scholarly journals Bone and Joint Tissue Penetration of the Staphylococcus-Selective Antibiotic Afabicin in Patients Undergoing Elective Hip Replacement Surgery

2018 ◽  
Vol 63 (3) ◽  
Author(s):  
Annick Menetrey ◽  
Annick Janin ◽  
John Pullman ◽  
J. Scott Overcash ◽  
Amina Haouala ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Soft Tissue ◽  
Synovial Fluid ◽  
Hip Replacement ◽  
Clinical Development ◽  
Efficacy Data ◽  
Content Type ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Joint Infections

ABSTRACT Afabicin (formerly Debio 1450, AFN-1720) is a prodrug of afabicin desphosphono (Debio 1452, AFN-1252), a novel antibiotic in development which targets the staphylococcal enoyl-acyl carrier protein reductase (FabI) and exhibits selective potent antibacterial activity against staphylococcal species, including methicillin-resistant Staphylococcus aureus. As part of clinical development in bone and joint infections, a distribution study in bone was performed in 17 patients who underwent elective hip replacement surgery. Patients received 3 doses of 240 mg afabicin orally (every 12 h) at various time points before surgery. Afabicin desphosphono concentrations were measured by liquid chromatography-tandem mass spectrometry in plasma, cortical bone, cancellous bone, bone marrow, soft tissue, and synovial fluid collected during surgery at 2, 4, 6, or 12 h after the third afabicin dose. The study showed good penetration of afabicin desphosphono into bone tissues, with mean area under the curve ratios for cortical bone-, cancellous bone-, bone marrow-, soft tissue-, and synovial fluid-to-total plasma concentrations of 0.21, 0.40, 0.32, 0.35, and 0.61, respectively. When accounting for the free fraction in plasma (2%) and synovial fluid (9.4%), the mean ratio was 2.88, which is indicative of excellent penetration and which showed that the afabicin desphosphono concentration was beyond the MIC90 of S. aureus over the complete dosing interval. These findings, along with preclinical efficacy data, clinical efficacy data for skin and soft tissue staphylococcal infection, the availability of both intravenous and oral formulations, and potential advantages over broad-spectrum antibiotics for the treatment of staphylococcal bone or joint infections, support the clinical development of afabicin for bone and joint infections. (This study has been registered at ClinicalTrials.gov under identifier NCT02726438.)

scholarly journals Our Experience with Short Stem Hip Replacement Surgery

2016 ◽  
Vol 6 (2) ◽  
Author(s):  
Sumeet Rastogi ◽  
Sanjiv K S Marya
Keyword(s):  
Soft Tissue ◽  
Hip Replacement ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Hip Implant ◽  
Excellent Outcome ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Context-A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips.Materials and methods-50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009). Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw) with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter.Statiscal analysis used-VAS and Harris hip score formed the basis of evaluationResults-These patients were followed up for a mean period of 49 months (Range 36-72 months). The average incision size was 14.38 cm (10-18 cm) and blood loss was 269 ml (175-450 ml). There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 %) had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41) patients had an excellent outcome at last follow-up.Conclusion-We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit initially followed by bone in-growth and was ideally suited to satisfy the requirements of a conservative hip implant. Unfortunately, due to unknown reasons, the implant has been recently withdrawn from the market by DePuy and is no longer available for use.Key MessageConservative hip stems that preserve bone and soft tissue at the time of surgery, prevent femoral stress shielding by circumferential loading, promote positive bone remodeling and help to make revision surgeries easier are ideally suited as hip implants for young active adults with end stage hip disease requiring hip replacement surgery.

Mechanisms of Hypercoagulability

1999 ◽  
Vol 82 (08) ◽  
pp. 902-906 ◽  
Author(s):  
Ola Dahl
Keyword(s):  
Bone Marrow ◽  
Hip Replacement ◽  
Low Molecular Weight ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Vein Thrombosis ◽  
Hip Replacement Surgery ◽  
Heparin Resistance ◽  
Deep Vein ◽  
The Brain

IntroductionPatients undergoing major traumas, major joint replacement surgery, and neurosurgery are at high risk for postoperative deep vein thrombosis (DVT). Even if modern low molecular weight heparin is given as prophylaxis, the frequency of DVT remains high in these patients.1-7 This may indicate that some patients possess a certain “heparin resistance,” due probably due to an overwhelming procoagulant activity and/or because the hypercoagulable state lasts for a longer time than presently assumed. Tissue factor (TF) is the primary cellular initiator of blood coagulation and the most potent trigger of blood clotting known today.8 Adventitia surrounding the major blood vessels, the brain, and the bone marrow are structures with high levels of TF.9 Elective hip replacement surgery, which is a fairly well-standardized procedure that involves a great deal of damage to the bone marrow, is therefore, well-suited as a model to study the mechanisms of hypercoagulability.

scholarly journals Soft-tissue thickness radiographic measurement: a marker to evaluate acute periprosthetic joint infection risk in total hip replacement

2021 ◽  
Vol 6 (6) ◽  
pp. 211-217
Author(s):  
Laura Rey Fernández ◽  
Francesc Angles Crespo ◽  
Silvia María Miguela Álvarez ◽  
Martí Carles Bernaus-Johnson ◽  
Agustí Bartra Ylla ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Joint Infection ◽  
Radiographic Measurement ◽  
Tissue Thickness ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Soft Tissue Thickness

Abstract. The objective of our study was to evaluate the association between acute periprosthetic joint infection (APJI) and radiographic measurement of soft-tissue thickness in elective total hip replacement surgery. A case-control study was conducted to compare the soft-tissue thickness radiographic measurement (SRM) at the hip in patients diagnosed with APJI based on Tsukayama et al. (2003) criteria after total hip replacement with patients that were not infected, at a single institution from 2013 to 2019. To minimize selection bias, each case was matched with two controls using the following methodology: patients of the same sex, with an age variation of ± 5 years, and nearest in surgery date to the cases were selected. All postoperative radiographs were performed in the first 24 h after total hip arthroplasty (THA) surgery as it is protocolized in our institution. Soft-tissue thickness radiographic measurement was defined as the distance from the tip of the greater trochanter to the skin following a perpendicular line to the femoral diaphysis in postoperative anteroposterior hip radiographs. In total, 78 patients were included (26 cases and 52 controls). The SRM median of the cases was 76.19 mm (SD: 26.518) and 53.5 mm (SD: 20.47) in controls. A multivariate logistic regression model showed an independent association between APJI and SRM (odds ratio (OR) = 1.033, 95 % confidence interval (CI) 1.007–1.059, p=0.012). Patients with an SRM greater than 60 mm had a 7-fold increase in the odds of APJI (OR = 7.295, 95 % CI = 2.364–22.511, p<0.001). The results of our study suggest an association between large SRM at the hip and the risk of APJI in patients with primary total hip arthroplasty. SRM may be a helpful and easy tool for evaluating the risk of APJI before elective primary total hip replacement surgery.

scholarly journals Penetration of Daptomycin into Bone and Synovial Fluid in Joint Replacement

2014 ◽  
Vol 58 (7) ◽  
pp. 3991-3996 ◽  
Author(s):  
D. Montange ◽  
F. Berthier ◽  
G. Leclerc ◽  
A. Serre ◽  
L. Jeunet ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Synovial Fluid ◽  
Hip Replacement ◽  
High Performance ◽  
Hplc Method ◽  
Clinical Activity ◽  
Content Type ◽  
Joint Infections ◽  
Bone Fragments ◽  
Single Intravenous Administration

ABSTRACTDaptomycin exhibits clinical activity in the treatment of infections with Gram-positive organisms, including infections due to methicillin-resistantStaphylococcus aureus. However, little is known about its penetration into bone and synovial fluid. The aim of our study was to assess the penetration of daptomycin into bone and synovial fluid after a single intravenous administration. This study was conducted in 16 patients who underwent knee or hip replacement and received a single intravenous dose of 8 mg of daptomycin per kg of body weight prior to surgery. Plasma daptomycin concentrations were measured 1 h after the end of daptomycin infusion and when bone fragments were removed. Daptomycin concentrations were also measured on bone fragments and synovial fluid collected at the same time during surgery. All samples were analyzed with a diode array–high-performance liquid chromatography (HPLC) method. After a single-dose intravenous infusion, bone daptomycin concentrations were above the MIC of daptomycin forStaphylococcus aureusin all subjects, and the median bone penetration percentage was 9.0% (interquartile range [IQR], 4.4 to 11.4). These results support the use of daptomycin in the treatment ofStaphylococcus aureusbone and joint infections.

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