scholarly journals Diagnosis and management of the infected total knee replacement: a practical surgical guide

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Akos Zahar ◽  
Martin Sarungi
Keyword(s):  
Surgical Management ◽  
Joint Infection ◽  
Level Of Evidence ◽  
Surgical Guide ◽  
Diagnosis And Management ◽  
Early Revision ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Total Knee ◽  
Key Steps

Abstract Purpose Prosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a significant burden in health care. Diagnosis and proper management are challenging. A standardised procedure for the diagnostic workup and surgical management provides clear benefits in outcome. Methods Several diagnostic protocols and definitions for PJI were established in recent years. Proper PJI diagnosis remains critical for success and for choosing the optimal treatment option. A distinct workup of diagnostic steps, the evaluation of the results in a multidisciplinary setup and the meticulous surgical management of the infection are the key factors of successful treatment. Results The management of PJI after TKA consists of early revision with debridement and implant retention (DAIR) in early cases or staged revision in late infections beyond 30 days postoperative or after onset of acute symptoms. The revision is performed as a two-stage procedure with the use of a fixed or mobile antibiotic spacer, or in selected cases as a single-stage operation with the use of local and systemic antibiotic treatment. Conclusions This paper reflects the opinion of two revision surgeons who follow the same protocol for diagnosis and treatment of PJI after TKA, highlighting the key steps in diagnosis and management. Level of evidence Expert’s opinion

scholarly journals Infection after Constrained Condylar Knee Arthroplasty: Incidence and microbiological findings in 100 consecutive complex primary and revision total knee arthroplasties

2018 ◽  
Vol 3 (5) ◽  
pp. 260-265 ◽  
Author(s):  
Marianne Westberg ◽  
Bjarne Grøgaard ◽  
Finnur Snorrason
Keyword(s):  
Joint Infection ◽  
Total Knee Arthroplasties ◽  
Primary Complex ◽  
Metal Implants ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Surgical Data ◽  
Lower Success Rate ◽  
Total Knee

Abstract. Background: To report incidence, microbiological findings, and treatment outcome of prosthetic joint infection (PJI) after constrained condylar knee arthroplasty.Methods: Retrospective study of 100 consecutive complex primary and revision total knee arthroplasties operated with constrained condylar knee arthroplasties between February 2006 and October 2015 at a single institution. Demographic and surgical data were registered, as well as data regarding infection, microbiology and treatment. Follow-up median 43 months; SD 32.Results: The overall incidence of acute postoperative PJI was low (3/100). 1/33 (3%), 1/ 45 (2%), and 1/22 (5%), following primary complex TKA, aseptic revisions, and septic revisions, respectively. The incidence of late acute hematogenous PJI was 5/100. 1/33 (3%),1/45 (2%), and 3/22 (14%) following primary complex TKA, aseptic revisions, and septic revisions, respectively. Late acute hematogenous infections were associated with a lower success rate of treatment with debridement and implant retention compared with acute postoperative PJIs, 1/5 versus 2/3.Conclusion: The risk of late acute hematogenous infections seems increased. Multiple previous surgery, poor soft tissue, and large metal implants may contribute to an increased lifelong susceptibility for bacteremias to cause PJIs.

scholarly journals Long-Term Use of Tedizolid in Osteoarticular Infections: Benefits among Oxazolidinone Drugs

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 53
Author(s):  
Eva Benavent ◽  
Laura Morata ◽  
Francesc Escrihuela-Vidal ◽  
Esteban Alberto Reynaga ◽  
Laura Soldevila ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Joint Infection ◽  
Diabetic Foot Infections ◽  
Osteoarticular Infections ◽  
Prosthetic Joint ◽  
Implant Retention ◽  
Lower Drug ◽  
Drug Drug Interaction ◽  
Staphylococcus Spp

Background: To evaluate the efficacy and safety of long-term use of tedizolid in osteoarticular infections. Methods: Multicentric retrospective study (January 2017–March 2019) of osteoarticular infection cases treated with tedizolid. Failure: clinical worsening despite antibiotic treatment or the need of suppressive treatment. Results: Cases (n = 51; 59% women, mean age of 65 years) included osteoarthritis (n = 27, 53%), prosthetic joint infection (n = 17, 33.3%), and diabetic foot infections (n = 9, 18%); where, 59% were orthopedic device-related. Most frequent isolates were Staphylococcus spp. (65%, n = 47; S. aureus, 48%). Reasons for choosing tedizolid were potential drug-drug interaction (63%) and cytopenia (55%); median treatment duration was 29 days (interquartile range -IQR- 15–44), 24% received rifampicin (600 mg once daily) concomitantly, and adverse events were scarce (n = 3). Hemoglobin and platelet count stayed stable throughout treatment (from 108.6 g/L to 116.3 g/L, p = 0.079; and 240 × 109/L to 239 × 109/L, p = 0.942, respectively), also in the subgroup of cases with cytopenia. Among device-related infections, 33% were managed with implant retention. Median follow-up was 630 days and overall cure rate 83%; among failures (n = 8), 63% were device-related infections. Conclusions: Long-term use of tedizolid was effective, showing a better safety profile with less myelotoxicity and lower drug-drug interaction than linezolid. Confirmation of these advantages could make tedizolid the oxazolidinone of choice for most of osteoarticular infections.

Lyme Prosthetic Joint Infection in Total Knee Arthroplasty

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Muzaffar Ali ◽  
Anthony O. Kamson ◽  
Nadia Hussain ◽  
Scott G. King
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Prosthetic Joint ◽  
Total Knee

scholarly journals Diagnostic Criteria and Treatment of Acute and Chronic Periprosthetic Joint Infection of Total Ankle Arthroplasty

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141984100
Author(s):  
Kempland C. Walley ◽  
Christopher B. Arena ◽  
Paul J. Juliano ◽  
Michael C. Aynardi
Keyword(s):  
Diagnostic Criteria ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Ankle Arthroplasty ◽  
Level Of Evidence ◽  
Ankle Arthroplasty ◽  
Prosthetic Joint ◽  
Ankle Replacement ◽  
Knee And Hip Arthroplasty

Background: Prosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a serious complication that results in significant consequences to the patient and threatens the survival of the ankle replacement. PJI in TAA may require debridement, placement of antibiotic spacer, revision arthroplasty, conversion to arthrodesis, or potentially below the knee amputation. While the practice of TAA has gained popularity in recent years, there is some minimal data regarding wound complications in acute or chronic PJI of TAA. However, of the limited studies that describe complications of PJI of TAA, even fewer studies describe the criteria used in diagnosing PJI. This review will cover the current available literature regarding total ankle arthroplasty infection and will propose a model for treatment options for acute and chronic PJI in TAA. Methods: A review of the current literature was conducted to identify clinical investigations in which prosthetic joint infections occurred in total ankle arthroplasty with associated clinical findings, radiographic imaging, and functional outcomes. The electronic databases for all peer-reviewed published works available through January 31, 2018, of the Cochrane Library, PubMed MEDLINE, and Google Scholar were explored using the following search terms and Boolean operators: “total ankle replacement” OR “total ankle arthroplasty” AND “periprosthetic joint infection” AND “diagnosis” OR “diagnostic criteria.” An article was considered eligible for inclusion if it concerned diagnostic criteria of acute or chronic periprosthetic joint infection of total ankle arthroplasty regardless of the number of patients treated, type of TAA utilized, conclusion, or level of evidence of study. Results: No studies were found in the review of the literature describing criteria for diagnosing PJI specific to TAA. Conclusions: Literature describing the diagnosis and treatment of PJI in TAA is entirely reliant on the literature surrounding knee and hip arthroplasty. Because of the limited volume of total ankle arthroplasty in comparison to knee and hip arthroplasty, no studies to our knowledge exist describing diagnostic criteria specific to total ankle arthroplasty with associated reliability. Large multicenter trials may be required to obtain the volume necessary to accurately describe diagnostic criteria of PJI specific to TAA. Level of Evidence: Level III, systematic review.

Prosthetic joint infection: Recent developments in diagnosis and management

2010 ◽  
Vol 61 (6) ◽  
pp. 443-448 ◽  
Author(s):  
Maria Adriana Cataldo ◽  
Nicola Petrosillo ◽  
Michela Cipriani ◽  
Roberto Cauda ◽  
Evelina Tacconelli
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnosis And Management ◽  
Prosthetic Joint ◽  
Recent Developments

Diagnosis and management of prosthetic joint infection

2012 ◽  
Vol 25 (6) ◽  
pp. 670-676 ◽  
Author(s):  
Trisha N. Peel ◽  
Kirsty L. Buising ◽  
Peter F.M. Choong
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnosis And Management ◽  
Prosthetic Joint

Prior hip or knee prosthetic joint infection in another joint increases risk three-fold of prosthetic joint infection after primary total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 91-97 ◽  
Author(s):  
B. P. Chalmers ◽  
J. T. Weston ◽  
D. R. Osmon ◽  
A. D. Hanssen ◽  
D. J. Berry ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Primary Total Knee Arthroplasty ◽  
Study Cohort ◽  
Study Group ◽  
Prosthetic Joint ◽  
Primary Tkas ◽  
History Of ◽  
Total Knee ◽  
Primary Total Knee

Aims There is little information regarding the risk of a patient developing prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) when the patient has previously experienced PJI of a TKA or total hip arthroplasty (THA) in another joint. The goal of this study was to compare the risk of PJI of primary TKA in this patient population against matched controls. Patients and Methods We retrospectively reviewed 95 patients (102 primary TKAs) treated between 2000 and 2014 with a history of PJI in another TKA or THA. A total of 50 patients (53%) were female. Mean age was 69 years (45 to 88) with a mean body mass index (BMI) of 36 kg/m2 (22 to 59). In total, 27% of patients were on chronic antibiotic suppression. Mean follow-up was six years (2 to 16). We 1:3 matched these (for age, sex, BMI, and surgical year) to 306 primary TKAs performed in 306 patients with a THA or TKA of another joint without a subsequent PJI. Competing risk with death was used for statistical analysis. Multivariate analysis was followed to evaluate risk factors for PJI in the study cohort. Results The cumulative incidence of PJI in the study cohort (6.1%) was significantly higher than the matched cohort (2.6%) at ten years (hazard ratio (HR) 3.3; 95% confidence interval 1.18 to 8.97; p = 0.02). Host grade in the study group was not a significant risk factor for PJI. Patients on chronic suppression had a higher rate of PJI (HR 15; p = 0.002), with six of the seven patients developing PJI in the study group being on chronic suppression. The new infecting microorganism was the same as the previous in only two of seven patients. Conclusion In this matched cohort study, patients undergoing a clean primary TKA with a history of TKA or THA PJI in another joint had a three-fold higher risk of PJI compared with matched controls with ten-year cumulative incidence of 6.1%. The risk of PJI was 15-fold higher in patients on chronic antibiotic suppression; further investigation into reasons for this and mitigation strategies are recommended. Cite this article: Bone Joint J 2019;101-B(7 Supple C):91–97

scholarly journals Risk of Recurrent Staphylococcus aureus Prosthetic Joint Infection in Rheumatoid Arthritis Patients—A Nationwide Cohort Study

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Namrata Singh ◽  
Rajeshwari Nair ◽  
Michihiko Goto ◽  
Martha L Carvour ◽  
Ryan Carnahan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Prosthetic Joint Infection ◽  
Proportional Hazards ◽  
Joint Infection ◽  
International Classification Of Diseases ◽  
Cox Proportional Hazards ◽  
Prosthetic Joint ◽  
Implant Retention

AbstractBackgroundTreatment of rheumatoid arthritis (RA) often involves immune-suppressive therapies. Concern for recurrent prosthetic joint infection (PJI) in RA patients might be high and could reduce use of joint implantation in these patients. We aimed to evaluate the risk of recurrence of PJI in RA patients compared with osteoarthritis (OA) patients by utilizing a large health care system.MethodsWe conducted a retrospective cohort study of all patients admitted for a Staphylococcus aureus PJI who underwent debridement, antibiotics, and implant retention (DAIR) or 2-stage exchange (2SE) between 2003 and 2010 at 86 Veterans Affairs Medical Centers. Both RA patients and the comparison group of osteoarthritis (OA) patients were identified using International Classification of Diseases, Ninth Revision, codes. All index PJI and recurrent positive cultures for S. aureus during 2 years of follow-up were validated by manual chart review. A Cox proportional hazards regression model was used to compare the time to recurrent PJI for RA vs OA.ResultsIn our final cohort of 374 veterans who had either DAIR or 2SE surgery for their index S. aureus PJI, 11.2% had RA (n = 42). The majority of the cohort was male (97.3%), and 223 (59.6%) had a methicillin-susceptible S. aureus PJI. RA patients had a similar risk of failure compared with OA patients, after adjusting for covariates (hazard ratio, 0.81; 95% confidence interval, 0.48–1.37).ConclusionsPrior diagnosis of RA does not increase the risk of recurrent S. aureus PJI. Further studies are needed to evaluate the effect of different RA therapies on outcomes of episodes of PJI.

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