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 ◽  
Vol 22 (1) ◽  
Author(s):  
Katrin Osmanski-Zenk ◽  
Annett Klinder ◽  
Christina Rimke ◽  
Dieter C. Wirtz ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Standard Procedure ◽  
Revision Arthroplasty ◽  
Treatment Regime ◽  
Two Stage ◽  
Treatment Protocols ◽  
One Stage ◽  
Revision Arthroplasties ◽  
Therapeutic Algorithms

Abstract Background There are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI), however, national or international guidelines for a standardised treatment regime are still lacking. The present paper evaluates the use of the predominant treatment protocols for PJI in certified total joint replacement centres (EPZ) in Germany based on an EndoCert questionnaire. Materials and methods The questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the treatment protocols for septic revision arthroplasties in EPZ. Questions targeted the various treatment options including prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and diagnostic sampling prior to re-implantation. All certified EPZ participated (n = 504) and the results from the current survey in 2020 were compared to data from a previous analysis in 2015. Results The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option increased (hip: + 6.3%; knee: + 6.6%). The majority of the centres (73.2%) indicated a 4–8 week period as the preferred interval between prosthesis removal and re-implantation in two-stage revision in hip as well as knee revisions. Centres with a higher number of revision surgeries (> 200 revisions/year), opted even more often for the 4–8 week period (92.3%). In two-stage revision the use of metal-based spacers with/without reinforcement with antibiotic-containing cement as an interim placeholder was significantly reduced in 2020 compared to 2015. There was also a clear preference for cemented anchoring in two-stage revision arthroplasty in the knee in 2020, whereas the majority of hip replacements was cementless. Additionally, in 2020 the number of samples for microbiological testing during the removal of the infected endoprosthesis increased and 72% of the centres took five or more samples. Overall, the number of EPZ with a standardised protocol for the procedure expanded from 2015 to 2020. Conclusion While 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.

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.

Preliminary Results After Changing From Two-Stage to One-Stage Revision Arthroplasty Protocol Using Cementless Arthroplasty for Chronic Infected Hip Replacements

2018 ◽  
Vol 33 (2) ◽  
pp. 527-532 ◽  
Author(s):  
Guillem Bori ◽  
Guillem Navarro ◽  
Laura Morata ◽  
Jenaro A. Fernández-Valencia ◽  
Alex Soriano ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Two Stage ◽  
Preliminary Results ◽  
One Stage ◽  
Hip Replacements ◽  
Cementless Arthroplasty

One stage treatment of temporomandibular joint complete bony ankylosis using total joint replacement

2016 ◽  
Vol 44 (4) ◽  
pp. 487-492 ◽  
Author(s):  
Giovanni Gerbino ◽  
Emanuele Zavattero ◽  
Sid Berrone ◽  
Guglielmo Ramieri
Keyword(s):  
Temporomandibular Joint ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
One Stage ◽  
Bony Ankylosis

Speech and Hearing Outcomes of the Patients with Cleft Lip and Palate: Comparison between One-Stage Simultaneous and Two-Stage Surgical Repairs

2020 ◽  
Vol 103 (11) ◽  
pp. 1171-1177
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Common Belief ◽  
Two Stage ◽  
Treatment Protocols ◽  
Palatal Fistula ◽  
One Stage ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Palate Repair

Background: Conventional treatment for cleft lip and palate patients is lip repair at three to four months and then palatal repair at nine to 12 months of age. However, for the patients who delay seeing a doctor especially in a developing area such as Northern Thailand, simultaneous lip and palate repair is performed at 12 to 18 months of age or later, depending on the age at the first visit. It is a common belief that patients with cleft lip and palate will be behind non-cleft patients in early development phonemes because of the open palate. This delay persists until the palate is repaired and on into the postoperative period. This proposition has not been proven with long-term clinical outcomes in one-stage repairs. Objective: To investigate the effects of one-stage repair on speech assessment, hearing, and incidence of palatal fistula. The results were compared with conventional two-stage surgical repairs. Materials and Methods: The present study was designed two groups. Group 1 consisted of 25 children (mean age 11.28±1.93 years) treated with a one-stage repair. Cleft lip, palate, and alveolus were repaired at a single surgical session in the first 18 months of life (mean age at the time of surgery 13.52±4.51 months). Group 2 consisted of 17 children (mean age 11.02±2.23 years) treated in two-stage surgical repairs. Lip repair was performed at a median age of 4.01 months (IQR 3.62 to 5.46), and palate repair was performed at a mean age of 13.54±4.14 months. Both groups underwent cleft lip and palate repairs at the Division of Plastic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University between January 1, 2004 and December 31, 2010. Speech and hearing for all patients were evaluated by experienced ENT doctors. The palatal fistula was evaluated by the same plastic surgeons. Results: One-stage repair showed significant normal articulation and less articulation disorder when compared with two-stage surgical repairs. However, no significant difference was determined for other speech assessments, hearing, and incidence of palatal fistula. Conclusion: Because one-stage repair seems to have a more positive influence on articulation, and both surgical treatment protocols give similar results on speech assessments, hearing, and incidence of palatal fistula, regardless of the timing of the surgery, the one-stage repair is not inferior to conventional two-stage surgical repairs for patients in developing areas. This is due to several important advantages, such as less hospitalization, lower cost, and less chance of nosocomial infection. Keywords: One-stage repair, Speech, Hearing, Palatal fistula, Cleft lip, Palate

scholarly journals Revision Surgery in Total Joint Replacement Is Cost-Intensive

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Markus Weber ◽  
Tobias Renkawitz ◽  
Florian Voellner ◽  
Benjamin Craiovan ◽  
Felix Greimel ◽  
...  
Keyword(s):  
Infection Rate ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Revision Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Complication Rates ◽  
Joint Replacements ◽  
Patient Reported ◽  
One Year

Revisions after total joint replacement increase constantly. In the current study, we analyzed clinical outcome, complication rates, and cost-effectiveness of revision arthroplasty. In a retrospective analysis of 162 revision hip and knee arthroplasties from our institutional joint registry responder rate, patient-reported outcome measures (EQ-5D, WOMAC), complication rates, and patient-individual charges in relation to reimbursement were compared with a matched control group of primary total joint replacements. Positive responder rate one year postoperatively was lower for revision arthroplasties with 72.9% than for primary arthroplasties with 90.1% (OR=0.30, 95%CI=0.18–0.59, p=0.001). Correspondingly, improvement in patient-reported outcome measures one year after surgery was lower in revision than in primary joint arthroplasty with EQ-5D 0.19±0.25 to 0.30±0.24 (p<0.001) and WOMAC 24.3±30.3 to 41.2±21.3 (p<0.001). Infection rate was higher in revision (6.8%) compared to primary replacements (0%, p=0.001). Mean charges in revision arthroplasty were 76.0% higher than in matched primary joint replacements (7110.8±2249.4$ to 4041.1±975.7$, p<0.001), whereas reimbursement was only 23.6% higher (9243.3±2258.4$ in revision and 7477.9±703.1$ in primary arthroplasty, p<0.001). Revision arthroplasty is associated with lower outcome and higher infection rate compared to primary replacements. The high financial expense of revision arthroplasty is only partly covered by a higher reimbursement.

scholarly journals 886. Impact of Type of Surgical Management on the Incidence of Recurrent Surgical Site Infections Following Hip and Knee replacements in Calgary, Alberta

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S478-S478
Author(s):  
Swati Chavda ◽  
Jenine Leal ◽  
Shannon Puloski ◽  
Elissa Rennert May
Keyword(s):  
Surgical Management ◽  
Early Recognition ◽  
Small Sample Size ◽  
Revision Arthroplasty ◽  
Surgical Site Infections ◽  
Small Sample ◽  
Recurrence Rates ◽  
Two Stage ◽  
One Stage ◽  
Significant Difference

Abstract Background Recurrent surgical site infections (SSIs) are associated with decreased quality of life for patients and increased economic burden to healthcare systems. Positive cultures at reimplantation and patient co-morbidities have been shown to increase the risk of recurrent SSI in hip and knee surgical site infections. Two-stage exchange has been considered for the most appropriate surgical management for these SSI’s, however, it is unclear whether the type of revision arthroplasty and pathogen of the first SSI impacts recurrence rates. Methods A retrospective review of prospectively collected data on all complex SSIs following primary hip and knee arthroplasties between April 1 2012 and March 31, 2019, in Calgary, Alberta was performed. Patients were followed for two years post-index arthroplasty to determine initial management of first complex SSI (Debridement, antibiotics and implant retention (DAIR) vs DAIR+liner exchange vs one-stage vs two-stage), rate of recurrent complex SSI, and microbiological data for first and subsequent SSI’s. Results Of the 142 complex SSIs, 95 (66.9%) were managed with DAIR and liner exchange, 25 (17.6%) were managed with DAIR, 13 (9.1%) with one-stage and 8 (5.6%) with two-stage procedures. The recurrence rate was 19/95 (20%) for DAIR and liner, 8/25 (32%) for DAIR alone, 2/13 (15%) with one stage, and 3/8 (37.5%) with two-stage. There was no significant difference in recurrence rates of complex SSI when stratified by surgical management. Of the pathogens, Staphylococcus aureus (S.aureus) (including methicillin-resistant S. aureus (MRSA)) accounted for 35.2% of total first SSI and 50% of recurrences. A significantly higher proportion of S.aureus infections (including MRSA) ended up with a recurrent infection compared to all other pathogens (p=0.045). Of the 32 recurrences, 28.1% were due to the same pathogen as the initial SSI. Conclusion S.aureus was the most common pathogen causing initial and recurrent SSIs. This reinforces that S.aureus complex SSIs would likely benefit from early recognition and aggressive treatment. Recurrence of SSI was not impacted by type of revision arthroplasty. This study is limited by a small sample size. These findings contribute to the paucity of literature in this area and suggest a need for expansion to larger populations. Disclosures All Authors: No reported disclosures

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