Preliminary Results After Changing From Two-Stage to One-Stage Revision Arthroplasty Protocol Using Cementless Arthroplasty for Chronic Infected Hip Replacements

2018 ◽  
Vol 33 (2) ◽  
pp. 527-532 ◽  
Author(s):  
Guillem Bori ◽  
Guillem Navarro ◽  
Laura Morata ◽  
Jenaro A. Fernández-Valencia ◽  
Alex Soriano ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Two Stage ◽  
Preliminary Results ◽  
One Stage ◽  
Hip Replacements ◽  
Cementless Arthroplasty

scholarly journals 257. Outcomes in Fungal Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Caitlyn M Hollingshead ◽  
Joan Duggan ◽  
Roberta Redfern ◽  
Gregory Georgiadis ◽  
Jason Tank
Keyword(s):  
Prosthetic Joint Infection ◽  
Candida Species ◽  
Joint Infection ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint ◽  
Hip Replacements ◽  
Fungal Organisms ◽  
Poor Outcomes ◽  
Wbc Count

Abstract Background There is a paucity of data in the literature regarding the most effective treatment and related outcomes of fungal prosthetic joint infection. The majority of reported cases are treated using a two stage revision method in which the initial prosthesis is removed and the patient is treated with systemic antifungal medications and potentially irrigation of the joint cavity with antifungal and antibacterial agents. Alternately, others have suggested a one-stage revision in order to prevent a period of significant functional impairment and potentially improved functional outcomes and lower overall costs. Cases of radical removal of the prosthesis without replacement have been reported. To date, the largest studies of total hip arthroplasty and total knee arthroplasty have included 37 and 45 patients, respectively. Methods A retrospective record review of patients admitted within two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed. Results Eighteen patients fit criteria. Nine patients had knee replacements and nine patients had hip replacements. The average age at time of infection was 61. Ten patients were female. Average BMI was 32.1. Twelve presented with a painful joint, eight presented with drainage, and one with dehiscence. Average WBC count was 9.3, average ESR was 47, and average CRP was 11.8. All patients were noted with Candida species. Eight patients were treated with two stage revisions, three received one stage revisions as destination therapy. One required amputation. All but one patient was associated with concurrent bacterial infection. Of the twelve patients that had known outcomes, six were noted with cure and six were noted with relapse. All patients that were cured received two stage exchange or girdlestone procedure. Conclusion In our study, fungal prosthetic joint infection was associated with poor outcomes. All of the patients in our study were noted with Candida species, which is in concordance with the known literature. Two stage exchange was associated with better outcomes. Disclosures All Authors: No reported disclosures

scholarly journals One-stage cementless revision arthroplasty for infected hip replacements

2008 ◽  
Vol 33 (5) ◽  
pp. 1195-1201 ◽  
Author(s):  
Jeong Joon Yoo ◽  
Young Sam Kwon ◽  
Kyung-Hoi Koo ◽  
Kang Sup Yoon ◽  
Young-Min Kim ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
One Stage ◽  
Hip Replacements

scholarly journals Evaluation of the standard procedure for treatment of periprosthetic joint infections of total knee and hip arthroplasty: a comparison of the 2015 and 2020 census in total joint replacement centres in Germany

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katrin Osmanski-Zenk ◽  
Annett Klinder ◽  
Christina Rimke ◽  
Dieter C. Wirtz ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Standard Procedure ◽  
Revision Arthroplasty ◽  
Treatment Regime ◽  
Two Stage ◽  
Treatment Protocols ◽  
One Stage ◽  
Revision Arthroplasties ◽  
Therapeutic Algorithms

Abstract Background There are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI), however, national or international guidelines for a standardised treatment regime are still lacking. The present paper evaluates the use of the predominant treatment protocols for PJI in certified total joint replacement centres (EPZ) in Germany based on an EndoCert questionnaire. Materials and methods The questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the treatment protocols for septic revision arthroplasties in EPZ. Questions targeted the various treatment options including prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and diagnostic sampling prior to re-implantation. All certified EPZ participated (n = 504) and the results from the current survey in 2020 were compared to data from a previous analysis in 2015. Results The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option increased (hip: + 6.3%; knee: + 6.6%). The majority of the centres (73.2%) indicated a 4–8 week period as the preferred interval between prosthesis removal and re-implantation in two-stage revision in hip as well as knee revisions. Centres with a higher number of revision surgeries (> 200 revisions/year), opted even more often for the 4–8 week period (92.3%). In two-stage revision the use of metal-based spacers with/without reinforcement with antibiotic-containing cement as an interim placeholder was significantly reduced in 2020 compared to 2015. There was also a clear preference for cemented anchoring in two-stage revision arthroplasty in the knee in 2020, whereas the majority of hip replacements was cementless. Additionally, in 2020 the number of samples for microbiological testing during the removal of the infected endoprosthesis increased and 72% of the centres took five or more samples. Overall, the number of EPZ with a standardised protocol for the procedure expanded from 2015 to 2020. Conclusion While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.

scholarly journals One-Stage Revision Arthroplasty for Infected Hip Replacements

2013 ◽  
Vol 7 (1) ◽  
pp. 184-189 ◽  
Author(s):  
Ernesto Muñoz-Mahamud ◽  
Xavier Gallart ◽  
Alejandro Soriano
Keyword(s):  
Hip Prosthesis ◽  
Revision Arthroplasty ◽  
Prosthesis Loosening ◽  
Hip Revision ◽  
Prosthesis Infection ◽  
Cementless Implant ◽  
One Stage ◽  
Prosthesis Replacement ◽  
Hip Replacements ◽  
Major Procedure

Infection remains a serious complication after total hip arthroplasty (THA) and is a leading cause of hip revision surgery. It is currently accepted that removal of the prosthesis is essential to curing an infection when facing chronic PJIs with prosthesis loosening. In order to avoid the disadvantages of a two-stage approach, some authors have proposed a one-stage hip revision for the treatment of hip prosthesis infection in selected patients using not only antibiotic-loaded cemented components but also cementless implant. In the case of a one-stage procedure, the patient is exposed to a single major procedure and therefore lower cumulative perioperative risk. A functional prosthesis replacement is completed without exposure to the complications associated with spacers. In addition, there are also benefits both financially and in terms of resource allocation.

scholarly journals 886. Impact of Type of Surgical Management on the Incidence of Recurrent Surgical Site Infections Following Hip and Knee replacements in Calgary, Alberta

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S478-S478
Author(s):  
Swati Chavda ◽  
Jenine Leal ◽  
Shannon Puloski ◽  
Elissa Rennert May
Keyword(s):  
Surgical Management ◽  
Early Recognition ◽  
Small Sample Size ◽  
Revision Arthroplasty ◽  
Surgical Site Infections ◽  
Small Sample ◽  
Recurrence Rates ◽  
Two Stage ◽  
One Stage ◽  
Significant Difference

Abstract Background Recurrent surgical site infections (SSIs) are associated with decreased quality of life for patients and increased economic burden to healthcare systems. Positive cultures at reimplantation and patient co-morbidities have been shown to increase the risk of recurrent SSI in hip and knee surgical site infections. Two-stage exchange has been considered for the most appropriate surgical management for these SSI’s, however, it is unclear whether the type of revision arthroplasty and pathogen of the first SSI impacts recurrence rates. Methods A retrospective review of prospectively collected data on all complex SSIs following primary hip and knee arthroplasties between April 1 2012 and March 31, 2019, in Calgary, Alberta was performed. Patients were followed for two years post-index arthroplasty to determine initial management of first complex SSI (Debridement, antibiotics and implant retention (DAIR) vs DAIR+liner exchange vs one-stage vs two-stage), rate of recurrent complex SSI, and microbiological data for first and subsequent SSI’s. Results Of the 142 complex SSIs, 95 (66.9%) were managed with DAIR and liner exchange, 25 (17.6%) were managed with DAIR, 13 (9.1%) with one-stage and 8 (5.6%) with two-stage procedures. The recurrence rate was 19/95 (20%) for DAIR and liner, 8/25 (32%) for DAIR alone, 2/13 (15%) with one stage, and 3/8 (37.5%) with two-stage. There was no significant difference in recurrence rates of complex SSI when stratified by surgical management. Of the pathogens, Staphylococcus aureus (S.aureus) (including methicillin-resistant S. aureus (MRSA)) accounted for 35.2% of total first SSI and 50% of recurrences. A significantly higher proportion of S.aureus infections (including MRSA) ended up with a recurrent infection compared to all other pathogens (p=0.045). Of the 32 recurrences, 28.1% were due to the same pathogen as the initial SSI. Conclusion S.aureus was the most common pathogen causing initial and recurrent SSIs. This reinforces that S.aureus complex SSIs would likely benefit from early recognition and aggressive treatment. Recurrence of SSI was not impacted by type of revision arthroplasty. This study is limited by a small sample size. These findings contribute to the paucity of literature in this area and suggest a need for expansion to larger populations. Disclosures All Authors: No reported disclosures

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 Reinfection rates after one- and two-stage revision surgery for hip and knee arthroplasty: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Annemarie L. Goud ◽  
Netanja I. Harlianto ◽  
Solaiman Ezzafzafi ◽  
Ewout S. Veltman ◽  
Joris E. J. Bekkers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Revision Arthroplasty ◽  
Two Stage ◽  
Reinfection Rate ◽  
Hip Revision ◽  
Hip Revision Arthroplasty ◽  
One Stage ◽  
Hip And Knee Arthroplasty

Abstract Purpose Revisions for periprosthetic joint infection of knee and hip arthroplasty can be performed following one- or two-stage treatment protocols. Current literature is inconclusive whether one protocol is superior to the other, as prior literature reported similar reinfection rates for both treatment options. We aimed to provide a systematic review and meta-analysis of current literature on septic arthroplasty revisions. Methods Between April 2015 and December 2020, Medline, Embase, and The Cochrane Library were searched for studies reporting reinfection outcomes in patients treated with one-stage and two-stage knee or hip revision arthroplasty. Two reviewers independently extracted data and disagreements were resolved by a third investigator. We utilized a double arcsine transformation, prior to pooling using a random-effects model. Results For hip revision arthroplasty, we identified 14 one-stage studies (n = 1237) with a pooled reinfection rate of 5.7% (95% CI 3.7–8.1%), and 46 two-stage studies (n = 5009) with a reinfection rate of 8.4% (95% CI 6.9–9.9%). For knee revision arthroplasty, 6 one-stage studies (n = 527) and 48 two-stage studies (n = 4344) were identified with reinfection rates of 12.7% (7.0–19.7%) and 16.2% (13.7–19.0%), respectively. Overall, reinfection rates did not vary substantially after subgroup analysis. Limitations of our study are the limited amount of one-stage studies that introduce a potential bias. Conclusion The reinfection rates following one- and two-stage hip and knee arthroplasty revisions were similar. Knee reinfection rates have increased compared to the previous analysis. Individual patient characteristics and adequate treatment algorithms are needed for a more individual selection approach, until a randomized trial is performed.

Molecular genetic background of haemophilia A patients with discrepancy between one-stage and two-stage factor VIII assays

2010 ◽  
Vol 30 (S 01) ◽  
pp. S153-S155
Author(s):  
D. Delev ◽  
S. Pahl ◽  
J. Driesen ◽  
H. Brondke ◽  
J. Oldenburg ◽  
...  
Keyword(s):  
Factor Viii ◽  
Genetic Background ◽  
Molecular Genetic ◽  
Haemophilia A ◽  
Two Stage ◽  
One Stage

Plasma Factor V Activation Is Prevented by Activated Protein C in the Presence of Phospholipid Vesicles, Not Platelets

1993 ◽  
Vol 69 (02) ◽  
pp. 124-129 ◽  
Author(s):  
Susan Solymoss ◽  
Kim Thi Phu Nguyen
Keyword(s):  
Western Blotting ◽  
Protein C ◽  
Thrombin Generation ◽  
Blood Platelets ◽  
Activated Protein C ◽  
Phospholipid Vesicles ◽  
Factor V ◽  
Two Stage ◽  
One Stage ◽  
Plasma Factor

SummaryActivated protein C (APC) is a vitamin K dependent anticoagulant which catalyzes the inactivation of factor Va and VIIIa, in a reaction modulated by phospholipid membrane surface, or blood platelets. APC prevents thrombin generation at a much lower concentration when added to recalcified plasma and phospholipid vesicles, than recalcified plasma and platelets. This observation was attributed to a platelet associated APC inhibitor. We have performed serial thrombin, factor V one stage and two stage assays and Western blotting of dilute recalcified plasma containing either phospholipid vesicles or platelets and APC. More thrombin was formed at a given APC concentration with platelets than phospholipid. One stage factor V values increased to higher levels with platelets and APC than phospholipid and APC. Two stage factor V values decreased substantially with platelets and 5 nM APC but remained unchanged with phospholipid and 5 nM APC. Western blotting of plasma factor V confirmed factor V activation in the presence of platelets and APC, but lack of factor V activation with phospholipid and APC. Inclusion of platelets or platelet membrane with phospholipid enhanced rather than inhibited APC catalyzed plasma factor V inactivation. Platelet activation further enhanced factor V activation and inactivation at any given APC concentration.Plasma thrombin generation in the presence of platelets and APC is related to ongoing factor V activation. No inhibition of APC inactivation of FVa occurs in the presence of platelets.

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