scholarly journals Augmented Total Elbow Arthroplasty with Femoral Strut Allograft for Revision of Prosthetic Joint Infection with Distal Humerus Bone Loss and Incomplete Union of Periprosthetic Humeral Shaft Fracture

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
William R. Monahan ◽  
Elizabeth Alaimo ◽  
Jared M. Mahylis
Keyword(s):  
Bone Loss ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Bone Allograft ◽  
Humeral Fracture ◽  
Distal Humerus ◽  
Total Elbow Arthroplasty ◽  
Definitive Treatment ◽  
Elbow Arthroplasty ◽  
Prosthetic Joint

Total elbow arthroplasty (TEA) prosthetic joint infection (PJI) in the setting of distal humerus bone loss poses a challenge for restoration of function. This can be complicated by a periprosthetic humeral fracture. Revision surgery in the setting of these pathologies possesses a significant challenge, especially when two or, in this case, all three problems are treated simultaneously. We present the clinical course, operative findings, and definitive treatment with the use of an augmented total elbow arthroplasty and femoral strut allograft reinforcement in detail. A review of the literature regarding the identification and management of infected TEA with augmented prosthesis and bone allograft augmentation of humerus fractures will be outlined in this case report.

Hematoma following total elbow arthroplasty: incidence, management, and outcomes

2020 ◽  
pp. 175857321989605
Author(s):  
Benjamin Zmistowski ◽  
Talia Chapman ◽  
Mihir Sheth ◽  
Charles L Getz ◽  
Matthew L Ramsey ◽  
...  
Keyword(s):  
Operating Room ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Total Elbow Arthroplasty ◽  
Complication Rates ◽  
Non Union ◽  
Hematoma Formation ◽  
Elbow Arthroplasty ◽  
Prosthetic Joint ◽  
Incidence Risk

Introduction This study investigates the incidence, risk factors for, and clinical outcomes of hematoma following total elbow arthroplasty. Methods We retrospectively reviewed patient and surgical characteristics as predictors of post-operative hematoma in 382 total elbow arthroplasty (196 primary, 157 revision, and 29 conversion) between May 2004 and February, 2017. For comparison of outcomes, cases were matched (1:2) with controls by age, gender, type of surgery, and surgical indication. Results Nineteen post-operative hematomas (5.0%; 19/382) were identified. Total elbow arthroplasty for post-traumatic arthritis (6.7%; 4/60), aseptic loosening (7.9%; 3/38), sequelae of periprosthetic joint infection (6.1%; 5/81), and non-union (28.6%; 2/7) had the highest incidence of hematoma. Clinic aspiration and compressive wrap was performed in 14 patients and avoided a return to the operating room in 78.6% (11/14). Seven patients (36.8%) required a return to the operating room, of which five (71.4%) had positive cultures and required treatment for prosthetic joint infection. Compared to the matched controls, hematoma formation predicted a higher rate of reoperation (36.8% versus 7.9%; p = 0.007) and a higher rate of subsequent prosthetic joint infection (35.7% versus 0%; p = 0.008). Conclusion Hematoma formation is associated with both prosthetic joint infection and return to the operating room after total elbow arthroplasty. Strategies to prevent hematoma formation after total elbow arthroplasty may reduce complication rates.

Complications in the treatment of prosthetic joint infection

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 145-150 ◽  
Author(s):  
Molly A. Hartzler ◽  
Katherine Li ◽  
Michael B. Geary ◽  
Susan Marie Odum ◽  
Bryan D. Springer
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Definitive Treatment ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint ◽  
Definition Of Success ◽  
One Year ◽  
Definition Of

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

scholarly journals Successful Treatment of Staphylococcus aureus Prosthetic Joint Infection with Bacteriophage Therapy

Viruses ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1182
Author(s):  
Claudia Ramirez-Sanchez ◽  
Francis Gonzales ◽  
Maureen Buckley ◽  
Biswajit Biswas ◽  
Matthew Henry ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Multidrug Resistant ◽  
Successful Outcome ◽  
Prolonged Treatment ◽  
Lytic Phage ◽  
Bacteriophage Therapy ◽  
Prosthetic Joint ◽  
Knee Joint Infection

Successful joint replacement is a life-enhancing procedure with significant growth in the past decade. Prosthetic joint infection occurs rarely; it is a biofilm-based infection that is poorly responsive to antibiotic alone. Recent interest in bacteriophage therapy has made it possible to treat some biofilm-based infections, as well as those caused by multidrug-resistant pathogens, successfully when conventional antibiotic therapy has failed. Here, we describe the case of a 61-year-old woman who was successfully treated after a second cycle of bacteriophage therapy administered at the time of a two-stage exchange procedure for a persistent methicillin-sensitive Staphylococcus aureus (MSSA) prosthetic knee-joint infection. We highlight the safety and efficacy of both intravenous and intra-articular infusions of bacteriophage therapy, a successful outcome with a single lytic phage, and the development of serum neutralization with prolonged treatment.

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