Gram-negative periprosthetic joint infection (PJI) has been poorly studied despite its rapidly increasing incidence. Treatment with one-stage revision using intra-articular (IA) infusion of antibiotics may offer a reasonable alternative with a distinct advantage of providing a means of delivering the drug in high concentrations. Carbapenems are regarded as the last line of defense against severe Gram-negative or polymicrobial infection. This study presents the results of one-stage revision using intra-articular carbapenem infusion for treating Gram-negative PJI, and analyzes the characteristics of bacteria distribution and drug sensitivity. We retrospectively reviewed 32 patients (22 hips and 11 knees) who underwent single-stage revision combined with IA carbapenem infusion between November 2013 and March 2020. The IA and intravenous (IV) carbapenem infusions were administered for a single Gram-negative infection, and IV vancomycin combined with IA carbapenems and vancomycin was applied for polymicrobial infection including Gram-negative bacteria. The bacterial community distribution, drug sensitivity, infection control rate, functional recovery, and complications were evaluated. Reinfection or death caused by PJI was regarded as a treatment failure.Aims
Methods
We report a systematic review and meta-analysis
of the peer-reviewed literature focusing on metal sensitivity testing
in patients undergoing total joint replacement (TJR). Our purpose
was to assess the risk of developing metal hypersensitivity post-operatively
and its relationship with outcome and to investigate the advantages
of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in
PubMed and EMBASE: 22 articles (comprising 3634 patients) met the
inclusion criteria. The frequency of positive tests increased after
TJR, especially in patients with implant failure or a metal-on-metal
coupling. The probability of developing a metal allergy was higher
post-operatively (odds ratio (OR) 1.52 (95% confidence interval
(CI) 1.06 to 2.31)), and the risk was further increased when failed
implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to
6.70)). Hypersensitivity testing was not able to discriminate between
stable and failed TJRs, as its predictive value was not statistically
proven. However, it is generally thought that hypersensitivity testing
should be performed in patients with a history of metal allergy
and in failed TJRs, especially with metal-on-metal implants and
when the cause of the loosening is doubtful.
