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.
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Beck, Sascha, Carolin Sehl, Sylvia Voortmann, Hedda Luise Verhasselt, Michael J. Edwards, Jan Buer, Mike Hasenberg, Erich Gulbins, and Katrin Anne Becker. "Sphingosine is able to prevent and eliminate Staphylococcus epidermidis biofilm formation on different orthopedic implant materials in vitro." Journal of Molecular Medicine 98, no. 2 (December 20, 2019): 209–19. http://dx.doi.org/10.1007/s00109-019-01858-x.
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Abstract Periprosthetic infection (PPI) is a devastating complication in joint replacement surgery. On the background of an aging population, the number of joint replacements and associated complications is expected to increase. The capability for biofilm formation and the increasing resistance of different microbes to antibiotics have complicated the treatment of PPI, requiring the need for the development of alternative treatment options. The bactericidal effect of the naturally occurring amino alcohol sphingosine has already been reported. In our study, we demonstrate the antimicrobial efficacy of sphingosine on three different strains of biofilm producing Staphylococcus epidermidis, representing one of the most frequent microbes involved in PPI. In an in vitro analysis, sphingosine’s capability for prevention and treatment of biofilm-contamination on different common orthopedic implant surfaces was tested. Coating titanium implant samples with sphingosine not only prevented implant contamination but also revealed a significant reduction of biofilm formation on the implant surfaces by 99.942%. When testing the antimicrobial efficacy of sphingosine on sessile biofilm-grown Staphylococcus epidermidis, sphingosine solution was capable to eliminate 99.999% of the bacteria on the different implant surfaces, i.e., titanium, steel, and polymethylmethacrylate. This study provides evidence on the antimicrobial efficacy of sphingosine for both planktonic and sessile biofilm-grown Staphylococcus epidermidis on contaminated orthopedic implants. Sphingosine may provide an effective and cheap treatment option for prevention and reduction of infections in joint replacement surgery. Key messages • Here we established a novel technology for prevention of implant colonization by sphingosine-coating of orthopedic implant materials. • Sphingosine-coating of orthopedic implants prevented bacterial colonization and significantly reduced biofilm formation on implant surfaces by 99.942%. • Moreover, sphingosine solution was capable to eliminate 99.999% of sessile biofilm-grown Staphylococcus epidermidis on different orthopedic implant surfaces.
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Lima, Ana Lucia L., Priscila R. Oliveira, Vladimir C. Carvalho, Eduardo S. Saconi, Henrique B. Cabrita, and Marcelo B. Rodrigues. "Periprosthetic Joint Infections." Interdisciplinary Perspectives on Infectious Diseases 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/542796.
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Implantation of joint prostheses is becoming increasingly common, especially for the hip and knee. Infection is considered to be the most devastating of prosthesis-related complications, leading to prolonged hospitalization, repeated surgical intervention, and even definitive loss of the implant. The main risk factors to periprosthetic joint infections (PJIs) are advanced age, malnutrition, obesity, diabetes mellitus, HIV infection at an advanced stage, presence of distant infectious foci, and antecedents of arthroscopy or infection in previous arthroplasty. Joint prostheses can become infected through three different routes: direct implantation, hematogenic infection, and reactivation of latent infection. Gram-positive bacteria predominate in cases of PJI, mainlyStaphylococcus aureusandStaphylococcus epidermidis. PJIs present characteristic signs that can be divided into acute and chronic manifestations. The main imaging method used in diagnosing joint prosthesis infections is X-ray. Computed tomography (CT) scan may assist in distinguishing between septic and aseptic loosening. Three-phase bone scintigraphy using technetium has high sensitivity, but low specificity. Positron emission tomography using fluorodeoxyglucose (FDG-PET) presents very divergent results in the literature. Definitive diagnosis of infection should be made by isolating the microorganism through cultures on material obtained from joint fluid puncturing, surgical wound secretions, surgical debridement procedures, or sonication fluid. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic infections in arthroplasty cases. Treatment in a single procedure is appropriate in carefully selected cases.
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Sangaletti, Rudy, Luigi Zanna, Mustafa Akkaya, Nemandra Sandiford, Seper Ekhtiari, Thorsten Gehrke, and Mustafa Citak. "Periprosthetic joint infection in patients with multiple arthroplasties." Bone & Joint Journal 105-B, no. 3 (March 1, 2023): 294–300. http://dx.doi.org/10.1302/0301-620x.105b3.bjj-2022-0800.r1.
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AimsDespite numerous studies focusing on periprosthetic joint infections (PJIs), there are no robust data on the risk factors and timing of metachronous infections. Metachronous PJIs are PJIs that can arise in the same or other artificial joints after a period of time, in patients who have previously had PJI.MethodsBetween January 2010 and December 2018, 661 patients with multiple joint prostheses in situ were treated for PJI at our institution. Of these, 73 patients (11%) developed a metachronous PJI (periprosthetic infection in patients who have previously had PJI in another joint, after a lag period) after a mean time interval of 49.5 months (SD 30.24; 7 to 82.9). To identify patient-related risk factors for a metachronous PJI, the following parameters were analyzed: sex; age; BMI; and pre-existing comorbidity. Metachronous infections were divided into three groups: Group 1, metachronous infections in ipsilateral joints; Group 2, metachronous infections of the contralateral lower limb; and Group 3, metachronous infections of the lower and upper limb.ResultsWe identified a total of 73 metachronous PJIs: 32 PJIs in Group 1, 38 in Group 2, and one in Group 3. The rate of metachronous infection was 11% (73 out 661 cases) at a mean of four years following first infection. Diabetes mellitus incidence was found significantly more frequently in the metachronous infection group than in non-metachronous infection group. The rate of infection in Group 1 (21.1%) was significantly higher (p = 0.049) compared to Groups 2 (6.2%) and 3 (3%). The time interval of metachronous infection development was shorter in adjacent joint infections. Concordance between the bacterium of the first PJI and that of the metachronous PJI in Group 1 (21/34) was significantly higher than Group 2 (13/38; p = 0.001).ConclusionThe findings of this study suggest that metachronous PJI occurs in more than one in ten patients with an index PJI. Female patients, diabetic patients, and patients with a polymicrobial index PJI are at significantly higher risk for developing a metachronous PJI. Furthermore, metachronous PJIs are significantly more likely to occur in an adjacent joint (e.g. ipsilateral hip and knee) as opposed to a more remote site (i.e. contralateral or upper vs lower limb). Additionally, adjacent joint PJIs occur significantly earlier and are more likely to be caused by the same bacteria as the index PJI.Cite this article: Bone Joint J 2023;105-B(3):294–300.
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Tsitko, Hanna, Paulina Dudzińska, Małgorzata Milanowska, Aleksandra Grudzińska, and Dominika Jarosz. "The diagnosis of periprosthetic joint infection after the arthroplasty of knee joint." Journal of Education, Health and Sport 13, no. 2 (December 23, 2022): 131–35. http://dx.doi.org/10.12775/jehs.2023.13.02.018.
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Total knee replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the knee joint. Due to the aging of the population and the prevalence of osteoarthritis, the number of arthroplasties is increasing every day. Such extensive surgical procedures are associated with a large number of postoperative complications, one of which is periprosthetic joint infection. The reported prevalence of PJI out to 2 years after knee replacement is 1.55 %. Misconceptions in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The aim of the following article was to provide an overview of the medical knowledge on the periprosthetic joint infection after the arthroplasty of knee joint.
Infections are caused by microbes that can enter the joint, which are most often coagulase-negative Staphylococci, Staphylococcus Aureus, Streptococci, Enterococci and Gram-negative bacteria. Fungal infections are much less common. The diagnostic process requires the involvement of a large group of medical personnel, which is why protocols with algorithms have been created to facilitate and standardize the diagnosis in the direction of periprosthetic joint infections. Mainly used tests from the patient's serum, synovial tests and histology. The positive results of the above tests are taken into account in the assessment of the fulfillment of the major and minor criteria to assess the likelihood of the occurrence of periprosthetic infection. This research paper aims to analyze the latest medical reports on the PJI diagnostic algorithm, laboratory and imaging studies of their effectiveness. This article was written based on analyzing data available in publications in Pubmed and Google Scholar databases
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Satalich, James, Julie Reznicek, Alexandra Bryson, Prayag Pershad, Nicholas Hooper, and Jibanananda Satpathy. "Prosthetic Joint Infection due to Histoplasma capsulatum in a Patient from Trinidad: Workup, Pathology, and Treatment." Case Reports in Orthopedics 2022 (August 5, 2022): 1–7. http://dx.doi.org/10.1155/2022/8998996.
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Histoplasma capsulatum is a rarely reported cause of prosthetic joint infections. This current case report is of a patient from Trinidad, with a history of a right total knee replacement (TKR), who underwent a successful two-stage revision due to a Histoplasmosis capsulatum periprosthetic joint infection (PJI). This case report offers a unique treatment plan to successfully treat Histoplasmosis capsulatum periprosthetic joint infections and emphasizes the importance of obtaining an accurate travel history.
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Sigmund, Irene K., Markus Luger, Reinhard Windhager, and Martin A. McNally. "Diagnosing periprosthetic joint infections." Bone & Joint Research 11, no. 9 (September 1, 2022): 608–18. http://dx.doi.org/10.1302/2046-3758.119.bjr-2022-0078.r1.
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Aims This study evaluated the definitions developed by the European Bone and Joint Infection Society (EBJIS) 2021, the International Consensus Meeting (ICM) 2018, and the Infectious Diseases Society of America (IDSA) 2013, for the diagnosis of periprosthetic joint infection (PJI). Methods In this single-centre, retrospective analysis of prospectively collected data, patients with an indicated revision surgery after a total hip or knee arthroplasty were included between 2015 and 2020. A standardized diagnostic workup was performed, identifying the components of the EBJIS, ICM, and IDSA criteria in each patient. Results Of 206 included patients, 101 (49%) were diagnosed with PJI with the EBJIS definition. IDSA and ICM diagnosed 99 (48%) and 86 (42%) as infected, respectively. A total of 84 cases (41%) had an infection based on all three criteria. In 15 cases (n = 15/206; 7%), PJI was present when applying only the IDSA and EBJIS criteria. No infection was detected by one definition alone. Inconclusive diagnoses occurred more frequently with the ICM criteria (n = 30/206; 15%) compared to EBJIS (likely infections: n = 16/206; 8%) (p = 0.029). A better preoperative performance of the EBJIS definition was seen compared with the ICM and IDSA definitions (p < 0.001). Conclusion The novel EBJIS definition identified all PJIs diagnosed by any other criteria. Use of the EBJIS definition significantly reduced the number of uncertain diagnoses, allowing easier clinical decision-making. Cite this article: Bone Joint Res 2022;11(9):608–618.
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Walter, Nike, Markus Rupp, Susanne Bärtl, Claus Uecker, and Volker Alt. "The Definition of the Term “Orthogeriatric Infection” for Periprosthetic Joint Infections." Geriatric Orthopaedic Surgery & Rehabilitation 13 (January 2022): 215145932211116. http://dx.doi.org/10.1177/21514593221111649.
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Introduction In the background of the aging population, an increase of geriatric patients with specific age-related co-morbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients. Material and methods In this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (≤70 years), geriatric multimorbidity and the Barthel index (≤30). Results Applying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71) revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, P = .007 and n = 24, 13.0% vs n = 5, 7.0%, P = .005). The Barthel index showed a significant correlation with mortality ( r = −.22, P = .011). Discussion We propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects. Conclusion The inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial.
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Indelli, Pier Francesco, Stefano Ghirardelli, Ferdinando Iannotti, Alessia Maria Indelli, and Gennaro Pipino. "Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)." Tropical Medicine and Infectious Disease 6, no. 2 (May 28, 2021): 91. http://dx.doi.org/10.3390/tropicalmed6020091.
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Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.
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Ennis, Hayley, Clark Jia-Long Chen, Kevin Bondar, Johnathon McCormick, Colin Zieminski, and Victor Hugo Hernandez. "Influential literatures in periprosthetic infection following joint arthroplasty: A bibliometric review." Journal of Orthopaedics, Trauma and Rehabilitation 28 (January 1, 2021): 221049172110097. http://dx.doi.org/10.1177/22104917211009777.
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The objective of this bibliometric literature review was to identify and analyze the most frequently cited manuscripts on the topic of periprosthetic joint infection. Periprosthetic infection following joint arthroplasty is a complication leading to rising rates of mortality and increasing economic strain. No prior study has evaluated the most impactful literature on the topic of periprosthetic joint infection (“PJI”) in total hip and knee arthroplasty. Knowledge and appreciation of the most influential publications on this topic can guide and inspire future research endeavors. Using the Clarivate Analytics Web of Science database, the 50 most cited articles related to periprosthetic infection following joint arthroplasty were identified. Numerous metrics including citation frequency, year of publication, country of origin, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. The seven most cited articles (per year) during the past 10 years were also identified. The years of publications of the articles included in the final analysis ranged from 1969 to 2014. “Current concepts: Prosthetic-joint infections” by Zimmerli et al. was the most frequently cited article. Level of Evidence (“LOE”) of 2 and 3 were the most common. Clinical outcomes was the most common article type. Mayo Clinic and Thomas Jefferson University produced the most publications. Hanssen and Parvisi were the most productive authors. 2000–2009 ( n = 25) was the most prolific decade in terms of number of publications. Using citation analysis as an indication of influence, the most influential articles on periprosthetic joint infection were highlighted. Analysis of the most recognized publication on PJI provides an enhanced understanding of the diagnosis, treatment, and future research of PJI. Future studies may combine the search results of multiple databases including Scopus, Web of Science and PubMed to rectify any discrepancies in citation data and to capture additional literature on PJI.
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Rodriguez-Merchan, Emerito Carlos, and Alberto D. Delgado-Martinez. "Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty." Journal of Clinical Medicine 11, no. 20 (October 18, 2022): 6128. http://dx.doi.org/10.3390/jcm11206128.
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Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient’s perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.
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Darwich, Ali, Franz-Joseph Dally, Khaled Abu Olba, Elisabeth Mohs, Sascha Gravius, Svetlana Hetjens, Elio Assaf, and Mohamad Bdeir. "Superinfection with Difficult-to-Treat Pathogens Significantly Reduces the Outcome of Periprosthetic Joint Infections." Antibiotics 10, no. 10 (September 23, 2021): 1145. http://dx.doi.org/10.3390/antibiotics10101145.
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Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty. In the course of a PJI, superinfections with pathogens that do not match the primary infecting micro-organism may occur. To our knowledge, there are no published data on the outcome of such infections in the literature. The aim of this study was to assess the outcome of PJI with superinfections with a difficult-to-treat (DTT) pathogen. Data of 169 consecutive patients with PJI were retrospectively analyzed in this single-center study. Cases were categorized into: Group 1 including non-DTT-PJI without superinfection, Group 2 DTT-PJI without superinfection, Group 3 non-DTT-PJI with DTT superinfection, and Group 4 non-DTT-PJI with non-DTT superinfection. Group 3 comprised 24 patients and showed, after a mean follow-up of 13.5 ± 10.8 months, the worst outcome with infection resolution in 17.4% of cases (p = 0.0001), PJI-related mortality of 8.7% (p = 0.0001), mean revision rate of 6 ± 3.6 (p < 0.0001), and duration of antibiotic treatment of 71.2 ± 45.2 days (p = 0.0023). PJI caused initially by a non-DTT pathogen with a superinfection with a DTT pathogen is significantly associated with the worst outcome in comparison to non-DTT-PJI, PJI caused initially by a DTT pathogen, and to non-DTT-PJI with a non-DTT superinfection.
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Somerson, Jeremy S., Matthew R. Boylan, Kevin T. Hug, Qais Naziri, Carl B. Paulino, and Jerry I. Huang. "Risk factors associated with periprosthetic joint infection after total elbow arthroplasty." Shoulder & Elbow 11, no. 2 (November 8, 2017): 116–20. http://dx.doi.org/10.1177/1758573217741318.
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Background For patients undergoing total elbow arthroplasty (TEA), the present study aimed to investigate: (i) what risk factors are associated with periprosthetic elbow infection; (ii) what is the incidence of infection after TEA; and (iii) what is the acuity with which these infections present? Methods The Statewide Planning and Research Cooperative System database was used to identify all patients who underwent TEA between 2003 and 2012 in New York State. Admissions for prosthetic joint infection (PJI) were identified using ICD-9 (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis code 996.66. Multivariate analysis was used to determine risk factors that were independently prognostic for PJI. Results Significant risk factors for PJI included hypothyroidism [odds ratio (OR) = 2.04; p = 0.045], tobacco use disorder (OR = 3.39; p = 0.003) and rheumatoid arthritis (OR = 3.31; p < 0.001). Among the 1452 patients in the study period who underwent TEA, 3.7% ( n = 54) were admitted postoperatively for PJI. There were 30 (56%) early infections, 17 (31%) delayed infections and seven (13%) late infections. Conclusions Pre-operative optimization of thyroid function, smoking cessation and management of rheumatoid disease may be considered in surgical candidates for TEA. The results of the present study add prognostic data to the literature that may be helpful with patient selection and risk profile analysis. Level of evidence Level III: prognostic study
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Christopher, Zachary K., Kade S. McQuivey, David G. Deckey, Jack Haglin, Mark J. Spangehl, and Joshua S. Bingham. "Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections." Journal of Bone and Joint Infection 6, no. 6 (June 8, 2021): 229–34. http://dx.doi.org/10.5194/jbji-6-229-2021.
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Abstract. Introduction: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP (mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion criteria: patients >18 years old who underwent surgical revision for PJI and had documented ESR and CRP values. Subjects were divided into two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in characterizing the duration of PJI. Results: 147 patients were included in the study (81 acute and 66 chronic). The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in chronic patients (p<0.001). The ESR / CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for ESR / CRP to predict a chronic (>0.96) vs. acute (<0.96) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62–0.83) and the specificity was 0.90 (95 % CI 0.81–0.94). Conclusions: The ESR / CRP ratio may help determine the duration of PJI in uncertain cases. This metric may give arthroplasty surgeons more confidence in defining the duration of the PJI and therefore aid in treatment selection.
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del Arco, Alfonso, and María Luisa Bertrand. "The Diagnosis of Periprosthetic Infection." Open Orthopaedics Journal 7, no. 1 (June 14, 2013): 178–83. http://dx.doi.org/10.2174/1874325001307010178.
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Periprosthetic infection (PJI) is the most serious joint replacement complication, occurring in 0.8-1.9% of knee arthroplasties and 0.3-1.7% of hip arthroplasties. A definition of PJI was proposed in the November 2011 issue of the journal Clinical Orthopedics and Related Research. The presence of a fistula or of local inflammatory signs is indicative of PJI, but in many cases local pain is the only symptom. In the absence of underlying inflammatory conditions, C-reactive protein measurement is the most useful preoperative blood test for detecting infection associated with a prosthetic joint. The most useful preoperative diagnostic test is the aspiration of synovial joint fluid to obtain a total and differential cell count and culture. Intraoperative frozen sections of periprosthetic tissues produce excellent accuracy in predicting a diagnosis of PJI but only moderate accuracy in ruling out the diagnosis. In this process, obtaining a quality sample is the first step, and determines the quality of microbiological results. Specimens for culture should be obtained prior to the initiation of antibiotic treatment. Sonication of a removed implant may increase the culture yield. Plain radiography has low sensitivity and low specificity for detecting infection associated with a prosthetic joint. Computed tomography and magnetic resonance imaging may be useful in the evaluation of complex cases, but metal inserts interfere with these tests, and abnormalities may be non-specific. Labelled-leucocyte imaging (e.g., leucocytes labelled with indium-111) combined with bone marrow imaging with the use of technetium-99m–labelled sulphur colloid is considered the imaging test of choice when imaging is necessary.
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Palan, Jeya, Ciaran Nolan, Kostas Sarantos, Richard Westerman, Richard King, and Pedro Foguet. "Culture-negative periprosthetic joint infections." EFORT Open Reviews 4, no. 10 (October 2019): 585–94. http://dx.doi.org/10.1302/2058-5241.4.180067.
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Culture-negative periprosthetic joint infections (CN-PJI) pose a significant challenge in terms of diagnosis and management. The reported incidence of CN-PJI is reported to be between 7% and 15%. Fungi and mycobacterium are thought to be responsible for over 85% of such cases with more fastidious bacteria accounting for the rest. With the advent of polymerase chain reaction, mass spectrometry and next generation sequencing, identifying the causative organism(s) may become easier but such techniques are not readily available and are very costly. There are a number of more straightforward and relatively low-cost methods to help surgeons maximize the chances of diagnosing a PJI and identify the organisms responsible. This review article summarizes the main diagnostic tests currently available as well as providing a simple diagnostic clinical algorithm for CN-PJI. Cite this article: EFORT Open Rev 2019;4:585-594. DOI: 10.1302/2058-5241.4.180067
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Marongiu, Giuseppe, Marco Conte, Vincenzo Verderosa, Stefano Congia, Giuseppe Dessì, Marco Verona, Vittorio Mazzarello, and Matthew Gavino Donadu. "Late onset periprosthetic joint infection of the knee caused by Streptococcus anginosus. Case presentation and literature review." Journal of Infection in Developing Countries 15, no. 03 (March 31, 2021): 436–41. http://dx.doi.org/10.3855/jidc.12326.
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Periprosthetic joint infection (PJI) is one of the most dramatic complications of joint arthroplasty. Although streptococcal bone and joint infections are less common than staphylococcal cases, their role as causative agents of bone and joint remains significant accounting for at least 10% of PJIs. Streptococcus anginosus group (SAG) bacteria are usually found in the normal flora of the urogenital tract, intestinal tract and oropharynx and could cause pyogenic infections to affect brain, lungs and liver. SAG bacteria are uncommonly reported as a cause of osteomyelitis and the involvement of a joint represent a rare event. S. anginosus has been anecdotical related to implant devices infections such as vascular prosthesis or orthopedic implants, however, PJI of the knee has never been fully reported before. We describe the case of a late onset periprosthetic knee infection due to Streptococcus anginosus successfully treated by a two-stage revision arthroplasty and postoperative parenteral Vancomycin, (2 g per day) and Levofloxacin (750 mg per day) for 4 weeks and then oral Levofloxacin for a further 2 weeks.
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Peel, Trisha N., Tim Spelman, Brenda L. Dylla, John G. Hughes, Kerryl E. Greenwood-Quaintance, Allen C. Cheng, Jayawant N. Mandrekar, and Robin Patel. "Optimal Periprosthetic Tissue Specimen Number for Diagnosis of Prosthetic Joint Infection." Journal of Clinical Microbiology 55, no. 1 (November 2, 2016): 234–43. http://dx.doi.org/10.1128/jcm.01914-16.
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ABSTRACTWe recently demonstrated improved sensitivity of prosthetic joint infection (PJI) diagnosis using an automated blood culture bottle system for periprosthetic tissue culture [T. N. Peel et al., mBio 7(1):e01776-15, 2016,https://doi.org/10.1128/mBio.01776-15]. This study builds on the prior research by examining the optimal number of periprosthetic tissue specimens required for accurate PJI diagnosis. Current guidelines recommend five to six, which is impractical. We applied Bayesian latent class modeling techniques for estimating diagnostic test properties of conventional culture techniques (aerobic and anaerobic agars and thioglycolate broth) compared to inoculation into blood culture bottles. Conventional, frequentist receiver operating characteristic curve analysis was conducted as a sensitivity analysis. The study was conducted at Mayo Clinic, Rochester, MN, from August 2013 through April 2014 and included 499 consecutive patients undergoing revision arthroplasty from whom 1,437 periprosthetic tissue samples were collected and processed. For conventional periprosthetic tissue culture techniques, the greatest accuracy was observed when four specimens were obtained (91%; 95% credible interval, 77 to 100%), whereas when using inoculation of periprosthetic tissues into blood culture bottles, the greatest accuracy of diagnosis was observed when three specimens were cultured (92%; 95% credible intervals, 79 to 100%). Results of this study show that the greatest accuracy of PJI diagnosis is obtained when three periprosthetic tissue specimens are obtained and inoculated into blood culture bottles or four periprosthetic tissue specimens are obtained and cultured using standard plate and broth cultures. Increasing the number of specimens to five or more, per current recommendations, does not improve accuracy of PJI diagnosis.
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Tansey, Rosamond, Yusuf Mirza, Mohamed Sukeik, Mohammed Shaath, and Fares Sami Haddad. "Definition of Periprosthetic Hip and Knee Joint Infections and the Economic Burden." Open Orthopaedics Journal 10, no. 1 (November 30, 2016): 662–68. http://dx.doi.org/10.2174/1874325001610010662.
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Periprosthetic Joint infection (PJI) following hip and knee replacements is an important complication causing major concern for patients, operating surgeons and healthcare systems. Therefore, a standardized definition of PJI is required to improve communication and allow for valid comparisons of various diagnostic and treatment strategies. This review summarizes the most commonly used definitions for PJI and the current consensus. It also highlights the economic burden related to PJIs and the importance of a multidisciplinary approach to managing those infections.
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Rajput, Vishal, R. M. D. Meek, and Fares S. Haddad. "Periprosthetic joint infection: what next?" Bone & Joint Journal 104-B, no. 11 (November 1, 2022): 1193–95. http://dx.doi.org/10.1302/0301-620x.104b11.bjj-2022-0944.
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Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there are still many unanswered questions. We now have a workable definition that everyone should align to, but we need to continue to focus on identifying the organisms involved. Surgical strategies are evolving and care is becoming more patient-centred. There are some good studies under way. There are, however, still numerous problems to resolve, and the challenge of PJI remains a major one for the orthopaedic community. This annotation provides some up-to-date thoughts about where we are, and the way forward. There is still scope for plenty of research in this area. Cite this article: Bone Joint J 2022;104-B(11):1193–1195.
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Li, Cheng, Nora Renz, Andrej Trampuz, and Cristina Ojeda-Thies. "Twenty common errors in the diagnosis and treatment of periprosthetic joint infection." International Orthopaedics 44, no. 1 (October 22, 2019): 3–14. http://dx.doi.org/10.1007/s00264-019-04426-7.
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Abstract Background Misconceptions and errors in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The goal of this paper is to systematically describe twenty common mistakes in the diagnosis and management of PJI, to help surgeons avoid these pitfalls. Materials and methods Common diagnostic and treatment errors are described, analyzed and interpreted. Results Diagnostic errors include the use of serum inflammatory biomarkers (such as C-reactive protein) to rule out PJI, incomplete evaluation of joint aspirate, and suboptimal microbiological procedures (such as using swabs or collection of insufficient number of periprosthetic samples). Further errors are missing possible sources of distant infection in hematogenous PJI or overreliance on suboptimal diagnostic criteria which can hinder or delay the diagnosis of PJI or mislabel infections as aseptic failure. Insufficient surgical treatment or inadequate antibiotic treatment are further reasons for treatment failure and emergence of antimicrobial resistance. Finally, wrong surgical indication, both underdebridement and overdebridement or failure to individualize treatment can jeopardize surgical results. Conclusion Multidisciplinary teamwork with infectious disease specialists and microbiologists in collaboration with orthopedic surgeons have a synergistic effect on the management of PJI. An awareness of the possible pitfalls can improve diagnosis and treatment results.
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Bourget-Murray, Jonathan, Isabel Horton, Jared Morris, Antoine Bureau, Simon Garceau, Hesham Abdelbary, and George Grammatopoulos. "Periprosthetic joint infection following hip hemiarthroplasty." Bone & Joint Open 3, no. 12 (December 1, 2022): 924–32. http://dx.doi.org/10.1302/2633-1462.312.bjo-2022-0138.r1.
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Aims The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. Methods A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years’ follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined. Results A total of 1,984 HAs were performed during the study period, and 44 sustained a PJI (2.2%). Multiple logistic regression analysis revealed that a higher CCI score (odds ratio (OR) 1.56 (95% confidence interval (CI) 1.117 to 2.187); p = 0.003), peripheral vascular disease (OR 11.34 (95% CI 1.897 to 67.810); p = 0.008), cerebrovascular disease (OR 65.32 (95% CI 22.783 to 187.278); p < 0.001), diabetes (OR 4.82 (95% CI 1.903 to 12.218); p < 0.001), moderate-to-severe renal disease (OR 5.84 (95% CI 1.116 to 30.589); p = 0.037), cancer without metastasis (OR 6.42 (95% CI 1.643 to 25.006); p = 0.007), and metastatic solid tumour (OR 15.64 (95% CI 1.499 to 163.087); p = 0.022) were associated with increasing PJI risk. Upon final follow-up, 17 patients (38.6%) failed initial treatment and required further surgery for HA PJI. One-year mortality was 22.7%. Factors associated with treatment outcome included lower preoperative Hgb level (97.9 g/l (SD 11.4) vs 107.0 g/l (SD 16.1); p = 0.009), elevated CRP level (99.1 mg/l (SD 63.4) vs 56.6 mg/l (SD 47.1); p = 0.030), and type of surgery. There was lower chance of success with DAIR (42.3%) compared to revision HA (66.7%) or revision with conversion to total hip arthroplasty (100%). Early-onset PJI (≤ six weeks) was associated with a higher likelihood of treatment failure (OR 3.5 (95% CI 1.2 to 10.6); p = 0.007) along with patients treated by a non-arthroplasty surgeon (OR 2.5 (95% CI 1.2 to 5.3); p = 0.014). Conclusion HA PJI initially treated with DAIR is associated with poor chances of success and its value is limited. We strongly recommend consideration of a single-stage revision arthroplasty with cemented components. Cite this article: Bone Jt Open 2022;3(12):924–932.
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Karczewski, Daniel, Lukas Schönnagel, Christian Hipfl, Doruk Akgün, and Sebastian Hardt. "Periprosthetic hip infection in octogenarians." Bone & Joint Journal 105-B, no. 2 (February 1, 2023): 135–39. http://dx.doi.org/10.1302/0301-620x.105b2.bjj-2022-1035.r1.
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Aims Periprosthetic joint infection (PJI) in total hip arthroplasty in the elderly may occur but has been subject to limited investigation. This study analyzed infection characteristics, surgical outcomes, and perioperative complications of octogenarians undergoing treatment for PJI in a single university-based institution. Methods We identified 33 patients who underwent treatment for PJIs of the hip between January 2010 and December 2019 using our institutional joint registry. Mean age was 82 years (80 to 90), with 19 females (57%) and a mean BMI of 26 kg/m2 (17 to 41). Mean American Society of Anesthesiologists (ASA) grade was 3 (1 to 4) and mean Charlson Comorbidity Index was 6 (4 to 10). Leading pathogens included coagulase-negative Staphylococci (45%) and Enterococcus faecalis (9%). Two-stage exchange was performed in 30 joints and permanent resection arthroplasty in three. Kaplan-Meier survivorship analyses were performed. Mean follow-up was five years (3 to 7). Results The two-year survivorship free of any recurrent PJI was 72% (95% confidence interval (CI) 56 to 89; 18 patients at risk). There were a total of nine recurrent PJIs at a mean of one year (16 days to eight years), one for the same pathogen as at index infection. One additional surgical site infection was noted at two weeks, resulting in a 69% (95% CI 52 to 86; 17 patients at risk) survivorship free of any infection at two years. There were two additional revisions for dislocations at one month each. As such, the two-year survivorship free of any revision was 61% (95% CI 42 to 80; 12 patients at risk). In addition to the aforementioned revisions, there was one additional skin grafting for a decubitus ulcer, resulting in a survivorship free of any reoperation of 54% (95% CI 35 to 73; ten patients at risk) at two years. Mean Clavien-Dindo score of perioperative complications was two out of five, with one case of perioperative death noted at six days. Conclusion Octogenarians undergoing surgery for PJI of the hip are at low risk of acute mortality, but are at moderate risk of other perioperative complications. One in two patients will undergo a reoperation within two years, with 70% attributable to recurrent infections. Cite this article: Bone Joint J 2023;105-B(2):135–139.
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Enz, Andreas, Silke C. Mueller, Philipp Warnke, Martin Ellenrieder, Wolfram Mittelmeier, and Annett Klinder. "Periprosthetic Fungal Infections in Severe Endoprosthetic Infections of the Hip and Knee Joint—A Retrospective Analysis of a Certified Arthroplasty Centre of Excellence." Journal of Fungi 7, no. 6 (May 21, 2021): 404. http://dx.doi.org/10.3390/jof7060404.
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The treatment of periprosthetic joint infections (PJI), and especially of re-infections, poses a highly complex problem in orthopaedic surgery. While fungal infections are rare, they present a special challenge. The therapy is often protracted and based on limited evidence. A total of 510 hip and knee revision surgeries were analysed for the occurrence of bacterial and fungal PJI. In patients with PJI, the duration of the hospital stay and the incidence of disarticulation of the infected joint were recorded. Out of the analysed revision arthroplasties, 43.5% were due to PJI. Monomicrobial infection occurred in 55.2%, dual microbial infection in 21.4%, and polymicrobial (≥3 different bacterial or fungal species) infection in 17.2% of the cases. Overall, Candida species were detected in 12.4% cases. Candida albicans was the main fungal pathogen. In 6.9% of cases, disarticulation of the joint was the only option to control PJI. The detection of polymicrobial infection more than doubled in follow-up revisions and there was a strong association between detection of Candida infection and disarticulation (OR 9.39). The majority of fungal infections were mixed infections of bacteria and Candida albicans. The choice of a biofilm penetrating antimycotic, e.g., caspofungin, together with a sufficient standard procedure for detection and surgical treatment can help to control the infection situation. Fungal infection often proves to be more difficult to treat than anticipated and is more frequent than expected.
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Masters, Thao, Aditya Bhagwate, Mrunal Dehankar, Kerryl Greenwood-Quaintance, Matthew P. Abdel, Robin Patel, and Robin Patel. "1193. Human Transcriptomic Analysis of Periprosthetic Joint Infection." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S619. http://dx.doi.org/10.1093/ofid/ofaa439.1378.
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Abstract Background Periprosthetic joint infection (PJI), a devastating complication of total joint replacement, is of incompletely understood pathogenesis and may sometimes be challenging to clinically distinguish from other causes of arthroplasty failure. Methods We characterized human gene expression in 93 specimens derived from surfaces of resected arthroplasties, comparing transcriptomes of subjects with infection- versus non-infection-associated arthroplasty failure. Results Differential gene expression analysis confirmed the association of 28 previously investigated biomarkers with PJI- bactericidal/permeability increasing protein (BPI), cathelicidin antimicrobial peptide (CAMP), chemokines CCL3, CCL4, and CXCL2, colony stimulating factor 2 receptor (CSF2RB), colony stimulating factor 3 (CSF3), alpha-defensin (DEFA4), receptor CD64B, intercellular adhesion molecule 1 (ICAM1), IFNG, IL13RA2, IL17D, IL1A, IL1B, IL1RN, IL2RA, IL2RG, IL5RA, IL6, IL8, lipopolysaccharide binding protein (LBP), lipocalin (LCN2), lactate dehydrogenase C (LDHC), lactotransferrin (LTF), matrix metallopeptidase 3 (MMP3), peptidase inhibitor 3 (PI3), and vascular endothelial growth factor A (VEGFA), as well as identified three novel molecules with diagnostic potential for detection of PJI- chemokine CCL20, coagulation factor VII (F7), B cell receptor FCRL4. Comparative analysis of infections caused by staphylococcal versus non-staphylococcal and Staphylococcus aureus versus Staphylococcus epidermidis showed significant elevated expression of IL13, IL17D, and metalloprotease protein MMP3 in staphylocococcal infections, and increased expression of IL1B, IL8, and platelet factor PF4V1 in S. aureus infections. Pathway analysis of over-presented genes suggested activation of host immune response and cellular maintenance and repair functions in response to invasion of infectious agents. Conclusion Our study provides new potential targets for diagnosis of PJI and targets for differentiation of PJI-associated infectious agents. Disclosures Matthew P. Abdel, MD, Dr. Abdel receives royalties from Stryker on certain hip and knee products, and is a paid consultant for Stryker. (Consultant) Robin Patel, MD, Accelerate Diagnostics (Grant/Research Support)CD Diagnostics (Grant/Research Support)Contrafect (Grant/Research Support)Curetis (Consultant)GenMark Diagnostics (Consultant)Heraeus Medical (Consultant)Hutchison Biofilm Medical Solutions (Grant/Research Support)Merck (Grant/Research Support)Next Gen Diagnostics (Consultant)PathoQuest (Consultant)Qvella (Consultant)Samsung (Other Financial or Material Support, Dr. Patel has a patent on Bordetella pertussis/parapertussis PCR issued, a patent on a device/method for sonication with royalties paid by Samsung to Mayo Clinic, and a patent on an anti-biofilm substance issued.)Selux Dx (Consultant)Shionogi (Grant/Research Support)Specific Technologies (Consultant)
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Reisener, Marie, and Carsten Perka. "Do Culture-Negative Periprosthetic Joint Infections Have a Worse Outcome Than Culture-Positive Periprosthetic Joint Infections? A Systematic Review and Meta-Analysis." BioMed Research International 2018 (July 12, 2018): 1–12. http://dx.doi.org/10.1155/2018/6278012.
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Background. Culture-negative periprosthetic joint infections (CN PJI) have not been well studied, and due to the lack of consensus on PJI, especially with culture-negative infections, there are considerable uncertainties. Due to the challenging clinical issue of CN PJI the aim of this systematic review is to describe incidence, diagnosis, and treatment outcomes based on the current literature on CN PJI.Hypothesis.The review is designed to assess the formal hypothesis that CN PJI of the hip and knee have a poorer outcome when compared with culture-positive ones.Study Design.It is systematic review with level of evidence 3.Methods.EMBASE, MEDLINE, and the Cochrane Library were searched electronically in January 2018. All studies regarding CN PJI of the hip or knee published in English or German with a minimum of 10 patients were included. Afterwards, the authors performed a descriptive analysis of diagnosis and treatment outcome.Result.Eight studies were identified that met the inclusion criteria. The incidence of CN PJI in the hip or knee ranged from 7% to 42 %. The included studies were pooled to give an overall incidence rate estimate of 11 % [95% confidence interval (CI): 10-12] based on a random-effects model. The most common surgical intervention was the two-stage revision of prosthesis with 283 patients. Postoperatively, the majority of patients received vancomycin as the antibiotic treatment, alone or in combination with other antibiotics. The rate of succesfully treated infections varied from 85% to 95 % in all included studies. The two-stage exchange arthroplasty had the best outcome, based on the infection-free survival rate of 95%, five years after treatment.Conclusions.We conclude that CN PJI have the same or even better results than culture-positive infections. Nonetheless, a standardized diagnostic protocol and evidence-based treatment strategies for CN PJI should be implemented for further studies.
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Akcaalan, Serhat, Halil Ibrahim Ozaslan, Ceyhun Caglar, Mehmet Emin Şimşek, Mustafa Citak, and Mustafa Akkaya. "Role of Biomarkers in Periprosthetic Joint Infections." Diagnostics 12, no. 12 (November 25, 2022): 2958. http://dx.doi.org/10.3390/diagnostics12122958.
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Periprosthetic joint infection (PJI) is one of the most serious complications after joint arthroplasty. The incidence rate of PJI after total joint replacement is 1–3%. Although there are different guidelines and diagnostic criteria used to diagnose PJI, diagnosing PJI is a highly difficult process for orthopedists. The current Musculoskeletal Infection Society (MSIS) criteria are widely used for the diagnosis of PJI. These criteria include results from blood/synovial fluid tests, physical examination, and histological and microbiological analyses of intra-operative samples. However, there is currently no blood or synovial test that can definitively diagnose PJI. To make a more effective diagnosis of PJI, a large number of studies have explored and continue to investigate biomarkers. This review aims to provide general information about serum and synovial markers used for the diagnosis of PJI that may be used to create a database to guide researchers in new studies.
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Enz, Andreas, Johanna Becker, Philipp Warnke, Friedrich Prall, Christoph Lutter, Wolfram Mittelmeier, and Annett Klinder. "Increased Diagnostic Certainty of Periprosthetic Joint Infections by Combining Microbiological Results with Histopathological Samples Gained via a Minimally Invasive Punching Technique." Journal of Clinical Medicine 9, no. 10 (October 20, 2020): 3364. http://dx.doi.org/10.3390/jcm9103364.
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Background: The diagnosis of low-grade infections of endoprostheses is challenging. There are still no unified guidelines for standardised diagnostic approaches, recommendations are categorised into major and minor criteria. Additional histopathological samples might sustain the diagnosis. However, ambulatory preoperative biopsy collection is not widespread. Method: 102 patients with hip or knee endoprosthesis and suspected periprosthetic joint infection (PJI) were examined by arthrocentesis with microbiological sample and histopathological punch biopsy. The data were retrospectively analysed for diagnosis concordance. Results: Preoperative microbiology compared to intraoperative results was positive in 51.9% (sensitivity 51.9%, specificity 97.3%). In comparison of preoperative biopsy to intraoperative diagnostic results 51.9% cases were positive (sensitivity 51.9%, specificity 100.0%). The combination of preoperative biopsy and microbiology in comparison to intraoperative results was positive in 70.4% of the cases (sensitivity 70.4%, specificity 97.3%). Conclusion: The diagnosis of PJI is complex. One single method to reliably detect an infection is currently not available. With the present method histopathological samples might be obtained quickly, easily and safely for the preoperative detection of PJI. A combination of microbiological and histopathological sampling increases the sensitivity up to 18.5% to detect periprosthetic infection.
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Murylev, Valery Yu, Alexander I. Rudnev, Grigory A. Kukovenko, Pavel M. Elizarov, Alexey V. Muzychenkov, and Semyon Sergeevich Alekseev. "Diagnosis of Deep Periprosthetic Infection of the Hip." Traumatology and Orthopedics of Russia 28, no. 3 (September 23, 2022): 123–35. http://dx.doi.org/10.17816/2311-2905-1797.
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Periprosthetic infection (PJI) is one of the most frequent and devastating complications of total hip arthroplasty (THA). Early and accurate diagnosis of PJI allows timely initiation of treatment. Various diagnostic tools and algorithms for hip PJI diagnosis are described. The available serum (ESR, CRP, D-dimer, etc.) and synovial (alpha-defensin, leukocyte esterase, D-lactate) biomarkers are listed, as well as their combinations for the purpose of PJI verification. Combined serum and synovial tests can significantly improve the efficiency of PJI hip diagnosis.
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Izakovicova, Petra, Olivier Borens, and Andrej Trampuz. "Periprosthetic joint infection: current concepts and outlook." EFORT Open Reviews 4, no. 7 (July 2019): 482–94. http://dx.doi.org/10.1302/2058-5241.4.180092.
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Periprosthetic joint infection (PJI) is a serious complication occurring in 1% to 2% of primary arthroplasties, which is associated with high morbidity and need for complex interdisciplinary treatment strategies. The challenge in the management of PJI is the persistence of micro-organisms on the implant surface in the form of biofilm. Understanding this ability, the phases of biofilm formation, antimicrobial susceptibility and the limitations of host local immune response allows an individual choice of the most suitable treatment. By using diagnostic methods for biofilm detection such as sonication, the sensitivity for diagnosing PJI is increasing, especially in chronic infections caused by low-virulence pathogens. The use of biofilm-active antibiotics enables eradication of micro-organisms in the presence of a foreign body. The total duration of antibiotic treatment following revision surgery should not exceed 12 weeks.Cite this article: EFORT Open Rev 2019;4:482-494. DOI: 10.1302/2058-5241.4.180092
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Korn, Maximilian, Richard Stein, Andreas Dolf, Farhad Shakeri, Andreas Buness, Cäcilia Hilgers, Werner Masson, et al. "High-Dimensional Analysis of Immune Cell Composition Predicts Periprosthetic Joint Infections and Dissects Its Pathophysiology." Biomedicines 8, no. 9 (September 17, 2020): 358. http://dx.doi.org/10.3390/biomedicines8090358.
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Accurate diagnosis of periprosthetic joint infections (PJI) is one of the most widely researched areas in modern orthopedic endoprosthesis. However, our understanding of the immunological basis of this severe complication is still limited. In this study, we developed a flow cytometric approach to precisely characterize the immune cell composition in periprosthetic joints. Using high-dimensional multi-parametric data, we defined, for the first time, the local immune cell populations of artificial joints. We identified significant differences in the cellular distribution between infected and non-infected samples, and revealed that myeloid-derived suppressor cells (MDSCs) act as potential regulators of infiltrating immune cells in PJI. Further, we developed an algorithm to predict septic and aseptic samples with high sensitivity and specificity, that may serve as an indispensable addition to the current criteria of the Musculoskeletal Infection Society. This study describes a novel approach to flow cytometrically analyze the immune cell infiltrate of joint fluid that not only improves our understanding of the pathophysiology of PJI, but also enables the development of a novel screening tool to predict infection status. Our data further suggest that pharmacological targeting of MDSCs represents a novel strategy for addressing PJI.
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Szymski, Dominik, Nike Walter, Volker Alt, and Markus Rupp. "Evaluation of Comorbidities as Risk Factors for Fracture-Related Infection and Periprosthetic Joint Infection in Germany." Journal of Clinical Medicine 11, no. 17 (August 27, 2022): 5042. http://dx.doi.org/10.3390/jcm11175042.
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Introduction: Fracture-related infections (FRI) and periprosthetic joint infections (PJI) represent a major challenge in orthopedic surgery. Incidence of both entities is annually growing. Comorbidities play an important role as an influencing factor for infection and thus, for prevention and treatment strategies. The aims of this study were (1) to analyze the frequency of comorbidities in FRI and PJI patients and (2) to evaluate comorbidities as causative risk factor for PJI and FRI. Methods: This retrospective cohort study analysed all ICD-10 codes, which were coded as secondary diagnosis in all in hospital-treated FRI and PJI in the year 2019 in Germany provided by the Federal Statistical Office of Germany (Destatis). Prevalence of comorbidities was compared with the prevalence in the general population. Results: In the year 2019, 7158 FRIs and 16,174 PJIs were registered in Germany, with 68,304 comorbidities in FRI (mean: 9.5 per case) and 188,684 in PJI (mean: 11.7 per case). Major localization for FRI were infections in the lower leg (55.4%) and forearm (9.2%), while PJI were located mostly at hip (47.4%) and knee joints (45.5%). Mainly arterial hypertension (FRI: n = 3645; 50.9%—PJI: n = 11360; 70.2%), diabetes mellitus type II (FRI: n = 1483; 20.7%—PJI: n = 3999; 24.7%), obesity (FRI: n = 749; 10.5%—PJI: n = 3434; 21.2%) and chronic kidney failure (FRI: n = 877; 12.3%—PJI: n = 3341; 20.7%) were documented. Compared with the general population, an increased risk for PJI and FRI was reported in patients with diabetes mellitus (PJI: 2.988; FRI: 2.339), arterial hypertension (PJI: 5.059; FRI: 2.116) and heart failure (PJI: 6.513; FRI: 3.801). Conclusion: Patients with endocrinological and cardiovascular diseases, in particular associated with the metabolic syndrome, demonstrate an increased risk for orthopedic implant related infections. Based on the present results, further infection prevention and treatment strategies should be evaluated.
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McNally, Martin, Ricardo Sousa, Marjan Wouthuyzen-Bakker, Antonia F. Chen, Alex Soriano, H. Charles Vogely, Martin Clauss, Carlos A. Higuera, and Rihard Trebše. "The EBJIS definition of periprosthetic joint infection." Bone & Joint Journal 103-B, no. 1 (January 1, 2021): 18–25. http://dx.doi.org/10.1302/0301-620x.103b1.bjj-2020-1381.r1.
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Aims The diagnosis of periprosthetic joint infection (PJI) can be difficult. All current diagnostic tests have problems with accuracy and interpretation of results. Many new tests have been proposed, but there is no consensus on the place of many of these in the diagnostic pathway. Previous attempts to develop a definition of PJI have not been universally accepted and there remains no reference standard definition. Methods This paper reports the outcome of a project developed by the European Bone and Joint Infection Society (EBJIS), and supported by the Musculoskeletal Infection Society (MSIS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Implant-Associated Infections (ESGIAI). It comprised a comprehensive review of the literature, open discussion with Society members and conference delegates, and an expert panel assessment of the results to produce the final guidance. Results This process evolved a three-level approach to the diagnostic continuum, resulting in a definition set and guidance, which has been fully endorsed by EBJIS, MSIS, and ESGIAI. Conclusion The definition presents a novel three-level approach to diagnosis, based on the most robust evidence, which will be useful to clinicians in daily practice. Cite this article: Bone Joint J 2021;103-B(1):18–25.
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Congia, Stefano, Gianfranco Puddu, Giulio Sorrentino, Giuseppe Dessì, and Giuseppe Marongiu. "Conservative treatment of early-onset tubercular periprosthetic joint infection following total knee arthroplasty." Journal of Infection in Developing Countries 14, no. 02 (February 29, 2020): 223–27. http://dx.doi.org/10.3855/jidc.12053.
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Tubercular periprosthetic joint infections (PJI) are uncommon diseases in developed countries. Therefore, the systematic screening for Mycobacterium tuberculosis (TB) is not currently recommended before a total knee arthroplasty procedure. However, due to the new human migration flows and higher mycobacterial infection rates, tuberculosis could represent a rare but potential cause for PJI. Controversies about tubercular PJI diagnosis, management and treatment still exist due to a lack of clinical evidence. In the current report we present the case of an early-onset M. tuberculosis PJI of the knee and its successful conservative treatment with two years follow-up.
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Fink, Bernd, and Florian Sevelda. "Periprosthetic Joint Infection of Shoulder Arthroplasties: Diagnostic and Treatment Options." BioMed Research International 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/4582756.
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Periprosthetic joint infection (PJI) is one of the most frequent reasons for painful shoulder arthroplasties and revision surgery of shoulder arthroplasties. Cutibacterium acnes (Propionibacterium acnes) is one of the microorganisms that most often causes the infection. However, this slow growing microorganism is difficult to detect. This paper presents an overview of different diagnostic test to detect a periprosthetic shoulder infection. This includes nonspecific diagnostic tests and specific tests (with identifying the responsible microorganism). The aspiration can combine different specific and nonspecific tests. In dry aspiration and suspected joint infection, we recommend a biopsy. Several therapeutic options exist for the treatment of PJI of shoulder arthroplasties. In acute infections, the options include leaving the implant in place with open debridement, septic irrigation with antibacterial fluids like octenidine or polyhexanide solution, and exchange of all removable components. In late infections (more than four weeks after implantation) the therapeutic options are a permanent spacer, single-stage revision, and two-stage revision with a temporary spacer. The functional results are best after single-stage revisions with a success rate similar to two-stage revisions. For single-stage revisions, the microorganism should be known preoperatively so that specific antibiotics can be mixed into the cement for implantation of the new prosthesis and specific systemic antibiotic therapy can be applied to support the surgery.
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Shohat, Noam, Javad Parvizi, and Majd Tarabichi. "New Technologies for Diagnosis of Periprosthetic Hip Infection." Journal of Hip Surgery 02, no. 02 (April 27, 2018): 068–75. http://dx.doi.org/10.1055/s-0038-1641757.
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AbstractPeriprosthetic joint infection (PJI) is a devastating mode of failure following total joint arthroplasty, imposing a serious burden on the healthcare system and society at large. Increasing demand for elective arthroplasty, as well as independent predictions demonstrating future rise in the prevalence of PJI, will lead to an increasing financial burden imposed by this dreadful complication. This challenge is further compounded by disturbing trends, such as drug-resistant organisms among others as a cause of PJI. The aim of this review is to provide the latest updates in the diagnosis of PJI, with a view to identifying areas in need of further research.
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McPherson, Edward J., Chad R. Ishmael, Brian Zukotynski, Robert E. Gallivan, and Madhav Chowdhry. "Lactococcus garvieae Periprosthetic Joint Infection in a Cattle Rancher with a Total Knee Arthroplasty: A Novel Reservoir Transmission." Journal of Orthopaedic Case Reports 12, no. 11 (2022): 76–82. http://dx.doi.org/10.13107/jocr.2022.v12.i11.3422.
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Introduction: Periprosthetic joint infection (PJI) remains a challenging complication of joint replacement surgery. With the more frequent use of immune modifying drugs and dietary changes in human populations, the resultant blunting of immune defenses allows for infections with less common organisms. Case Report: Lactococcus garvieae is an anaerobic, gram-positive coccus with reservoirs in fish and domesticated farm animals. Only two prior cases of PJI due to L. garvieae have been reported, both with reported marine transmission. We report a case of L. garvieae associated PJI in a cattle rancher with the first reported case of transmission from a bovine reservoir. The PJI was associated with intra-articular rice body formation, and the diagnosis confirmed with the aid of next generation DNA sequencing. A successful two stage exchange was performed. We propose a novel transmission mechanism with microbe entry via direct hematogenous inoculation during the patient’s duties as a rancher. Conclusion: When an unusual organism is detected in a PJI, the treatment team should research the host reservoir(s) of the organism and correlate with the patient’s exposure risk. While contamination of cultures is possible, a thorough investigation should be performed prior to that assumption. This reinforces the basic concept that a careful history remains vital when treating an unusual infection presentation. Next generation DNA sequencing is a useful confirmatory tool in establishing the offending organism. Lastly, the identification of rice bodies should raise suspicion for infection. Although not always associated with infection, efforts should be redoubled to identify or rule out a causative micro-organism(s). Keywords: Lactococcus garvieae, Periprosthetic Joint Infection, PJI, Total Knee Arthroplasty, TKA, Next Generation DNA Sequencing, Rice Bodies.
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Bozhkova, S. A., P. P. Ivanov, E. A. Zemlyanskaya, and N. N. Kornilov. "Fungal Periprosthetic Infection after Total Knee Arthroplasty (Case Report and Review)." Traumatology and Orthopedics of Russia 25, no. 4 (December 23, 2019): 134–40. http://dx.doi.org/10.21823/2311-2905-2019-25-4-134-140.
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The rate of periprosthetic infection (PJI) following primary total knee arthroplasty ranges from 0,5 to 6%, while after the revision arthroplasty PJI rate grows up to 13,6%. Despite the fact that PJI is more often caused by gram-positive microorganisms, the treatment of patients induced by gram-negative pathogens and fungi is the most complex and associated with the higher recurrence rate. This paper presents a positive two-stage treatment of a patient with fungal periprosthetic infection with a review of current medical literature. Revision, sanation of infection site and implantation of articulating antibacterial spacer was performed in the first stage of treatment. The second stage, which was the implantation of a revision prosthesis, followed in 6 months after removal of infection nidus. Subsequently the authors obtained good functional outcomes and stopping the infection process.
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Kvarda, Peter, Christian Puelacher, Martin Clauss, Richard Kuehl, Hatice Gerhard, Christian Mueller, and Mario Morgenstern. "Perioperative myocardial injury and mortality after revision surgery for orthopaedic device-related infection." Bone & Joint Journal 104-B, no. 6 (June 1, 2022): 696–702. http://dx.doi.org/10.1302/0301-620x.104b6.bjj-2021-1486.r1.
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Aims Periprosthetic joint infections (PJIs) and fracture-related infections (FRIs) are associated with a significant risk of adverse events. However, there is a paucity of data on cardiac complications following revision surgery for PJI and FRI and how they impact overall mortality. Therefore, this study aimed to investigate the risk of perioperative myocardial injury (PMI) and mortality in this patient cohort. Methods We prospectively included consecutive patients at high cardiovascular risk (defined as age ≥ 45 years with pre-existing coronary, peripheral, or cerebrovascular artery disease, or any patient aged ≥ 65 years, plus a postoperative hospital stay of > 24 hours) undergoing septic or aseptic major orthopaedic surgery between July 2014 and October 2016. All patients received a systematic screening to reliably detect PMI, using serial measurements of high-sensitivity cardiac troponin T. All-cause mortality was assessed at one year. Multivariable logistic regression models were applied to compare incidence of PMI and mortality between patients undergoing septic revision surgery for PJI or FRI, and patients receiving aseptic major bone and joint surgery. Results In total, 911 consecutive patients were included. The overall perioperative myocardial injury (PMI) rate was 15.4% (n = 140). Septic revision surgery for PJI was associated with a significantly higher PMI rate (43.8% (14/32) vs 14.5% (57/393); p = 0.001) and one-year mortality rate (18.6% (6/32) vs 7.4% (29/393); p = 0.038) compared to aseptic revision or primary arthroplasty. The association with PMI persisted in multivariable analysis with an adjusted odds ratio (aOR) of 4.7 (95% confidence interval (CI) 2.1 to 10.7; p < 0.001), but was not statistically significant for one-year mortality (aOR 1.9 (95% CI 0.7 to 5.4; p = 0.240). PMI rate (15.2% (5/33) vs 14.1% (64/453)) and one-year mortality (15.2% (5/33) vs 9.1% (41/453)) after FRI revision surgery were comparable to aseptic long-bone fracture surgery. Conclusion Patients undergoing revision surgery for PJI were at a risk of PMI and death compared to those undergoing aseptic arthroplasty surgery. Screening for PMI and treatment in specialized multidisciplinary units should be considered in major bone and joint infections. Cite this article: Bone Joint J 2022;104-B(6):696–702.
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Saleh, A., J. George, M. Faour, A. K. Klika, and C. A. Higuera. "Serum biomarkers in periprosthetic joint infections." Bone & Joint Research 7, no. 1 (January 2018): 85–93. http://dx.doi.org/10.1302/2046-3758.71.bjr-2017-0323.
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ObjectivesThe diagnosis of periprosthetic joint infection (PJI) is difficult and requires a battery of tests and clinical findings. The purpose of this review is to summarize all current evidence for common and new serum biomarkers utilized in the diagnosis of PJI.MethodsWe searched two literature databases, using terms that encompass all hip and knee arthroplasty procedures, as well as PJI and statistical terms reflecting diagnostic parameters. The findings are summarized as a narrative review.ResultsErythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the two most commonly published serum biomarkers. Most evidence did not identify other serum biomarkers that are clearly superior to ESR and CRP. Other serum biomarkers have not demonstrated superior sensitivity and have failed to replace CRP and ESR as first-line screening tests. D-dimer appears to be a promising biomarker, but more research is necessary. Factors that influence serum biomarkers include temporal trends, stage of revision, and implant-related factors (metallosis).ConclusionOur review helped to identify factors that can influence serum biomarkers’ level changes; the recognition of such factors can help improve their diagnostic utility. As such, we cannot rely on ESR and CRP alone for the diagnosis of PJI prior to second-stage reimplantation, or in metal-on-metal or corrosion cases. The future of serum biomarkers will likely shift towards using genomics and proteomics to identify proteins transcribed via messenger RNA in response to infection and sepsis. Cite this article: A. Saleh, J. George, M. Faour, A. K. Klika, C. A. Higuera. Serum biomarkers in periprosthetic joint infections. Bone Joint Res 2018;7:85–93. DOI: 10.1302/2046-3758.71.BJR-2017-0323.
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Solarino, Giuseppe, Antonella Abate, Giovanni Vicenti, Antonio Spinarelli, Andrea Piazzolla, and Biagio Moretti. "Reducing periprosthetic joint infection: what really counts?" Joints 03, no. 04 (October 2015): 208–14. http://dx.doi.org/10.11138/jts/2015.3.4.208.
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Periprosthetic joint infection (PJI) remains one of the most challenging complications after joint arthroplasty. Despite improvements in surgical techniques and in the use of antibiotic prophylaxis, it remains a major cause of implant failure and need for revision. PJI is associated with both human host-related and bacterial agentrelated factors that can interact in all the phases of the procedure (preoperative, intraoperative and postoperative). Prevention is the first strategy to implement in order to minimize this catastrophic complication.The present review focuses on the preoperative period, and on what to do once risk factors are fully understood and have been identified.