the past 15 years. We performed a population-based cohort study using linked administrative databases in Ontario, Canada in accordance with RECORD and STROBE guidelines. All primary total hip replacements performed for osteoarthritis in patients aged 55 or older between January 1st 2002 – December 31st 2016 in Ontario, Canada were identified. Periprosthetic joint infection as the cause for revision surgery was identified with the International Classification of Diseases, 10th Edition (ICD-10), Clinical Modification diagnosis code T84.53 in any component of the healthcare data set. Data were obtained from the Institute for Clinical Evaluative Sciences (ICES). Demographic data and outcomes are summarized using descriptive statistics. We used a Cox proportional hazards model to analyze the effect of surgical factors and patient factors on the risk of developing PJI. Surgical factors include the approach, use of bone graft, use of cement, and the year of surgery. Patient factors include sex, age at surgery, income quintile and rurality (community vs. urban). We compared the 1,2,5 and 10 year PJI rates for patients undergoing THA each year of our cohort with the Cochran-Armitage test. Less than 0.1% of data were missing from all fields except for rurality which was lacking 0.3% of data. A total of 100,674 patients aged 55 or older received a primary total hip arthroplasty for osteoarthritis from 2002–2016. We identified 1034 cases of revision surgery for
Aim. One of the most accurate and inexpensive tests in detection of
Introduction. Fluorodeoxuglucose(FDG) Positron Emission Tomography(PET) scan is used in the diagnosis of
Objectives. Investigate the incorporation of an antibiotic in bone cement using liposomes (a drug delivery system) with the potential to promote osseointegration at the bone cement interface whilst maintaining antibiotic elution, anti-microbiological efficacy and cement mechanical properties.
Introduction.
Introduction. The intra-operative diagnosis of
Aim. Revision surgery and debridement and implant retention are recognised approaches for managing
Aim. To assess the analytical performance and to establish the cut-off of synovial fluid D-lactate concentration for the diagnosis of
Aims. The aims of this study were to characterize antibiotic choices for perioperative total knee arthroplasty (TKA) and total hip arthroplasty (THA) prophylaxis, assess antibiotic allergy testing efficacy, and determine rates of
Deep infection represents one of the most devastating complications of total knee arthroplasty. Commonly implicated organisms are gram positive bacteria such as staphylococcus aureus, staphylococcus epidermidis and group B streptococcus. Occasionally, infection may be caused by rare organisms, particularly in the immunocompromised host. We present a case of infected total knee arthroplasty in a penicillin allergic patient, caused by Pasteurella multocida, 13 weeks after the initial surgery. This was treated by open debridement and change of insert as well as aggressive antibiotic therapy. The patient admitted contact with a cat and three dogs at home. Pasteurella multocida is a facultatively anaerobic gram negative coccobacillus. It is a commensal in the nasopharygeal tract of domestic pets such as cats and dogs. Human infection can often be attributed to a bite or scratch.
Aim. To study whether revision for
Aim. We report on the performance of a simple algorithm using a combination of synovial fluid White blood cell count(WBC), C-reactive protein(CRP) and α-Defensin(AD) tests to aid in the diagnosis of
Aim. Phage therapy has attracted attention as a promising alternative treatment option for biofilm infections. To establish a successful phage therapy, a comprehensive stock of different phages covering a broad bacterial spectrum is crucial. We screened human and environmental sources for presence of lytic phages against selected bacteria. Methods. Saliva collected from 10 volunteers and 500 ml of sewage water were screened for the presence of lytic phages active against 20 clinical strains of Staphylococcus aureus and 10 of Escherichia coli, both isolated from patients with
Joint replacement is a life-enhancing, cost-effective surgical intervention widely used to treat disabling joint pain mainly caused by osteoarthritis. Hip and knee joint replacements are common, highly successful operations bringing many patients relief from pain, and improve mobility.
Aim. Pre-operative distinction between
Aim. Early
Aim. The use of piperacillin/tazobactam with vancomycin as empirical antimicrobial therapy (EAT) for
Background. Smoking has been associated with poor tissue oxygenation and vascularisation, predisposing smokers to a higher risk for postsurgical infections. The aim of this study was to estimate and compare the incidence of
Aim. Debridement, antibiotics and implant retention (DAIR) has become the preferred treatment in early
Although there is still no absolute diagnostic test for infection of the prosthetic joint, the synovial fluid leukocyte count and neutrophil percentage have been reported as having high sensitivity and specificity but to date the cut off values for these tests are not agreed upon. We investigated whether leukocyte count and differential of aspirated joint fluid are valuable tools in the diagnosis of suspected
Aims: The diagnosis of a
Diagnosis of chronic
Aim. Data on
No single test is 100% sensitive and specific for the diagnosis of
Aim. Diagnosing or excluding a chronic
Aim. The frequency of arthroplasty among older people is increasing. Taking care of
Aim.
Introduction. Periprosthetic infection (PJI) after primary total knee arthroplasty (TKA) remains a challenging issue affecting 1–2% of cases. Locally delivered prophylactic antibiotics, including tobramycin or gentamicin mixed in polymethylmethacrylate (PMMA) bone cement and vancomycin powder, are increasingly used despite a lack of high quality evidence for either practice. In this study, we report the antibiotic susceptibility of organisms recovered in culture from patients with acute
Aim.
Aim. Obese patients are not only more likely to receive total joint arthroplasty, but are also more prone to postoperative complications. The most severe complication is a
In a new rabbit model of carbapenem-resistant Klebsiella pneumoniae knee-prosthesis infection, we studied the efficacy of colistin cement alone or in combination with systemic intramuscular (i.m.) injections of colistin. Seven days after infection, surgical debridement and removal of the infected prostheses were performed, and rabbits were randomly assigned to one of four different treatment groups of twelve rabbits: prosthesis replacement by drug-free cement spacer (control) prosthesis replacement by colistin-loaded cement spacer (3 MUI of colistin/40 g of cement) (colistin local), prosthesis replacement by drug-free cement spacer and i.m. colistin (12 mg/kg of body weight, three time a day for 7 days), or colistin local + i.m. We observed a statistically significant difference (p = 0.049) between the colistin local + systemic group and the control group in the criteria of number of rabbits with sterile bone under the total number of rabbits. Combination of systemic and local colistin could be an interesting therapeutic option to cure carbapenem-resistant Klebsiella pneumoniae peri
The benefits of cell salvage autotransfusion are well reported. There is a common non-evidenced belief amongst revision arthroplasty surgeons that auto-transfusion is potentially contraindicated in infected revisions. The aim is to study the immediate and delayed outcomes of using cell saver on patients undergoing PJI surgery. Prospective cohort service evaluation registered with the local audit department. 20 PJI cases in 18 patients where cell saver was used over a period of 4 years. Intraoperative fluid and tissue samples were taken for culture. Blood culture from salvaged blood pre and post leucodepletion filter were sent for microbiological analysis. Data on type of surgery, blood loss, further allogenic transfusion and SIRS response was collected. Success of infection clearance was assessed using 2019 MSIS ORT. Five patients receiving autologous blood in non-infection cases were used as controls. Mean age for the PJI group was 67.7 years, 67% female. 11 patients (67%) had 1st stage surgery and 5 (25%) underwent 2nd stage whereas 4 patients had single stage surgery. The mean calculated blood loss was 1398 mls (range 400–3000mls). 6 Patients required further allogenic transfusion. 16 patients received blood via a leuco-depletion filter. The same organism grown from tissues was identified in post-filter blood in 8/17 patients (47%). 2/20 have grown a different organism in post-filtered blood, _P.Acne._ 2 patients developed SIRS upon auto-transfusion, however one was thought to be secondary to cementing. The control group had 443 mls mean amount of blood loss and 1 patient developed a SIRS response. 14/20 (70%) patients had successful clearance of infection (tier 1) 2 patients died prior to undergoing 2nd stage. Using cell saver did not impact main outcome of infection clearance in PJI surgery. We would advocate its routine usage whilst avoiding direct collection of heavily contaminated blood.
Introduction: Infections associated with prosthetic joints cause significant morbidity and account for substantial costs for health care systems. The management of
The Danish Hip Arthroplasty Register (DHR) is a national database on total hip arthroplasties (THAs) with a high completeness and validity of registration for primary procedures. The aim was to validate the registration in DHR for revisions due to
Aim. Over the past three years, roughly 100,000 hip and knee replacements have been performed by the Brazilian Public Healthcare System.
Aim. When a
Surgical treatment of Hip PJI by resection of the infected implants and tissue and placement of a “spacer” which elutes antibiotic via antibiotic loaded cement is an accepted treatment option. There is some controversy over whether this “spacer” should be articulating or static. Proponents of the articulating option argue that there is improved function and maintenance of the soft tissue envelop. Critics have suggested that additional biomaterials may compromise eradication of infection. This study compares our results of the 2 treatment options. A review of our institutional PJI database between 2016 and 2021 identified 87 patients who were treated with resection arthroplasty for unilateral total hip PJI. The cohort was analyzed for demographics and type for surgery, as well as medical comorbidities, survivorship, and treatment success. 44 patients were female, the mean age of all patients was 62. 44 patients were treated with Articulating apacers, and 43 patients treated with static spacers. There was no significant difference between ASA or Elixhauser score, and no significant difference between mortality or treatment failure. This study did not show any difference between the patients who receive static spacers, from those who received articulating spacers, and deomstrated similar treatment success rates. From this data there does not appear to be any difference in success rates between those patients that were treated with static spacers and those that were treated with articulating spacers.
Post operative
Introduction. Pre-operative aspiration and culture is the gold standard for the diagnosis of peri-prosthetic infection. This study aimed to ascertain the diagnostic accuracy of culture of joint aspiration with or without saline re-aspiration in the event of a dry-tap. Patients/Materials & Methods. Retrospective analysis of 343 hip aspirations in patients deemed to have moderate-high risk of infection and ultimately proceeded to revision arthroplasty over 12 years at a large quaternary referral centre where pre-operative aspiration is routine. Results. Fluid was aspirated in 141(41%) cases and dry taps in which saline injection-re-aspiration was performed occurred in 202 (59%) cases. Overall sensitivity and specificity of diagnostic aspirate were 82% (74–88%) and 79% (74–84%) respectively. Sensitivity and specificity of saline injection-re-aspiration after dry tap were 79% (64–87%) and 86% (78–92%) compared to 84% (74–91%) and 74% (66–81%) for direct aspiration. Discussion. Pre-operative joint aspiration and culture is a sensitive and specific test for the confirmation of diagnosis in patients at a moderate to high risk of
Periprosthetic joint infection (PJI) occurs in 0.2-2% of primary hip and knee arthroplasty and is a leading cause of revision surgery, impaired function, and increased morbidity and mortality. Topical, intrawound vancomycin administration allows for high local drug concentrations at the surgical site and has demonstrated good results in prevention of surgical site infection after spinal surgery. It is a promising treatment to prevent infection following hip and knee arthroplasty. Prior studies have been limited by small sample sizes and the low incidence of PJI. This systematic review and meta-analysis was performed to determine the effectiveness of topical vancomycin for the primary prevention of PJI in hip and knee arthroplasty. A search of Embase, MEDLINE, and PubMed databases as of June 2020 was performed according to PRISMA guidelines. Studies comparing topical vancomycin to standard perioperative intravenous antibiotics in primary THA and TKA with a minimum of three months follow-up were identified. The results from applicable studies were meta-analysed to determine the impact of topical vancomycin on PJI rates as well as wound-related and overall complications. Results were expressed as odds ratios (ORs) and 95% confidence intervals Nine comparative observational studies were eligible for inclusion. 3371 patients treated with 0.5-2g of topical vancomycin were compared to 2884 patients treated with standard care. Only one of nine studies found a significantly lower rate of PJI after primary THA or TKA (OR 0.09-1.97, p=0.04 for one study, p>0.05 for eight of nine studies), though meta-analysis showed a significant benefit, with vancomycin lowering PJI rates from 1.6% in controls to 0.7% in the experimental group (OR 0.47, p=0.02, Figure 1). Individually, only one of five studies showed a significant benefit to topical vancomycin in THA, while none of seven studies investigating PJI after TKA showed a benefit to topical vancomycin. In meta-analysis of our subgroups, there was a significant reduction in PJI with vancomycin in THA (OR 0.34, p=0.04), but there was no significant difference in PJI after TKA (OR 0.60, p = 0.13). In six studies which reported complication rates other than PJI, there were no significant differences in overall complication rates with vancomycin administration for any study individually (OR 0.48-0.94, p>0.05 for all studies), but meta-analysis found a significant difference in complications, with a 6.7% overall complication rate in controls compared to 4.8% after topical vancomycin, largely driven by a lower PJI incidence (OR 0.76, p=0.04). Topical vancomycin is protective against PJI after hip and knee arthroplasty. No increase in wound-related or overall complication rates was found with topical vancomycin. This meta-analysis is the largest to date and includes multiple recent comparative studies while excluding other confounding interventions (such as povidone-iodine irrigation). However, included studies were predominantly retrospective and no randomized-controlled trials have been published. The limited evidence summarized here indicates topical vancomycin may be a promising modality to decrease PJI, but there is insufficient evidence to conclusively show a decrease in PJI or to demonstrate safety. A prospective, randomized-controlled trial is ongoing to better answer this question. For any figures or tables, please contact the authors directly.
Tc 99m labelled leukocytes scintigraphy (LLS) could be useful for the diagnosis of bone and joint infections. The aim of our study was to evaluate its performances specifically in the diagnosis of