scholarly journals Self-Resolution of a Draining Sinus Tract in a Patient with Chronic Periprosthetic Hip Infection

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Trevor J. Shelton ◽  
Alton W. Skaggs ◽  
Gavin C. Pereira
Keyword(s):  
Total Hip Arthroplasty ◽  
Consensus Statement ◽  
Joint Infection ◽  
Sinus Tract ◽  
Suppressive Therapy ◽  
Musculoskeletal Infection ◽  
Full Resolution ◽  
Prosthetic Joint ◽  
Hip Infection ◽  
Minor Criteria

We report a novel case of a patient who had a draining sinus soon after a total hip arthroplasty that spontaneously resolved. The patient voluntarily discontinued antibiotic suppressive therapy (AST) after 10 years of treatment and paradoxically experienced full resolution of signs of chronic prosthetic joint infection (PJI), including recovery of his left-sided draining sinus tract. Now 8 years after discontinuing AST, the patient has no pain, good function, and no major or minor criteria of joint infection according to the Musculoskeletal Infection Society (MSIS) workgroup. The authors have not identified literature describing a similar resolution of draining sinus tracts from around a prosthetic joint after discontinuing AST. Despite the resolution of this patient’s sinus tract, the authors do not advocate for discontinuing AST in patients with a draining sinus tract. However, in spite of the fact that the MSIS consensus statement suggests that a draining sinus is a sure sign of PJI and that the assumption is that the infection will not go away until explant, this case was different.

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.

scholarly journals State-of-the-art diagnosis and surgical treatment of acute peri-prosthetic joint infection following primary total hip arthroplasty

2018 ◽  
Vol 3 (7) ◽  
pp. 434-441 ◽  
Author(s):  
Pablo A. Slullitel ◽  
José I. Oñativia ◽  
Martin A. Buttaro ◽  
Marisa L. Sánchez ◽  
Fernando Comba ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Musculoskeletal Infection ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Highly Correlated

Acute peri-prosthetic joint infection (PJI) following total hip arthroplasty (THA) is a potentially devastating and undesired complication, with a prevalence of 0.3% to 2.9%. Its suspicion begins with a meticulous physical examination and anamnesis. Diagnosis should be made on the basis of the Musculoskeletal Infection Society criteria. Serum and synovial biomarkers are very useful tools when major criteria are absent. Although sometimes not possible due to medical conditions, surgery is usually the first line of treatment. Although its outcome is highly correlated with the isolated microorganism, irrigation and debridement with implant retention (DAIR) is the gold standard for treatment. Ideally, the prior approach should be proximally and distally extended to augment the field of view and remove all of the prosthetic modular components, that is, femoral head and acetabular insert. Given DAIR’s unclear control of infection, with successful outcomes in the range of 30% to 95%, one- or two-stage revision protocols may play a role in certain cases of acute infections; nonetheless, further prospective, randomized studies are necessary to compare long-term outcomes between DAIR and revision surgeries. Following surgical treatment, length of antibiotherapy is in the range of six weeks to six months, without any difference in outcomes between short and long protocols. Treatment should be adjusted to the isolated bacteria and controlled further with post-operative serum biomarker levels.Cite this article: EFORT Open Rev 2018;3:434-441. DOI: 10.1302/2058-5241.3.170032

ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 187-192
Author(s):  
Jared A. Warren ◽  
Oliver Scotting ◽  
Hiba K. Anis ◽  
James Bircher ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Musculoskeletal Infection ◽  
Hip Hemiarthroplasty ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
Prosthetic Joint ◽  
The Mean

AbstractDiagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

scholarly journals Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

2020 ◽  
Vol 9 (9) ◽  
pp. 2917
Author(s):  
Thomas Ackmann ◽  
Burkhard Möllenbeck ◽  
Georg Gosheger ◽  
Jan Schwarze ◽  
Tom Schmidt-Braekling ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Preoperative Assessment ◽  
Diagnostic Value ◽  
Musculoskeletal Infection ◽  
Prosthetic Joint ◽  
The Individual ◽  
Low Sensitivity ◽  
D Dimer

Introduction: D-dimer is a diagnostic criterion for periprosthetic joint infection (PJI) of the Musculoskeletal Infection Society (MSIS) in 2018. The aim of this study was to evaluate the serum D-dimer values in comparison to C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of PJI. Materials and Methods: We included 119 patients (50 women, 69 men; 71 knees, 48 hips) undergoing revision arthroplasty with preoperative assessment of CRP, IL-6, and serum D-dimer. Cases were classified as infected or aseptic based on the MSIS criteria of 2018. Receiver operating curves and Youden’s index were used to define an ideal cut-off value and sensitivity and specificity for the individual parameters, and respective combinations were calculated using cross-tables. Results: The median D-dimer level (2320 vs. 1105 ng/mL; p < 0.001), the median CRP level (4.0 vs. 0.5 mg/dL; p < 0.001), and the median IL-6 level (21.0 vs. 5.0 pg/mL; p < 0.001) were significantly higher in the group of PJI compared to the group with aseptic failure. The calculated optimal cut-off values were 2750 ng/mL (AUC 0.767) for D-dimer, 1.2 mg/dL (AUC 0.914) for CRP, and 10.0 pg/mL (AUC 0.849) for IL-6. D-dimer showed a sensitivity of 38% and specificity of 94%, whereas the CRP and IL-6 had sensitivities of 88% and 76%, and specificities of 87% and 92%, respectively. Conclusion: In comparison with CRP and IL-6, serum D-dimer showed low sensitivity and specificity in our cohort. While CRP and IL-6 combination had the highest sensitivity, a combination of Il-6 and D-dimer or CRP and IL-6 had the highest specificity.

scholarly journals 392. Epidemiology and Treatment Outcome of Gram-Negative Polymicrobial, Gram-Positive Polymicrobial and Mixed Polymicrobial Prosthetic Joint Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S202-S202 ◽  
Author(s):  
Babak Hooshmand ◽  
Dima Youssef ◽  
Kathleen M Riederer ◽  
Susan M Szpunar ◽  
Meredith M Coyle ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Joint Infection ◽  
Suppressive Therapy ◽  
Two Stage ◽  
Gram Positive ◽  
Gram Negative ◽  
Presenting Symptoms ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Prosthesis Removal

Abstract Background Polymicrobial prosthetic joint infections (PMPJIs) are rare but treatment is usually challenging. Published studies described the PMPJIs without differentiating the component pathogens. We assessed clinical features and treatment outcome among Gram-negative polymicrobial (GNPM), Gram-positive polymicrobial (GPPM) and mixed polymicrobial (MPM) PJIs. Methods A retrospective cohort was studied at three Ascension hospitals in Detroit from January 2012 to December 2018. Cases were identified using the International Classification of Diseases, 9th and 10th Revision code specific for PJIs. Patient’s electronic medical records were reviewed. Results 38 patients with PMPJI with a mean age of 67 years. were identified. 71% patients were female and caucasians. Nineteen (50%) patients had MPM, 16 (42%) had GPPM and 3 had GNPM. Among MPM PJIs, 14 (74%) involved hips, 4 (21%) knee and 1 (5%) ankle joint. Among GPPM PJIs, 7 (44%) involved hips, 8 (50%) knee and 1 (6%) shoulder joints. Among GNPM PJIs, 1 (33%) involved hip and 2 (67%) involved knee joints. 4 (21%), 1 (6%), and 1 (33%) patients had diabetes among MPM, GPPM and GNPM, respectively. Symptom onset of less than a week was noted in 13 (68%), 5 (31%), 3(100%) and of more than 3 weeks in 3 (16%), 7 (43%) and in 0 among MPM, GPPM and GNPM, respectively. 18 (95%), 12 (75%) and 2 (67%) patients presented with pain; 16 (84%), 6 (38%) and 3 (100%) patients had drainage among MPM, GPPM and GNPM, respectively. Among MPM PJIs, 12 (63%) underwent debridement, antibiotics and implant retention (DAIR), 2 (11%) for two stage exchange, 4 (21%) for chronic suppressive therapy and 1 (5%) had an amputation. 6 (58%) were readmitted within 6 months; 3 (50%) required prosthesis removal, 1 (4%) each died, was made hospice and was lost to follow-up. Among GPPM PJIs, 12 (75%) underwent DAIR and 4 (25%) went for two stage exchange. 9 (69%) patients among GPPM PJIs were readmitted in 6 months and 3 (50%) required prosthesis removal. All 3 of GNPM PJIs underwent DAIR and none were readmitted in 6 months. Conclusion Pain and drainage were common presenting symptoms. All GNPM PJIs presented within 1 week of symptoms and were treated successfully with DAIR. MPM and GPPM PJIs had high readmission rates and 6/26 (23%) managed with DAIR required prosthesis removal. Disclosures All authors: No reported disclosures.

scholarly journals First results of a uniform regional treatment protocol and registration for acute prosthetic join infection in the South-East of the Netherlands

2019 ◽  
Vol 4 (3) ◽  
pp. 133-139 ◽  
Author(s):  
Maud C. Kamp ◽  
Robin W.T.M. van ◽  
Loes Janssen ◽  
M.C. (Marieke) van
Keyword(s):  
Joint Infection ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
The South ◽  
Musculoskeletal Infection ◽  
Regional Collaboration ◽  
Prosthesis Retention ◽  
Prosthetic Joint ◽  
Definition Of ◽  
Regional Treatment

Abstract. Introduction: Prosthetic joint infection (PJI) is a relatively uncommon (average incidence 0.5-2%) but devastating complication, with significant morbidity and leading to tremendously increased health care costs. In 2013, delegates from nine hospitals covering a large region in the South-East Netherlands composed one combined treatment protocol for acute PJI of total hip and knee arthroplasty (THA and TKA). This protocol was based on the definition of acute PJI according to Workgroup of the American Musculoskeletal Infection Society (MSIS) and the principles of debridement, antibiotics, irrigation and retention (DAIR).Methods: Patients with a THA or TKA treated with DAIR because of suspicion of PJI were selected from the online PJI database. PJI was defined as at least two phenotypically identical pathogens, isolated in cultures from at least two separate tissues, obtained from the affected prosthetic joint. Acute PJIs, occurring within 90 days after primary implantation, between January 2014 and December 2016, were analyzed. We analyzed the PJI incidence rate, patient clinical and microbiological characteristics of PJI, outcome of the DAIR treatment and adherence to the regional protocol.Results: A total of 310 primary THA or TKA with a suspected PJI were registered in the regional PJI database, 236 met the definition of acute PJI, representing overall incidence of 1.12%. Following the regional treatment protocol replacement of exchangeable parts took place in 45% in 2014 to 70% in 2016. After 12 months follow-up, prosthesis retention was achieved in 87% and 3% of the patients died within one year after the primary surgery.Conclusion: Results of the regional cohort are in line with the available literature. Regional collaboration and regular feedback on registered data resulted in better adherence to the combined treatment protocol. Despite our attempts to improve PJI care, PJI remains a serious complication of THA and TKA with a significant mortality rate and burden for the patient.

scholarly journals Successful Treatment of a Prosthetic Joint Infection due toMycobacterium abscessus

2009 ◽  
Vol 20 (3) ◽  
pp. e94-e96 ◽  
Author(s):  
Andrew Petrosoniak ◽  
Paul Kim ◽  
Marc Desjardins ◽  
B Craig Lee
Keyword(s):  
Total Hip Arthroplasty ◽  
Antibacterial Therapy ◽  
Hip Arthroplasty ◽  
Successful Treatment ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Mycobacterium Abscessus ◽  
Successful Outcome ◽  
Prosthetic Joint ◽  
Microbiological Cure

Prosthetic joint infection due toMycobacterium abscessusis uncommon and optimal therapy remains poorly defined. Following a two-stage revision, clinical and microbiological cure was achieved in a patient with aM abscessus-infected total hip arthroplasty. A prolonged course of directed antibacterial therapy comprising clarithromycin and cefoxitin coupled with the application of amikacin-impregnated cement likely contributed to the successful outcome.

scholarly journals Increasing risk of prosthetic joint infection after total hip arthroplasty

2012 ◽  
Vol 83 (5) ◽  
pp. 449-458 ◽  
Author(s):  
Håvard Dale ◽  
Anne M Fenstad ◽  
Geir Hallan ◽  
Leif I Havelin ◽  
Ove Furnes ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Increasing Risk
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