Aim. Dissolvable antibiotic-loaded calcium sulphate beads have been utilized for management of periprosthetic joint infection (PJI) and for
Prosthetic joint infection (PJI) is a devastating and costly complication of total joint arthroplasty (TJA). Use of extended oral antibiotic prophylaxis (EOAP) has become increasingly popular in the United States following a highly publicized study (Inabathula et al) from a single center demonstrating a significant protective effect (81% reduction) against PJI in ‘high-risk’ patients. However, these results have not been reproduced elsewhere and EOAP use directly conflicts with current antibiotic stewardship efforts. In order to study the role of EOAP in PJI prevention, consensus is needed for what defines ‘high-risk’ patients. The revision TJA (rTJA) population is an appropriate group to study due to having a higher incidence of PJI. The purpose of the current study was to rigorously determine which preoperative conditions described by Inabathula et al. (referred to as Inabathula criteria (IBC)) confer a higher rate of PJI in patients undergoing aseptic rTJA. 2,256 patients that underwent aseptic rTJA at a single high-volume institution between 2016–2022 were retrospectively reviewed. Patient demographics and comorbidities were recorded to determine if they had 1 or more ‘IBC’, a long list of preoperative conditions including autoimmune diseases, active smoking, body mass index (BMI)>35, diabetes mellitus, and chronic kidney disease (CKD). Reoperation for PJI at 90-days and 1-year was recorded. Chi-squared or Fischer's exact tests were calculated to determine the association between preoperative presence/absence of IBC and PJI. Multivariable logistic regressions were conducted to determine if specific comorbidities within the IBC individually conferred an increased PJI risk.Aim
Method
Aim. Culture-based conventional methods are still the gold standard to identify microorganisms in hip and knee PJIs diagnosis. However, such approach presents some limitations due to prior antimicrobial treatment or the presence of unusual and fastidious organisms. Molecular techniques, in particular specific real-time and broad-range polymerase chain reaction (PCR), are available for diagnostic use in a suspected PJI. However, limited data is available on their sensitivity and specificity. This study aimed to evaluate the performance of a rapid and simple Investigational Use Only (IUO) version of the BioFire® JI multiplex PCR panel when compared to traditional microbiological procedures. Method. Fifty-eight native synovial fluid samples were recovered from 49 patients (female n=26; male =23) who underwent one or multiple septic or
Early and/or prolonged wound discharge after total knee arthroplasty often raises the question whether this is a sign of an early infection or if the prolonged discharge leads to a secondary deep wound infection from migrating skin bacteria. Confronted with the dilemma of what to do with early PWC our department implemented a new treatment protocol in 2002 to deal with early PWC after TKA in order to standardize decision-making. The aim of this study was to report our long-term results using this protocol on a prospective cohort primary TKA and revision TKA performed for other reasons than infection. This report focuses on the results of DAIR (debridement, antibiotics and implant retention) performed for early PPJI and/or early wound complications without clinical signs of infection. After implementing our treatment algorithm regarding postoperative wound complications in early 2002, we initiated a quality registration including every primary and non infected revision TKA performed. Between January 2002 and August 2012 1439 consecutive primary knee arthroplasties were performed at our institution. During the same period a total of 120 knee revisions for reasons not related to infection were performed. All patients undergoing DAIR within three months of the index procedure where divided into two groups: successful and unsuccessful. Successful DAIR didn't require any more surgery and the implant could be retained with a minimum follow up time of two years. Unsuccessful DAIR required at least one more surgical intervention. Treatment with DAIR was successful in 47 of 62 patients operated with primary and revision TKA as index operation. Those patients had no signs of infection and no antimicrobial therapy after a minimum of one year follow up time. The remaining 15 patients were in need of further surgery. Positive cultures could be obtained in 41 of 62 patients including those operated for