Aims. This study aimed to evaluate the BioFire
Aims. Musculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and
Acute bone and
Aims. Trained immunity confers non-specific protection against various types of infectious diseases, including bone and
Aims. This aim of this study was to analyze the detection rate of rare pathogens in bone and
Aims. Periprosthetic
Aim. There have been many attempts to define the criteria by which prosthetic joint infection (PJI) is diagnosed. Our aim is to validate the 2021 European Bone and
Aims. There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic
Aims. This study evaluated the definitions developed by the European Bone and
Aim. Synovial fluid investigation is the best alternative to diagnose prosthetic joint infection (PJI) before adequate microbiological/histology sampling during revision surgery. Although accurate preoperative diagnosis is certainly recommended, puncturing every patient before revision arthroplasty raises concerns about safety and feasibility issues especially in difficult to access joint (e.g., hip), that often require OR time and fluoroscopy/ultrasound guidance. Currently there is no clear guidelines regarding optimal indications to perform preoperative joint aspiration to diagnose PJI before revision surgery. The main goal of this study is to determine the accuracy of our institutional criteria using the new European Bone and
Aims. The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for infection. The primary aim of this study was to measure the treatment success rate for octogenarians undergoing revision total hip arthroplasty (THA) for periprosthetic
Aims. Despite numerous studies focusing on periprosthetic
Aims. The diagnosis of periprosthetic
Periprosthetic
Aims. This study aimed to evaluate the clinical application of the PJI-TNM classification for periprosthetic
Aims. Periprosthetic
Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and
Aims. The aims of this study were to determine the incidence and factors for developing periprosthetic
Aims. A higher failure rate has been reported in haematogenous periprosthetic
Aims. The diagnosis of periprosthetic
Aim. Serum parameters continue to be a focus of research in diagnosing periprosthetic
Aims. To investigate the optimal thresholds and diagnostic efficacy of commonly used serological and synovial fluid detection indexes for diagnosing periprosthetic
Accurate diagnosis is key in correctly managing prosthetic joint infection (PJI). Our aim is to compare the preoperative performance of three PJI definitions comparing it to definitive postoperative classification. This is a multicenter retrospective study of patients who have undergone total hip or knee revision surgery in four different European institutions. For this specific study, cases with no preoperative synovial fluid differential leukocyte count and less than four intraoperative microbiology samples were excluded. Cases were classified using the 2021 EBJIS, the 2018 International Consensus Meeting (ICM) and the 2013 Musculoskeletal Infection Society (MSIS) PJI definitions. Preoperative classification was based on clinical features, inflammatory markers and synovial fluid leukocyte count and microbiology results.Aim
Method
Aims. Histology is widely used for diagnosis of persistent infection during reimplantation in two-stage revision hip and knee arthroplasty, although data on its utility remain scarce. Therefore, this study aims to assess the predictive value of permanent sections at reimplantation in relation to reinfection risk, and to compare results of permanent and frozen sections. Methods. We retrospectively collected data from 226 patients (90 hips, 136 knees) with periprosthetic
Aims. The aim of this study was to evaluate the optimal deep tissue specimen sample number for histopathological analysis in the diagnosis of periprosthetic
Aims. The management of periprosthetic
Background. Increasing evidence suggests a link between the bearing surface used in total hip arthroplasty (THA) and the occurrence of infection. It is postulated that polyethylene has immunomodulatory effects and may influence bacterial function and survival, thereby impacting the development of periprosthetic
Aims. Despite numerous studies on periprosthetic
Aims. Fungal periprosthetic
Aims. Serum inflammatory parameters are widely used to aid in diagnosing a periprosthetic
Aims. This study aimed to explore the diagnostic value of synovial fluid neutrophil extracellular traps (SF-NETs) in periprosthetic
Background. The diagnosis of periprosthetic
Aims. The aim of this study was to evaluate the diagnostic accuracy of the absolute synovial polymorphonuclear neutrophil cell (PMN) count for the diagnosis or exclusion of periprosthetic
Aims. Fungal periprosthetic
Periprosthetic
Introduction. Vancomycin is a commonly used antibiotic for prophylaxis in total joint replacement surgery. Several studies have reported superior local tissue concentration of vancomycin using intraosseous (IO) infusion compared with standard intravenous (IV) administration in total knee arthroplasty (TKA). We reviewed patients undergoing primary TKA who received IO vancomycin to a group receiving IV vancomycin. Methods. A retrospective review of 1038 patient who underwent primary TKA at our institution was performed from May 1, 2016 to May 1, 2019. This was a consecutive series of patients before and after we adopted this technique. IO vancomycin administration technique has been previously reported from our institution (500mg vancomycin in 200mL solution). Comparisons included preoperative and postoperative creatinine values, adverse reaction to vancomycin, tourniquet time, re-operation rates, periprosthetic
Aims. A revision for periprosthetic
Aim. Several options to standardize the definition of periprosthetic
Aims. The aim of this study was to analyze the prevalence of culture-negative periprosthetic
All adult patients with proven Aim
Method
Aim. Patients with late acute periprosthetic
Aim. To investigate the impact of waiting for surgical treatment for bone and
Elevated synovial leukocyte count is a minor criterion derived from the musculoskeletal infection society (MSIS) widely used in clinical practice for diagnosis of prosthetic joint infection. There is evidence to suggest analysis within 1 hour, preferentially within 30 minutes, of aspiration reduces the risk of ex vivo cell lysis occurring during prolonged transport. Multiple site working is more common practice and the availability of a lab on site to perform these tests is not always possible. We aimed to assess whether we could safely perform synovial leukocyte counts within our cold site in the diagnosis of prosthetic joint infection. We reviewed all orthopaedic synovial fluid aspirates within the lower limb arthroplasty unit from April 2021 – April 2022 performed at South Tees NHS Foundation Trust. We assessed time from aspirate to the lab using electronic data resources. This information was compared with the labs ability to perform a synovial leukocyte count to determine the impact of delays on testing. 110 patients (34.5% hips and 63.6% knees) were identified between two sites. Time from aspirate to lab ranged from 0 mins to 26 hrs 34 mins. Mean time to processing was 3hrs 10 mins. 50% of all samples had a synovial leukocyte count performed. 67% of patients had a cell differential performed. There was no difference in the ability to perform a synovial leukocyte count between samples process in < 2hours vs > 6 hours. We conclude that it is safe practice to perform joint aspirates for the work up of periprosthetic
Aims. This study aimed to explore the role of small colony variants (SCVs) of Staphylococcus aureus in intraosseous invasion and colonization in patients with periprosthetic
Aims. One-stage exchange for periprosthetic
Aims. Periprosthetic hip and knee infection remains one of the most severe complications following arthroplasty, with an incidence between 0.5% to 1%. This study compares the outcomes of revision surgery for periprosthetic
Aim. Periprosthetic
An increasing elderly population means joint replacement surgery numbers are projected to increase, with associated complications such as periprosthetic
Aim. The aim of this study was to investigate the metabolomic profile of synovial fluid in periprosthetic
Aims. National joint registries under-report revisions for periprosthetic
Aim. Rifampicin as a biofilm-active antibiotic drug has a significant role in the treatment of periprosthetic
Aims. Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic
Abstract. Aims. The primary aim of this study was to evaluate the outcomes of fungal knee periprosthetic
Aims. Despite recent literature questioning their use, vancomycin and clindamycin often substitute cefazolin as the preoperative antibiotic prophylaxis in primary total knee arthroplasty (TKA), especially in the setting of documented allergy to penicillin. Topical povidone-iodine lavage and vancomycin powder (VIP) are adjuncts that may further broaden antimicrobial coverage, and have shown some promise in recent investigations. The purpose of this study, therefore, is to compare the risk of acute periprosthetic
Aims. Accurate diagnosis of chronic periprosthetic
Aims. The management of periprosthetic
Aim. Periprosthetic
Background. Periprosthetic
Aims. Periprosthetic
Aim. A large body of evidence is emerging to implicate that dysregulation of the gut microbiome (dysbiosis) increases the risk of surgical site infections. Gut dysbiosis is known to occur in patients with inflammatory bowel disease (IBD), allowing for translocation of bacteria across the inflamed and highly permeable intestinal mucosal wall. The null hypothesis was that IBD was not associated with increased risk of periprosthetic
Aims. Histology is an established tool in diagnosing periprosthetic
Aim. It is traditionally stated that around 80% of all periprosthetic
Aims. The aim of this meta-analysis is to assess the association between exchange of modular parts in debridement, antibiotics, and implant retention (DAIR) procedure and outcomes for hip and knee periprosthetic
Aims. We aimed to evaluate the utility of . 68. Ga-citrate positron emission tomography (PET)/CT in the differentiation of periprosthetic
Aim. This study assesses the ability of the JS-BACH classification of bone infection to predict clinical and patient-reported outcomes in prosthetic joint infection (PJI). Method. Patients who received surgery for suspected PJI at two specialist bone infection centres within the UK between 2010 and 2015 were classified using the JS-BACH classification into either ‘uncomplicated’, ‘complex’ or ‘limited options’. All patients were classified by two clinicians blinded to outcome, with any discrepancies adjudicated by a third reviewer. At the most recent follow-up, patients were assessed for (i) any episode of recurrence since the index operation and (ii) the status of the joint. A Cox proportional-hazard model assessed significant predictors of recurrence following the index procedure. Patient-reported outcomes included the EuroQol EQ-5D-3L index score and the EQ-visual analogue score (VAS) at 0, 14, 42, 120 and 365 days following the index operation. Results. 220 patients met the inclusion criteria during the study period which included PJI of the knee (n=111), hip (n=102), shoulder (n=4) and elbow (n=3). The median time to final follow-up was 4.7 years (inter-quartile range 2.7 – 6.7 years). Controlling for type of index procedure and site of infection, Cox proportional-hazards ratio of recurrence when being classified as complex versus uncomplicated was 25.2 (95% CI 3.45 – 183.7, p<0.001) and having limited options verses uncomplicated was 59.0 (95% CI 7.93 – 439.1, p<0.001). None of the patients who were classified as ‘uncomplicated’ PJI (0/52) had received either amputation, joint fusion, excision arthroplasty, chronic suppressive anti-biotics, had died from sepsis secondary to PJI or were awaiting treatment for an active infection at final follow-up. This compared to 21.3% (27/127) of patients classified as ‘complex’ PJI and 65.9% (27/41) of patients classified as ‘limited options’. Compared to the age-matched population, patients with ‘uncomplicated’ PJI reported similar EQ-index scores (age-matched population: 0.782, ‘uncomplicated’: 0.730, SD 0.326) and EQ-VAS (age-matched: 77.9, ‘uncomplicated’ PJI: 79.4, SD 20.9). This was significantly higher when compared to patients classified as ‘complex’ (EQ-index: 0.515 SD 0.323, p<0.012; EQ-VAS: 68.4 SD 19.4, p=0.042) and ‘limited options’ (EQ-index: 0.333 SD 0.383, p<0.001; EQ-VAS: 60.2, SD 23.1, p=0.005, ANOVA with Tukey post-hoc comparison). Conclusions. We have demonstrated that the JS-BACH classification for bone and
Aims. Use of molecular sequencing methods in periprosthetic
Aim. We aimed to evaluate the impact of knee periprosthetic
Aims. Although low-intensity pulsed ultrasound (LIPUS) combined with disinfectants has been shown to effectively eliminate portions of biofilm in vitro, its efficacy in vivo remains uncertain. Our objective was to assess the antibiofilm potential and safety of LIPUS combined with 0.35% povidone-iodine (PI) in a rat debridement, antibiotics, and implant retention (DAIR) model of periprosthetic
Objectives. The diagnosis of periprosthetic
Aims. Treatment outcomes for methicillin-resistant Staphylococcus aureus (MRSA) periprosthetic
Aims. Delayed postoperative inoculation of orthopaedic implants with persistent wound drainage or bacterial seeding of a haematoma can result in periprosthetic
Aims. To explore the clinical efficacy of using two different types of articulating spacers in two-stage revision for chronic knee periprosthetic
Aims. Periprosthetic
Aim. To assess whether recurrence of PJI and osteomyelitis impacts patient-reported quality of life (QoL). Method. We studied patients receiving surgical treatment for confirmed PJI or osteomyelitis in one of 26 centres in the UK. Patients completed the EQ-5D-3L questionnaire, directly after surgery, at day 14, day 42, day 120 and day 365 after surgery and were assessed for evidence of recurrence. Results. Of 621 patients with PJI, 99 had recurrent infection (15.9%). Patients with recurrence reported significantly lower QoL at one year after surgery compared to those without recurrence (EQ-5D-3L index score with recurrence: 0.368, SD0.344 vs. no recurrence: 0.592, SD0.315, p<0.001). Patients were grouped based on the timing of their recurrence: <42 days (n=27); 42–120 (n=28); or >120 days (n=44) post-surgery. At the time-point immediately preceding the diagnosis of recurrence, QoL was significantly lower than in corresponding patients without recurrence (recurrence <42 days, p<0.05; 42–120 days, p<0.001; >120 days, p<0.05). In 358 cases of osteomyelitis, 39 patients had recurrent infection (10.9%). Recurrence of osteomyelitis produced significantly lower QoL at one year after surgery compared to patients without recurrent infection (EQ-5D-3L for recurrence: 0.385, SD0.345 vs. no recurrence: 0.634, SD0.349, p<0.001). Patients with recurrence after 120 days (n=21) reported significantly lower QoL than those with no recurrence at the time-point immediately preceding the diagnosis of recurrence (p<0.01). In contrast to patients with PJI, patients with osteomyelitis who had recurrence diagnosed before 120 days (n=18) reported similar outcome scores to patients who did not have recurrence. Conclusion. Failure to eradicate infection greatly affects patient QoL. This study supports the monitoring of EQ-5D-3L among patients treated for bone and
Aims. Periprosthetic
Aims. Gram-negative periprosthetic
Objectives. Periprosthetic
Aim. The number of periprosthetic
Aim. Apart from other biomarkers isolated in the synovial fluid, alpha-defensin appears to be a promising diagnostic tool to confirm a periprosthetic
Aim. The current antibiotic treatment of periprosthetic
Aims. The aim of this study was to estimate the 90-day periprosthetic
Aim. As the populations of patients who have multiple prosthetic joints increase these years, the fate of a single joint periprosthetic
Aims. Fungal and mycobacterial periprosthetic
Aims. Achievement of accurate microbiological diagnosis prior to revision is key to reducing the high rates of persistent infection after revision knee surgery. The effect of change in the microorganism between the first- and second-stage revision of total knee arthroplasty for periprosthetic
Aims. The preoperative diagnosis of periprosthetic
Aims. Debridement, antibiotics, and implant retention (DAIR) remains one option for the treatment of acute periprosthetic
Aim. Diagnosing periprosthetic
Purpose. Intra-articular corticosteroid injection is widely used for symptomatic relief of knee osteoarthritis. However, if pain is not improved which consequences a total knee arthroplasty (TKA), there is a potential risk of post-operative periprosthetic
Periprosthetic
Abstract. Introduction. Periprosthetic
Aim. Optimal strategies for surgical and antimicrobial management of Candida periprosthetic
Aim. The clinical relevance of microbial DNA detected via next-generation sequencing (NGS) remains unknown. This multicenter study was conceived to: 1) identify species on NGS that may predict periprosthetic
Aim. Periprosthetic
Periprosthetic
Aims. The outcome of repeat septic revision after a failed one-stage exchange for periprosthetic
Aims. As a proven and comprehensive molecular technique, metagenomic next-generation sequencing (mNGS) has shown its potential in the diagnosis of pathogens in patients with periprosthetic
Aims. In cases of severe periprosthetic
Introduction. Management of periprosthetic