Outcomes of revision arthroplasty for shoulder periprosthetic joint infection: a three-stage revision protocol

Aims The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. Methods A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. Results We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. Conclusion Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.

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Value of mNGS in sonication fluid for the diagnosis of periprosthetic joint infection

Arthroplasty ◽

10.1186/s42836-019-0006-4 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Chongjing Zhang ◽

Xinyu Fang ◽

Zida Huang ◽

Wenbo Li ◽

Chao-fan Zhang ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Pathogenic Microorganisms ◽

Musculoskeletal Infection ◽

Conventional Culture ◽

Culture Positive ◽

Positive Results ◽

Aseptic Failure ◽

Fluid Culture

Abstract Objective To evaluate the effectiveness of metagenomics next-generation sequencing (mNGS) for the detection of pathogenic microorganisms in periprosthetic joint infection (PJI) using the sonication fluid from removed prosthesis. Methods In this prospective diagnostic cohort study, 44 patients who underwent revision arthroplasty in our hospital from December 2016 to December 2018 were screened. Seven cases were excluded due to incomplete clinical data, insufficient synovial fluid or failure of sequencing. According to the PJI diagnostic criteria recommended by the Musculoskeletal Infection Society (MSIS), the patients were defined as PJI or aseptic failure (AF). Conventional culture, sonication fluid culture and mNGS were performed, in order to assess the value of mNGS using sonication fluid for the diagnosis of PJI, and the mNGS results were analyzed and compared with the conventional and sonication fluid culture. Results Among the 37 patients, 24 were diagnosed with PJI (64.86%), while 13 were diagnosed with aseptic failure. Among the 24 patients diagnosed with PJI, 15 cases (62.5%), 17 cases (70.8%) and 24 cases (100%) yielded positive results in conventional culture, sonication fluid culture and mNGS, respectively. In addition, mNGS detected the same pathogenic microorganisms in 16 out of the 17 (94.12%) culture-positive (conventional + sonication fluid) PJI cases. In the only one discrepancy case, Enterococcus faecalis was identified in the cultures, while Enterobacter cloacae was detected by mNGS. In the AF group, the results of the conventional culture were all negative. Nevertheless, Staphylococcus epidermidis was detected in the sonication fluid culture and mNGS in one case. The diagnostic sensitivity of mNGS for PJI was 100%, which was significantly higher than 70.83% (P = 0.039) of the sonication fluid culture and 62.5% (P = 0.021) of the conventional culture. The diagnostic specificity of mNGS for PJI was 92.31%, which was not significantly different (P > 0.05) from those of the conventional culture (100%) and sonication fluid culture (92.31%). Conclusion We demonstrated that mNGS using sonication fluid can improve the detection rate of pathogenic microorganisms and provide valuable information for the diagnosis of PJI. In addition, mNGS can effectively identify pathogenic microorganisms in culture-negative PJIs cases, especially for the cases who have been treated with antibiotics before sample acquisition or have fastidious microorganisms. Therefore, this method can potentially help to guide the clinical use of antibiotics.

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The direct anterior approach: treating periprosthetic joint infection of the hip using two-stage revision arthroplasty

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-019-03317-1 ◽

2019 ◽

Vol 140 (2) ◽

pp. 255-262 ◽

Cited By ~ 1

Author(s):

Martin Thaler ◽

Ricarda Lechner ◽

Dietmar Dammerer ◽

Hermann Leitner ◽

Ismail Khosravi ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Anterior Approach ◽

Joint Infection ◽

Revision Arthroplasty ◽

Direct Anterior Approach ◽

Two Stage

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Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

World Journal of Orthopedics ◽

10.5312/wjo.v10.i10.340 ◽

2019 ◽

Vol 10 (10) ◽

pp. 340-347

Author(s):

Ewout S Veltman ◽

Dirk Jan F Moojen ◽

Marc L van Ogtrop ◽

Rudolf W Poolman

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Two Stage

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Serum D-Lactate, a Novel Serological Biomarker, Is Promising for the Diagnosis of Periprosthetic Joint Infection

10.21203/rs.3.rs-1216974/v1 ◽

2022 ◽

Author(s):

Yanyang Chen ◽

Huhu Wang ◽

Xiyao Chen ◽

Hairong Ma ◽

Jingjie Zheng ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Operating Characteristic ◽

Point Of Care ◽

Joint Infection ◽

Revision Arthroplasty ◽

Roc Curves ◽

Serological Screening ◽

Musculoskeletal Infection ◽

Highly Sensitive ◽

Diagnostic Values

Abstract Background: Although many markers are used for diagnosis of periprosthetic joint infection (PJI), serological screening and diagnosis for PJI are still challenging. We evaluated the performance of serum D-lactate and compared it with ESR, coagulation-related biomarkers and synovial D-lactate for the diagnosis of PJI.Methods: Consecutive patients with preoperative blood and intraoperative joint aspiration of a prosthetic hip or knee joint before revision arthroplasty were prospectively included. The diagnosis of PJI was based on the criteria of the Musculoskeletal Infection Society, and the diagnostic values of markers were estimated based on receiver operating characteristic (ROC) curves by maximizing sensitivity and specificity using optimal cutoff values.Results: Of 52 patients, 26 (50%) were diagnosed with PJI, and 26 (50%) were diagnosed with aseptic failure. ROC curves showed that serum D-lactate, fibrinogen (FIB) and ESR had equal areas under the curve (AUCs) of 0.80, followed by D-dimer and fibrin degradation product, which had AUCs of 0.67 and 0.69, respectively. Serum D-lactate had the highest sensitivity of 88.46% at the optimal threshold of 1.14 mmol/L, followed by FIB and ESR, with sensitivities of 80.77% and 73.08%, respectively, while there were no significant differences in specificity (73.08%, 73.08% and 76.92%, respectively). Conclusion: Serum D-lactate showed similar performance to FIB and ESR for diagnosis of PJI. The advantages of serum D-lactate are pathogen-specific, highly sensitive, minimally invasive and rapidly available making serum D-lactate useful as a point-of-care screening test for PJI.

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Two-stage revision arthroplasty for Mycobacterium Tuberculosis periprosthetic joint infection: An outcome analysis

PLoS ONE ◽

10.1371/journal.pone.0203585 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0203585 ◽

Cited By ~ 5

Author(s):

Chih-Hsiang Chang ◽

Chih-Chien Hu ◽

Yuhan Chang ◽

Pang-Hsin Hsieh ◽

Hsin-Nung Shih ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Outcome Analysis ◽

Two Stage

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Neutrophil-Lymphocyte Ratio as A Complementary Biomarker of Periprosthetic Joint Infection: A Retrospective Review

10.21203/rs.3.rs-26625/v1 ◽

2020 ◽

Author(s):

Yongyu Ye ◽

Minghui Gu ◽

Weishen Chen ◽

Guoyan Xian ◽

Linli Zheng ◽

...

Keyword(s):

Roc Curve ◽

Periprosthetic Joint Infection ◽

Diagnostic Performance ◽

Joint Infection ◽

Revision Arthroplasty ◽

Diagnostic Odds Ratio ◽

Bivariate Analysis ◽

Roc Curve Analysis ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio

Abstract Background: Diagnosing a periprosthetic joint infection (PJI) is challenging. No single biomarker can accurately recognize PJI preoperatively in a timely manner. Therefore, the aim of the present study was to investigate the usefulness of the neutrophil-lymphocyte ratio (NLR) in aiding the diagnosis of PJI.Methods: We retrospectively evaluated the medical records of 109 patients who had undergone revision arthroplasty (77 with aseptic mechanic failure and 32 with PJI) from July 2011 to November 2018. Bivariate analysis followed by multivariate logistic regression was applied to compare NLR between two groups. The receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of NLR alone and in combination with C-reactive protein (CRP) and the erythrocyte sedimentation ratio (ESR).Results: NLR was significantly higher in patients with PJI than in patients of the aseptic revision group (3.12 ± 2.45 vs. 2.10 ± 1.03, p < 0.05). ROC curve analysis revealed that NLR had a sensitivity of 56.25% and a specificity of 80.52% with an optimal threshold of 2.52. The diagnostic performance of NLR alone was inferior to that of CRP and ESR as demonstrated by the area under curve, sensitivity, and diagnostic odds ratio. When used in combination with CRP, the diagnostic performance was nearly equal to the combined performance of CRP and ESR or that of all three biomarkers (p > 0.05).Conclusions: NLR is associated with PJI and could be regarded as a complementary marker, which in combination with CRP could improve the diagnostic performance for PJI.

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