Long-term antimicrobial suppression prevents treatment failure of streptococcal periprosthetic joint infection

2019 ◽  
Vol 79 (3) ◽  
pp. 236-244 ◽  
Author(s):  
Nora Renz ◽  
Anastasia Rakow ◽  
Michael Müller ◽  
Carsten Perka ◽  
Andrej Trampuz
Keyword(s):  
Treatment Failure ◽  
Periprosthetic Joint Infection ◽  
Joint Infection

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 <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 < .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.

Recalcitrant Periprosthetic Joint Infection With Iliac Fossa Abscess After Total Hip Arthroplasty

2021 ◽  
Author(s):  
Kuo-Ti Peng ◽  
Tsung-Yu Huang ◽  
Jiun-Liang Chen ◽  
Chiang-Wen Lee ◽  
Hsin-Nung Shih
Keyword(s):  
Total Hip Arthroplasty ◽  
Treatment Failure ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Iliac Fossa ◽  
Joint Infection ◽  
Treatment Success ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Orthopedic Procedure

Abstract Background: Total hip arthroplasty (THA) is a widely used and successfully performed orthopedic procedure for treating severe hip osteoarthritis, rheumatoid arthritis, and avascular necrosis. However, periprosthetic joint infection (PJI) after THA is a devastating complication for patients and orthopedic surgeons. Although surgical technology has been advanced and antibiotic-loaded cemented spacers or beads have developed, the treatment failure rate of one- or two-stage exchange arthroplasty for PJI is reported to be high, with >10% rate of incidence. Therefore, determining the possible pathogenesis and increasing the treatment success rate is a clinically important and urgent issue. Methods: A total of 256 patients with PJI who had undergone THA from 2005 to 2015 were included in this retrospective review. Seven patients required combined ilioinguinal and anterlateoal approach for debridement of iliac fossa abscess and infected hip lesion, included five patients with intraoperative pus leakage from the acetabular inner wall and the other two patients who underwent pre-operative pelvic computed tomography (CT) because of repeat PJI treatment failure. All available data from the medical records from all patients were retrospectively analyzed.Results: Of the 256 patients, seven (3.1%) patients was combined iliac fossa abscess in our cohort. For the microbiologic analysis, a total of thirteen pathogens were isolated from seven recurrent PJI patients with iliac fossa abscess, and Staphylococus aureus was the most commomly pathogen (4 out of 7 cases). The serum white blood cell (WBC) count was decreased significantly two weeks after debridement with combined the ilioinguinal and anterolateral approach compared to the day before surgery (11840/μL vs. 7370/μL; p<0.01), and level of C-reactive protein (CRP) was decreased at postoperative one week (107 mg/dL vs. 47.31 mg/dL; p=0.03). Furthermore, no recurrent infection was found in six revision THA patient in a follow up of 7.1 year. Conclusion: This result suggests that pre-operative pelvic CT and cautious identification of uncertain pus leakage from the inner wall of the acetabulum is essential for the diagnosis of recurrent PJI. Radical debridement with combined ilioinguinal and anterlateoal approach may aviod treatment failure in recurrent PJI with iliac fossa abscess.

scholarly journals Orthoplastics in Periprosthetic Joint Infection of the Knee: Treatment Concept for Composite Soft-tissue Defect with Extensor Apparatus Deficiency

2020 ◽  
Vol 5 (3) ◽  
pp. 160-171 ◽  
Author(s):  
Rik Osinga ◽  
Maurice Michel Eggimann ◽  
Steven John Lo ◽  
Richard Kühl ◽  
Alexander Lunger ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Soft Tissue Defect ◽  
Anterolateral Thigh Flap ◽  
Treatment Concept ◽  
Long Term Outcome ◽  
Tissue Defect ◽  
Extensor Apparatus

Abstract. Introduction: Reconstruction of composite soft-tissue defects with extensor apparatus deficiency in patients with periprosthetic joint infection (PJI) of the knee is challenging. We present a single-centre multidisciplinary orthoplastic treatment concept based on a retrospective outcome analysis over 20 years.Methods and Results: One-hundred sixty patients had PJI after total knee arthroplasty. Plastic surgical reconstruction of a concomitant perigenicular soft-tissue defect was indicated in 47 patients. Of these, six presented with extensor apparatus deficiency. One patient underwent primary arthrodesis and five patients underwent reconstruction of the extensor apparatus. The principle to reconstruct missing tissue 'like with like' was thereby favoured: Two patients with a wide soft-tissue defect received a free anterolateral thigh flap with fascia lata; one patient with a smaller soft-tissue defect received a free sensate, extended lateral arm flap with triceps tendon; and two patients who did not qualify for free flap surgery received a pedicled medial sural artery perforator gastrocnemius flap. Despite good functional results 1 year later, long-term follow-up revealed that two patients had to undergo arthrodesis because of recurrent infection and one patient was lost to follow-up.Conclusion: These results show that PJI of the knee and extensor apparatus deficiency is a dreaded combination with a poor long-term outcome. Standardization of surgical techniques for a defined PJI problem and consensus on study variables may facilitate interinstitutional comparisons of outcome data, and hence, improvement of treatment concepts.

Long-Term Results of a 2-Stage Exchange Protocol for Periprosthetic Joint Infection Following Total Hip Arthroplasty in 164 Hips

2019 ◽  
Vol 101 (1) ◽  
pp. 74-84 ◽  
Author(s):  
Stephen M. Petis ◽  
Matthew P. Abdel ◽  
Kevin I. Perry ◽  
Tad M. Mabry ◽  
Arlen D. Hanssen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Long Term Results ◽  
Total Hip

scholarly journals Long-Term Patient-Related Quality of Life after Knee Periprosthetic Joint Infection

2021 ◽  
Vol 10 (5) ◽  
pp. 907
Author(s):  
Nike Walter ◽  
Markus Rupp ◽  
Katja Hierl ◽  
Matthias Koch ◽  
Maximilian Kerschbaum ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Successful Treatment ◽  
Periprosthetic Joint Infection ◽  
Normative Data ◽  
Joint Infection ◽  
Sf 36 ◽  
The Mean ◽  
The Impact

Background: We aimed to evaluate the impact of knee periprosthetic joint infection (PJI) by assessing the patients’ long-term quality of life and explicitly their psychological wellbeing after successful treatment. Methods: Thirty-six patients with achieved eradication of infection after knee PJI were included. Quality of life was evaluated with the EQ-5D and SF-36 outcome instruments as well as with an ICD-10 based symptom rating (ISR) and compared to normative data. Results: At a follow-up of 4.9 ± 3.5 years the mean SF-36 score was 24.82 ± 10.0 regarding the physical health component and 46.16 ± 13.3 regarding the mental health component compared to German normative values of 48.36 ± 9.4 (p < 0.001) and 50.87 ± 8.8 (p = 0.003). The mean EQ-5D index reached 0.55 ± 0.33 with an EQ-5D VAS rating of 52.14 ± 19.9 compared to reference scores of 0.891 (p < 0.001) and 68.6 ± 1.1 (p < 0.001). Mean scores of the ISR revealed the psychological symptom burden on the depression scale. Conclusion: PJI patients still suffer from significantly lower quality of life compared to normative data, even years after surgically successful treatment. Future clinical studies should focus on patient-related outcome measures. Newly emerging treatment strategies, prevention methods, and interdisciplinary approaches should be implemented to improve the quality of life of PJI patients.

scholarly journals Trend of serum C-reactive protein is associated with treatment outcome of hip Periprosthetic joint infection undergoing two-stage exchange arthroplasty: a case control study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhong-Yan Li ◽  
Yu-Chih Lin ◽  
Chih-Hsiang Chang ◽  
Szu-Yuan Chen ◽  
Tung-Wu Lu ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Treatment Failure ◽  
Periprosthetic Joint Infection ◽  
Kidney Diseases ◽  
Joint Infection ◽  
Multivariate Logistic Regression Analysis ◽  
C Reactive Protein ◽  
Two Stage ◽  
Reactive Protein ◽  
Exchange Arthroplasty

Abstract Background Serum C-reactive protein (CRP) trends are critical for monitoring patients’ treatment response following a two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of the hip. However, CRP trends are poorly described in the literature. The primary aim of this study was to identify the relationships between PJI treatment outcomes and our proposed CRP trend definitions, parameters, and microbiological data. The secondary aim was to investigate CRP trends after the occurrence of spacer-related complications. Methods We conducted a retrospective review of 74 patients treated with a two-stage exchange protocol for PJI in a tertiary referral joint center between 2014 and 2016. Patients with factors that may affect CRP levels (inflammatory arthritis, concomitant infections, liver and kidney diseases, and intensive care admissions) were excluded. CRP trends were categorized into five types and PJI treatment outcome was defined as “success” or “failure” according to the Delphi criteria. Results Treatment was successful in 67 patients and failed in 7 patients. Multivariate logistic regression analysis showed that type 5 CRP, defined as serum CRP fluctuation without normalization after first stage surgery (odds ratio [OR]: 17.4; 95% confidence interval [CI]: 2.3–129.7; p = 0.005), and methicillin-resistant Staphylococcus aureus (MRSA; OR: 14.5; 95% CI: 1.6–131.7; p = 0.018) were associated with treatment failure. Spacer-related complications occurred in 18 patients. Of these, 12 had elevated CRP levels at later follow-up, while six had no elevation in CRP levels. Conclusions We found that MRSA infection and type 5 CRP were associated with PJI treatment failure.

scholarly journals 255. Utility of Magnetic Resonance Imaging in Predicting Failure of DAIR (Debridement, Antibiotics, and Implant Retention) for Treatment of Periprosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S234-S234
Author(s):  
Milan Kapadia ◽  
Alissa Burge ◽  
Eric Bogner ◽  
Peter Sculco ◽  
Alberto V Carli
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Treatment Failure ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Univariate Analysis ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Adjacent Tissue ◽  
Implant Retention

Abstract Background Debridement, antibiotics, and implant retention (DAIR) is commonly utilized to treat acute periprosthetic joint infection (PJI) where thorough debridement of affected tissues is considered essential. Small case series describe occurrences where PJI spreads into adjacent tissues (iliopsoas recess in hips; neurovascular bundle in knees) and bone (osteomyelitis). Surgeons often cite adjacent tissue/bone infiltration as a poor predictor for DAIR. We sought to evaluate if the presence of adjacent tissue/bony lesions on preoperative magnetic resonance imaging (MRI) was associated with poorer DAIR outcomes. Methods MSIS criteria-positive hip (n=22) and knee (n=12) PJI cases in our institution from 2010-2020, with preoperative MRI prior to DAIR treatment, were evaluated. Demographics, microbiology, chronicity, and host grade were recorded. MRIs were assessed by two board-certified radiologists blinded to treatment outcomes, scoring images based on the presence of 18 distinct findings. Inter-rater reliability was calculated using bias adjusted Kappa scores. Failure was defined as repeat surgery for PJI. Univariate analysis and logistic regression were used to determine predictors of DAIR success at 90 days and 2 years. Results When comparing successful and non-successful hip PJI cases, the presence of a psoas recess fluid collection on MRI was significantly predictive of a higher rate of treatment failure at 2 years (odds ratio=0.12; p = 0.045), with a moderate adjusted kappa score of 0.5. With regard to knee PJI cases, capsular disruption (40% [2/5] vs 100% [7/7], p= 0.046) and patellar tendon disruption (25% [1/4] vs 100% [8/8], p = 0.018) were independently associated with higher 90-day failure. However, knee MRI findings were not predictive of failure using regression. Conclusion In this preliminary study, preoperative MRI findings anecdotally linked with PJI treatment failure could be reliably identified. However, few predicted DAIR failure. Further studies are needed to clarify the role of MRI in predicting PJI treatment success. Disclosures All Authors: No reported disclosures

scholarly journals Outcomes of Acute Hematogenous Periprosthetic Joint Infection in Total Ankle Arthroplasty Treated with Irrigation, Debridement, and Polyethylene Exchange

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0007
Author(s):  
James Lachman ◽  
Jania A. Ramos ◽  
James Nunley ◽  
James DeOrio ◽  
Samuel Adams
Keyword(s):  
Staphylococcus Aureus ◽  
Failure Rate ◽  
Periprosthetic Joint Infection ◽  
Patient Reported Outcomes ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Ankle Arthroplasty ◽  
Primary Arthroplasty ◽  
Patient Reported

Category: Ankle Introduction/Purpose: Acute hematogenous periprosthetic joint infection(PJI) is defined in the literature as infection diagnosed and treated within two to four weeks from the onset of symptoms. In total hip and knee arthroplasty, irrigation, debridement(I&D) and polyethylene exchange with component retention is the treatment of choice. There is minimal literature evaluating this treatment method for PJI in total ankle arthroplasty (TAA), however, with four patients being the largest sample size. The purpose of this study was to evaluate both the clinical and patient reported outcomes and survivorship of treating PJI in TAA with I&D and polyethylene exchange in patients with acute hematogenous PJIs. Methods: A single center, retrospective chart review of prospectively collected data in patients with TAA PJI who subsequently underwent I&D and polyethylene exchange with retention of metal components was conducted. The primary outcome was failure rate of I&D and polyethylene exchange where failure was defined as subsequent removal of all components and two-stage revision or arthrodesis. Patient reported outcomes collected before primary arthroplasty, after primary arthroplasty and after polyethylene exchange were also analyzed. Results: We identified 11 patients with acute hematogenous PJI who underwent I&D/ polyethylene exchange with retention of metal components. The average time from onset of symptoms to I&D/ polyethylene exchange was 11.55 days +/-5.57. The mean follow-up after this surgery was 2.8 years +/-1.45. The long-term failure rate was 50%. The most common bacteria isolated in patients who failed was Methicillin Resistant Staphylococcus Aureus (MRSA). The most common bacteria isolated in patients who retained their implants was Methicillin Sensitive Staphylococcus Aureus(MSSA). Visual Analog Scale (VAS), Short Musculoskeletal Function Assessment (SMFA), Short Form-36 (SF36), and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale showed significant improvement when compared to preoperative scores in patients who retained their implants both after primary and after I&D and polyethylene exchange. Conclusion: I&D and polyethylene exchange with retention of metal components has comparable long-term survivorship to those reported in the Knee and Hip Arthroplasty literature. Patient reported outcomes after I&D and polyethylene exchange were comparable to those collected after primary arthroplasty in patients who ultimately retained their implants. Two variables which were independent predictors of failure of this surgery include duration of symptoms prior to I&D as well as organism isolated on culture. With a failure rate of 50%, the authors recommend thorough evaluation on a case by case basis prior to indicating a patient for single stage I&D with polyethylene exchange.

One-stage exchange should be avoided in periprosthetic joint infection cases with massive femoral bone loss or with history of any failed revision to treat periprosthetic joint infection

2021 ◽  
Vol 103-B (7) ◽  
pp. 1247-1253
Author(s):  
Pablo A. Slullitel ◽  
José I. Oñativia ◽  
Gerardo Zanotti ◽  
Fernando Comba ◽  
Francisco Piccaluga ◽  
...  
Keyword(s):  
Bone Loss ◽  
Periprosthetic Joint Infection ◽  
Cumulative Incidence ◽  
Periprosthetic Fracture ◽  
Joint Infection ◽  
Single Stage ◽  
Femoral Bone ◽  
One Stage

Aims There is a paucity of long-term studies analyzing risk factors for failure after single-stage revision for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). We report the mid- to long-term septic and non-septic failure rate of single-stage revision for PJI after THA. Methods We retrospectively reviewed 88 cases which met the Musculoskeletal Infection Society (MSIS) criteria for PJI. Mean follow-up was seven years (1 to 14). Septic failure was diagnosed with a Delphi-based consensus definition. Any reoperation for mechanical causes in the absence of evidence of infection was considered as non-septic failure. A competing risk regression model was used to evaluate factors associated with septic and non-septic failures. A Kaplan-Meier estimate was used to analyze mortality. Results The cumulative incidence of septic failure was 8% (95% confidence interval (CI) 3.5 to 15) at one year, 13.8% (95% CI 7.6 to 22) at two years, and 19.7% (95% CI 12 to 28.6) at five and ten years of follow-up. A femoral bone defect worse than Paprosky IIIA (hazard ratio (HR) 13.58 (95% CI 4.86 to 37.93); p < 0.001) and obesity (BMI ≥ 30 kg/m2; HR 3.88 (95% CI 1.49 to 10.09); p = 0.005) were significantly associated with septic failure. Instability and periprosthetic fracture were the most common reasons for mechanical failure (5.7% and 4.5%, respectively). The cumulative incidence of aseptic failure was 2% (95% CI 0.4 to 7) at two years, 9% (95% CI 4 to 17) at five years, and 12% (95% CI 5 to 22) at ten years. A previous revision to treat PJI was significantly associated with non-septic failure (HR 9.93 (95% CI 1.77 to 55.46); p = 0.009). At the five-year timepoint, 93% of the patients were alive (95% CI 84% to 96%), which fell to 86% (95% CI 75% to 92%) at ten-year follow-up. Conclusion Massive femoral bone loss was associated with greater chances of developing a further septic failure. All septic failures occurred within the first five years following the one-stage exchange. Surgeons should be aware of instability and periprosthetic fracture being potential causes of further aseptic revision surgery. Cite this article: Bone Joint J 2021;103-B(7):1247–1253.

Sign in / Sign up

Export Citation Format

Share Document