scholarly journals Application of leukocyte esterase strip test in the screening of periprosthetic joint infections and prospects of high-precision strips

Arthroplasty ◽  
2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Qing-Yuan Zheng ◽  
Guo-Qiang Zhang
Keyword(s):  
Diagnostic Criteria ◽  
New Technologies ◽  
Joint Infection ◽  
Diagnostic Techniques ◽  
Joint Arthroplasty ◽  
Quantitative Detection ◽  
Broad Application ◽  
Joint Infections ◽  
Strip Test ◽  
Machine Reading

Abstract Periprosthetic joint infection (PJI) represents one of the most challenging complications after total joint arthroplasty (TJA). Despite the availability of a variety of diagnostic techniques, the diagnosis of PJI remains a challenge due to the lack of well-established diagnostic criteria. The leucocyte esterase (LE) strips test has been proved to be a valuable diagnostic tool for PJI, and its weight in PJI diagnostic criteria has gradually increased. Characterized by its convenience, speed and immediacy, leucocyte esterase strips test has a prospect of broad application in PJI diagnosis. Admittedly, the leucocyte esterase strips test has some limitations, such as imprecision and liability to interference. Thanks to the application of new technologies, such as machine reading, quantitative detection and artificial intelligence, the LE strips test is expected to overcome the limitations and improve its accuracy.

scholarly journals The biofilm eradication activity of acetic acid in the management of periprosthetic joint infection

2018 ◽  
Vol 7 (8) ◽  
pp. 517-523 ◽  
Author(s):  
S. T. J. Tsang ◽  
P. J. Gwynne ◽  
M. P. Gallagher ◽  
A. H. R. W. Simpson
Keyword(s):  
Acetic Acid ◽  
Periprosthetic Joint Infection ◽  
Reference Strain ◽  
Treatment Time ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Joint Infections ◽  
Biofilm Model ◽  
Arthroplasty Surgery

ObjectivesPeriprosthetic joint infection following joint arthroplasty surgery is one of the most feared complications. The key to successful revision surgery for periprosthetic joint infections, regardless of treatment strategy, is a thorough deep debridement. In an attempt to limit antimicrobial and disinfectant use, there has been increasing interest in the use of acetic acid as an adjunct to debridement in the management of periprosthetic joint infections. However, its effectiveness in the eradication of established biofilms following clinically relevant treatment times has not been established. Using an in vitro biofilm model, this study aimed to establish the minimum biofilm eradication concentration (MBEC) of acetic acid following a clinically relevant treatment time.Materials and MethodsUsing a methicillin-sensitive Staphylococcus aureus (MSSA) reference strain and the dissolvable bead assay, biofilms were challenged by 0% to 20% acetic acid (pH 4.7) for ten minutes, 20 minutes, 180 minutes, and 24 hours.ResultsThe MBEC of acetic acid was found to be: 15%, 11%, 3.2%, and 0.8% following a ten-minute, 20-minute, 180-minute, and 24-hour treatment, respectively.ConclusionThis study found that the MBEC of acetic acid following a 10- or 20-minute treatment time exceeded its safety threshold, making these concentrations unsuitable as a topical debridement adjunct. However, a clinically acceptable concentration (5%) was still found to eliminate 96.1% of biofilm-associated MSSA following a 20-minute treatment time. Cite this article: S. T. J. Tsang, P. J. Gwynne, M. P. Gallagher, A. H. R. W. Simpson. The biofilm eradication activity of acetic acid in the management of periprosthetic joint infection. Bone Joint Res 2018;7:517–523. DOI: 10.1302/2046-3758.78.BJR-2018-0045.R1

Blood and synovial fluid calprotectin as biomarkers to diagnose chronic hip and knee periprosthetic joint infections

2021 ◽  
Vol 103-B (1) ◽  
pp. 46-55
Author(s):  
Dariusz Grzelecki ◽  
Piotr Walczak ◽  
Marta Szostek ◽  
Aleksandra Grajek ◽  
Stanisław Rak ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Synovial Fluid ◽  
Knee Arthroplasty ◽  
Predictive Value ◽  
Joint Infection ◽  
Total Hip ◽  
Joint Infections ◽  
Hip And Knee Arthroplasty ◽  
Aseptic Revision ◽  
Strip Test

Aims Calprotectin (CLP) is produced in neutrophils and monocytes and released into body fluids as a result of inflammation or infection. The aim of this study was to evaluate the utility of blood and synovial CLP in the diagnosis of chronic periprosthetic joint infection (PJI). Methods Blood and synovial fluid samples were collected prospectively from 195 patients undergoing primary or revision hip and knee arthroplasty. Patients were divided into five groups: 1) primary total hip and knee arthroplasty performed due to idiopathic osteoarthritis (OA; n = 60); 2) revision hip and knee arthroplasty performed due to aseptic failure of the implant (AR-TJR; n = 40); 3) patients with a confirmed diagnosis of chronic PJI awaiting surgery (n = 45); 4) patients who have finished the first stage of the PJI treatment with the use of cemented spacer and were qualified for replantation procedure (SR-TJR; n = 25), and 5) patients with rheumatoid arthritis undergoing primary total hip and knee arthroplasty (RA; n = 25). CLP concentrations were measured quantitatively in the blood and synovial fluid using an immunoturbidimetric assay. Additionally, blood and synovial CRP, blood interleukin-6 (IL-6), and ESR were measured, and a leucocyte esterase (LE) strip test was performed. Results Patients with PJI had higher CLP concentrations than those undergoing aseptic revision in blood (median PJI 2.14 mg/l (interquartile range (IQR) 1.37 to 3.56) vs AR-TJR 0.66 mg/l (IQR 0.3 to 0.83); p < 0.001) and synovial fluid samples (median PJI 20.46 mg/l (IQR 14.3 to 22.36) vs AR-TJR 0.7 mg/l (IQR 0.41 to 0.95); p < 0.001). With a cut-off value of 1.0 mg/l, blood CLP showed a sensitivity, specificity, positive predictive value, and negative predictive value of 93.3%, 87.5%, 89.4%, and 92.1%, respectively. For synovial fluid with a cut-off value of 1.5 mg/l, these were 95.6%, 95%, 95.5%, and 95%, respectively. Conclusion This small study suggests that synovial and blood CLP are useful markers in chronic PJI diagnosis with similar or higher sensitivity and specificity than routinely used markers such as CRP, ESR, IL-6, and LE. CLP was not useful to differentiate patients with PJI from those with rheumatoid arthritis. Cite this article: Bone Joint J 2021;103-B(1):46–55.

New Technologies for Diagnosis of Periprosthetic Hip Infection

2018 ◽  
Vol 02 (02) ◽  
pp. 068-075 ◽  
Author(s):  
Noam Shohat ◽  
Javad Parvizi ◽  
Majd Tarabichi
Keyword(s):  
Periprosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
New Technologies ◽  
Financial Burden ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Drug Resistant ◽  
Hip Infection ◽  
Mode Of Failure ◽  
Increasing Demand

AbstractPeriprosthetic joint infection (PJI) is a devastating mode of failure following total joint arthroplasty, imposing a serious burden on the healthcare system and society at large. Increasing demand for elective arthroplasty, as well as independent predictions demonstrating future rise in the prevalence of PJI, will lead to an increasing financial burden imposed by this dreadful complication. This challenge is further compounded by disturbing trends, such as drug-resistant organisms among others as a cause of PJI. The aim of this review is to provide the latest updates in the diagnosis of PJI, with a view to identifying areas in need of further research.

scholarly journals The bactericidal effect of vancomycin is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christiane Schwerdt ◽  
Eric Röhner ◽  
Sabrina Böhle ◽  
Benjamin Jacob ◽  
Georg Matziolis
Keyword(s):  
Staphylococcus Aureus ◽  
Tranexamic Acid ◽  
Total Joint Arthroplasty ◽  
Staphylococcus Epidermidis ◽  
Joint Infection ◽  
Bactericidal Effect ◽  
Joint Arthroplasty ◽  
Zone Of Inhibition ◽  
Agar Diffusion Test

AbstractOne of the most challenging complications of total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). There is growing evidence of a good anti-infective effect of intrawound vancomycin powder in total joint arthroplasty. At the same time, various different locally applied substances have become popular in total joint arthroplasty. The objective of this study was therefore to investigate a possible inhibition of the bactericidal effect of vancomycin by tranexamic acid, adrenalin, lidocaine, or dexamethasone. The bactericidal effect of vancomycin was quantified using the established method of the agar diffusion test. The plates were incubated with Staphylococcus aureus or Staphylococcus epidermidis and four wells were stamped out. The wells were filled with vancomycin alone, the tested substance alone or a mixture of the two. The fourth well remained empty as a control. The plates were incubated overnight at 37 °C and the zone of inhibition in each field was measured on the next day. All tests were run three times for each pathogen and mean values and standard deviations of the measurements were calculated. Differences between the substances were tested using the t-test at a level of significance of 0.05. The bacterial growth was homogeneous on all plates. The baseline value for the zone of inhibition of vancomycin was on average 6.2 ± 0.4 mm for Staphylococcus aureus and 12 ± 0.3 mm for Staphylococcus epidermidis. In all other substances, no inhibition was detected around the well. The combination of vancomycin and each other substance did not show any different result compared to vancomycin alone. The bactericidal effect of vancomycin on staphylococci is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro.

scholarly journals Efficacy of hydrofibre dressing following total joint arthroplasty: a meta-analysis of randomised controlled trials

2021 ◽  
pp. 112070002110126
Author(s):  
Raman Mundi ◽  
Harman Chaudhry ◽  
Seper Ekhtiari ◽  
Prabjit Ajrawat ◽  
Daniel M Tushinski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Joint Infection ◽  
The United States ◽  
Joint Arthroplasty ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Observable Effect ◽  
The Impact

Introduction: In the United States, over 1,000,000 total joint arthroplasty (TJA) surgeries are performed annually and has been forecasted that this number will exceed 4,000,000 by the year 2030. Many different types of dressing exist for use in TJA surgery, and it is unclear if any of the newer, hydrofibre dressings are superior to traditional dressings at reducing rates of infections or improving wound healing. Thus, the aim of this systematic review and meta-analysis was to assess the impact of hydrofiber dressings on reducing complications. Methods: A systematic review and meta-analysis was performed using the online databases MEDLINE and the Cochrane Library. Randomized controlled trials (RCTs) comparing hydrofibre dressings to a standard dressing were included. Summary measures are reported as odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs). Our primary outcome was prosthetic joint infection (PJI). Secondary outcomes included blisters, dressing changes and wound irritation. Results: 5 RCTs were included. Hydrofibre dressing had no observable effect on PJI or wound irritation (OR 0.53; 95% CI, 0.14–1.98; p = 0.35). Hydrofibre dressings reduced the rate of blisters (OR 0.36; 95% CI, 0.14–0.90; p = 0.03) and number of dressing changes (MD -1.89; 95% CI, -2.68 to -1.11). Conclusions: In conclusion, evidence suggests hydrofibre dressings have no observable effect on PJI and wound irritation. Evidence for reduction in blisters and number of dressings is modest given wide CIs and biased trial methodologies. Use of hydrofibre dressings should be considered inconclusive for mitigating major complications in light of current best evidence.

scholarly journals Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

2021 ◽  
Vol 6 (2) ◽  
pp. 91
Author(s):  
Pier Francesco Indelli ◽  
Stefano Ghirardelli ◽  
Ferdinando Iannotti ◽  
Alessia Maria Indelli ◽  
Gennaro Pipino
Keyword(s):  
Joint Infection ◽  
Treatment Strategies ◽  
High Morbidity ◽  
Treatment Protocols ◽  
Joint Infections ◽  
Prevention And Treatment ◽  
Efficient Control ◽  
Cement Joint ◽  
Clay Nanotubes

Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.

scholarly journals Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients

2019 ◽  
Vol 4 (5) ◽  
pp. 209-215
Author(s):  
Cybele Lara Abad ◽  
Vania Phuoc ◽  
Prashant Kapoor ◽  
Pritish K. Tosh ◽  
Irene G. Sia ◽  
...  
Keyword(s):  
Stem Cell ◽  
Septic Arthritis ◽  
Hematopoietic Stem Cell ◽  
Joint Infection ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Prosthetic Joint ◽  
Increased Risk

Abstract. Background: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.Methods: We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.Results: Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).Conclusion: BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

scholarly journals 7 Management of Periprosthetic Joint Infection

2021 ◽  
Keyword(s):  
Decision Making ◽  
Periprosthetic Joint Infection ◽  
Total Joint Arthroplasty ◽  
Joint Infection ◽  
Joint Arthroplasty ◽  
Orthopaedic Surgeon ◽  
Systemic Complications ◽  
Surgical Decision ◽  
Surgical Options ◽  
Surgical Decision Making

Periprosthetic joint infection (PJI) continues to be a devastating problem in the field of total joint arthroplasty. There are a number of surgical options to decide from and management decisions are based upon the interplay between host, pathogen, and surgeon characteristics. The goal of management is to maximize function, prevent systemic complications, and eradicate infection. Throughout this chapter we will discuss the most relevant recent literature and guiding theories to assist the treating orthopaedic surgeon in the surgical decision-making process.

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.

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