scholarly journals Rates of periprosthetic infection and surgical revision in Beijing (China) between 2014 and 2016: a retrospective multicenter cross-sectional study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Hui-ming Peng ◽  
Long-chao Wang ◽  
Ji-ying Cheng ◽  
Yi-xin Zhou ◽  
Hua Tian ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Periprosthetic Infection ◽  
Mainland China ◽  
Surgical Revision ◽  
Two Stage ◽  
Cross Sectional ◽  
One Stage ◽  
Prosthesis Retention ◽  
Beijing China ◽  
Open Debridement

Abstract Background Periprosthetic joint infection (PJI) is a rare but devastating complication after total joint arthroplasty. There is a paucity of data on the incidence and prevalence of periprosthetic infection in mainland China. This study aimed to analyze the rates of surgical revision after arthroplasty due to PJI and the procedures followed in Beijing, China. Methods The study involved a retrospective multicenter cross-sectional survey of patients undergoing revisions for periprosthetic infection after hip/knee arthroplasty at nine hospitals in Beijing from 2014 to 2016. Age, gender, body mass index, primary diagnosis, comorbidity, primary surgery, treatment methods, and post-revision complications were analyzed. Results A total of 38,319 hip/knee arthroplasties and 366 (0.96%) revisions for PJI were identified. Of these, 161 (161/14,110; 1.14%) revisions involved hip arthroplasty, whereas 205 (205/24,209; 0.85%) revisions were due to knee arthroplasty. Procedures for revisions of infected hip included 7 (4.3%) cases of open debridement and prosthesis retention, 32 (19.9%) cases of one-stage exchange, 121 (75.2%) cases of two-stage exchange, and 1 (0.007%) case of hip dissection. As for the infected knee, the procedures included 45 (22.0%) cases of open debridement and prosthesis retention, 13 (6.3%) cases of one-stage exchange, 143 (69.8%) cases of two-stage exchange, and 4 (0.02%) cases of knee fusion. Conclusions The study found the rates of revision due to PJI to be low. Nonetheless, the incidence of PJI in mainland China could be higher and calls for more elaborate studies in geographically and socioeconomically diverse health institutions.

scholarly journals Trends in the treatment of infected knee arthroplasty

2020 ◽  
Vol 5 (10) ◽  
pp. 672-683
Author(s):  
Ismail Remzi Tözün ◽  
Vahit Emre Ozden ◽  
Goksel Dikmen ◽  
Kayahan Karaytuğ
Keyword(s):  
Knee Arthroplasty ◽  
Clinical Signs ◽  
Sinus Tract ◽  
Soft Tissue Defect ◽  
Treatment Modalities ◽  
Causative Organism ◽  
Optimal Timing ◽  
Two Stage ◽  
Serological Tests ◽  
One Stage

Essential treatment methods for infected knee arthroplasty involve DAIR (debridement, antibiotics, and implant retention), and one and two-stage exchange arthroplasty. Aggressive debridement with the removal of all avascular tissues and foreign materials that contain biofilm is mandatory for all surgical treatment modalities. DAIR is a viable option with an acceptable success rate and can be used as a first surgical procedure for patients who have a well-fixed, functioning prosthesis without a sinus tract for acute-early or late-hematogenous acute infections with no more than four weeks (most favourable being < seven days) of symptoms. Surgeons must focus on the isolation of the causative organism with sensitivities to bactericidal treatment as using one-stage exchange. One-stage exchange is indicated when the patients have: minimal bone loss/soft tissue defect allowing primary wound closure, easy to treat micro-organisms, absence of systemic sepsis and absence of extensive comorbidities. There are no validated serum or synovial biomarkers to determine optimal timing of re-implantation for two-stage exchange. Antibiotic-free waiting intervals and joint aspiration before the second stage are no longer recommended. The decision to perform aspiration should be made based on the index of suspicion for persistent infection. Re-implantation can be performed when the treating medical team feels that the clinical signs of infection are under control and serological tests are trending downwards. Cite this article: EFORT Open Rev 2020;5:672-683. DOI: 10.1302/2058-5241.5.190069

A biomechanical evaluation of one-stage vs two-stage bilateral knee arthroplasty patients

1999 ◽  
Vol 9 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Lester S Borden ◽  
Julie E Perry ◽  
Brian L Davis ◽  
Tammy M Owings ◽  
Mark D Grabiner
Keyword(s):  
Knee Arthroplasty ◽  
Two Stage ◽  
Bilateral Knee ◽  
One Stage ◽  
Biomechanical Evaluation

scholarly journals One-stage versus two-stage revision of the infected knee arthroplasty - a randomized multicenter clinical trial study protocol

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Martin Lindberg-Larsen ◽  
◽  
Anders Odgaard ◽  
Charlotte Fredborg ◽  
Henrik Morville Schrøder
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Cohort Study ◽  
Randomized Trial ◽  
Functional Status ◽  
Knee Arthroplasty ◽  
Stage Versus ◽  
Two Stage ◽  
One Stage

Abstract Background A two-stage prosthesis exchange procedure has been the gold standard in surgical treatment of the chronically infected knee arthroplasty so far. This includes 2 surgeries/hospitalizations and an interim period of 2–3 months between surgeries with impaired health, functional status and quality of life of the patients. A one-stage exchange procedure holds many obvious advantages compared to the two-stage approach, but outcomes of a one-stage versus two-stage procedures have never been investigated in a randomized clinical trial. The purpose of this study is primarily to investigate time-adjusted differences in functional status of patients after one-stage versus two-stage revision. Secondary, to report time-adjusted differences in quality of life, complications (including re-revisions due to infection) and mortality. Methods This study is a pragmatic, multi-center, randomized, non-inferiority trial comparing one-stage versus two-stage revision of the infected knee arthroplasty. Seven Danish hospitals are currently participating in the study, but additional hospitals can enter the study if adhering to protocol. Ninety-six patients will be included prospectively. Follow-up will be with PROM-questionnaires and clinical controls up to 10 years. The patients who are not able to participate in the randomized trial are followed in a parallel cohort study. PROM’s Oxford Knee Score and EQ5D + EQ5D VAS questionnaires are completed preoperatively and sent out to the study participants at 6 weeks, 3, 6, 9, 12, 18 and 24 months as well as 5 and 10 years postoperatively. In addition a tailor made cost questionnaire on the non-treating hospital resource use, community health and social service use, travel costs, time off work and informal care are sent out. Discussion If one of the two treatment alternatives is found superior in both domains of quality of life (both knee-specific and generic) and health economics, that treatment should be promoted. Other outcomes will open informed discussions about treatment strategies for periprosthetic knee infections. Trial registration The randomized trial is registered on ClinicalTrials.gov with ID NCT03435679, initial release date January 31, 2018 and the cohort study is registered with ID NCT04427943, submitted January 8, 2020 and posted June 11, 2020.

Two-stage Reimplantation in Infected Total Knee Arthroplasty by Using Resterilized Femoral and Tibial Components with a New Polyethylene Insert: Report of 4 Cases with at Least 15 Years’ Follow-up

2021 ◽  
Vol 23 (6) ◽  
pp. 411-416
Author(s):  
Alpaslan Öztürk ◽  
Nazan Çevik ◽  
Yavuz Akalın ◽  
Oğuz Çetin ◽  
Özgür Avci( ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Cement ◽  
Knee Arthroplasty ◽  
Periprosthetic Infection ◽  
Polyethylene Insert ◽  
Two Stage ◽  
Second Stage ◽  
Articulating Spacer ◽  
Total Knee

Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients.  Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphy­lococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up.  Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective.

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