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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 78 - 78
24 Nov 2023
Bernaus M Carmona F De Espinosa Vázquez de Sola JML Valentí A Abizanda G Cabodevilla AR Torres D Calero JA Font L Del Pozo JL
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Aim

To provide proof of concept in an in vivo animal model for the prevention of prosthetic joint infection prevention using electric fields along with conventional antibiotic prophylaxis.

Corresponding Author: Marti Bernaus

Method

First, we standardized the animal model to simulate implant contamination during the surgical procedure. We then implanted cobalt-chrome prostheses adapted to both knees of two New Zealand White rabbits, under standard aseptic measures and antibiotic prophylaxis with cefazolin. Prior to implantation, we immersed the prostheses in a 0.3 McFarland inoculum of S. aureus (ATCC 25923) for 30 seconds. In the first animal (control), the joint was directly closed after washing with saline. In the second animal (case), both prostheses were treated with electric current pulses for 30 seconds, washed with saline, and the joint was closed. After 72 hours, both animals were reoperated for the collection of periprosthetic tissue and bone samples, and prosthesis removal. In all samples, we performed quantitative cultures prior to vortexing and sonication, as well as prolonged cultures of the sonication broth. We confirmed the absence of contamination by identification with MALDI-TOF (VITEK-MS) and automated antibiotic susceptibility testing of the isolated colonies (VITEK-2).


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 79 - 79
1 Oct 2022
Bernaus M Cubillos YL Soto S Bermúdez A Calero JA Torres D Veloso M Font-Vizcarra L
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Aim

To evaluate the efficiency of pulse lavage combined with electrical fields to remove biofilm from a metallic surface.

Method

Using a 12-well culture plate designed for the application of electrical fields, strains of S. epidermidis were incubated at each well for 24 hours at 37ºC. After incubation, supernatant culture medium was removed, and each well was filled with 3ml of normal saline. Six different models were compared: a) control, b) low-pressure pulse lavage, c) high-pressure pulse lavage, d) pulsed electrical fields, e) low-pressure pulse lavage in combination with pulsed electrical fields, and f) high-pressure pulse lavage in combination with pulsed electrical fields. In all cases, exposure time was set to 25 seconds. In the electrical field models, 50 pulses were applied.

After exposure, each bottom electrode was scraped carefully to release adhered bacteria. Subsequently, different dilutions of biofilm removed were spread onto Müller Hinton agar plates and incubated for 24h at 37 ºC, and colony-forming units (CFU) per milliliters were counted. Bacterial counts were then compared to the control model.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 18 - 18
1 Oct 2022
Veloso M Bernaus M Lopez M de Nova AA Camacho P Vives MA Perez MI Santos D Moreno JE Auñon A Font-Vizcarra L
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Aim

The treatment of fracture-related infections (FRI) focuses on obtaining fracture healing and eradicating infection to prevent osteomyelitis. Treatment guidelines include removal, exchange, or retention of the implants used according to the stability of the fracture and the time from the infection. Infection of a fracture in the process of healing with a stable fixation may be treated with implant retention, debridement, and antibiotics. Nonetheless, the retention of an intramedullary nail is a potential risk factor for failure, and it is recommended to exchange or remove the nail. This surgical approach implies additional life-threatening risks in elderly fragile hip fracture patients.

Our study aimed to analyze the results of implant retention for the treatment of infected nails in elderly hip fracture patients.

Methods

Our retrospective analysis included patients 65 years of age or older with an acute fracture-related infection treated with implant retention from 2012 to 2020 in 6 Spanish hospitals with a minimum 1-year follow-up. Patients that required open reduction during the initial fracture surgery were excluded. Variables included in our analysis were patient demographics, type of fracture, date of FRI diagnosis, causative microorganism, and outcome. Treatment success was defined as fracture healing with infection eradication without the need for further hospitalization.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_10 | Pages 53 - 53
1 Oct 2022
Cardona CG Omiste I Johnson MCB Veloso M Gómez L Cisneros BE Camarena JHN García DB Font-Vizcarra L
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Aim

Acute post-surgical infection is one of the most serious complications after instrumented thoracolumbar fusion with an incidence of 0.7%-12%. Acute infection can lead to an increase in morbidity, mortality, and economic costs for the healthcare system.

The main objective of our study was to determine the variables associated with a higher risk of acute infection after thoracolumbar instrumentation in our center.

Methods

We conducted an observational case-control study including instrumented fusions of the thoracolumbar spine performed between 2015 and 2021 at our institution. We included patients with thoracolumbar fusions after a fracture or for the treatment of degenerative pathology.

We analyzed demographic variables related to the surgical procedure, the causative microorganism of infection, the outcome of infection treatment, and complications.

We performed a descriptive analysis of all variables and a univariate comparison of cases and controls. The dichotomous variables were compared using the Fisher test, while the quantitative variables were compared using the Student's T-test. A p-value of <0.05 is taken into account to consider the statistical significance. SPSS v25 Windows program was used for statistical analyses.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 16 - 16
1 Dec 2021
Columbrans AO González NH Rubio ÁA Font-Vizcarra L Ros JM Crespo FA Colino IA Johnson MCB Lucena IC Moreno JE Cardona CG Moral E Martínez RN Duran MV
Full Access

Aim

The purpose of this study is to analyze the demographic and microbiological variables of acute ankle infections posterior to ankle osteosynthesis and to determine the different characteristics of patients withE. cloacae infection.

Method

A multicenter retrospective observational study (4 national hospitals) of acute post osteosynthesis infections of ankle fracture operated between 2015 and 2018 was implemented. The demographic and microbiological variables relating to the surgical intervention and the antibiotic treatment performed were collected. A descriptive assessment of all the variables and a univariate comparison between patients with E. cloacae infection and patients with alternative microorganism infections were performed. The SPSS v25 program for Windows was the choice for statistical analysis.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 22 - 22
1 Dec 2019
Veloso M Bernaus M Angles F Gómez L Cubillos YL Soto S Font-Vizcarra L
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Aim

To evaluate bacterial adhesion and biofilm formation to metallic cerclage wire versus polymer cerclage system (SuperCable®)

Methods

Experimental in vitro study to evaluate quantitative bacterial adherence to different cerclage wire materials. Two types of cerclage wires were compared: a metallic versus a polymer based wire (SuperCable®).

A two-centimeter cerclage wire piece of each material was included in 2 mL of tryptic soy broth (TSB) culture media, inoculated with 10 microliters of a 0.5 McFarland of a Staphylococcus epidermidis strain and cultivated at 37°C during 2h for adhesion and 48h for biofilm formation. After this time, the cerclages were washed using a 1% phosphate buffered saline (PBS) and sonicated in new culture medium. After sonication, dilutions of each culture were spread in TSB agar and incubated 37°C during 24h. The number of colonies were counted and the cfu/cm2 was calculated.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 62 - 62
1 Dec 2018
Huguet S Luna R Miguela S Bernaus M Matamala A Cuchi E Font-Vizcarra L
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Aim

The effectiveness of mandatory joint aspiration prior to re-implantation in patients with a cement spacer already in place is unclear.

The aim of this study was to evaluate the role of culturing articular fluid obtained by joint aspiration prior to re-implantation in patients who underwent a two stage septic revision.

Method

A retrospective observational study was conducted, assessing51 patients that underwent a two stage septic hip or knee revision from 2010 to 2017.

According to the results of intraoperative cultures, after the first stage revision each patient was treated with an antibiotic protocol for 6–8 weeks. Following two weeks without antibiotics, a culture of synovial fluid was obtained. Synovial fluid was obtained by direct joint aspiration in cases of knee spacers by and by joint aspiration guided by fluoroscopy in the theatre room in cases of hip spacers. Synovial fluid was transferred into a Vacutainer ACD® flask. Samples were processed and analysed in the microbiology laboratory. Gram stains were performed and the sample was subsequently transferred into a BacALERT bottle (bioMérieux, France) and incubated in a BacALERT instrument for seven days.

Results of these cultures were recorded and compared with cultures obtained during re-implantation surgery.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 50 - 50
1 Dec 2018
Huguet S Gómez L Bernaus M Matamala A Cuchi E Font-Vizcarra L
Full Access

Aim

In two-stage replacements for septic loosening, some studies have suggested that associate bacterial colonization of spacers had a worse result in relation to the control of the infection and a higher rate of complications after the implantation of the definitive prosthesis.

The aim of our study was to determine the reoperation rate of patients undergoing two-stage revision surgery according to the results of spacer sonication.

Method

A retrospective observational study was conducted in which 56 hip or knee spacers implanted at our center from 2010 to 2017 were analysed. Patients were grouped into three categories:

Patients with positive spacer sonication fluid culture, with or without positive cultures from the rest of the samples.

Patients with negative spacer sonication culture and negative second-stage intraoperative cultures.

Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples.