scholarly journals Diagnosis and management of infected arthroplasty

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 54
Author(s):  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Carlos A. Higuera
Keyword(s):  
Joint Infection ◽  
Treatment Options ◽  
Clinical Situation ◽  
The United States ◽  
Sinus Tract ◽  
Two Stage ◽  
International Consensus ◽  
Musculoskeletal Infection ◽  
One Stage ◽  
Exchange Arthroplasty

Periprosthetic joint infection (PJI) is one of the most dreadful complications after THA and TKA. Though prevention is of utmost importance in PJI management, the last decade has seen many remarkable developments in PJI diagnosis, including the introduction of several standardized PJI diagnostic definitions and biomarkers. Depending on the specific clinical situation, a myriad of treatment options for PJI are offered. Our review aims to summarize the pertinent information on PJI diagnosis and synthesize literature on the different treatment methods currently used in clinical practice. One of the most accepted PJI diagnostic definitions was developed by the Musculoskeletal Infection Society (MSIS) in 2011, later modified in the 2013 International Consensus Meeting (ICM). After promising results from studies, alpha-defensins and D-dimer were recently incorporated into the 2018 ICM PJI definition. The management choices for PJI include irrigation and debridement (DAIR), one-stage exchange arthroplasty, or two-stage exchange arthroplasty, to name a few. While two-stage revision has traditionally been the treatment of choice in the United States, there has been a growing body of evidence framing one-stage revision as a comparable choice. One-stage revision should be offered in patients meeting strict selection criteria: no sinus tract, proper soft tissue available for wound closure, appropriate bone stock, a favorable identifiable organism with encouraging antibiotic sensitivities (for cement and oral suppression later), and robust immunological status. DAIR can be considered in case of early infections with sensitive infecting organisms. Patients with multiple unsuccessful revisions or those who refuse further surgical intervention for PJI can be offered antibiotic suppression. If nothing seems to work, salvage procedures (resection arthroplasty and arthrodesis) are available as a last resort. Further research is encouraged to improve on diagnostic capabilities and develop evidence on the best treatment of choice for PJI.

The treatment of periprosthetic joint infection: safety and efficacy of two stage versus one stage exchange arthroplasty

2020 ◽  
Vol 17 (3) ◽  
pp. 245-252 ◽  
Author(s):  
Joseph R. Palmer ◽  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Jorge Manrique ◽  
Aldo M. Riesgo ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Stage Versus ◽  
Two Stage ◽  
Safety And Efficacy ◽  
One Stage ◽  
Exchange Arthroplasty

Complications in the treatment of prosthetic joint infection

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 145-150 ◽  
Author(s):  
Molly A. Hartzler ◽  
Katherine Li ◽  
Michael B. Geary ◽  
Susan Marie Odum ◽  
Bryan D. Springer
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Definitive Treatment ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint ◽  
Definition Of Success ◽  
One Year ◽  
Definition Of

Aims Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. Methods We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. Results Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. Conclusion Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145–150.

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 ◽  
Author(s):  
Katrin Osmanski-Zenk ◽  
Annett Klinder ◽  
Christina Rimke ◽  
Dieter C. Wirtz ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Clear Trend ◽  
One Stage ◽  
Revision Arthroplasties ◽  
Therapeutic Algorithms

Abstract Background Since there are no national or international algorithms there are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI). Therefore, the present paper evaluates the respective protocols from different centres on the basis of an EndoCert questionnaire to treat PJI in certified total joint replacement centres (EPZ).Materials and methodsA questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the principles to treat septic revision arthroplasties in EPZ including questions on various treatment options: prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and sampling prior to reimplantation. All certified EPZ were included (n = 504). The results of the current survey 2020 were compared to those of a previous analysis.ResultsThe number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery has clearly decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option has increased (hip: +6.3%; knee: +6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the interval between prosthesis removal and reimplantation for two-stage replacement for both, hip and knee revisions. Amongst centres with a higher number of revision surgeries (>200 revisions/year), there were even more that opted for the 4-8 week period (92.3%). The Girdlestone situation, but also metal-based spacers with/without reinforcement with antibiotic-containing cement, are less frequently used. When exchanging knee replacements, there was a clear trend towards cemented anchoring, whereas cementless anchorage was preferred for hip replacements. Overall, the number of EPZ with a standardised protocol for the procedure continues to increase. In addition, more samples for microbiological testing are taken when removing the endoprosthesis, 72% of the centres take 5 or more samples.ConclusionWhile 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 Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections

2016 ◽  
Vol 10 (1) ◽  
pp. 646-653 ◽  
Author(s):  
Manny Nguyen ◽  
Mohamed Sukeik ◽  
Akos Zahar ◽  
Ikram Nizam ◽  
Fares Sami Haddad
Keyword(s):  
Current Literature ◽  
Joint Infection ◽  
Surgical Techniques ◽  
Infection Rates ◽  
Two Stage ◽  
Joint Replacement Surgery ◽  
One Stage ◽  
Exchange Arthroplasty ◽  
Functional Scores ◽  
Knee Replacements

Background: Periprosthetic joint infection (PJI) is a devastating complication of joint replacement surgery. In an aging population of the developed world, the increasing numbers of hip and knee replacements will inevitably lead to increasing incidence of PJI, carrying with (it) significant patient morbidity and cost to the health care system. Two-stage exchange arthroplasty is currently the gold standard but it is associated with multiple operations, prolonged hospitalization and impaired functionality. One-stage exchange arthroplasty is similar to the two-stage procedure but the interval between removal of the prosthesis and reimplantation of a new one is only a few minutes. It has the theoretical benefits of a single anesthetic, shorter hospitalization, less cost and improved function. Methods: We reviewed the current literature regarding the outcomes of one-stage exchange arthroplasties focusing on re-infection rates and functional outcomes. Results: Current themes around the one-stage exchange procedure include the indications for the procedure, definition of re-infection, surgical techniques used to provide fixation and differences in approach for hip and knee replacements. Conclusion: The current literature on one-stage exchange procedure is promising, with comparable results to two-stage revisions for hips and knees in selected patients. However, there is a great need for a large multi-centred randomized control trial, focusing on re-infection rates and functional scores postoperatively, to provide concrete guidelines in managing this complex condition.

Repeat two-stage exchange arthroplasty for prosthetic hip re-infection

2018 ◽  
Vol 100-B (9) ◽  
pp. 1157-1161 ◽  
Author(s):  
T. S. Brown ◽  
K. A. Fehring ◽  
M. Ollivier ◽  
T. M. Mabry ◽  
A. D. Hanssen ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Recurrent Infection ◽  
High Rate ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Exchange Arthroplasty ◽  
Prosthetic Joint

Aims Recurrent infection following two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) is a devastating complication. The purpose of this study was to report the survival of repeat two-stage revision hip arthroplasty, describe complications, and identify risk factors for failure. Patients and Methods We retrospectively identified 19 hips (19 patients) that had undergone repeat two-stage revision THA for infection between 2000 to 2013. There were seven female patients (37%) and the mean age was 60 years (30 to 85). Survival free from revision was assessed via Kaplan–Meier analysis. The patients were classified according to the Musculoskeletal Infection Society (MSIS) system, and risk factors for failure were identified. Mean follow-up was four years (2 to 11). Results Gram-positive bacteria were responsible for 16/17 (94%) of the re-infections where microbes were identified. Following the repeat two-stage exchange arthroplasty, survival free from any revision was 74% (95% confidence interval (CI) 56% to 96%, 14 at risk) at two years and 45% (95% CI 25% to 75%, five at risk) at five years. Failure to control infection resulted in re-operation or revision in 42%A of patients (8/19). Survival free from revision was not dependent on host grade. Conclusion Re-infection after two-stage exchange hip arthroplasty for PJI presents a challenging scenario. Repeat two-stage exchange arthroplasty has a low survival free from revision at five years (45%) and a high rate of re-infection (42%). Cite this article: Bone Joint J 2018;100-B:1157–61.

scholarly journals Low frequency of local findings in periprosthetic hip infection caused by low-virulent bacteria compared to periprosthetic knee infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takashi Imagama ◽  
Kazushige Seki ◽  
Toshihiro Seki ◽  
Yuta Matsuki ◽  
Kazuhiro Yamazaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Potential Risk ◽  
Bacterial Species ◽  
Joint Infection ◽  
Sinus Tract ◽  
Musculoskeletal Infection ◽  
Knee Infection ◽  
Hip Infection ◽  
Potential Risk Factors ◽  
Periprosthetic Knee Infection

AbstractPeriprosthetic joint infection (PJI) is suspected when local findings such as pain, swelling, hyperthermia, and sinus tract are present. However, the frequency of these findings and the difference between hip and knee are unclear. This study compared the positive rates of local findings in periprosthetic hip infection (PHI) with periprosthetic knee infection (PKI), and aimed to identify potential risk factors associated with the frequency. One hundred one PJI (46 hips and 55 knees) fulfilled the 2018 Musculoskeletal infection society criteria were analysed retrospectively to assess the positive rates of each local finding. Patients were categorized into two groups based on the presence or absence of each local finding, and the influence of two potential risk factors [body mass index (BMI) and C-reactive protein (CRP)] was investigated. Causative bacterial species were divided into high and low-virulent groups, and then culture negative cases were included in low-virulent group. PHI had significantly lower rates of pain, swelling and hyperthermia compared to PKI. Overall, up to one-third of PHI had pain as only symptom. High BMI and low-virulent bacteria were associated with lower frequency of swelling and hyperthermia in PHI. CRP had no impact on positive rates of local findings. PHI was oligosymptomatic in a significant percentage of cases. This is particularly important in obese patients and infection by low-virulent bacteria.

Two-Stage Exchange Arthroplasty Is a Favorable Treatment Option Upon Diagnosis of a Fungal Periprosthetic Joint Infection

2018 ◽  
Vol 33 (11) ◽  
pp. 3555-3560 ◽  
Author(s):  
Feng-Chih Kuo ◽  
Karan Goswami ◽  
Noam Shohat ◽  
Kier Blevins ◽  
Alexander J. Rondon ◽  
...  
Keyword(s):  
Treatment Option ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Two Stage ◽  
Exchange Arthroplasty

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

2020 ◽  
Vol 7 ◽  
Author(s):  
Simon Marmor ◽  
Younes Kerroumi ◽  
Vanina Meyssonnier ◽  
Luc Lhotellier ◽  
Antoine Mouton ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Effective Strategy ◽  
One Stage ◽  
Exchange Arthroplasty
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