Increased Prevalence of Depressive Symptoms in Patients Undergoing Revision for Periprosthetic Joint Infection

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

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Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽

10.3390/diagnostics11030434 ◽

2021 ◽

Vol 11 (3) ◽

pp. 434

Author(s):

Frank Sebastian Fröschen ◽

Sophia Schell ◽

Matthias Dominik Wimmer ◽

Gunnar Thorben Rembert Hischebeth ◽

Hendrik Kohlhof ◽

...

Keyword(s):

Synovial Fluid ◽

Multiple Regression ◽

Complement System ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Expression Patterns ◽

Factor H ◽

Low Grade ◽

Complement Factors ◽

Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

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Periprosthetic Joint Infection after Elbow Arthroplasty

Bone and Joint Infections ◽

10.1002/9781119720676.ch14 ◽

2021 ◽

pp. 231-249

Author(s):

Yvonne Achermann ◽

Michael C. Glanzmann ◽

Christoph Spormann

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Elbow Arthroplasty

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The change of coagulation profile in two-staged arthroplasty for periprosthetic joint infection patients: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02477-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Hao Li ◽

Rui Li ◽

L. L. Li ◽

Wei Chai ◽

Chi Xu ◽

...

Keyword(s):

Cohort Study ◽

Periprosthetic Joint Infection ◽

Retrospective Cohort Study ◽

Persistent Infection ◽

Retrospective Cohort ◽

Joint Infection ◽

Diagnostic Study ◽

Level Of Evidence ◽

Coagulation Profile ◽

Significant Difference

Abstract Aims Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty. We performed a retrospective cohort study to evaluate (1) the change of coagulation profile in two-staged arthroplasty patients and (2) the relationship between coagulation profile and the outcomes of reimplantation. Method Between January 2011 and December 2018, a total of 202 PJI patients who were operated on with two-staged arthroplasty were included in this study initially. This study continued for 2 years and the corresponding medical records were scrutinized to establish the diagnosis of PJI based on the 2014 MSIS criteria. The coagulation profile was recorded at two designed points, (1) preresection and (2) preimplantation. The difference of coagulation profile between preresection and preimplantation was evaluated. Receiver operating characteristic curves (ROC) were used to evaluate the diagnostic efficiency of the coagulation profile and change of coagulation profile for predicting persistent infection before reimplantation. Results The levels of APTT, INR, platelet count, PT, TT, and plasma fibrinogen before spacer implantation were significantly higher than before reimplantation. No significant difference was detected in the levels of D-dimer, ACT, and AT3 between the two groups. The AUC of the combined coagulation profile and the change of combined coagulation profile for predicting persistent infection before reimplantation was 0.667 (95% CI 0.511, 0.823) and 0.667 (95% CI 0.526, 0.808), respectively. Conclusion The coagulation profile before preresection is different from before preimplantation in two-staged arthroplasty and the coagulation markers may play a role in predicting infection eradication before reimplantation when two-stage arthroplasty is performed. Level of evidence Level III, diagnostic study.

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Unusual Microorganisms in Periprosthetic Joint Infection

Bone and Joint Infections ◽

10.1002/9781119720676.ch3 ◽

2021 ◽

pp. 21-49

Author(s):

Camelia Marculescu ◽

Werner Zimmerli

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection

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Candida Periprosthetic Joint Infection: Is It Curable?

Antibiotics ◽

10.3390/antibiotics10040458 ◽

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.

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Periprosthetic Joint Infection Prophylaxis in the Elderly after Hip Hemiarthroplasty in Proximal Femur Fractures: Insights and Challenges

Antibiotics ◽

10.3390/antibiotics10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Dolors Rodríguez-Pardo ◽

Laura Escolà-Vergé ◽

Júlia Sellarès-Nadal ◽

Pablo S. Corona ◽

Benito Almirante ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Antimicrobial Prophylaxis ◽

Joint Infection ◽

Asymptomatic Bacteriuria ◽

Infection Prophylaxis ◽

Beta Lactam ◽

Hip Hemiarthroplasty ◽

Femur Fractures ◽

Published Evidence ◽

Prophylactic Measures

We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by clindamycin or a glycopeptide in beta-lactam allergies. A personalized antibiotic scheme may be considered when colonization by a multidrug-resistant microorganism (MDRO) is suspected. Particularly in methicillin-resistant Staphylococcus aureus (MRSA) colonization or a high prevalence of MRSA-caused PJIs a glycopeptide with cefazolin is recommended. Strategies such as cutaneous decolonization of MDROs, mainly MRSA, or preoperative asymptomatic bacteriuria treatment have also been addressed with debatable results. Some areas of research are early detection protocols in MDRO colonizations by polymerase-chain-reaction (PCR), the use of alternative antimicrobial prophylaxis, and antibiotic-impregnated bone cement in HHA. Given that published evidence addressing PJI prophylactic strategies in PFFs requiring HHA is scarce, PJIs can be reduced by combining different prevention strategies after identifying individuals who will benefit from personalized prophylaxis.

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