scholarly journals The Fate of Failed Debridement, Antibiotics, and Implant Retention in Infected Knee Arthroplasties: Nothing to Lose

Cureus ◽  
2021 ◽  
Author(s):  
Özkan Öztürk ◽  
Mahmut Özdemir ◽  
Mehmet Cenk Turgut ◽  
Murat Altay
Keyword(s):  
Implant Retention

Influence of moderate cigarette-smoking on the peri-implant clinicoradiographic inflammatory parameters around cement- and screw-retained dental implants

2020 ◽  
Author(s):  
Mana Alqahtani
Keyword(s):  
Cigarette Smoking ◽  
Dental Implants ◽  
Smoking History ◽  
Inflammatory Parameters ◽  
Significant Difference ◽  
Implant Retention ◽  
Level Of Significance ◽  
Soft Tissue Inflammation ◽  
Post Hoc ◽  
Adjustment Test

The aim was to assess the influence of moderate cigarette-smoking on the clinical (bleeding on probing [BoP] and probing depth [PD]) and radiographic (crestal bone resorption [CBR]) around cement- and screw-retained dental implants at 5 years’ follow-up. A questionnaire was used to collect information about age, gender, smoking history, duration of implants in function, jaw location of the implant, and daily toothbrushing and flossing. Peri-implant BoP, PD and CBR were measured in all groups. Group comparisons were performed using one-way analysis of variance and for multiple comparisons, the Bonferroni Post hoc adjustment test was performed. Level of significance was set at P<0.05. Forty-eight patients (25 smokers and 23 non-smokers) had cement-retained dental implants; and 48 (24 smokers and 24 non-smokers) had screw-retained dental implants. Among patients with cement and screw-retained dental implants, PD (P<0.05) and CBR (P<0.05) were significantly higher among smokers than non-smokers. The peri-implant sites that demonstrated BoP were statistically significantly higher among non-smokers (P<0.05) than smokers among patients with cement- and screw-retained dental implants. There was no statistically significant difference in peri-implant PD and CBR among smokers with cement- and screw-retained dental implants. Among non-smokers with cement and screw-retained dental implants, there was no statistically significant difference in BoP, PD and CBR. Cigarette-smoking is associated with an increased PD and CBR around cement- and screw-retained dental implants. Cigarette-smoking increases peri-implant soft tissue inflammation as well as loss of crestal bone and this relationship is independent of the type of implant retention protocol used.The author recommends that cement- and screw-retained dental implants are suitable for prosthesis restoration in non-smokers. Further studies on dual-smokers (individuals smoking cigarettes and other forms of tobacco products) are needed related to the clinicoradiographic inflammatory parameters around cement- and screw-retained dental implants

scholarly journals Long-Term Use of Tedizolid in Osteoarticular Infections: Benefits among Oxazolidinone Drugs

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 53
Author(s):  
Eva Benavent ◽  
Laura Morata ◽  
Francesc Escrihuela-Vidal ◽  
Esteban Alberto Reynaga ◽  
Laura Soldevila ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Joint Infection ◽  
Diabetic Foot Infections ◽  
Osteoarticular Infections ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Lower Drug ◽  
Drug Drug Interaction ◽  
Staphylococcus Spp

Background: To evaluate the efficacy and safety of long-term use of tedizolid in osteoarticular infections. Methods: Multicentric retrospective study (January 2017–March 2019) of osteoarticular infection cases treated with tedizolid. Failure: clinical worsening despite antibiotic treatment or the need of suppressive treatment. Results: Cases (n = 51; 59% women, mean age of 65 years) included osteoarthritis (n = 27, 53%), prosthetic joint infection (n = 17, 33.3%), and diabetic foot infections (n = 9, 18%); where, 59% were orthopedic device-related. Most frequent isolates were Staphylococcus spp. (65%, n = 47; S. aureus, 48%). Reasons for choosing tedizolid were potential drug-drug interaction (63%) and cytopenia (55%); median treatment duration was 29 days (interquartile range -IQR- 15–44), 24% received rifampicin (600 mg once daily) concomitantly, and adverse events were scarce (n = 3). Hemoglobin and platelet count stayed stable throughout treatment (from 108.6 g/L to 116.3 g/L, p = 0.079; and 240 × 109/L to 239 × 109/L, p = 0.942, respectively), also in the subgroup of cases with cytopenia. Among device-related infections, 33% were managed with implant retention. Median follow-up was 630 days and overall cure rate 83%; among failures (n = 8), 63% were device-related infections. Conclusions: Long-term use of tedizolid was effective, showing a better safety profile with less myelotoxicity and lower drug-drug interaction than linezolid. Confirmation of these advantages could make tedizolid the oxazolidinone of choice for most of osteoarticular infections.

scholarly journals A Short-Course Antibiotic Prophylaxis Is Associated with Limited Antibiotic Resistance Emergence in Post-Operative Infection of Pelvic Primary Bone Tumor Resection

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 768
Author(s):  
Yoann Varenne ◽  
Stéphane Corvec ◽  
Anne-Gaëlle Leroy ◽  
David Boutoille ◽  
Mỹ-Vân Nguyễn ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Bone Tumor ◽  
Tumor Resection ◽  
Surgical Site Infections ◽  
Implant Removal ◽  
Pelvic Bone ◽  
Resistance Pattern ◽  
Cure Rate ◽  
Implant Retention ◽  
The Impact

Resections of primary pelvic bone tumors are frequently complicated by surgical site infections (SSIs), thereby impairing the functional prognosis of patients, especially in case of implant removal. Although prophylactic antibiotics play an essential role in preventing SSIs, there are presently no recommendations that support their appropriate use. This study aimed to assess the impact of a 24 h prophylactic protocol on the bacterial ecology, the resistance pattern, and the SSI healing rate. We hypothesized that this protocol not only limits the emergence of resistance but also results in a good cure rate with implant retention in case of SSI. A retrospective study was performed that included all patients with an SSI following a pelvic bone tumoral resection between 2005 and 2017 who received a 24 h antibiotic prophylaxis protocol. Twenty-nine patients with an SSI were included. We observed a 75.9% rate of polymicrobial infection, with a high prevalence of digestive flora microorganisms and a majority of wild-type phenotypes. We confirmed that there was no significant emergence of resistant flora. After first-line debridement, antibiotics (DA) if any implant was used, or debridement, antibiotics, and implant retention (DAIR) whenever possible, we obtained a 79.3% cure rate, with implant removal in 20% of cases. The absence of an implant was significantly associated with SSI healing. Early infection management and low resistance profiles may also have a positive effect, but this needs to be confirmed in a larger cohort. In light of this, the use of a 24 h prophylactic protocol in primary pelvic bone tumor resections is associated with a favorable infection cure rate and implant retention in case of SSI, and minimal selection of resistant microorganisms.

scholarly journals Diagnosis and management of the infected total knee replacement: a practical surgical guide

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Akos Zahar ◽  
Martin Sarungi
Keyword(s):  
Surgical Management ◽  
Joint Infection ◽  
Level Of Evidence ◽  
Surgical Guide ◽  
Diagnosis And Management ◽  
Early Revision ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Total Knee ◽  
Key Steps

Abstract Purpose Prosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a significant burden in health care. Diagnosis and proper management are challenging. A standardised procedure for the diagnostic workup and surgical management provides clear benefits in outcome. Methods Several diagnostic protocols and definitions for PJI were established in recent years. Proper PJI diagnosis remains critical for success and for choosing the optimal treatment option. A distinct workup of diagnostic steps, the evaluation of the results in a multidisciplinary setup and the meticulous surgical management of the infection are the key factors of successful treatment. Results The management of PJI after TKA consists of early revision with debridement and implant retention (DAIR) in early cases or staged revision in late infections beyond 30 days postoperative or after onset of acute symptoms. The revision is performed as a two-stage procedure with the use of a fixed or mobile antibiotic spacer, or in selected cases as a single-stage operation with the use of local and systemic antibiotic treatment. Conclusions This paper reflects the opinion of two revision surgeons who follow the same protocol for diagnosis and treatment of PJI after TKA, highlighting the key steps in diagnosis and management. Level of evidence Expert’s opinion

scholarly journals Hi-PoAD technique for Adolescent Idiopathic Scoliosis in Adult: Personal case series

2021 ◽  
Author(s):  
Cesare Faldini ◽  
Francesca Barile ◽  
Fabrizio Perna ◽  
Stefano Pasini ◽  
Michele Fiore ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Idiopathic Scoliosis ◽  
Case Series ◽  
Deformity Correction ◽  
Pedicle Screws ◽  
Mechanical Complication ◽  
Non Union ◽  
Implant Retention ◽  
Surgical Data

Abstract Purpose The aim of this article is to present an original surgical technique for the treatment of rigid Adult Idiopathic Scoliosis (AdIS) and the results at minimum 2 years follow-up in a cohort of 40 patients. Methods We retrospectively reviewed 40 patients affected by rigid AdIS, older than 40 years and operated with a posterior one stage surgical technique summarized with the acronym Hi-PoAD, (high-density pedicle screws, Ponte osteotomies, asymmetric rods contouring, direct vertebral rotation). The demographic and surgical data were collected, and the improvement of clinical scores and radiologic parameters was obtained after surgery, at 1 and 2 years and at final follow-up, to assess deformity correction, coronal and sagittal balance and clinical outcome. Results The average follow-up was 2.9 years (range 2–3.5). Average coronal Cobb angle decreased from 65.0° ± 8.4 to 18.9° ± 3.9 (p < 0.01). Rotation sagittal angle decreased from 26.2° ± 4.4° to 12.4° ± 2.8° (p < 0.01). Mean thoracic kyphosis improved from 23.1° ± 3.6° to 36.0° ± 3.9°. SRS-22 improved form 2.9 ± 0.4 to 3.7 ± 0.6 (p < 0.01). Four early post-operative deep wound infections were observed, all healed after debridement and implant retention. No mechanical complication, junctional kyphosis, deformity progression or non-union were recorded at the last follow-up. Conclusions Hi-PoAD technique proved to be safe and effective in the treatment of rigid Adult Idiopathic Scoliosis. The reason for the success is related to the combined strategies adopted, that dissipates corrective forces over several levels, reducing mechanical stress at the screw–bone interface and optimizing corrective potential.

scholarly journals Debridement, Antibiotics, and Implant Retention Is a Viable Treatment Option for Early Periprosthetic Joint Infection Presenting More Than 4 Weeks After Index Arthroplasty

2019 ◽  
Vol 71 (3) ◽  
pp. 630-636 ◽  
Author(s):  
Claudia A M Löwik ◽  
Javad Parvizi ◽  
Paul C Jutte ◽  
Wierd P Zijlstra ◽  
Bas A S Knobben ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Viable Option ◽  
Time Intervals ◽  
Implant Retention ◽  
Time Point ◽  
Viable Treatment

Abstract Background The success of debridement, antibiotics, and implant retention (DAIR) in early periprosthetic joint infection (PJI) largely depends on the presence of a mature biofilm. At what time point DAIR should be disrecommended is unknown. This multicenter study evaluated the outcome of DAIR in relation to the time after index arthroplasty. Methods We retrospectively evaluated PJIs occurring within 90 days after surgery and treated with DAIR. Patients with bacteremia, arthroscopic debridements, and a follow-up &lt;1 year were excluded. Treatment failure was defined as (1) any further surgical procedure related to infection; (2) PJI-related death; or (3) use of long-term suppressive antibiotics. Results We included 769 patients. Treatment failure occurred in 294 patients (38%) and was similar between time intervals from index arthroplasty to DAIR: the failure rate for Week 1–2 was 42% (95/226), the rate for Week 3–4 was 38% (143/378), the rate for Week 5–6 was 29% (29/100), and the rate for Week 7–12 was 42% (27/65). An exchange of modular components was performed to a lesser extent in the early post-surgical course compared with the late course (41% vs 63%, respectively; P &lt; .001). The causative microorganisms, comorbidities, and durations of symptoms were comparable between time intervals. Conclusions DAIR is a viable option in patients with early PJI presenting more than 4 weeks after index surgery, as long as DAIR is performed within at least 1 week after the onset of symptoms and modular components can be exchanged.

Implant retention and removal after internal fixation of the symphysis pubis

Injury ◽  
2005 ◽  
Vol 36 (7) ◽  
pp. 827-831 ◽  
Author(s):  
Raghu Raman ◽  
Craig S. Roberts ◽  
Hans-Christoph Pape ◽  
Peter V. Giannoudis
Keyword(s):  
Internal Fixation ◽  
Symphysis Pubis ◽  
Implant Retention

Results of Isolated Femoral Component Revision With Well-Fixed Acetabular Implant Retention

2010 ◽  
Vol 25 (8) ◽  
pp. 1188-1195 ◽  
Author(s):  
Kyung Soon Park ◽  
Taek Rim Yoon ◽  
Eun Kyoo Song ◽  
Keun Bae Lee
Keyword(s):  
Femoral Component ◽  
Implant Retention ◽  
Component Revision ◽  
Acetabular Implant

Debridement, Antibiotics and Implant Retention (DAIR) in Periprosthetic Joint Infection (PJI): what predicts success or failure?

2021 ◽  
Author(s):  
Rui Xiang Toh ◽  
Zhen Ning Yeo ◽  
Ming Han Lincoln Liow ◽  
Jerry Yongqiang Chen ◽  
Seng-Jin Yeo ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Implant Retention

Cefazolin and rifampin: A coagulopathy-inducing combination

2021 ◽  
Author(s):  
Natalia E Castillo Almeida ◽  
Ryan W Stevens ◽  
Pooja Gurram ◽  
Christina G Rivera ◽  
Gina A Suh
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Assessment Tool ◽  
International Normalized Ratio ◽  
Medication Therapy ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Implant Retention ◽  
History Of

Abstract Purpose To identify risk factors that may predispose patients to rifampin- and cefazolin-induced coagulopathy. Summary An 86-year-old man with a history of rheumatoid arthritis on chronic prednisone and stage 3 chronic kidney disease, notably not on warfarin, presented to the hospital with a 10-day history of right hip pain, swelling, and drainage after a recent right total-hip arthroplasty. The patient underwent a combination of surgical intervention and medication therapy with rifampin and ceftriaxone. After discharge and at postoperative day 9, ceftriaxone was changed to cefazolin due to increasing alkaline phosphatase levels. Four weeks after the initial debridement, antibiotics, and implant retention, the patient underwent a second irrigation and debridement due to persistent infection. Cefazolin and rifampin therapy was extended. Three days later, the patient presented to the emergency room with significant bleeding at the surgical site and a profoundly elevated prothrombin time and international normalized ratio (INR). No potential contributors were identified. The Naranjo adverse drug reaction probability scale identified cefazolin and rifampin as the probable cause of elevated INR. The Liverpool adverse drug reaction avoidability assessment tool classified this adverse event as “definitely avoidable.” Conclusion Rifampin-containing regimens are often recommended to treat staphylococcal prosthetic joint infections when the implant is retained. In methicillin-susceptible staphylococcal infections, cefazolin is routinely employed as the β-lactam backbone of definitive antimicrobial regimens. Although rifampin- and cefazolin-induced hypoprothrombinemia seems to be rare, adverse consequences of its occurrence may be prevented with appropriate monitoring.

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