Topical Tranexamic Acid Use in Knee Periprosthetic Joint Infection Is Safe and Effective

Recommendation: Every intra-articular injection of the ankle is an invasive procedure associated with potential healthcare-associated infections, including periprosthetic joint infection (PJI) following total ankle arthroplasty (TAA). Based on the limited current literature, the ideal timing for elective TAA after corticosteroid injection for the symptomatic native ankle joint is unknown. The consensus workgroup recommends that at least 3 months pass after corticosteroid injection and prior to performing TAA. Level of Evidence: Limited. Delegate Vote: Agree: 92%, Disagree: 8%, Abstain: 0% (Super Majority, Strong Consensus)

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Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽

10.3390/diagnostics11030434 ◽

2021 ◽

Vol 11 (3) ◽

pp. 434

Author(s):

Frank Sebastian Fröschen ◽

Sophia Schell ◽

Matthias Dominik Wimmer ◽

Gunnar Thorben Rembert Hischebeth ◽

Hendrik Kohlhof ◽

...

Keyword(s):

Synovial Fluid ◽

Multiple Regression ◽

Complement System ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Expression Patterns ◽

Factor H ◽

Low Grade ◽

Complement Factors ◽

Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

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Periprosthetic Joint Infection after Elbow Arthroplasty

Bone and Joint Infections ◽

10.1002/9781119720676.ch14 ◽

2021 ◽

pp. 231-249

Author(s):

Yvonne Achermann ◽

Michael C. Glanzmann ◽

Christoph Spormann

Keyword(s):

Periprosthetic Joint Infection ◽

Joint Infection ◽

Elbow Arthroplasty

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The bactericidal effect of vancomycin is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro

Scientific Reports ◽

10.1038/s41598-021-90302-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christiane Schwerdt ◽

Eric Röhner ◽

Sabrina Böhle ◽

Benjamin Jacob ◽

Georg Matziolis

Keyword(s):

Staphylococcus Aureus ◽

Tranexamic Acid ◽

Total Joint Arthroplasty ◽

Staphylococcus Epidermidis ◽

Joint Infection ◽

Bactericidal Effect ◽

Joint Arthroplasty ◽

Zone Of Inhibition ◽

Agar Diffusion Test

AbstractOne of the most challenging complications of total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). There is growing evidence of a good anti-infective effect of intrawound vancomycin powder in total joint arthroplasty. At the same time, various different locally applied substances have become popular in total joint arthroplasty. The objective of this study was therefore to investigate a possible inhibition of the bactericidal effect of vancomycin by tranexamic acid, adrenalin, lidocaine, or dexamethasone. The bactericidal effect of vancomycin was quantified using the established method of the agar diffusion test. The plates were incubated with Staphylococcus aureus or Staphylococcus epidermidis and four wells were stamped out. The wells were filled with vancomycin alone, the tested substance alone or a mixture of the two. The fourth well remained empty as a control. The plates were incubated overnight at 37 °C and the zone of inhibition in each field was measured on the next day. All tests were run three times for each pathogen and mean values and standard deviations of the measurements were calculated. Differences between the substances were tested using the t-test at a level of significance of 0.05. The bacterial growth was homogeneous on all plates. The baseline value for the zone of inhibition of vancomycin was on average 6.2 ± 0.4 mm for Staphylococcus aureus and 12 ± 0.3 mm for Staphylococcus epidermidis. In all other substances, no inhibition was detected around the well. The combination of vancomycin and each other substance did not show any different result compared to vancomycin alone. The bactericidal effect of vancomycin on staphylococci is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro.

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