General versus Neuraxial Anesthesia in Revision Surgery for Periprosthetic Joint Infection

Periprosthetic joint infection of the hip due to Salmonella sp. is rare. It is sometimes difficult to treat and needed a prolonged antibiotic treatment. We reported a case of periprosthetic joint infection of the hip in a 67 years old female who received prior left total hip arthroplasty. Two-stage revision surgery with antibiotic-loaded cement spacer has been performed to the patient and successfully control the infection. Review of the literatures also has been done. Salmonella Sp. has to be considered as one of differential etiology in the case of infected arthroplasty especially in an immunosuppressed patient. It showed still there has been no consensus in the treatment of choice for this particular case.

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Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience

Journal of Bone and Joint Infection ◽

10.5194/jbji-7-1-2022 ◽

2022 ◽

Vol 7 (1) ◽

pp. 1-9

Author(s):

Karsten D. Ottink ◽

Stefan J. Gelderman ◽

Marjan Wouthuyzen-Bakker ◽

Joris J. W. Ploegmakers ◽

Andor W. J. M. Glaudemans ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

A Priori ◽

Nuclear Imaging ◽

Added Value ◽

Low Grade ◽

Predictive Values ◽

Sensitivity Specificity

Abstract. Background: A low-grade periprosthetic joint infection (PJI) may present without specific symptoms, and its diagnosis remains a challenge. Three-phase bone scintigraphy (TPBS) and white blood cell (WBC) scintigraphy are incorporated into recently introduced diagnostic criteria for PJI, but their exact value in diagnosing low-grade PJI in patients with nonspecific symptoms remains unclear. Methods: In this retrospective study, we evaluated patients with a prosthetic joint of the hip or knee who underwent TPBS and/or WBC scintigraphy between 2009 and 2016 because of nonspecific symptoms. We reviewed and calculated diagnostic accuracy of the TPBS and/or WBC scintigraphy to diagnose or exclude PJI. PJI was defined based on multiple cultures obtained during revision surgery. In patients who did not undergo revision surgery, PJI was ruled out by clinical follow-up of at least 2 years absent of clinical signs of infection based on MSIS 2011 criteria. Results: A total of 373 patients were evaluated, including 340 TPBSs and 142 WBC scintigraphies. Thirteen patients (3.5 %) were diagnosed with a PJI. TPBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were 71 %, 65 %, 8 % and 98 %, respectively. Thirty-five percent of TPBS showed increased uptake. Stratification for time intervals between the index arthroplasty and the onset of symptoms did not alter its diagnostic accuracy. WBC scintigraphy sensitivity, specificity, PPV and NPV were 30 %, 90 %, 25 % and 94 %, respectively. Conclusion: Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection.

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Six-stage revision surgery of a triple periprosthetic joint infection due to a delayed diagnosis of a bilateral psoas abscess: a case report

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2021.0033 ◽

2021 ◽

Author(s):

C Lucero ◽

F Díaz-Dilernia ◽

F Comba ◽

G Zanotti ◽

F Piccaluga ◽

...

Keyword(s):

Case Report ◽

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Daily Living ◽

Psoas Abscess ◽

Joint Infection ◽

Delayed Diagnosis ◽

Left Knee ◽

Complex Scenario

Case We present a case of a 70-year-old woman with simultaneous periprosthetic joint infection (PJI) of both hips and left knee due to a bilateral psoas abscess. The patient underwent debridement and implants removal with the consequent reimplantation in a sequential six-stage revision surgery. At four years of follow-up and in spite of the patient’s comorbidities and current PJI presentation, she maintains full activities of daily living without restrictions. Conclusion Accurate and early diagnosis of a psoas abscess is crucial. This case report provides experience of a complex scenario, the decision-making involved and the outcomes of an underdiagnosed complication.

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Development of a Preoperative Risk Calculator for Reinfection Following Revision Surgery for Periprosthetic Joint Infection

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.08.004 ◽

2020 ◽

Cited By ~ 1

Author(s):

Christian Klemt ◽

Venkatsaiakhil Tirumala ◽

Evan J. Smith ◽

Anand Padmanabha ◽

Young-Min Kwon

Keyword(s):

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Risk Calculator ◽

Preoperative Risk

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Erratum to: Is Neuraxial Anesthesia Safe in Patients Undergoing Surgery for Treatment of Periprosthetic Joint Infection?

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-015-4406-7 ◽

2015 ◽

Vol 473 (9) ◽

pp. 3062-3062

Author(s):

Mohammad R. Rasouli ◽

Priscilla K. Cavanaugh ◽

Camilo Restrepo ◽

Hasan Huseyin Ceylan ◽

Mitchell G. Maltenfort ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Neuraxial Anesthesia

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Elevated ESR and CRP Prior to Second-Stage Reimplantation Knee Revision Surgery for Periprosthetic Joint Infection Are Associated with Increased Reinfection Rates

The Journal of Knee Surgery ◽

10.1055/s-0041-1733902 ◽

2021 ◽

Author(s):

Christian Klemt ◽

Anand Padmanabha ◽

John G. Esposito ◽

Samuel Laurencin ◽

Evan J. Smith ◽

...

Keyword(s):

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Elevated Serum ◽

Revision Total Knee Arthroplasty ◽

Optimal Timing ◽

Two Stage ◽

Second Stage ◽

Knee Revision Surgery ◽

Knee Revision

Abstract Purpose Although two-stage revision surgery is considered as the most effective treatment for managing chronic periprosthetic joint infection (PJI), there is no current consensus on the predictors of optimal timing to second-stage reimplantation. This study aimed to compare clinical outcomes between patients with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) prior to second-stage reimplantation and those with normalized ESR and CRP prior to second-stage reimplantation. Methods We retrospectively reviewed 198 patients treated with two-stage revision total knee arthroplasty for chronic PJI. Cohorts included patients with: (1) normal level of serum ESR and CRP (n = 96) and (2) elevated level of serum ESR and CRP prior to second-stage reimplantation (n = 102). Outcomes including reinfection rates and readmission rates were compared between both cohorts. Result At a mean follow-up of 4.4 years (2.8–6.5 years), the elevated ESR and CRP cohort demonstrated significantly higher reinfection rates compared with patients with normalized ESR and CRP prior to second-stage reimplantation (33.3% vs. 14.5%, p < 0.01). Patients with both elevated ESR and CRP demonstrated significantly higher reinfection rates, when compared with patients with elevated ESR and normalized CRP (33.3% vs. 27.6%, p = 0.02) as well as normalized ESR and elevated CRP (33.3% vs. 26.3%, p < 0.01). Conclusion This study demonstrates that elevated serum ESR and/or CRP levels prior to reimplantation in two-stage knee revision surgery for chronic PJI are associated with increased reinfection rate after surgery. Elevation of both ESR and CRP were associated with a higher risk of reinfection compared with elevation of either ESR or CRP, suggesting the potential benefits of normalizing ESR and CRP prior to reimplantation in treatment of chronic PJI.

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Long-Term Outcomes of Staged Revision Surgery for Chronic Periprosthetic Joint Infection of Total Hip Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm11010122 ◽

2021 ◽

Vol 11 (1) ◽

pp. 122

Author(s):

Christopher W. Day ◽

Kerry Costi ◽

Susan Pannach ◽

Gerald J. Atkins ◽

Jochen G. Hofstaetter ◽

...

Keyword(s):

Mortality Rate ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Periprosthetic Joint Infection ◽

Functional Outcomes ◽

Joint Infection ◽

Harris Hip Score ◽

Worst Case ◽

Total Hip

Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Staged revision surgery is considered effective in eradicating PJI. We aimed to determine the rate of infection resolution after each stage of staged revision surgery (first stage, repeat first stage, second stage, excision arthroplasty, and reimplantation) and to assess functional outcomes and the mortality rate at ten years in a consecutive series of 30 chronic PJI of total hip arthroplasties. Infection resolution was defined as no clinical nor laboratory evidence of infection at 24 months after the last surgery and after a minimum of 12 months following cessation of antimicrobial treatment. Four patients died within 24 months of their final surgery. Nineteen patients, 73% (worst-case analysis (wca) 63%), were infection free after 1 surgery; 22 patients, 85% (wca 73%), were infection free after 2 surgeries; and 26 patients, 100% (wca 87%), were infection free after three and four surgeries. The median Harris Hip Score was 41 prior to first revision surgery and improved to 74 at twelve months and 76 at ten years after the final surgery. Thirteen patients died at a mean of 64 months from first revision, giving a mortality rate of 43% at ten years, which is approximately 25% higher than that of an age-matched general population. The results show that with repeated aggressive surgical treatment, most PJIs of the hip are curable. Ten years after successful treatment of PJI, functional outcomes and pain are improved and maintained compared to before initial surgery, but this must be balanced against the high 10-year mortality. Level of evidence: cohort studies.

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