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Bone & Joint Research
Vol. 9, Issue 10 | Pages 635 - 644
1 Oct 2020
Lemaignen A Grammatico-Guillon L Astagneau P Marmor S Ferry T Jolivet-Gougeon A Senneville E Bernard L

Aims

The French registry for complex bone and joint infections (C-BJIs) was created in 2012 in order to facilitate a homogeneous management of patients presented for multidisciplinary advice in referral centres for C-BJI, to monitor their activity and to produce epidemiological data. We aimed here to present the genesis and characteristics of this national registry and provide the analysis of its data quality.

Methods

A centralized online secured database gathering the electronic case report forms (eCRFs) was filled for every patient presented in multidisciplinary meetings (MM) among the 24 French referral centres. Metrics of this registry were described between 2012 and 2016. Data quality was assessed by comparing essential items from the registry with a controlled dataset extracted from medical charts of a random sample of patients from each centre. Internal completeness and consistency were calculated.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 83 - 83
1 Dec 2018
Lemaignen A Astagneau P Marmor S Ferry T Seng P Mainard D Jenny J Laurent F Grare M Jolivet-Gougeon A Senneville E Bernard L
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Aim

Bone and joint infections (BJI) are associated with a heavy morbidity and high health costs. Comorbidities, device associated infections and complicated journeys are associated with increased mortality, treatment failures and costs. For this reason, 24 referral centers (RC) have been created in 2009 in order to advise about management of “complex” BJI in weekly multidisciplinary meetings (MM). Since end of 2012, data from these meetings are gathered in a national database. We aimed to describe the data from this French registry of BJI and determine factors associated with the definition of “complex” BJI.

Method

Demographic, clinical, microbiologic and therapeutic characteristics of patients are systematically recorded in the database. Data from the first presentation in RC for each adult patients are presented. Complexity of BJI is recorded after each meeting according to 4 criteria (first failure, complex antibiotic therapy, precarious underlying conditions or complex surgical procedure). Part of unavailable data have been completed by pattern extraction from text-encoded commentaries. Factors associated with complexity were determined by multivariate logistic regression.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 14 - 14
1 Dec 2017
Zeller M Granier M Auber T Graff W Strat VL Lhotellier L Blandine M Marmor S Meyssonnier V Mouton A Passeron D Zeller V Klein E Heym B
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Aim

Periprosthetic joint infection (PJI) is nowadays the most important problem leading to failure in primary and revision total knee (TKA) and total hip arthroplasty (THA), therefore accurate diagnosis of PJI is necessary. We evaluated a commercial multiplex PCR system1 for diagnosis of PJI in joint aspiration fluids prior to surgery.

Method

A total of 32 patients were included in the study. Twenty-four patients had TKA and eight had THA. Joint aspiration fluids were examined by standard bacteriological procedures. Excess material of joint aspirates was frozen at −20°C until testing by multiplex PCR1. Inclusion criteria were a minimum leucocyte count of 2.000 per ml and at least 60% of polymorphonucleaur neutrophils (PNN) in the joint aspiration fluid.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 38 - 38
1 Dec 2017
Amara M Bauer T Bercot B Heym B Jacquier H Joste V Marmor S Salomon E France SCID
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Aim

The frequency of arthroplasty among older people is increasing. Taking care of Prosthetic Joint infection (PJI) in this specific population is a challenge. The purpose of this multicentric retrospective study was to evaluate the bacterial epidemiology of hip and knee PJI in octogenarians and nonagenarians over ten years.

Method

Data were collected using two softwares* in each of the 4 Centers participating.

Inclusion criteria:

age ≥ 80 years PJI (knee or hip)

between January 2007 and December 2016

microbiological data available (strains isolated from osteo-articular samples)

Bacterial identification: biochemical methods, followed by Malditof since 2009. For Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacteriaceae, resistance profiles to antibiotics frequently used in PJI were collected. Antimicrobial susceptibility testing: disk diffusion (recommendations: French Society of Microbiology yearly updated).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 83 - 83
1 Dec 2017
Bart G Meyssonnier V Kerroumi Y Lhotellier L Graff W Passeron D Mouton A Ziza JM Desplaces N Marmor S Zeller V
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Aim

Treatment of chronic prosthetic joint infection (PJI) combines exchange arthroplasty and effective antibiotic therapy. Staphylococci are the most frequent microorganism isolated in PJIs, with resistance to methicillin found in 15–50% of the cases. Data from randomized trials on treatment of methicillin-resistant staphylococci are lacking and the choice of antibiotic(s) and recommendations vary according to authors. To date, combination therapy including vancomycin is the treatment of choice.

Minocycline, a cyclin antibiotic, is naturally effective against methicillin-resistant staphylococci. We use this antibiotic since many years in combination with vancomycin for the treatment of multi-drug resistant staphylococcal bone and joint infections.

The aim of this study is to analyze the outcome of patients treated with combination antibiotic therapy including minocycline for the treatment of chronic methicillin-resistant staphylococcal PJI.

Method

We conducted a cohort study between 2004 and 2014 in our referral center for bone and joint infections. Data were extracted from the prospective database. All the patients receiving an initial combination therapy including at least 4 weeks of minocycline, given orally, and another IV antibiotic, usually high-dose continuous IV vancomycin, for chronic MR staphylococcal PJI and who underwent one or two stage exchange arthroplasty, were included. They were followed prospectively for at least 2 years.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 75 - 75
1 Dec 2015
Marmor S Desplaces N Bauer T Heym B Sol O Rogé J Mahé F Desire L Ghout I Ropers J Gaillard J Rottman M
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The diagnosis of prosthetic joint infections (PJI) represents a critical challenge for orthopedic surgeons and infectious disease specialists. The diagnosis of PJI is often delayed because non-invasive assays lack sensitivity and specificity. A novel multiplex immunoassay detecting antibodies against Staphylococci, Propionibacteria and Streptococcus agalactiae was developed and its performance evaluated in a prospective, multicenter, non-interventional study.

The Luminex-based assay measures serum IgG against a proprietary panel of recombinant purified antigens from Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus agalactiae and Propionibacterium acnes. Patients undergoing revision arthroplasty were included over a 2-year period (from 2012 up to 2014) in two French reference centers in compliance with IRB and French regulations. PJI cases were defined microbiologically (≥2 intraoperative samples yielding the same microorganism) for confrontation of microbiological and immunoassay data.

455 patients were eligible for study analyses. 149 patients (32.7%) were found to be infected. Among the most frequent infecting species recovered were S. aureus (30%), S. epidermidis (26%), P. acnes (9%), S. lugdunensis (6%), and S. agalactiae (4%). The sensitivity and specificity values of the test were, respectively, 75.9% (63/83) and 82.2% (180/219) for staphylococci (S. aureus, S. epidermidis, S. lugdunensis), 38.5% (5/13) and 81.9% (190/232) for P. acnes, and 66.7% (4/6) and 92.4% (208/225) for S. agalactiae. Interestingly, all cases (9/9) involving S. lugdunensis were detected by the test and the sensitivity for S. epidermidis reached 79.4% in patients more than three months after joint replacement. In a similar fashion, 89.5% (17/19) in the subpopulation with elevated inflammatory markers (ESR>30 and CRP>10).

The assay correctly identified 67% of the microbiologically positive patients that were negative by ESR or CRP screening.

This novel multiplex serological test allows the rapid and non-invasive diagnosis of the most frequent PJI pathogens, showing a good correlation with microbiological culture. and appears to be a new promising tool in the management of PJI, adding sensitivity to the current serological assays and enhancing the management of patients with pauci-inflammatory PJI.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 275 - 275
1 Jul 2008
MARMOR S HARDY P GAUDIN P PAILLARD P TANG HNA
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Purpose of the study: The incidence and type of complications observed with arthroscopic procedures remains a timely subject, particularly as the use of new techniques becomes increasingly widespread.

Material and methods: In cooperation with the members of ISAKOS, The International Society of Arthroscopy, Knee surgery and Orthopaedic Surgery, we instituted two studies: a retrospective study of upper limb arthroscopy complications and a prospective incidence study during a 30-day inclusion period with patient review at one month and quality-of-life scoring.

Results: The retrospective study analyzed complications of 57,604 arthroscopic procedures of the upper limb performed by 99 surgeons from 38 countries. Neurological complications, though generally transient, were the most frequent and were related to traction, locoregional anesthesia or the operative technique. Four deaths were recorded, all anesthesia-related. The prospective study included 364 patients operated on by 50 surgeons. There were 16 initial complications (4.39%): material problem (n=12), three intraoperative bleeding (n=3), atelectasia (n=1). The rate of conversion was 2.47%. At one month, there were five complications reported in 133 patients (3.75%): anesthesia-related problem (n=1), bleeding (n=1), synovial fistula (n=1), reflex dystrophy (n=2). There were no infections and no neurological lesions. The one-month outcome was considered good or excellent by 98.5% of surgeons.

Discussion and conclusion: The results of these surveys are in agreement with data in the literature where the rate of complications is higher in prospective studies than in retrospective studies. The prospective study did not disclose any neurological complication while arthroscopy of the upper limb is generally considered to raise the risk of with this type of complication. This study recalls that although arthoscopy has enabled a decreased incidence in complications compared with open surgery, it is not a benign intervention and can produce complications.