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Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 35 - 35
1 Dec 2021
Sigmund IK Holinka J Sevelda F Staats K Lass R Kubista B Giurea A Windhager R
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Aim

Although established serum inflammatory biomarkers, such as serum C-reactive protein (CRP) and serum white blood cell count (WBC), showed low accuracies in the literature, they are still commonly used in diagnosing periprosthetic joint infections (PJI). For a sufficient preoperative diagnosis novel more accurate serum parameters are needed. The aim of our study was to evaluate the performances of the established and novel routinely available serum parameters in diagnosing periprosthetic joint infections when using the proposed European Bone and Joint Infection Society (pEBJIS) criteria.

Method

In this retrospective study, 177 patients with an indicated revision surgery after a total joint replacement were included from 2015 to 2019. The easily accessible and routinely available serum parameters CRP, WBC, the percentage of neutrophils (%N), the neutrophils to lymphocytes ratio (NLR), fibrinogen and the platelet count to mean platelet volume ratio (PC/mPV) were evaluated preoperatively. The performances were examined via receiver operating characteristic (ROC) curve analysis (AUC). The curves were compared using the z-test. Seventy-five cases (42%) showed a PJI based on the pEBJIS-criteria.


The Bone & Joint Journal
Vol. 101-B, Issue 3 | Pages 288 - 296
1 Mar 2019
Sigmund IK Holinka J Sevelda F Staats K Heisinger S Kubista B McNally MA Windhager R

Aims

This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid diagnosis of native joint septic arthritis

Patients and Methods

Consecutive patients with suspected septic arthritis undergoing aseptic diagnostic joint aspiration were included. The aspirate was used for analysis by mPCR and conventional microbiological analysis. A joint was classed as septic according to modified Newman criteria. Based on receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) values of the mPCR and the synovial fluid culture were compared using the z-test. A total of 72 out of 76 consecutive patients (33 women, 39 men; mean age 64 years (22 to 92)) with suspected septic arthritis were included in this study.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 44 - 44
1 Dec 2017
Sigmund IK Gamper J Weber C Holinka J Funovics P Windhager R
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Aim

Periprosthetic joint infections are a devastating complication after modular endoprosthetic reconstruction following resection of a musculoskeletal tumour. Due to long operating times, soft tissue dissection and immunosuppression, the infection rate after limb salvage is high and ranges between 8% and 15%. The aim of this retrospective single centre study was to assess the reinfection and re-reinfection rate after septic complications of megaprostheses.

Method

In this retrospective study, 627 patients with a primary replacement of a musculoskeletal tumour of the lower limb and reconstruction by a megaprosthesis were recorded from 1983 – 2016. 83 out of 621 patients available for follow-up experienced an infection (13.4%). Two patients were treated with debridement and removal of the mobile parts, 61 patients with a one-stage revision, 16 patients with a two-stage revision, and 4 patients with an amputation. The mean follow up was 133 months (range: 2 – 423 months).


The Bone & Joint Journal
Vol. 99-B, Issue 1 | Pages 66 - 72
1 Jan 2017
Sigmund IK Holinka J Gamper J Staats K Böhler C Kubista B Windhager R

Aims

The diagnosis of periprosthetic joint infection (PJI) remains demanding due to limitations of all the available diagnostic tests. The synovial fluid marker, α-defensin, is a promising adjunct for the assessment of potential PJI. The purpose of this study was to investigate the qualitative assessment of α-defensin, using Synovasure to detect or exclude periprosthetic infection in total joint arthroplasty.

Patients and Methods

We studied 50 patients (28 women, 22 men, mean age 65 years; 20 to 89) with a clinical indication for revision arthroplasty who met the inclusion criteria of this prospective diagnostic study. The presence of α-defensin was determined using the qualitative Synovasure test and compared with standard diagnostic methods for PJI. Based on modified Musculoskeletal Infection Society (MSIS) criteria, 13 cases were categorised as septic and 36 as aseptic revisions. One test was inconclusive.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 54 - 54
1 Dec 2016
Staats K Kolbitsch P Sigmund IK Böhler C Holinka J Windhager R
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Aim

Aim of the study was to find out whether patients with positive minor criteria but without meeting the MSIS definition have a difference in the outcome after revision-surgery compared to patients without any MSIS-criteria? And does the reason for revision-surgery (eg. loosening) have an additional influence on the outcome parameters in patients with positive minor criteria?

Method

A retrospective matched-pair analysis with 98 patients who had undergone revision-surgery after TJA was performed. Forty-nine patients who showed 1 to 3 positive minor criteria (PMC) whereas 49 patients without any positive minor criteria (aseptic complications control group) were compared regarding re-revision-rate and revision-free survival. Patients were matched regarding sex, age, joint and comorbidities using the classification system by McPherson et al. Reasons for revisions were categorized in loosening, body wear, periprosthetic fracture/mechanical failure and soft-tissue complication. Endpoints were defined as re-revision for any cases.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 6 - 6
1 Dec 2016
Sigmund IK Holinka J Gamper J Staats K Böhler C Kubista B Windhager R
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Aim

Quantitative assessment of alpha-Defensin offers a promising approach for diagnosing a periprosthetic joint infection (PJI) with sensitivities and specificities ranging from 97% to 100% and 95% to 100%, respectively. However, to the best of our knowledge and after due inquiry little information exists concerning qualitative measurements of alpha-Defensin. The aim of this study was to assess the diagnostic accuracy of the alpha-Defensin test, a lateral flow test for the qualitative detection of alpha-Defensin.

Method

In this study, 50 patient with indicated revision surgery met the inclusion criteria due to septic or aseptic loosening. In addition to clinical standard diagnostics of PJI, the alpha-Defensin test* for the assessment of the qualitative alpha-Defensin in the synovial fluid was performed. The results were compared with the sensitivity and specificity of currently available clinical tests, specifically C-reactive protein (CRP), frozen section, definitive histology, bacteriology and sonication.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_15 | Pages 2 - 2
1 Dec 2015
Böhler C Dragana M Puchner S Windhager R Holinka J
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Septic arthritis is a therapeutic emergency with a high mortality rate (about 11%)(1). Inadequate treatment can cause permanent joint damage. Management of the septic arthritis includes prompt antibiotic treatment as well as joint-decompression and removal of purulent material(2). It is still discussed controversially and there is little evidence which surgical concept is preferable: arthroscopy with lavage and debridement or open arthrotomy with synovectomy(3,4). The aim of the study was to compare efficacy of arthroscopy and arthrotomy in patients with septic gonarthritis.

We evaluated 70 consecutive patients who underwent arthroscopy or arthrotomy at our clinic, because of a bacterial monarthritis of the knee between 2002 and 2010. Our primary outcome was the early recurrence of infection (> 3 months after surgery), which made a second surgery necessary. We compared patients who suffered reinfection and those who did not, in regard to the surgery type as well as potential confounders like comorbidity (measured by Charlson comorbidity index), age, body mass index (BMI), Gächter's -, Kellgren and Lawrence - and Outerbridge classification, duration of symptoms and inflammatory parameters. Furthermore we evaluated differences of the confounders between the surgery groups.

From the 70 patients 41 were treated arthroscopic and 29 with arthrotomy. In total eight patients (11.4%) had to undergo a second surgery because of early reinfection. The rate was significantly higher in patients treated with arthrotomy (n=6; 20.7%) compared to those treated with arthroscopy (n=2; 4.9%) (p=0.041). Whereas we found no significant influence of potential confounders between the reinfection group and the group where primary eradication was achieved. Patients who underwent arthrotomy were significantly older, had more comorbidities (both p<0.001) and higher grades of osteoarthritis according to Kellgren and Lawrence classification (p=0.023). In order to adjust the study population towards confounders we performed a subgroup analysis on patients of the second and third age percentile. When we repeated our analysis we still found a significant higher reinfection rate in the arthrotomy group (p=0.036). At the same time there were no differences in prevalence of confounders, neither between the two surgery groups, nor between the reinfection and the primary eradication group.

Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower reinfection rate than those treated with arthrotomy. As arthroscopy is the less invasive and more sufficient method it should be considered the routine treatment according to our data.


The Bone & Joint Journal
Vol. 95-B, Issue 5 | Pages 678 - 682
1 May 2013
Holinka J Pilz M Kubista B Presterl E Windhager R

The aim of this study was to evaluate whether coating titanium discs with selenium in the form of sodium selenite decreased bacterial adhesion of Staphylococcus aureus and Staph. epidermidis and impeded osteoblastic cell growth.

In order to evaluate bacterial adhesion, sterile titanium discs were coated with increasing concentrations of selenium and incubated with bacterial solutions of Staph. aureus (ATCC 29213) and Staph. epidermidis (DSM 3269) and stained with Safranin-O. The effect of selenium on osteoblastic cell growth was also observed. The adherence of MG-63 cells on the coated discs was detected by staining with Safranin-O. The proportion of covered area was calculated with imaging software.

The tested Staph. aureus strain showed a significantly reduced attachment on titanium discs with 0.5% (p = 0.011) and 0.2% (p = 0.02) selenium coating. Our test strain from Staph. epidermidis showed a highly significant reduction in bacterial adherence on discs coated with 0.5% (p = 0.0099) and 0.2% (p = 0.002) selenium solution. There was no inhibitory effect of the selenium coating on the osteoblastic cell growth.

Selenium coating is a promising method to reduce bacterial attachment on prosthetic material.

Cite this article: Bone Joint J 2013;95-B:678–82.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 329 - 329
1 Jul 2011
Funovics PT Holinka J Kotz R Dominkus M
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Endoprosthetic replacement following oncological conditions has shown to be at higher risk of sceptical complications due to the use of implants of unusual size, major soft tissue loss and immunsupression.

373 patients have been treated at our institution for malignant tumours of the bone or soft tissue around the knee with a modular tumour-prostheses of the knee joint since their availability from 1978. Infection or septic complications were identified in 78 patients (20.9%).

In 15 cases of superficial wound healing disturbances with a fistula simple excision and revision of the wound was performed. In 48 cases of deep periprosthetic infections patients underwent one-stage revision with explantation of the total prosthetic material except femoral and tibial stems, extensive debridement of the wound and replantation of the disinfected prostheses throughout one operation. In 8 patients two-stage revision of the prostheses was performed, using an antibiotic impregnated cement spacer and Steinmann nails. In 5 patients amputation of the affected limb was indicated, whereas 2 patients could be treated conservatively. Out of the patients treated by one-stage revision 16 developed recurrent infection and had to undergo consecutive surgery. After two-stage surgery 4 patients showed signs of septic recurrence.

According to our results deep periprosthetic infection of tumour-prostheses primarily can be treated by one-stage revision, in recurrent infections, however, two-stage revision should be performed. We additionally suggest the use of local or pedicled muscle flaps to obtain better soft tissue coverage of the prostheses after infection.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 320 - 320
1 Jul 2011
Holinka J Lass R Pfeiffer M Graninger W Hirschl A Presterl E
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Objectives: Microbial biofilms protect planctonic bacteria growing on the implants surfaces from detection and antibiotic treatment. To investigate the efficacy of sonication cultures in our patients with prosthetic joint infections we compared our findings with the results to those of periprosthetic tissue cultures and histology.

Methods: The sonication cultures of the explanted prosthesis were cultured according to the protocol by Trampuz et al. in the New England Journal of Medicin and using the routine method incubating the aspirated pus and periprosthetic material in brain-heart-infusion broth without sonication. To assess the most frequently affected component of the prosthesis all components were “sono-cultured” separately. The diagnosis of infection was based on the presence of bacteria or leucocytes in pus or tissue plus local signs and symptoms and/or systemic markers of inflammation (fever, leucocytosis, increased C-reactive protein)

Results: We investigated 60 patients with 40 septically and 20 aseptically explanted components of total knee (n=24), hip (n=21) tumor (n=6) and shoulder (n=2) endoprosthesis, as well as osteosynthetic material (n=6) and spinal instrumentation (n=1). The most frequently affected component of the hip prosthesis was the femoral head (100%) and the inlay (88%), of the knee prosthesis was the Patella (58%) and the tibia plateau (56%), of the tumor prosthesis were the polyethylene components (100%), of the shoulder prosthesis was the sphere and stem (each 100%), of the osteosynthesis material were the plate and screws (each 33%) and of the spine instrumentation were the rod and the screws (each 100%). From all detected pathogens in sonication cultures the most frequently were Staphylococcus aureus (25%), Staphylococcus epidermidis (22%) and Streptococci (13%). The sensitivity of sonication cultures and periprosthetic tissue cultures was 85% and 78% without preoperative antibiotic therapy compared with histological analysis of 100% sensitivity. The specificity was 89% for sonication cultures, 95% for periprosthetic tissue cultures and 100% for histological analysis.

Conclusion: Our results of separating the explanted components for sonication culture proved the detection of valid pathogens for every kind of endoprosthesis or implants and supplied further information for the focus of infection.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 586 - 586
1 Oct 2010
Holinka J Lass R Pfeiffer M Wanivenhaus A
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Background: We present a prospective two to ten year follow-up of soft tissue balancing surgery at the subluxated second MTP joint. The purpose of this study was to find out the effect of soft tissue balancing techniques of the second MTP joint on long term VAS and AOFAS results. As second hypotheses we compared the results of two different techniques, one group with additional transarticular Kirschner wire (KW) fixation of the second MTP joint temporary for 3 weeks postoperative and the other group without.

Materials and Methods: Fifty-four patients, 45 women and nine men, with a total of 62 operative interventions were included in our follow-up evaluation. Soft tissue balancing techniques we used were capsulotomy, lengthening of the extensor tendons, incision of the collateral ligaments and intrinsic muscles with or without temporary transarticular Kirschner wire (KW) fixation.

Pre- und postoperative VAS and AOFAS scores, as well as clinical and radiological findings were analyzed. One weightbearing and one without weightbearing dorsoplantar radiograph as well as a 45 degrees rotated radiograph were done pre and postoperatively to proof the position of the second toe.

Results: The statistical calculations showed a highly significant outcome (p< 0.0001) comparing pre- to postoperative scores.

Explorative data analysis as well as chi-square tests comparing the two groups - 29 second toes with and 33 second toes without temporarily additional transarticular KW fixation of the MTP joint - showed homogeneous distribution of all scores.

Conclusion: Our evaluation showed highly significant improvement with soft tissue balancing for subluxated second MTP joint of the second metatarsal, but no benefit from additional KW fixation of the MTP joint.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 536 - 536
1 Oct 2010
Giurea A Holinka J Jenny J Kotz R Kubista B Lass R Miehlke R Pfeiffer M
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Introduction: Total knee arthroplasty in obese patients remains a challenge to most surgeons. Surgical complication rates as well as perioperative morbidity are higher than total knee arthroplasty in the nonobese. The purpose of this paper is to review our experience with total knee arthroplasty in superobese patients (BMI> 50).

Methods: From 1998–2005, 84 patients underwent 148 knee arthroplasties. Sixty-four patients underwent simultaneous bilateral total knee arthroplasties and 20 patients underwent unilateral knee arthroplasties. They were compared with similar group of nonobese patients who underwent knee arthroplasties during the same time period. All patients received combined regional and general anesthesia.

Results: Mean follow-up was 3.8 years (2–7). Knee society scores improved by 36 points in the superobese (pre-op 47 to 83 post-op) and by 45 points in the non-obese (pre-op 47 to 93 post-op) (p< .05). There was a greater incidence of complications in the superobese group, namely superficial wound infections and deep vein thrombosis. There was late loosening in three tibial components and instability in two patients that required revision in the superobese group. No reoperations in the nonobese group.

Conclusion: Although total knee arthroplasty may be safely performed in the superobese, it may be complicated by infection, loosening, instability, and lower knee scores.