scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - results of a survey within the EndoCert initiative

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet. Methods A survey on the principles of treatment of PJI in Germany was conducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%. Results For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI. Conclusion The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of The Standard Procedure for the Treatment of Periprosthetic Joint Infections (PJI) in Germany - Results of a Survey within the EndoCert Initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Selection Of Patients ◽  
Selection Of

Abstract Background: The PJI is a severe complication in the field of arthroplasty.Despite the rising number of primary joint replacements, no therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use DAIR. A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The rising number of primary joint replacements underlines the importance of developing standards and harmonized definitions for the treatment of PJI. These standards have not yet been fully achieved. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment option in Germany. This summary of principles could serve as a basis for the development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of The Standard Procedure For Treatment of Periprosthetic Joint Infections of Total Knee and Hip Arthroplasty: A Comparison of The 2015 and 2020 Census in Total Joint Replacement Centres in Germany

2021 ◽  
Author(s):  
Katrin Osmanski-Zenk ◽  
Annett Klinder ◽  
Christina Rimke ◽  
Dieter C. Wirtz ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Clear Trend ◽  
One Stage ◽  
Revision Arthroplasties ◽  
Therapeutic Algorithms

Abstract Background Since there are no national or international algorithms there are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI). Therefore, the present paper evaluates the respective protocols from different centres on the basis of an EndoCert questionnaire to treat PJI in certified total joint replacement centres (EPZ).Materials and methodsA questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the principles to treat septic revision arthroplasties in EPZ including questions on various treatment options: prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and sampling prior to reimplantation. All certified EPZ were included (n = 504). The results of the current survey 2020 were compared to those of a previous analysis.ResultsThe number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery has clearly decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option has increased (hip: +6.3%; knee: +6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the interval between prosthesis removal and reimplantation for two-stage replacement for both, hip and knee revisions. Amongst centres with a higher number of revision surgeries (>200 revisions/year), there were even more that opted for the 4-8 week period (92.3%). The Girdlestone situation, but also metal-based spacers with/without reinforcement with antibiotic-containing cement, are less frequently used. When exchanging knee replacements, there was a clear trend towards cemented anchoring, whereas cementless anchorage was preferred for hip replacements. Overall, the number of EPZ with a standardised protocol for the procedure continues to increase. In addition, more samples for microbiological testing are taken when removing the endoprosthesis, 72% of the centres take 5 or more samples.ConclusionWhile there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.

Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection

2021 ◽  
Vol 103-B (8) ◽  
pp. 1373-1379
Author(s):  
Hosam E. Matar ◽  
Benjamin V. Bloch ◽  
Susan E. Snape ◽  
Peter J. James
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Primary Outcome Measure ◽  
Revision Total Knee Arthroplasty ◽  
Single Stage ◽  
Two Stage ◽  
Joint Infections ◽  
Total Knee

Aims Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. Methods A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups. Results A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517). Conclusion Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373–1379.

Prosthetic Joint Infections

2016 ◽  
Author(s):  
David Mabey ◽  
Hasan E. Baydoun ◽  
Jamil D. Bayram
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Joint Infection ◽  
Treatment Options ◽  
Joint Fluid ◽  
Care Providers ◽  
Joint Replacement Surgery ◽  
Fluid Analysis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Prosthetic joint infection (PJI), a complication of joint replacement surgery, presents with fever, joint pain, erythema, effusion, and joint loosening. Many advances have decreased the risk of infection, such as the use of perioperative antimicrobial prophylaxis and intraoperative laminar airflow. Joint fluid analysis should be pursued by the orthopedic surgeons; primary and acute care providers should consult the definitive care team and refer these patients for admission. Organisms causing prosthetic joint infections often grow in biofilms, which make them difficult to treat. Surgical treatment options include one or two-stage prosthesis exchange, debridement with retention of the prosthesis, resection arthroplasty, arthrodesis, or amputation. Antibiotic therapy should be guided by intraoperative cultures and selected in consultation with the infectious disease service.

scholarly journals Pasteurella multocidaNon-Native Joint Infection after a Dog Lick: A Case Report Describing a Complicated Two-Stage Revision and a Comprehensive Review of the Literature

2015 ◽  
Vol 26 (4) ◽  
pp. 212-217 ◽  
Author(s):  
Lam Philip W ◽  
Andrea V Page
Keyword(s):  
Pasteurella Multocida ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Review Of The Literature ◽  
Coagulase Negative Staphylococci ◽  
Two Stage ◽  
Oral Flora ◽  
Comprehensive Review ◽  
Joint Infections ◽  
Prosthetic Joint Infections

Prosthetic joint infections (PJIs) are commonly caused by pathogens such asStaphylococcus aureusand coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized.Pasteurella multocidais a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused byP multocidahave been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes aP multocidajoint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regardingP multocidaPJIs follows.

Fungal prosthetic joint infection in total hip or knee arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 589-595 ◽  
Author(s):  
C. Theil ◽  
T. Schmidt-Braekling ◽  
G. Gosheger ◽  
E. A. Idelevich ◽  
B. Moellenbeck ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Fungal Infections ◽  
Joint Infection ◽  
Treatment Success ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Total Hip ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Aims Fungal prosthetic joint infections (PJIs) are rare and account for about 1% of total PJIs. Our aim was to present clinical and microbiological results in treating these patients with a two-stage approach and antifungal spacers. Patients and Methods We retrospectively reviewed our institutional database and identified 26 patients with positive fungal cultures and positive Musculoskeletal Infection Society (MSIS) criteria for PJI who were treated between 2009 and 2017. We identified 18 patients with total hip arthroplasty (THA) and eight patients with total knee arthroplasty (TKA). The surgical and antifungal treatment, clinical and demographic patient data, complications, relapses, and survival were recorded and analyzed. Results The median follow-up was 33 months. The success rate was 38.5% (10/26). Fluconazole resistance was found in 15%. Bacterial co-infection was common in 44% of patients for THA and 66% of patients with TKA. Mortality, reoperations, and treatment failure were common complications. Conclusion Treatment with a two-stage exchange is a possible option for treatment, although fungal infections have a high failure rate. Therapeutic factors for treatment success remain unclear. Cite this article: Bone Joint J 2019;101-B:589–595.

scholarly journals Diagnosis and management of infected arthroplasty

SICOT-J ◽  
2021 ◽  
Vol 7 ◽  
pp. 54
Author(s):  
Tejbir S. Pannu ◽  
Jesus M. Villa ◽  
Carlos A. Higuera
Keyword(s):  
Joint Infection ◽  
Treatment Options ◽  
Clinical Situation ◽  
The United States ◽  
Sinus Tract ◽  
Two Stage ◽  
International Consensus ◽  
Musculoskeletal Infection ◽  
One Stage ◽  
Exchange Arthroplasty

Periprosthetic joint infection (PJI) is one of the most dreadful complications after THA and TKA. Though prevention is of utmost importance in PJI management, the last decade has seen many remarkable developments in PJI diagnosis, including the introduction of several standardized PJI diagnostic definitions and biomarkers. Depending on the specific clinical situation, a myriad of treatment options for PJI are offered. Our review aims to summarize the pertinent information on PJI diagnosis and synthesize literature on the different treatment methods currently used in clinical practice. One of the most accepted PJI diagnostic definitions was developed by the Musculoskeletal Infection Society (MSIS) in 2011, later modified in the 2013 International Consensus Meeting (ICM). After promising results from studies, alpha-defensins and D-dimer were recently incorporated into the 2018 ICM PJI definition. The management choices for PJI include irrigation and debridement (DAIR), one-stage exchange arthroplasty, or two-stage exchange arthroplasty, to name a few. While two-stage revision has traditionally been the treatment of choice in the United States, there has been a growing body of evidence framing one-stage revision as a comparable choice. One-stage revision should be offered in patients meeting strict selection criteria: no sinus tract, proper soft tissue available for wound closure, appropriate bone stock, a favorable identifiable organism with encouraging antibiotic sensitivities (for cement and oral suppression later), and robust immunological status. DAIR can be considered in case of early infections with sensitive infecting organisms. Patients with multiple unsuccessful revisions or those who refuse further surgical intervention for PJI can be offered antibiotic suppression. If nothing seems to work, salvage procedures (resection arthroplasty and arthrodesis) are available as a last resort. Further research is encouraged to improve on diagnostic capabilities and develop evidence on the best treatment of choice for PJI.

scholarly journals Topical and Oral Therapies for Childhood Atopic Dermatitis and Plaque Psoriasis

Children ◽  
2019 ◽  
Vol 6 (11) ◽  
pp. 125
Author(s):  
Travis Frantz ◽  
Ellen G. Wright ◽  
Esther A. Balogh ◽  
Abigail Cline ◽  
Adrienne L. Adler-Neal ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Guidelines ◽  
Oral Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Expert Advice ◽  
Off Label ◽  
Systemic Treatments ◽  
Standardized Treatment

Background: Treatment of atopic dermatitis and psoriasis in children is difficult due to lack of standardized treatment guidelines and few FDA-approved treatment options. Treatments approved for adults may be used off-label in pediatric patients. Objective: This review evaluates the topical and oral treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric atopic dermatitis and psoriasis. Methods: A PubMed review of topical and systemic treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments. Results: The search identified seven topical and five systemic treatments that are routinely employed to treat pediatric atopic dermatitis and psoriasis. Limitations: Standardized guidelines regarding treatment choice, dosing, and long-term safety are scarce. Reviews may be subject to ascertainment bias. Conclusions: Current treatment guidelines are based on clinical experience and expert advice with few treatments officially approved for atopic dermatitis and psoriasis in children.

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