scholarly journals Is There a Role for Spacer Exchange in Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection?

2020 ◽  
Vol 9 (9) ◽  
pp. 2901 ◽  
Author(s):  
Elie Kozaily ◽  
Emanuele Chisari ◽  
Javad Parvizi
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
The United States ◽  
Conclusive Evidence ◽  
Cement Spacer ◽  
Two Stage ◽  
Local Antibiotics ◽  
Additional Surgery ◽  
Surgeon Experience ◽  
Hip And Knee Arthroplasty

Periprosthetic joint infection (PJI) continues to be one of the most serious complications after hip and knee arthroplasty. The choice of surgical treatment depends on a multitude of factors like chronicity of infection, host factors, and institutional or surgeon experience. Two-stage exchange remains one of the most commonly used technique for chronic PJI in the United States of America. The intended two-stage revision may involve an additional interim procedure where the initial antibiotic cement spacer is removed and a new spacer is inserted. Mostly, the rationale behind spacer exchange is an additional load of local antibiotics before proceeding to reimplantation. There is no conclusive evidence whether a spacer exchange confers additional benefits, yet it delays reimplantation and exposes already fragile patients to the risks and morbidity of an additional surgery.

scholarly journals Salmonella sp. as the Cause of Periprosthetic Joint Infection of the Hip: Report of a Rare Case and Review of Past 10-year Literatures

2020 ◽  
Vol 8 (C) ◽  
pp. 117-120
Author(s):  
Asep Santoso ◽  
Pamudji Utomo ◽  
Iwan Budiwan Anwar ◽  
Tangkas Sibarani ◽  
Bintang Soetjahjo ◽  
...  
Keyword(s):  
Case Report ◽  
Total Hip Arthroplasty ◽  
Literature Review ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Rare Case ◽  
Joint Infection ◽  
Cement Spacer ◽  
Two Stage ◽  
Revision Procedure

BACKGROUND: Periprosthetic joint infection (PJI) due to Salmonella sp. is rare. It is sometimes difficult to treat and need prolonged antibiotic treatment. CASE REPORT: We reported a case of PJI of the hip in a 67-year-old female who received prior left total hip arthroplasty. Two-stage revision surgery with antibiotic-loaded cement spacer had been performed to the patient and successfully control the infection. CONCLUSION: Although literature review showed that there has been no consensus for the treatment of Salmonella PJI, a two-stage revision procedure has been more commonly performed to control the infection by previous authors and might be the safest way to control Salmonella PJI recently.

One-stage revision is as effective as two-stage revision for chronic culture-negative periprosthetic joint infection after total hip and knee arthroplasty

2021 ◽  
pp. 1-7
Author(s):  
Janna van den Kieboom ◽  
Venkatsaiakhil Tirumala ◽  
Hayden Box ◽  
Ruben Oganesyan ◽  
Christian Klemt ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Randomized Study ◽  
Treatment Strategies ◽  
Revision Arthroplasty ◽  
Two Stage ◽  
One Stage ◽  
Hip And Knee Arthroplasty ◽  
Culture Negative

Aims Removal of infected components and culture-directed antibiotics are important for the successful treatment of chronic periprosthetic joint infection (PJI). However, as many as 27% of chronic PJI patients yield negative culture results. Although culture negativity has been thought of as a contraindication to one-stage revision, data supporting this assertion are limited. The aim of our study was to report on the clinical outcomes for one-stage and two-stage exchange arthroplasty performed in patients with chronic culture-negative PJI. Methods A total of 105 consecutive patients who underwent revision arthroplasty for chronic culture-negative PJI were retrospectively evaluated. One-stage revision arthroplasty was performed in 30 patients, while 75 patients underwent two-stage exchange, with a minimum of one year's follow-up. Reinfection, re-revision for septic and aseptic reasons, amputation, readmission, mortality, and length of stay were compared between the two treatment strategies. Results The patient demographic characteristics did not differ significantly between the groups. At a mean follow-up of 4.2 years, the treatment failure for reinfection for one-stage and two-stage revision was five (16.7%) and 15 patients (20.0%) (p = 0.691), and for septic re-revision was four (13.3%) and 11 patients (14.7%) (p = 0.863), respectively. No significant differences were observed between one-stage and two-stage revision for 30- 60- and 90-day readmissions (10.0% vs 8.0%; p = 0.714; 16.7% vs 9.3%; p = 0.325; and 26.7% vs 10.7%; p = 0.074), one-year mortality (3.3% vs 4.0%; p > 0.999), and amputation (3.3% vs 1.3%; p = 0.496). Conclusion In this non-randomized study, one-stage revision arthroplasty demonstrated similar outcomes including reinfection, re-revision, and readmission rates for the treatment of chronic culture-negative PJI after TKA and THA compared to two-stage revision. This suggests culture negativity may not be a contraindication to one-stage revision arthroplasty for chronic culture-negative PJI in selected patients.

scholarly journals The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jun Fu ◽  
Yi Xiang ◽  
Ming Ni ◽  
Jiying Chen ◽  
Xiang Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Cement Spacer ◽  
Two Stage ◽  
Acetabular Bone ◽  
Wall Defect ◽  
Second Stage ◽  
Acetabular Bone Defect

Abstract Background Spacer complications may affect final clinical outcome of the two-stage approach in periprosthetic joint infection (PJI) patients. This study aimed to investigate clinical outcomes and complications of augmented antibiotic-loaded cement spacer in PJI patients with acetabular bone defect. Methods Data on PJI patients with acetabular bone defect receiving two-stage revision from January 2009 to December 2016, in our hospital were retrospectively reviewed. Screw-cement-shell was used to improve the stability of the hip with acetabular wall defect. Handmade acetabular spacer could prevent femoral spacer entering into pelvis in patients with acetabular internal wall defect. A total of 26 patients (11 males and 15 females) were included in the current study. Their mean age was 46.7 ± 15.4 years old. Clinical outcomes and complications were measured. Results Twenty-one of total 26 hips (21/26, 80.8%) showed positive cultures and 15/26 (57.7%) samples were cultured with staphylococcus. Of enrolled patients, 5/26 (19.2%) developed mixed infection. There was one patient (3.8%) with spacer dislocation and two (7.7%) with spacer fracture. One patient developed acute PJI 5 years after the second-stage revision, so overall success rate among these patients was 96.2%. Differences in Paprosky classifications before the first and second stage did not reach significant level (p > 0.05). Hip Harris score was raised from 40.9 ± 14.0 to 81.2 ± 11.2 (p < 0.05). Conclusions Augmented antibiotic-loaded cement spacer could achieve satisfactory clinical outcomes in PJI patients with acetabular bone defect. It provided joint mobility, increased additional joint stability, and decreased iatrogenic bone defect caused by acetabular wear.

scholarly journals Candida Periprosthetic Joint Infection: Is It Curable?

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 458
Author(s):  
Laura Escolà-Vergé ◽  
Dolors Rodríguez-Pardo ◽  
Pablo S. Corona ◽  
Carles Pigrau
Keyword(s):  
Medical Devices ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Antifungal Treatment ◽  
Cement Spacer ◽  
Candida Spp ◽  
Best Management ◽  
High Quality Evidence ◽  
Patients At Risk ◽  
Quality Evidence

Candida periprosthetic joint infection (CPJI) is a rare and very difficult to treat infection, and high-quality evidence regarding the best management is scarce. Candida spp. adhere to medical devices and grow forming biofilms, which contribute to the persistence and relapse of this infection. Typically, CPJI presents as a chronic infection in a patient with multiple previous surgeries and long courses of antibiotic therapy. In a retrospective series of cases, the surgical approach with higher rates of success consists of a two-stage exchange surgery, but the best antifungal treatment and duration of antifungal treatment are still unclear, and the efficacy of using an antifungal agent-loaded cement spacer is still controversial. Until more evidence is available, focusing on prevention and identifying patients at risk of CPJI seems more than reasonable.

Two-Stage Exchange Arthroplasty Is a Favorable Treatment Option Upon Diagnosis of a Fungal Periprosthetic Joint Infection

2018 ◽  
Vol 33 (11) ◽  
pp. 3555-3560 ◽  
Author(s):  
Feng-Chih Kuo ◽  
Karan Goswami ◽  
Noam Shohat ◽  
Kier Blevins ◽  
Alexander J. Rondon ◽  
...  
Keyword(s):  
Treatment Option ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Exchange Arthroplasty

scholarly journals Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

2020 ◽  
Author(s):  
Cheng Li ◽  
Cristina Ojeda Thies ◽  
Chi Xu ◽  
Andrej Trampuz
Keyword(s):  
Risk Factors ◽  
Bibliometric Analysis ◽  
Periprosthetic Joint Infection ◽  
Clinical Medicine ◽  
Meta Analysis ◽  
Joint Infection ◽  
Relevant Literature ◽  
The United States ◽  
Steroid Injections ◽  
Joint Replacement Surgery

Abstract Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.

scholarly journals Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

2019 ◽  
Vol 10 (10) ◽  
pp. 348-355 ◽  
Author(s):  
Ewout S Veltman ◽  
Dirk Jan F Moojen ◽  
Marc L van Ogtrop ◽  
Rudolf W Poolman
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Two Stage

A Case of Periprosthetic Joint Infection Because of Rothia Mucilaginosa

2021 ◽  
Author(s):  
Janse T Schermerhorn ◽  
Donald F Colantonio ◽  
Derek T Larson ◽  
Robert J McGill
Keyword(s):  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnostic Delay ◽  
Infectious Agent ◽  
Two Stage ◽  
Treatment Regimens ◽  
History Of ◽  
Rothia Mucilaginosa ◽  
One Year

ABSTRACT Periprosthetic joint infection (PJI) is a rare but devastating complication of total joint arthroplasty. Identifying the offending infectious agent is essential to appropriate treatment, and uncommon pathogens often lead to a diagnostic delay. This case describes the first known instance of a total knee arthroplasty (TKA) with Rothia mucilaginosa, a typical respiratory tract organism. This report aims to provide insight into the treatment of this atypical PJI, as there are only six previously published cases of Rothia species PJI septic arthritis. The patient is a 64-year-old diabetic male who underwent a right TKA and left TKA ∼6 months later. Approximately 3 weeks status post-left TKA, he showed evidence of left PJI. One year after treatment and recovery from his left PJI, he presented with several months of right knee pain and fatigue. Subsequent labs and imaging revealed right PJI. No recent history of dental disease or work was observed. He then underwent two-stage revision right knee arthroplasty and microbial cultures yielded Rothia mucilaginosa. After initial empiric treatment, antibiotic therapy was narrowed to 6 weeks of vancomycin. Following negative aspiration cultures the patient underwent reimplantation of right TKA components. One year following treatment, the patient was fully recovered with no evidence of infection. This case emphasizes the possibility of microbial persistence despite various antibiotic treatment regimens for the patient’s contralateral knee arthroplasty and PJI. Additionally, this case demonstrates the importance of two-stage revision in patients with PJI, and the viability of treating Rothia species PJIs with vancomycin.

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