Academic literature on the topic 'Periprosthetic infection (PPI)'
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Journal articles on the topic "Periprosthetic infection (PPI)"
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Silanteva, T. A., A. M. Ermakov, and A. S. Tryapichnikov. "Histological evaluation of periprosthetic infection using HOES scale and CD15 expression analysis at the stage of the hip revision arthroplasty." Traumatology and Orthopedics of Russia 27, no. 2 (July 13, 2021): 84–98. http://dx.doi.org/10.21823/2311-2905-2021-27-2-84-98.
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Background.The effectiveness improvement and standardization of the methods of histological diagnosing periprosthetic infection (PPI) is an urgent task in the treatment of complications after large joint arthroplasty. Purpose of the study— Histopathological evaluation of the infection involvement of periprosthetic tissues at the stage of revision arthroplasty for deep infection of the hip using HOES scale and immunohistochemical analysis of CD15 expression.Materials and Methods.A single-center prospective study was performed on the clinical intraoperative material obtained at the stage of revision arthroplasty of the hip in 27 patients at the age of 65 (55÷69) years. The group of examination included patients with acute and chronic forms of deep periprosthetic infection. Light-optical microscopic investigation of the samples of periprosthetic connective-tissue membrane and bone tissue from the foci of infectious involvement was made on paraffin sections stained with hematoxylin and eosin; with the immunohistochemical reaction to determine the expression of CD15 neutrophil granulocyte markers. HOES Scale for pathohistological assessment was used in order to objectify osteomyelitis signs in periprosthetic bone tissue.Results. The signs of acute and chronic stages of periprosthetic osteomyelitis were observed in 9/16 patients with PPI chronic course within 1–30 months of postoperative period, from one to 18 months after manifestation of the symptoms. The signs of subsided osteomyelitis were determined in 12/27 patients with PPI of acute and chronic forms. Infected periprosthetic membranes were found in 19/27 clinical cases in the early and longterm time periods after arthroplasty surgery. A direct significant correlation was revealed between histopathological signs of infecting the periprosthetic bone and the connective-tissue periprosthetic membrane, especially strong one in patients with acute and chronic PPI osteomyelitis.Conclusion. The use of HOES Scale and the analysis of CD15 expression ensure the objectivity of PPI histological diagnosing. The results obtained indicate an increased risk of osteomyelitis development in patients with chronic periprosthetic infection after the hip arthroplasty.
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Guseynov, A. I., А. V. Baranov, A. A. Radzhabov, V. A. Derbenev, V. I. Karandashov, and N. P. Alexandrova. "Photodynamic therapy for periprosthetic joint infection." Laser Medicine 25, no. 1 (August 10, 2021): 9–15. http://dx.doi.org/10.37895/2071-8004-2021-25-1-9-15.
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Introduction. The increase in the number of patients with joint and hip diseases is an actual problem in the clinical medicine. Objective: to improve outcomes of the combined surgical treatment of patients with deep periprosthetic infection (PPI) by developing and improving surgical techniques using spacers and laser technologies.Material and methods. Thirty-five patients with suppurated large joints as a complication after their replacement were examined and treated. In 9 (25.7 %) patients, PPI developed within 3–12 months after the primary arthroplasty. Twenty (57.1 %) patients developed PPI within 1–2 years after the surgery. In 4 (11.4 %) cases, suppuration in the endoprosthetic area developed in 2–3 years, and in 2 (5.7 %) patients – in 3–3.5 years. The age of the patients was 47–70 years. The main group consisted of 20 patients, the control group – of 15 patients. Patients from the main group had laser photodynamic therapy (PDT) session after the removal of endoprosthetic elements and devitalized tissues.Results. Patients from the main group had uneventful postoperative course – less pain syndrome, rapid resolution of the infl ammatory process, wound healing by the primary tension.Conclusion. Application of a new intraoperative PDT technique, developed by the authors, promotes rapid resolution of purulent-infl ammatory process and better healing of postoperative wounds by primary tension.
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Shpinyak, S. P., A. P. Barabash, and Yu A. Barabash. "OPTIMIZATION OF DIAGNOSIS AND TREATMENT FOR PERIPROSTHETIC KNEE INFECTION." Vestnik travmatologii i ortopedii imeni N.N. Priorova, no. 3 (September 30, 2017): 14–19. http://dx.doi.org/10.32414/0869-8678-2017-3-14-19.
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Purpose of study: to analyze the modern approaches to classification of large joints periprosthetic infection (PPI) and evaluate the results of revision surgical interventions in patients with deep PPI of the knee. Patients and methods. One hundred fifty three patients, 51 men and 102 women (mean age 57.3±12.4 years), with deep PPI were operated on. Treatment tactics was determined by the term after primary operation. In early PPI (n=31) sanitation interventions with implant preservation and in late PPI (n=122) – two step interventions with long period between the operations (over 4 weeks) were performed. Results. Follow up made up from 2 to 5 years. Sanitation interventions with implant preservation were successful in71% of patients. In group of patients with late PPI satisfactory results were achieved in 89.6% of cases. On the basis of the obtained data the variants of diagnosis and treatment tactics optimization as well as its adaptation to domestic public health system were proposed.
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Shpinyak, Sergey P., A. P. Barabash, and Yu A. Barabash. "Optimization of Diagnosis and Treatment for Periprosthetic Knee Infection." N.N. Priorov Journal of Traumatology and Orthopedics 24, no. 3 (September 15, 2017): 14–19. http://dx.doi.org/10.17816/vto201724314-19.
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Purpose of study: to analyze the modern approaches to classification of large joints periprosthetic infection (PPI) and evaluate the results of revision surgical interventions in patients with deep PPI of the knee. Patients and methods. One hundred fifty three patients, 51 men and 102 women (mean age 57.3±12.4 years), with deep PPI were operated on. Treatment tactics was determined by the term after primary operation. In early PPI (n=31) sanitation interventions with implant preservation and in late PPI (n=122) - two step interventions with long period between the operations (over 4 weeks) were performed. Results. Follow up made up from 2 to 5 years. Sanitation interventions with implant preservation were successful in71% of patients. In group of patients with late PPI satisfactory results were achieved in 89.6% of cases. On the basis of the obtained data the variants of diagnosis and treatment tactics optimization as well as its adaptation to domestic public health system were proposed.
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Roschke, E., T. Kluge, F. Stallkamp, A. Roth, D. Zajonz, K. T. Hoffmann, O. Sabri, R. Kluge, and M. Ghanem. "Use of PET-CT in diagnostic workup of periprosthetic infection of hip and knee joints: significance in detecting additional infectious focus." International Orthopaedics 46, no. 3 (October 7, 2021): 523–29. http://dx.doi.org/10.1007/s00264-021-05218-8.
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Abstract Introduction The diagnosis and management of periprosthetic knee and hip infections as well as the identification and management of possible additional infectious foci is of great importance for successful therapy. This study analyses the importance of 18F deoxyglucose PET-CT (PET-CT) in the identification of additional infectious focus and subsequent impact on management of periprosthetic infection (PPI). Material and methods A retrospective analysis of the clinical data and findings in the period from January 2008 to December 2018 was carried out. One hundred and four patients with in-hospital treatment due to PPI of a hip or knee joint were identified and included in this study. All patients underwent a standardized clinical examination and further surgical and antibiotic therapy. The reevaluation of performed PET-CTs was specifically carried out with regard to the local PPI or detection of secondary foci. Results PET-CT successfully verified the PPI in 84.2% of the patients. A total of 78 possible additional foci were detected in PET-CT in 56 (53.8%) of the examined patients. Predilection sites for possible secondary foci were joints (42.3%), pulmonary (15.4%), ear-nose-throat (15.4%), spine (11.5%), and the musculocutaneous tissues (11.5%). Fifty-four positive PET-CT findings were confirmed clinically with need of additional adequate treatment. Conclusion PET-CT is a valuable diagnostic tool to confirm periprosthetic joint infection. At the same time, the whole-body PET/CT may detect additional foci of infection with impact on subsequent treatment strategy. PET was of special value in detecting infections at distant locations far from the primary infected joint in significant number. These distant infection locations can be potential cause of a re-infection. This clearly reflects the need of their diagnosis.
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Dobrovol’skaya, N. Yu, N. P. Prishchepa, E. V. Preobrazhenskaya, and N. N. Pchelova. "PCR RESEARCH AS AN AUXILIARY METHOD FOR DIAGNOSTICS OF PERIPHRESITICAL INFECTION AFTER ENDOSTREDITISION OF JOINTS (CLINICAL CASE)." Russian Clinical Laboratory Diagnostics 65, no. 5 (April 15, 2020): 332–36. http://dx.doi.org/10.18821/0869-2084-2020-65-5-332-336.
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Periprosthetic infection (PPI) after arthroplasty of large joints is the third (among the main causes of unsatisfactory results of surgical treatment) a serious threat to the health of patients. The «gold standard» for the diagnosis of PPI is the bacteriological examination of samples of periprosthetic tissues and synovial fluid. In 10-30% of cases, it is impossible to isolate microorganisms, which is explained by the difficulty of cultivation and taking antibiotics before sampling. The purpose of study is to demonstrate the diagnostic value of PCR diagnostics for identifying the genetic material of an infectious pathogen of a culture-negative periprosthetic infection. Material of the study is a description of a clinical case of a culture-negative periprosthetic infection that caused a second two-stage revision of the hip joint prosthesis In the first episode of PPI that occurred 3 years after hip replacement, a microbiological examination of the puncture of the trochanteric zone of the operated joint revealed a massive increase in methicillin-resistant Staphylococcus epidermidis (MRSE). A two-stage revision joint replacement was performed. 5 years after the revision, the patient was hospitalized with clinical and radiological signs of PPI, while examining the puncture of the joint revealed characteristic PPI cytosis. Microbiological examination of punctate and intraoperative aspirate at the first stage of the repeated two-stage revision endoprosthesis replacement did not reveal aerobic and anaerobic microorganisms. In PCR studies, the DNA of methicillin-sensitive Staphylococcus aureus (MSSA) was detected in washouts from the removed components of the endoprosthesis; no resistance marker (mecA gene) was found. Given the concomitant oncological disease, this result determined the appointment of pathogenetic antibiotic therapy, the effectiveness of which was confirmed after 8 weeks at the II stage of revision. The PCR study of joint and trochanteric punctures (before surgery), flushing from the removed spacer components (after ultrasound treatment) and intraoperative aspirate from the joint did not reveal Staphylococcus aureus DNA and resistance marker (mecA gene). In some cases of periprosthetic infection, traumatologists and orthopedists deal with culturally negative results of a microbiological study of the patient’s biomaterial and swabs from the components of endoprostheses in the presence of clinical manifestations of PPI, confirmed by laboratory diagnostics and X-ray examination. According to the literature, such clinical situations are observed in 10-30% of cases and are caused by previous antibiotic therapy in the early stages of an infectious complication. After surgical treatment of PPI for the selection of adequate antibiotic therapy, such patients need to at least indirectly determine the type of infection pathogen, which is achieved by the use of additional diagnostic methods, such as a PRC study. In the case described by us, after a course of antibiotic therapy, prescribed according to the results of the first PCR study, the patient’s body does not contain DNA traces of the desired infectious agent. Thus, the repeated PCR not only confirmed the accuracy of the initial diagnosis of the source of infection, but also further illustrated the success of the rehabilitation of the periprosthetic infection using a correctly selected antibacterial drug at the previous stage of the study. The use of the PCR method made it possible to diagnose the pathogen and prescribe adequate antibiotic therapy for culture-negative periprosthetic infection.
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Scheele, Christian, Isabelle Krauel, Florian Pohlig, Heinrich Muehlhofer, Ludger Gerdesmeyer, Igor Lasic, Peter Michael Prodinger, Ingo Banke, Rüdiger von Eisenhart-Rothe, and Norbert Harrasser. "Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm." Zeitschrift für Orthopädie und Unfallchirurgie 157, no. 06 (October 28, 2019): 684–94. http://dx.doi.org/10.1055/a-1034-0923.
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Abstract Background Periprosthetic joint infection (PPI) is one of the most common reasons for revision in total knee arthroplasty (TKA). Percutaneous synovial biopsy is considered as a well-established diagnostic tool in ambiguous cases of chronic pain after TKA. The exact number of undetected low-grade infections remains unclear. Objectives The aim of this prospective study was to compare the diagnostic accuracy of arthroscopically guided and unguided synovial biopsy. Additionally, the prevalence of initially undetected PPI during synovial biopsy and revision surgery was assessed. Materials and Methods 40 patients suffering from chronic pain after TKA and the clinical suspicion of PPI were included in the study. Synovial biopsies were collected in a standardized manner first without and then with arthroscopic visual control. Using both techniques, six samples were collected each (5 for microbiology, 1 for histology). 19 patients, initially classified aseptic, underwent revision surgery later. Results The diagnosis of PPI was made in 10.0% of unguided biopsies (4 cases, 2× microbiologically, 2× histologically), 7.5% of arthroscopic biopsies (3 cases, 3× histologically) and 12.5% (5 cases, 3× histologically, 2× microbiologically) of all cases. Only histologic evaluation led to concordant positive findings using both techniques in two patients. The proportion of non-representative biopsies was twice as high after unguided tissue collection than after arthroscopic biopsy (30.0 vs. 15.0%). Microbiologic evaluation of arthroscopically collected biopsies did not lead to the diagnosis of PPI, which might have been essential to the selection of the appropriate antimicrobial therapy. During revision surgery the diagnosis of PPI was made in 22.2% of cases. Conclusions In patients suffering from chronic pain after TKA, periprosthetic low-grade infection was diagnosed in a relevant proportion of cases. Therefore, synovial biopsies for histological and microbiological evaluation should be collected whenever thereʼs clinical suspicion of PPI. For histological evaluation, samples should be collected using arthroscopic control and ideally multiple biopsies should be taken. For microbiological evaluation, excessive joint lavage should be avoided.
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Triapichnikov, A. S., B. V. Kamshilov, D. A. Kolotygin, and N. M. Belokrylov. "Outcomes of two-stage revision arthroplasty in the treatment of patients with periprosthetic hip infection (retrospective cohort study)." Genij Ortopedii 28, no. 2 (April 29, 2022): 173–78. http://dx.doi.org/10.18019/1028-4427-2022-28-2-173-178.
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Introduction Periprosthetic infection (PPI) is a serious challenge for orthopedic surgeons. Two-stage revision with an antibiotic-impregnated spacer is one of the most common methods for treating periprosthetic infection. Purpose To evaluate the functional results of the second stage of revision arthroplasty in patients with PPI and to determine the survival of the endoprosthesis components. Materials and methods We retrospectively studied the results of the second stage of treatment (removal of the spacer and installation of the endoprosthesis) in 23 patients admitted to the department for the period 2016–2019. All patients received a spacer during the first stage of treatment. The mean age of the patients was 53.7 ± 2.2 years. Males prevailed (91.3 %). Results Three patients developed infection recurrence in the follow-up period of 44.4 ± 1.9 months. The effectiveness of revision arthroplasty performed as the second stage of treatment was 87 %. The Harris Hip Score before the second examination was 42.3 ± 2.5 points, at the time of the last follow-up examination it was significantly higher, 78.32 ± 3.8 points (p = 0.000052; Z – 4.04). Discussion The success of two-stage revision arthroplasty is influenced by the factors associated with patients’ co-morbidities, pathogenicity of the pathogen identified at the first stage, as well as the features of the implants used and surgical tactics. Conclusion The second stage of revision arthroplasty in patients who received a spacer with an antibiotic for the treatment of periprosthetic infection at the first stage significantly improved their functional state. The Kaplan-Meier implant survival rate was 77.5 %.
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Nikolaev, Nikolay S., Nadezhda N. Pchelova, Elena V. Preobrazhenskaya, Valentina V. Nazarova, and Natal’ya Yu Dobrovol’skaya. "“Unexpected” Infections in Revision Arthroplasty for Aseptic Loosening." Traumatology and Orthopedics of Russia 27, no. 3 (October 28, 2021): 56–70. http://dx.doi.org/10.21823/2311-2905-2021-27-3-56-70.
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Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight. The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology. Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection. Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out. Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.
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Maliuchenko, Leonid I., Nikolay S. Nikolaev, Nadezhda N. Pchelova, Dmitry Nikolaevich Efimov, Elena V. Preobrazhenskaia, and Vladimir U. Emelianov. "Linear-Chain Nanostructured Carbon with a Silver Film Plated on Metal Components Has a Promising Effect for the Treatment of Periprosthetic Joint Infection." Osteology 1, no. 4 (December 8, 2021): 238–46. http://dx.doi.org/10.3390/osteology1040022.
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Background: Due to the aging of the world population, the number of joint diseases, along with the number of arthroplasties, has increased, simultaneously increasing the amount of complications, including periprosthetic joint infection (PPI). In this study, to combat a PPI, we investigated the antimicrobial properties of the new composite cover for titanium implants, silver-doped carbyne-like carbon (S-CLC) film. Methods: The first assay investigated the antimicrobial activity against Pseudomonas aeruginosa and releasing of silver ions from S-CLC films into growth media covered with S-CLC with a thickness of 1, 2, and 4 mm. The second assay determined the direct antibacterial properties of the S-CLC film’s surface against Staphylococcus aureus, Enterococcus faecalis, or P. aeruginosa. The third assay studied the formation of microbial biofilms of S. aureus or P. aeruginosa on the S-CLC coating. Silver-doped carbyne-like carbon (S-CLC)-covered or titanium plates alone were used as controls. Results: S-CLC films, compared to controls, prevented P. aeruginosa growth on 1 mm thickness agar; had direct antimicrobial properties against S. aureus, E. faecalis, and P. aeruginosa; and could prevent P. aeruginosa biofilm formation. Conclusions: S-CLC films on the Ti surface could successfully fight the most common infectious agent in PPI, and prevented biofilm formation.
Book chapters on the topic "Periprosthetic infection (PPI)"
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Khan, Umraz, Graeme Perks, Rhidian Morgan-Jones, Peter James, Colin Esler, Vince Smyth, and Vanya Gant. "Introduction." In Pathways in Prosthetic Joint Infection, 1–8. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791881.003.0001.
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This chapter introduces the book and discusses the definition of periprosthetic joint infection, classification of surgical site infections, incidence of prosthetic joint infection (PJI) in total knee replacement, quantifying PJI, and the burden of PJI. The aims are to unify our understsanding of this condition, to bring into sharp focus the need for vigilance, and to raise the profile of this condition amongst allied specialties. Whilst remaining reatively low, the incidence of PJI is not zero. Prevention is far better for the patient, surgeon, and the National Health Service and must remain the goal of the operating surgeon.
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"7 Management of Periprosthetic Joint Infection." In Management of Orthopaedic Infections, edited by Antonia F. Chen. New York, NY: Thieme Medical Publishers, Inc., 2021. http://dx.doi.org/10.1055/b-0041-181982.
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Periprosthetic joint infection (PJI) continues to be a devastating problem in the field of total joint arthroplasty. There are a number of surgical options to decide from and management decisions are based upon the interplay between host, pathogen, and surgeon characteristics. The goal of management is to maximize function, prevent systemic complications, and eradicate infection. Throughout this chapter we will discuss the most relevant recent literature and guiding theories to assist the treating orthopaedic surgeon in the surgical decision-making process.
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Jarusriwanna, Atthakorn, and Chaturong Pornrattanamaneewong. "Complications after Total Knee Arthroplasty: Stiffness, Periprosthetic Joint Infection, and Periprosthetic Fracture." In Arthroplasty - Advanced Techniques and Future Perspectives [Working Title]. IntechOpen, 2022. http://dx.doi.org/10.5772/intechopen.105745.
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Total knee arthroplasty (TKA) is one of the most successful surgical procedures with effective treatment in patients suffering from end-stage knee osteoarthritis. The goal of the operation is to improve pain, correct the deformity, and increase function. However, complications after surgery are the important factors related to dissatisfied TKA. Stiffness, periprosthetic joint infection (PJI), and periprosthetic fracture are among the most common complications following TKA and usually raise issues as concern points for both patients and the surgeons. Each complication needs precise assessment and specific care to prevent further serious issues. In this chapter, the authors will focus and describe all of these three frequent complications in details from their definition to management.
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Leonenko, Vasiliy N., Yulia E. Kaliberda, and Vasiliy A. Artyuk. "A Modeling Framework for Decision Support in Periprosthetic Joint Infection Treatment." In pHealth 2021. IOS Press, 2021. http://dx.doi.org/10.3233/shti210581.
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In this paper, we present a framework, which aims at facilitating the choice of the best strategy related to the treatment of periprosthetic joint infection (PJI). The framework includes two models: a detailed non-Markovian model based on the decision tree approach, and a general Markov model, which captures the most essential states of a patient under treatment. The application of the framework is demonstrated on the dataset provided by Russian Scientific Research Institute of Traumatology and Orthopedics “R.R. Vreden”, which contains records of patients with PJI occurred after total hip arthroplasty. The methods of cost-effectiveness analysis of treatment strategies and forecasting of individual treatment outcomes depending on the selected strategy are discussed.
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A. Sandiford, Nemandra, and Konrad Wronka. "The Impact of the Multidisciplinary Team on the Management of Prosthetic Joint Infection in Trauma and Orthopaedic Surgery." In Teamwork in Healthcare [Working Title]. IntechOpen, 2020. http://dx.doi.org/10.5772/intechopen.94124.
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Periprosthetic Joint Infection (PJI) is a devastating complication of the Total Joint Arthroplasty (TJA). It presents a great challenge for the clinician to diagnose and manage it appropriately, with significant morbidity for the patients and cost for health care providers. The purpose of this study is to review and examine the role of multi-disciplinary team (MDT) approach in diagnosis and management of prosthetic joint infection (PJI) and how this approach can influence outcomes. All published literature examining the role of multidisciplinary care in the management of PJI and the influence of this approach to the management and outcomes of patients with this diagnosis were included. Studies published in languages other than English were excluded. There is a paucity of data on the influence of multidisciplinary care on outcomes of the management of PJI. Evidence suggests that the MDT has important role in ensuring all factors in the management of this complex group are considered and best possible care is delivered. Multicentre randomised clinical trials are required to assess the influence of MDT’S on outcome as well as important questions around the structuring of these teams.
Conference papers on the topic "Periprosthetic infection (PPI)"
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Fuchs, Michael, Sven Geissler, Janine Mikutta, Georg N. Duda, Carsten Perka, Andrej Trampuz, and Andrea Sass. "Soluble Pecam-1 As Biomarker In Periprosthetic Joint Infections (PJI)." In Deutscher Kongress für Orthopädie und Unfallchirurgie. Georg Thieme Verlag KG, 2020. http://dx.doi.org/10.1055/s-0040-1717359.
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