External validation study of hip peri-prosthetic joint infection with cemented custom-made articulating spacer (CUMARS)

2020 ◽  
pp. 112070002096066 ◽  
Author(s):  
Jonathan Quayle ◽  
Ahmed Barakat ◽  
Antonio Klasan ◽  
Aaina Mittal ◽  
Philip Stott
Keyword(s):  
Prosthetic Joint Infection ◽  
Weight Bearing ◽  
Joint Infection ◽  
External Validation ◽  
Prosthetic Joint ◽  
Articulating Spacer ◽  
Custom Made ◽  
Eradication Of Infection ◽  
Lost To Follow Up

Introduction: Peri-prosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The use of custom-made articulating spacers (CUMARS) has been described for use in the first of 2-stage treatment. We report our outcomes of managing PJI using CUMARS. Methods: Patients undergoing 1st-stage revision using the Exeter standard stem, all-polyethylene acetabulum and antibiotic-loaded cement were identified. Medical records were assessed for demographics, microbiological and operative treatment, complications, eradication of infection and reoperations. No postoperative restrictions were enforced. 2nd-stage revision was undertaken in the presence of pain or subsidence. Results: 53 patients underwent 1st-stage revision using this technique. The average follow-up was 3.9 (range 0.5–7.2) years. Infection was eradicated in 47 (88.7%) patients. 2 patients had chronic infection managed with suppressive antibiotics, 2 patients died before eradication confirmed, 1 patient had raised inflammatory markers but no positive aspiration cultures, 1 patient was lost to follow-up. Complications occurred in 5 (9.4%) patients – 4 dislocations and 1 infected haematoma. 4 patients required a repeated 1st stage. 2nd-stage revision was performed in 19 patients (35%). Conclusions: The CUMARS technique is an effective way of eradicating PJI after THA. It maintains function by providing a stable construct that permits weight-bearing. It delays or negates the need for 2nd-stage revision. Furthermore, it allows surgeons to choose between managing patients prospectively as a single-stage revision with the option of reverting to a 2nd stage.

scholarly journals Management of peri-prosthetic joint infection and severe bone loss after total hip arthroplasty using a long-stemmed cemented custom-made articulating spacer (CUMARS)

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
J. Quayle ◽  
A. Barakat ◽  
A. Klasan ◽  
A. Mittal ◽  
G. Chan ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Femoral Stem ◽  
Leg Length ◽  
Prosthetic Joint ◽  
Articulating Spacer ◽  
Custom Made ◽  
Femoral Stems ◽  
Tissue Factors

Abstract Background There is little evidence on techniques for management of peri-prosthetic infection (PJI) in the context of severe proximal femoral bone loss. Custom-made articulating spacers (CUMARS) utilising cemented femoral stems as spacers was described providing better bone support and longer survival compared to conventional articulating spacers. We retrospectively report our experience managing PJI by adaptation of this technique using long cemented femoral stems where bone loss precludes use of standard stems. Methods Patients undergoing 1st stage revision for infected primary and revision THA using a cemented long stem (> 205 mm) and standard all-polyethylene acetabulum between 2011 and 2018 were identified. After excluding other causes of revision (fractures or aseptic loosening), Twenty-one patients remained out of total 721 revisions. Medical records were assessed for demographics, initial microbiological and operative treatment, complications, eradication of infection and subsequent operations. 2nd stage revision was undertaken in the presence of pain or subsidence. Results Twenty-one patients underwent 1st stage revision with a cemented long femoral stem. Mean follow up was 3.9 years (range 1.7–7.2). Infection was eradicated in 15 (71.4%) patients. Two patients (9.5%) required repeat 1st stage and subsequently cleared their infection. Three patients (14.3%) had chronic infection and are on long term suppressive antibiotics. One patient (4.8%) was lost to follow up before 2 years. Complications occurred in seven patients (33%) during or after 1st stage revision. Where infection was cleared, 2nd stage revision was undertaken in 12 patients (76.5%) at average of 9 months post 1st stage. Five (23.8%) CUMARS constructs remained in-situ at an average of 3.8 years post-op (range 2.6–5.1). Conclusions Our technique can be used in the most taxing of reconstructive scenarios allowing mobility, local antibiotic delivery, maintenance of leg length and preserves bone and soft tissue, factors not afforded by alternative spacer options.

Outcomes of repeat two-stage exchange hip arthroplasty for prosthetic joint infection

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 110-115 ◽  
Author(s):  
N. Khan ◽  
D. Parmar ◽  
M. S. Ibrahim ◽  
B. Kayani ◽  
F. S. Haddad
Keyword(s):  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Antimicrobial Treatment ◽  
Successful Outcome ◽  
Two Stage ◽  
Persistent Symptoms ◽  
Prosthetic Joint ◽  
Revision Tha

Aims The increasing infection burden after total hip arthroplasty (THA) has seen a rise in the use of two-stage exchange arthroplasty and the use of increasingly powerful antibiotics at the time of this procedure. As a result, there has been an increase in the number of failed two-stage revisions during the past decade. The aim of this study was to clarify the outcome of repeat two-stage revision THA following a failed two-stage exchange due to recurrent prosthetic joint infection (PJI). Patients and Methods We identified 42 patients who underwent a two-stage revision THA having already undergone at least one previous two stage procedure for infection, between 2000 and 2015. There were 23 women and 19 men. Their mean age was 69.3 years (48 to 81). The outcome was analyzed at a minimum follow-up of two years. Results A satisfactory control of infection and successful outcome was seen in 26 patients (57%). There therefore remained persistent symptoms that either required further surgery or chronic antibiotic suppression in 16 patients (38%). One-third of patients had died by the time of two years’ follow-up. Conclusion The rate of failure and complication rate of repeat two-stage exchange THA for PJI is high and new methods of treatment including host optimization, immunomodulation, longer periods between stages, and new and more powerful forms of antimicrobial treatment should be investigated. Cite this article: Bone Joint J 2019;101-B(6 Supple B):110–115.

Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database

2015 ◽  
Vol 36 (10) ◽  
pp. 1198-1207 ◽  
Author(s):  
Leslie Grammatico-Guillon ◽  
Sabine Baron ◽  
Philippe Rosset ◽  
Christophe Gaborit ◽  
Louis Bernard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Public Hospitals ◽  
Prosthetic Material ◽  
Hospital Database ◽  
Prosthetic Joint

BACKGROUNDHip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.OBJECTIVETo assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.METHODSA historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.RESULTSA total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.CONCLUSIONSThe hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.Infect Control Hosp Epidemiol 2015;36(10):1198–1207

scholarly journals Debridement, antibiotics, irrigation, and retention of the prosthesis with antibiotic-impregnated calcium hydroxyapatite in periprosthetic hip joint infection

2021 ◽  
Author(s):  
Hiroki Wakabayashi ◽  
Masahiro Hasegawa ◽  
Yohei Naito ◽  
Shine Tone ◽  
Akihiro Sudo
Keyword(s):  
Joint Infection ◽  
Calcium Hydroxyapatite ◽  
Clinical Results ◽  
Prosthetic Joint ◽  
Component Revision ◽  
Rate Of Success ◽  
Lost To Follow Up ◽  
Surrounding Bone ◽  
Antibiotic Delivery

Abstract Background We have developed antibiotic-impregnated calcium hydroxyapatite (CHA) as a novel antibiotic delivery system. Here, we assessed the clinical results of debridement, antibiotics, irrigation, and retention of the prosthesis (DAIR) with antibiotic-impregnated CHA for the treatment of prosthetic joint-associated infection (PJI) after total hip arthroplasty (THA). Methods Twelve patients (13 hips) treated with DAIR for PJI after THA at our institution between 1997 and 2017 were retrospectively evaluated. The study group included four men (five hips) and eight women, with an average age of 66.1 (range, 56–90) years. Four patients (five hips) had symptoms of infection within less than 3 weeks; however, eight patients had symptoms of infection over 3 weeks. All patients received DAIR with antibiotic-impregnated CHA in the surrounding bone. In one patient, the cup component revision was performed with one-stage re-implantation because of loosening, but the stem component was retained. In nine patients (10 hips), vancomycin hydrochloride was impregnated in the CHA. Results The average duration of follow-up was 8.3 (range, 2.9–18.6) years. No patients were lost to follow-up. Four patients included in this study died of other causes, with an average follow-up of 6.7 (range, 4.0–12.5) years. Intra-operative cultures were positive in 12 hips. Ten of 12 patients (11 of 13 hips) were successfully treated, and no signs of infection were observed at the latest follow-up. In two of 12 patients (two of 13 hips) for whom treatment failed, infection was successfully treated with two-stage re-implantation. Both patients had diabetes mellitus and symptoms of infection over 3 weeks. Eighty-five percent of patients were successfully treated by DAIR with antibiotic-impregnated CHA. No complications were observed with this antibiotic-impregnated CHA. Conclusions DAIR treatment with antibiotic-impregnated CHA produce a higher rate of success in patients with PJI after THA.

scholarly journals Coxiella burnetti prosthetic joint infection in an immunocompromised woman: iterative surgeries, prolonged ofloxacin-rifampin treatment and complex reconstruction were needed for the cure

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Patrick Miailhes ◽  
Anne Conrad ◽  
Chantal Sobas ◽  
Frederic Laurent ◽  
Sebastien Lustig ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Q Fever ◽  
Joint Infection ◽  
Case Presentation ◽  
Recommended Treatment ◽  
Prosthetic Joint ◽  
Chronic Q Fever ◽  
Combined Use ◽  
Tnf Α

Abstract Background Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii, a strictly intracellular pathogen that can cause acute and chronic infection. Chronic Q fever can occur in immunocompetent as well as in immuno-compromised hosts, as a persistent localized infection. The main localizations are endocardial, vascular and, less frequently, osteoarticular. The most frequent osteoarticular form is spondyliscitis. Recommended treatment is combined doxycycline and hydroxychloroquine for 18 months, with cotrimoxazole as another option. Coxiella burnetti infection has been implicated in rare cases of prosthetic joint infection (PJI), and the medical and surgical management and outcome in such cases have been little reported. Case presentation We report an unusual case of chronic Q fever involving a hip arthroplasty in an immunocompromised woman treated with tumor necrosis factor (TNF)-α blockers for rheumatoid arthritis. Numerous surgical procedures (explantation, “second look”, femoral resection and revision by megaprosthesis), modification of the immunosuppressant therapy and switch from doxycycline-hydroxychloroquine to prolonged ofloxacin-rifampin combination therapy were needed to achieve reconstruction and treat the PJI, with a follow-up of 7 years. Conclusions Coxiella burnetti PJI is a complex infection that requires dedicated management in an experienced reference center. Combined use of ofloxacin-rifampin can be effective.

scholarly journals Multiplex Antibody Measurement for Post-treatment Follow-up of Staphylococcal Prosthetic Joint Infection: A Diagnostic Pilot Study

2019 ◽  
Vol 4 (5) ◽  
pp. 227-233
Author(s):  
Thomas BAUER ◽  
Simon MARMOR ◽  
Idir GHOUT ◽  
Elsa SALOMON ◽  
Faten EL SAYED ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Marked Change ◽  
Post Treatment ◽  
Antibody Detection ◽  
Post Surgery ◽  
Prosthetic Joint ◽  
Luminex Technology ◽  
One Year

Abstract. Introduction: Multiplex-antibody detection has been recently proposed for the noninvasive diagnosis of staphylococcal prosthetic joint infection (PJI). We evaluated this approach for the post-treatment follow-up of patients.Methods: Nineteen cases of staphylococcal PJI were prospectively followed for one year after treatment. The IgG response against eight staphylococcal antigens was measured before surgery and one year post-surgery using Luminex technology (Austin, TX, USA); median fluorescence intensity values determined for each antigen were transformed into a “Total Response Index” (TRI).Results: Patients (11 women/8 men) had a mean (SD) age of 72.2 (12.4) years. Site of prosthesis was the knee (n=10), the hip (n=8) and the shoulder (n=1). Ten patients were infected by S. epidermidis, six by S. aureus, and three by S. lugdunensis. TRI values at one year were significantly lower than pre-surgery values (mean [SD]: 5.9 [1.8] versus 8.1 [3.4], p=0.02) and decreased, on average, by 21.2%. TRI values markedly increased in two patients. One patient had a relapse of S. aureus PJI at five months post-surgery, with a 37% increase of the TRI. The other had septic failure three months after revision for S. lugdunensis PJI; all intraoperative samples remained culture-negative, but the TRI increased by 51% and the antibody profile showed a marked change, suggesting a reinfection with another staphylococcal species.Conclusion: Multiplex-antibody measurement may be useful for the follow-up of staphylococcal PJI and may help to detect septic failure involving organisms targeted by the assay.

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