The surgical management of late PJI was usually done in two stages with the placement of a temporary cement spacer. The development of one-stage surgical care raises questions about the two-stage strategy. The objectives of this study are to identify the complications related to the presence of the cement spacer within a two-stage strategy. The septic recurrence rate is also evaluated after a minimum follow-up of two years. Medical files of 208 patients (101 knees and 107 hips) who underwent a two-stage revision for late PJI prosthesis infection were retrospectively reviewed. Antibiotic loaded articulated homemade cement spacers were used. Second stage was usually planned on average 4 to 6 weeks after the first stage. Patients were allowed to walk without loading. The success rate was defined as the absence of septic recurrence after a minimum follow-up of two years. Descriptive statistics and uni- and multivariate analysis were conducted.Introduction
Material and methods
We wonder what the results of two stage procedures were in terms of morbidity (amputation, dead) and infection recurrence. We also seek to identify risk factors for failure and see if the results of a second two stage surgery were not even worse. We retrospectively reviewed 140 prosthetic joint infection (PJI) treated with a two stage procedure. Patient data has been reviewed to determine which factors would be predictive for failure.Aim
Material and Methods
Apart from other biomarkers isolated in the synovial fluid, alpha-defensin appears to be a promising diagnostic tool to confirm a periprosthetic joint infection (PJI) in the hip or knee. The purpose of this study was to evaluate the sensitivity and specificity of an alpha defensin lateral flow (ADLF) test compared to usual standard classifications in the diagnostic management of PJI. This investigation was set up as a multicenter prospective cohort study. Synovial fluid was obtained by means of joint aspiration or intra-operative tissue biopsies. A presumptive PJI diagnosis was made according to criteria outlined by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA) and the European Bone and Joint Infection Society (EBJIS). The intention to treat by the surgeon was logged. Sensibility and specificity for the ADLF test was plotted for each aforementioned diagnostic algorithm. Spearman correlations between all scores were analyzed. Multiple logistic regression was used to determine the contribution of independent variables to the probability of PJI.Aim
Method
Irrigation is a major step during debridement surgery in the context of Prosthetic Joint Infections (PJI), but its effects on biofilms are poorly described. The present study aims at evaluating the effect of PW alone or followed by antibiotics on MSSA and MRSA biofilms grown on Ti6Al4V coupons in-vitro. Strains: 1 reference (MSSA: ATCC25923; MRSA: ATCC33591) and 2 clinical MSSA and MRSA isolated from PJI. Biofilm culture: Coupons were incubated for 24h at 37°C with bacteria (starting inoculum ∼6.6Log10CFU/mL in TGN [TSB + 1% glucose + 2% NaCl]), under shaking at 50rpm. Treatment: Half of the coupons were irrigated with 50mL physiological serum from 5cm using a Stryker Interpulse; the coupons were then either analysed (ControlT0 and PWT0) or reincubated for 24h in TGN or TGN containing flucloxacillin (MSSA) or vancomycin (MRSA) at MIC or 20mg/L. Analysis: Coupons were rinsed twice with PBS. Biomass was measured by crystal violet (CV) assay. CFUs were counted after recovering bacteria from coupons using sonication and TSA plating.Aim
Method
DAIR is an attractive treatment for PJI. The purpose of this study is to determine predictive factors of failure. We reviewed all DAIR procedures for hip PJI performed between 2002–2017 (n=69). Data recorded included all factors correlated with treatment failure. KLIC score and an adapted McPherson score (sum of three criteria where the lower score is three for 3 A and the higher is 9 for 3 C) were analyzed.Background
Materials and Methods
