While frequently discussed as a standard treatment for the management of an infected shoulder replacement, there is little information on the outcome of
We describe the use of a protocol of irrigation and debridement
(I&
D) with retention of the implant for the treatment of periprosthetic
infection of a total elbow arthroplasty (TEA). This may be an attractive
alternative to staged re-implantation. Between 1990 and 2010, 23 consecutive patients were treated in
this way. Three were lost to follow-up leaving 20 patients (21 TEAs)
in the study. There were six men and 14 women. Their mean age was
58 years (23 to 76). The protocol involved: component unlinking,
irrigation and debridement (I&
D), and the introduction of antibiotic
laden cement beads; organism-specific intravenous antibiotics; repeat
I&
D and re-linkage of the implant if appropriate; long-term
oral antibiotic therapy. Aims
Patients and Methods
The aim of this study was to compare the results of resection arthroplasty with
The aim of this study is to compare the results of resection arthroplasty with
The management of a bacterial periprosthetic infection by
There remains to be substantial debate on the best treatment of the infected shoulder arthroplasty. Infection after shoulder arthroplasty is an uncommon but devastating complication with a reported incidence from 0 to 4%. The most common organism responsible for infection following rotator cuff surgery, instability surgery, ORIF proximal humerus fractures, and shoulder arthroplasty is Prop. Acnes. A thorough history is important because many patients have a history of difficulty with wound healing or drainage. Prop. Acnes typically does not start to grow until day 5, therefore it is critical to keep cultures a minimum of 10 to 14 days. Diagnosis can be difficult, particularly among patients undergoing revision surgery. The majority of patients with a low grade infection do not have overt signs of infection such as erythema or sinus tracts. Preoperative lab values as well as intraoperative pathology have been shown to be unreliable in predicting who will have positive cultures at the time of revision surgery. There are a number of options for treating a patient with a post-operative infection. Critical variables include the timing of infection, status of the host, the specific organism, status of implant fixation, and the status of the rotator cuff and deltoid. One of the most frequently employed options for treating the infected shoulder arthroplasty is
Introduction. Metaphyseal cones with cemented stems are frequently used in revision total knee arthroplasties (TKAs). However, if the diaphysis has been previously violated (as in revision of a failed stemmed implant), the resultant sclerotic canal can impair cemented stem fixation, which is vital for cone ingrowth and long-term fixation. We report the outcomes of our novel solution to this problem, in which impaction grafting and a cemented stem in the diaphysis was combined with an uncemented metaphyseal cone for revision TKAs with severely compromised bone. Methods. A metaphyseal cone was combined with diaphyseal impaction grafting and cemented stems in a novel fashion for 35 revision TKAs. Mean age at revision TKA was 70 years, with 63% being male. Patients had a mean of 4 prior knee arthroplasty procedures. Indications for the revision with this construct were aseptic loosening (80%) and
Introduction. Many surgeons are reluctant to use a constrained liner at the time of acetabular component revision given concerns this might result in early acetabular component loosening. We hypothesized that with appropriate initial implant stabilization of highly porous acetabular components with supplemental screw fixation, constrained liners could be safely used at the time of acetabular revision. Methods. We retrospectively identified 148 revision total hip arthroplasties (THAs) where a constrained liner of one design was cemented into a newly placed highly porous acetabular component fixed with supplemental screws (mean 5 screws). Mean age at revision THA was 69 years, with 68% being female. The most common indications for revision were
Infection after shoulder arthroplasty is an uncommon but devastating complication with a reported incidence from 0% to 4%. Prop. Acnes is the most common organism responsible for infection following rotator cuff surgery, instability surgery, ORIF proximal humerus fractures, and shoulder arthroplasty. A detailed history is critical because many patients have a history of difficulty with wound healing or drainage. Prop. Acnes typically does not start to grow until Day 5, therefore it is critical to keep cultures a minimum of 10 to 14 days. Diagnosis can be difficult, particularly among patients undergoing revision surgery. The majority of patients with a low grade infection do not have overt signs of infection such as erythema or sinus tracts. Pre-operative lab values as well as intra-operative pathology have been shown to be unreliable in predicting who will have positive cultures at the time of revision surgery. There are a number of options for treating a patient with a post-operative infection. Important variables include the timing of infection, status of the host, the specific organism, status of implant fixation, and the status of the rotator cuff and deltoid. One of the most frequently employed options for treating the infected shoulder arthroplasty is
For most complex primary total knee replacement there is associated soft tissue and bone loss. A constrained condylar implant can be useful in improving the stability of the knee after revision. Augmentation is commonly used to deal with bone loss on the femoral and tibial side of the joint. Stems are known to reduce the load at the interface of the femoral and tibial component and transfer the load into the medullary canals. There are problems with using stems in the complex primary knee setting however, which include: (1) increased cost, (2) difficulty with removal should further revision be necessary, (3) violation of the intramedullary canals if infection occurs, (4) increased operating time. For these reasons a CCK implant was developed without stems in 1998. The use of this device must be very selective and it is primarily used for severe valgus deformity in elderly patients. In a revision setting where there is good preservation of femoral and/or tibial bone but the need for increased constraint is present (e.g. unicompartmental, cruciate retaining knee) a CCK without stems can be used with good results. We retrospectively reviewed 36 primary constrained condylar knee implants without stem extensions from 1998 to 2000 in 31 patients with knees in 15 degrees valgus or greater. All patients were followed up for a minimum 10 years (range, 10 to 12 years). One patient had aseptic loosening and needed to be revised with stemmed components at 9 years post surgery. Wear was found in two patients. One patient, with severe rheumatoid arthritis, had infection and required a
For most revision total knee replacement there is associated soft tissue and bone loss. A constrained condylar implant can be useful in improving the stability of the knee after revision. Augmentation is commonly used to deal with bone loss on the femoral and tibial side of the joint. Stems are known to reduce the load at the interface of the femoral and tibial component and transfer the load into the medullary canals. There are problems with using stems in the revision setting however, which include: (1) increased cost, (2) difficulty with removal should further revision be necessary, (3) violation of the intramedullary canals if infection occurs, (4) increased operating time. For these reasons a CCK implant was developed without stems in 1998. The use of this device must be very selective and it is primarily used for severe valgus deformity in elderly patients. In a revision setting where there is good preservation of femoral and/or tibial bone but the need for increased constraint is present (e.g. unicompartmental, cruciate retaining knee) a CCK without stems can be used with good results. We retrospectively reviewed 36 primary constrained condylar knee implants without stem extensions from 1998 to 2000 in 31 patients with knees in 15 degrees valgus or greater. All patients were followed up for a minimum 10 years (range, 10 to 12 years). One patient had aseptic loosening and needed to be revised with stemmed components at 9 years post-surgery. Wear was found in two patients. One patient, with severe rheumatoid arthritis, had infection and required a
Purpose.
For most revision total knee replacement there is associated soft tissue and bone loss. A constrained condylar implant can be useful in improving the stability of the knee after revision. Augmentation is commonly used to deal with bone loss on the femoral and tibial side of the joint. Stems are known to reduce the load at the interface of the femoral and tibial component and transfer the load into the medullary canals. There are problems with using stems in the revision setting, however, which include: (1) increased cost, (2) difficulty with removal should further revision be necessary, (3) violation of the intramedullary canals if infection occurs, (4) increased operating time. For these reasons a CCK implant was developed without stems in 1998. The use of this device must be very selective and it is primarily used for severe valgus deformity in elderly patients. In a revision setting where there is good preservation of femoral and/or tibial bone but the need for increased constraint is present (e.g. unicompartmental, cruciate retaining knee) a CCK without stems can be used with good results. We retrospectively reviewed 36 primary constrained condylar knee implants without stem extensions from 1998 to 2000 in 31 patients with knees in 15° valgus or greater. All patients were followed up for a minimum 10 years (range, 10 to 12 years). One patient had aseptic loosening and needed to be revised with stemmed components at nine years post-surgery. Wear was found in two patients. One patient, with severe rheumatoid arthritis, had infection and required a
Introduction: Infection post knee arthroplasty is a catastrophic surgical complication offering a major challenge to the orthopaedic surgeon. We present the outcome of a two-stage revision implantation technique utilizing a rotational hinge prosthesis with an antibiotic impregnated cement spacer in the interim period. Materials &
Method: Since 1995, 38 definitely infected knee replacements were revised. All were followed prospectively over a 10 year period. Initial treatment consisted of thorough debridement, removal of implants and a period of antibiotic administration. Vancomycin impregnated articulating cement spacer was inserted in the interim. C-reactive protein values were monitored periodically. At second stage all patients were clinically and biochemically free of infection. Results: Second stage revision was performed at an average interval of 9 months (range 4 – 11 months). Average length of hospital stay post 2. nd. stage was 19.8 ± 8.2 days. At follow-up (3.5 ± 2.5 years) outcome was poor in 33 % (amputations, arthrodesis, re-infections), good in 49 % (decreased ROM, PFJ pain) and excellent in 13 %. 3, 5% of patients had died with their prostheses in situ. The average pre and post operative Oxford Knee Score were 47.0 ± 7.5 and 21.6 ± 4.3 respectively. Conclusion:
Metal-on-metal bearing was re-introduced with the aim of eliminating polyethylene wear and resulting complications of osteolysis and aseptic loosening in total hip arthroplasty (THA). However, authors of recent studies have reported periprosthetic osteolysis and aseptic failure following second-generation metal-on-metal THA. The purpose of this study is to report the results at a minimum of five years following cementless total hip arthroplasty with a contemporary metal-on-metal articulation. Our study included findings of histologic examination on periprosthetic tissues from revised hips and wear and roughness analysis of retrieved implants. A consecutive series of 158 cementless THAs that were performed in 154 patients using a contemporary metal-on-metal bearing were assessed at a mean of 6.5 years (5 to 8). Their mean age at surgery was 53 years (21 to 80). The patients were assessed clinically with use of the Harris hip score, and the hips were assessed radiographically. Histological analysis was performed on specimens retrieved from the revised hips, and wear and roughness measurements were made for the explanted prostheses. The average Harris hip score improved from 45 points preoperatively to 92 points at the final follow-up examination. There was no aseptic loosening of the femoral or acetabular components. One hip was revised because of recurrent dislocation and one was managed with
We report the long-term results of the management
of neglected chronically infected total knee replacements with a
two-stage re-implantation protocol. In 18 of 34 patients (53%) a
resistant organism was isolated. All cases were treated by the same
surgical team in a specialist centre and had a mean follow-up of
12.1 years (10 to 14). They were evaluated clinically and radiologically
using the Knee Society Score (KSS) and the American Knee Society Roentgenographic
scoring system, respectively. One patient died after eight years
from an unrelated cause and two were lost to follow-up. Three patients
(8.8%) developed a recurrent infection for which further surgery
was required. The infection was eradicated successfully in 31 patients
(91.1%). There was one case of aseptic loosening after 13 years.
We found a significant improvement in the KSS at final follow-up
(p <
0.001).
Vancomycin and fosfomycin are antibiotics commonly used to treat methicillin-resistant Vancomycin-impregnated articulating cement spacers and fosfomycin-impregnated articulating cement spacers were immersed in sterile phosphate-buffered saline (PBS) solutions and then incubated. Samples were collected for bioactivity evaluation. The aliquots were tested for MRSA inhibition with the disc diffusion method, and the inhibition zone diameters were measured. The inhibition zone differences were evaluated using the Wilcoxon Rank Sum Test.Objectives
Methods
Seven stiff total knee arthroplasties are presented
to illustrate the roles of: 1) manipulation under general anesthesia;
2) multiple concurrent diagnoses in addition to stiffness; 3) extra-articular
pathology; 4) pain as part of the stiffness triad (pain and limits
to flexion or extension); 5) component internal rotation; 6) multifactorial
etiology; and 7) surgical exposure in this challenging clinical
problem.
Metaphyseal bone loss is common with revision
total knee replacement (RTKR). Using the Anderson Orthopaedic Research
Institute (AORI) classification, type 2-B and type 3 defects usually
require large metal blocks, bulk structural allograft or highly
porous metal cones. Tibial and femoral trabecular metal metaphyseal
cones are a unique solution for large bone defects. These cones
substitute for bone loss, improve metaphyseal fixation, help correct
malalignment, restore the joint line and may permit use of a shorter
stem. The technique for insertion involves sculpturing of the remaining
bone with a high speed burr and rasp, followed by press-fit of the
cone into the metaphysis. The fixation and osteoconductive properties
of the porous cone outer surface allow ingrowth and encourage long-term
biological fixation. The revision knee component is then cemented
into the porous cone inner surface, which provides superior fixation
compared with cementing into native but deficient metaphyseal bone.
The advantages of the cone compared with allograft include: technical
ease, biological fixation, no resorption, and possibly a lower risk
of infection. The disadvantages include: difficult extraction and
relatively short-term follow-up. Several studies using cones report
promising short-term results for the reconstruction of large bone
defects in RTKR. Cite this article: