scholarly journals Intra-wound vancomycin powder for the eradication of periprosthetic joint infection after debridement and implant exchange: experimental study in a rat model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Wei ◽  
Kai Tong ◽  
Siqi Zhou ◽  
Hui Wang ◽  
Yinxian Wen ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Serum Levels ◽  
Control Group ◽  
Post Surgery ◽  
Vancomycin Powder ◽  
Mrsa Infection ◽  
Serum Biochemical ◽  
The One

Abstract Background Intra-wound vancomycin powder (VP) has been used in clinical practice to prevent periprosthetic joint infection (PJI) after primary knee/hip arthroplasty. The role of intra-wound VP in the setting of debridement and implant exchange after PJI remains undefined. This study aimed to explore the efficacy and safety of intra-wound VP in the control of methicillin-resistant S. aureus (MRSA) infection after debridement and implant exchange. Methods PJI modeling by knee prosthesis implantation and MRSA inoculation, debridement and implant exchange were performed in Wistar rats successively to mimic the one-stage exchange arthroplasty of PJI patients. Two weeks of systemic vancomycin (SV) or/and intraoperative intra-wound VP of single dosage were applied after revision surgery. Results No post-surgery deaths, incision complications and signs of drug toxicity were observed. The microbial counts of SV or intra-wound VP group were significantly reduced compared with the control group, while bacteria were still detected on the bone, soft-tissue and prosthesis. The elimination of bacterial counts, along with improvement of tissue inflammation and serum inflammatory markers, were observed in the rats with SV plus intra-wound VP. Serum levels of vancomycin in all groups were lower than that of causing nephrotoxicity, while no statistic difference was observed in the serum biochemical marker among the groups. Conclusions Intra-wound VP is effective after debridement and implant exchange in our current rat PJI model. Neither SV nor intra-wound VP alone could eradicate the bacteria within a two-weeks treatment course, while SV plus intra-wound VP could eliminate the MRSA infection, without notable hepatic or renal toxicity and any incision complications.

scholarly journals Effects of dietary fructo-oligosaccharides on laying performance and serum biochemical parameters of yellow broiler breeder hens

2019 ◽  
Vol 131 ◽  
pp. 01081
Author(s):  
Zhao Feng ◽  
Zhongsheng Xia
Keyword(s):  
Serum Levels ◽  
Control Group ◽  
Broiler Breeder ◽  
Breeder Hens ◽  
Dietary Nutrients ◽  
Laying Performance ◽  
Broiler Breeder Hens ◽  
Serum Biochemical ◽  
Biochemical Indices ◽  
Better Than

24-week-old local yellow broiler breeder hens were selected to study the effects of dietary fructo-oligosaccharides(FOS)or antibiotics(bacitracin zinc)on laying performance, serum biochemical indices and dietary mutrient metabolizability. The results showed that: compared with the control group, dietary FOS supplemented with 0.2%, 0.4%, 0.6% could increase the laying rate, average egg weight, feed egg ratio, eggs percent of pass, fertility rate and hatchability of qualified egg, and reduce serum levels of total cholesterol and triglyceride, and improve the apparent metabolizability of dietary nutrients. The effects of diet supplemented with FOS was better than those of diet supplement with 0.05% antibiotics.It was suggested that the appropriate additive amount of FOS in diets for yellow broiler breeder hens should be 0.4%.

scholarly journals Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

2020 ◽  
Vol 9 (10) ◽  
pp. 3349
Author(s):  
Henrik C. Bäcker ◽  
Chia H. Wu ◽  
David Krüger ◽  
Clemens Gwinner ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Control Group ◽  
Total Hip ◽  
Metal On Metal ◽  
Matching Criteria ◽  
The Impact

Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.

scholarly journals Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Jon E. Minter
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Extensor Mechanism ◽  
Physical Constraint ◽  
Total Knee ◽  
Ligamentous Instability ◽  
Revision Tka

BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection.  (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint).  The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented.  We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.

scholarly journals Effectiveness of diluted povidone-iodine lavage for preventing periprosthetic joint infection: an updated systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Naomi Kobayashi ◽  
Emi Kamono ◽  
Kento Maeda ◽  
Toshihiro Misumi ◽  
Yohei Yukizawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Periprosthetic Joint Infection ◽  
Fixed Effects ◽  
Povidone Iodine ◽  
Meta Analysis ◽  
Joint Infection ◽  
Assessment Process ◽  
Cochrane Library ◽  
Saline Control ◽  
Control Group

Abstract Background Of the several methods used to prevent surgical site infection (SSI), diluted povidone-iodine (PI) lavage is used widely. However, the clinical utility of PI for preventing periprosthetic joint infection (PJI) remains controversial. The aim of this study was to perform a systematic review and meta-analysis of the utility of dilute PI lavage for preventing PJI in primary and revision surgery. Methods This study was conducted in accordance with the PRISMA checklist for systematic reviews and meta-analyses. A comprehensive literature search of PubMed, CINAHL, ClinicalTrials.gov, and Cochrane Library databases was performed. The results are summarized qualitatively and as a meta-analysis of pooled odds ratios with 95% confidence intervals (95% CIs). Heterogeneity of treatment effects among studies was classified as low, moderate, or high, corresponding to I2 values of < 25%, 25–50%, and > 50%. A random effects model was applied in cases of high heterogeneity; otherwise, the fixed effects model was applied. Subgroup analyses were conducted to identify potential sources of heterogeneity. Results After the screening and eligibility assessment process, eight studies were finally extracted for analysis. Overall, the results showed that PI had no significant effect on PJI with ununified control group. However, subgroup analysis of studies with a saline control group revealed an odds ratio of 0.33 (95% CI, 0.16–0.71) for the PI group, suggesting a significant effect for preventing PJI. Conclusion The systematic review and meta-analysis of the current literature demonstrates that diluted PI lavage is significantly better than saline solution lavage for preventing PJI. Level of evidence Level I, Systematic review and meta-analysis.

scholarly journals The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing

2021 ◽  
Vol 10 (3) ◽  
pp. 434
Author(s):  
Wen-Chi Su ◽  
Yu-Chin Lai ◽  
Cheng-Hung Lee ◽  
Cheng-Min Shih ◽  
Chao-Ping Chen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Statistical Significance ◽  
Joint Infection ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Skin Preparation ◽  
Total Hip ◽  
Chlorhexidine Bathing

Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA.

scholarly journals Decreased Incidence of Periprosthetic Joint Infection in Total Hip Arthroplasty with Use of Topical Vancomycin

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
David A Crawford ◽  
Keith R Berend ◽  
Joanne B Adams ◽  
Adolph V Lombardi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Anterior Approach ◽  
Joint Infection ◽  
Lateral Approach ◽  
Control Group ◽  
Total Hip ◽  
Joint Infections ◽  
Direct Lateral Approach

Background: Periprosthetic joint infections following total hip arthroplasty (THA) can cause significant patient morbidity and carry with them a substantial cost burden to the healthcare system.  The purpose of this study was to assess whether the addition of topical vancomycin decreased the incidence of superficial and deep infections after primary total hip arthroplasty?    Methods: We performed a retrospective analysis of patients who underwent primary THA with (1070 hips) and without (815 hips) the use of topical vancomycin.  Records were reviewed to determine incidence of PJI. Infections were categorized as deep or superficial. Medical comorbidity data was evaluated for known risk factors including diabetes, rheumatoid arthritis, and BMI. Records were further reviewed to determine surgical approach used and bacterial cause of PJI.    Results: The overall incidence of infection in the control group was 1.47% (12 hips) and significantly decreased to 0.47% (5 hips) with the addition of topical vancomycin (p=0.022). Deep infections also decreased from 0.86% (7 hips) in the control group to 0.09% (1 hip) in the vancomycin group (p=0.011).  There was no difference in BMI or percent of patients with diabetes between groups.       In all patients, regardless of vancomycin use, the incidence of infection in the direct lateral approach was higher (2.04%, 9 hips) than the anterior approach (0.055%, 8 hips)  (p=0.004). Conclusions:  We found a lower incidence of periprosthetic joint infection after THA with the addition of topical vancomycin. We also found a decreased incidence of infection in patients who had surgery through an anterior approach compared with those who had a direct lateral approach.

scholarly journals Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

2020 ◽  
Vol 5 (3) ◽  
pp. 128-132
Author(s):  
Marrit Hoekstra ◽  
Ewout S. Veltman ◽  
Ruben F.R.H.A Nurmohamed ◽  
Bruce van Dijk ◽  
Rob J. Rentenaar ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Sensitivity And Specificity ◽  
Periprosthetic Joint Infection ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Clinical Importance ◽  
Tissue Cultures ◽  
Knee Joint Infection ◽  
Total Knee

Abstract. Background: Diagnosis of periprosthetic joint infection (PJI) can be troublesome. Sonication can be a helpful tool in culturing bacteria that are difficult to detect with standard tissue cultures. Aim of this study is to evaluate the clinical importance of our standardized sonication protocol in detecting periprosthetic joint infection.Materials and methods: All patients with revision surgery of a hip or knee prosthesis between 2011 and 2016 were retrospectively reviewed and divided in two groups: clinically suspected of infection or not suspected of infection. For both tissue culture and implant sonication, calculations of sensitivity and specificity were performed. Clinical relevance of sonication was evaluated by calculating in which percentage of patients' sonication influenced clinical treatment.Results: 226 patients with revision of a total hip prosthesis (122 patients) or a total knee prosthesis (104 patients) were included. Sensitivity of perioperatively taken tissue cultures was 94.3% and specificity was 99.3%. For sonication sensitivity was 80.5% and specificity was 97.8%.In the infection group eight patients (9%) with only one positive tissue culture and a positive sonication fluid culture with the same pathogen were found.Interpretation: Although sensitivity and specificity of sonication was lower compared to tissue cultures, periprosthetic joint infection could only be established in 8 patients (9%) suspected of infection because of a positive result of the sonication fluid culture.Sonication leads to clinically relevant changes in treatment and seems therefore to be a helpful diagnostic tool in clinical practice.

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