Temporary new implant spacers increase post-reimplantation total knee prosthesis survival after periprosthetic joint infection

2020 ◽  
Author(s):  
Colin Y. L. Woon ◽  
Joseph Nguyen ◽  
Milan Kapadia ◽  
Celeste A. Russell ◽  
Michael Henry ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Total Knee Prosthesis ◽  
Prosthesis Survival ◽  
Total Knee

scholarly journals Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Jon E. Minter
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Extensor Mechanism ◽  
Physical Constraint ◽  
Total Knee ◽  
Ligamentous Instability ◽  
Revision Tka

BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection.  (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint).  The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented.  We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.

scholarly journals Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

2020 ◽  
Vol 5 (3) ◽  
pp. 128-132
Author(s):  
Marrit Hoekstra ◽  
Ewout S. Veltman ◽  
Ruben F.R.H.A Nurmohamed ◽  
Bruce van Dijk ◽  
Rob J. Rentenaar ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Sensitivity And Specificity ◽  
Periprosthetic Joint Infection ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Clinical Importance ◽  
Tissue Cultures ◽  
Knee Joint Infection ◽  
Total Knee

Abstract. Background: Diagnosis of periprosthetic joint infection (PJI) can be troublesome. Sonication can be a helpful tool in culturing bacteria that are difficult to detect with standard tissue cultures. Aim of this study is to evaluate the clinical importance of our standardized sonication protocol in detecting periprosthetic joint infection.Materials and methods: All patients with revision surgery of a hip or knee prosthesis between 2011 and 2016 were retrospectively reviewed and divided in two groups: clinically suspected of infection or not suspected of infection. For both tissue culture and implant sonication, calculations of sensitivity and specificity were performed. Clinical relevance of sonication was evaluated by calculating in which percentage of patients' sonication influenced clinical treatment.Results: 226 patients with revision of a total hip prosthesis (122 patients) or a total knee prosthesis (104 patients) were included. Sensitivity of perioperatively taken tissue cultures was 94.3% and specificity was 99.3%. For sonication sensitivity was 80.5% and specificity was 97.8%.In the infection group eight patients (9%) with only one positive tissue culture and a positive sonication fluid culture with the same pathogen were found.Interpretation: Although sensitivity and specificity of sonication was lower compared to tissue cultures, periprosthetic joint infection could only be established in 8 patients (9%) suspected of infection because of a positive result of the sonication fluid culture.Sonication leads to clinically relevant changes in treatment and seems therefore to be a helpful diagnostic tool in clinical practice.

Differential Bacterial Load on Components of Total Knee Prosthesis in Patients with Prosthetic Joint Infection

2012 ◽  
Vol 35 (10) ◽  
pp. 735-741 ◽  
Author(s):  
Johannes Holinka ◽  
Magdalena Pilz ◽  
Alexander M. Hirschl ◽  
Wolfgang Graninger ◽  
Reinhard Windhager ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Bacterial Load ◽  
Total Knee Prosthesis ◽  
Prosthetic Joint ◽  
Total Knee

Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

2021 ◽  
Author(s):  
Blair S. Ashley ◽  
Javad Parvizi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Difficult Problem ◽  
Postoperative Course ◽  
Infected Total Knee Arthroplasty ◽  
Treatment Considerations ◽  
Total Knee

AbstractTotal knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.

Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 191-195
Author(s):  
Elizabeth B. Gausden ◽  
Matthew B. Shirley ◽  
Matthew P. Abdel ◽  
Rafael J. Sierra
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Significant Risk ◽  
Wound Dehiscence ◽  
Increased Risk ◽  
Primary Tkas ◽  
Traumatic Wound ◽  
Total Knee

Aims To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA). Methods From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed. Results Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component. Conclusion Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J 2021;103-B(6 Supple A):191–195.

On the true wear rate of ultrahigh molecular weight polyethylene in the total knee prosthesis

1984 ◽  
Vol 18 (2) ◽  
pp. 207-224 ◽  
Author(s):  
Robert M. Rose ◽  
Michael D. Ries ◽  
Igor L. Paul ◽  
Aldo M. Crugnola ◽  
Edward Ellis
Keyword(s):  
Molecular Weight ◽  
Wear Rate ◽  
Knee Prosthesis ◽  
Ultrahigh Molecular Weight Polyethylene ◽  
Total Knee Prosthesis ◽  
Ultrahigh Molecular Weight ◽  
Total Knee
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