Unexpected low-grade infections in revision hip arthroplasty for aseptic loosening

2021 ◽  
Vol 103-B (6) ◽  
pp. 1070-1077
Author(s):  
Christian Hipfl ◽  
Wiebke Mooij ◽  
Carsten Perka ◽  
Sebastian Hardt ◽  
Georgi I. Wassilew
Keyword(s):  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Implant Failure ◽  
Revision Hip Arthroplasty ◽  
Coagulase Negative Staphylococcus ◽  
Histopathological Analysis ◽  
Low Grade ◽  
Single Specimen ◽  
Musculoskeletal Infection

Aims The purpose of this study was to evaluate unexpected positive cultures in total hip arthroplasty (THA) revisions for presumed aseptic loosening, to assess the prevalence of low-grade infection using two definition criteria, and to analyze its impact on implant survival after revision. Methods A total of 274 THA revisions performed for presumed aseptic loosening from 2012 to 2016 were reviewed. In addition to obtaining intraoperative tissue cultures from all patients, synovial and sonication fluid samples of the removed implant were obtained in 215 cases (79%) and 101 cases (37%), respectively. Histopathological analysis was performed in 250 cases (91%). Patients were classified as having low-grade infections according to institutional criteria and Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) 2013 criteria. Low-grade infections according to institutional criteria were treated with targeted antibiotics for six weeks postoperatively. Implant failure was defined as the need for re-revision resulting from periprosthetic joint infection (PJI) and aseptic reasons. The mean follow-up was 68 months (26 to 95). Results Unexpected positive intraoperative samples were found in 77 revisions (28%). Low-grade infection was diagnosed in 36 cases (13%) using institutional criteria and in nine cases (3%) using MSIS ICM 2013 criteria. In all, 41 patients (15%) had single specimen growth of a low-virulent pathogen and were deemed contaminated. Coagulase-negative Staphylococcus and anaerobes were the most commonly isolated bacteria. Implant failure for PJI was higher in revisions with presumed contaminants (5/41, 12%) compared to those with low-grade infections (2/36, 6%) and those with negative samples (5/197, 3%) (p = 0.021). The rate of all-cause re-revision was similar in patients diagnosed with low-grade infections (5/36, 14%) and those with presumed contaminants (6/41, 15%) and negative samples (21/197, 11%) (p = 0.699). Conclusion Our findings suggest that the presumption of culture contamination in aseptic revision hip arthroplasty may increase the detection of PJI. In this cohort, the presence of low-grade infection did not increase the risk of re-revision. Further studies are needed to assess the relevance of single specimen growth and the benefits of specific postoperative antibiotic regimens. Cite this article: Bone Joint J 2021;103-B(6):1070–1077.

scholarly journals Incidence of low-grade infection in aseptic loosening of total hip arthroplasty

2010 ◽  
Vol 81 (6) ◽  
pp. 667-673 ◽  
Author(s):  
Dirk Jan F Moojen ◽  
Gijs van Hellemondt ◽  
H Charles Vogely ◽  
Bart J Burger ◽  
Geert H I M Walenkamp ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Low Grade ◽  
Total Hip

Short-term Complications After Revision Hip Arthroplasty for Prosthetic Joint Infection Are Increased Relative to Noninfectious Revisions

2018 ◽  
Vol 33 (9) ◽  
pp. 2997-3002 ◽  
Author(s):  
Venkat Boddapati ◽  
Michael C. Fu ◽  
Matthew W. Tetreault ◽  
Jason L. Blevins ◽  
Shawn S. Richardson ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Hip Arthroplasty ◽  
Short Term ◽  
Prosthetic Joint

scholarly journals Neutrophil to lymphocyte ratio as a predictor for diagnosis of early Periprosthetic joint infection

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bao-Zhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
Li-Bo Hao ◽  
Ji-Ying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Early Postoperative Period ◽  
Infected Group ◽  
Neutrophil To Lymphocyte Ratio ◽  
Musculoskeletal Infection ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. Methods We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. Results The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6 mg/l in the uninfected group (p < 0.001). The median of ESR was 34.8 mm/hr. in the infected group and 17.4 mm/hr. in the uninfected group (p < 0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p < 0.001). The median of IL-6 was 46 pg/ml and 6.4 pg/ml (p < 0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632). Conclusions This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

scholarly journals Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer

2017 ◽  
Vol 41 (11) ◽  
pp. 2253-2258 ◽  
Author(s):  
Dariusz Marczak ◽  
Marek Synder ◽  
Marcin Sibiński ◽  
Michał Polguj ◽  
Julian Dudka ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Hip Arthroplasty ◽  
Comparison Study ◽  
Two Stage

scholarly journals Two-Stage Revision Arthroplasty for Periprosthetic Hip Infection: Mean Follow-Up of Ten Years

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Szu-Yuan Chen ◽  
Chi-Chien Hu ◽  
Chun-Chieh Chen ◽  
Yu-Han Chang ◽  
Pang-Hsin Hsieh
Keyword(s):  
Hip Arthroplasty ◽  
Cox Regression ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Harris Hip Score ◽  
Two Stage ◽  
Eradication Of Infection ◽  
The Mean

Background. Two-stage revision hip arthroplasty is the gold standard for treatment of patients with chronic periprosthetic joint infection (PJI), but few studies have reported outcomes beyond short-term follow-up.Methods. A total of 155 patients who underwent two-stage revision arthroplasty for chronic PJI in 157 hips were retrospectively enrolled in this study between January 2001 and December 2010. The mean patient age was 57.5 years, the mean prosthetic age was 3.6 years, and the interim interval was 17.8 weeks. These patients were followed up for an average of 9.7 years.Results. At the latest follow-up, 91.7% of the patients were free of infection. The mean Harris hip score improved significantly from 28.3 points before operation to 85.7 points at the latest follow-up. Radiographically, there was aseptic loosening of the stem or acetabular components in 4 patients. In the multivariate survival analysis using a Cox regression model, repeated debridement before final reconstruction, an inadequate interim period, bacteriuria or pyuria, and cirrhosis were found to be the independent risk factors for treatment failure.Conclusion. Our data show that two-stage revision hip arthroplasty provides reliable eradication of infection and durable reconstruction of the joint in patients with PJI caused by a variety of pathogens.

Comparison of patients treated with or without a spacer in two stage revision hip arthroplasty for periprosthetic joint infection

2016 ◽  
Vol 73 (5) ◽  
pp. 520-522 ◽  
Author(s):  
Dariusz Marczak ◽  
Marek Synder ◽  
Marcin Sibiński ◽  
Marcin Waśko ◽  
Michał Polguj ◽  
...  
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Hip Arthroplasty ◽  
Two Stage

scholarly journals Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

2020 ◽  
Author(s):  
BaoZhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
LiBo Hao ◽  
Jiying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Early Postoperative Period ◽  
Infected Group ◽  
Neutrophil To Lymphocyte Ratio ◽  
Musculoskeletal Infection ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background: Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty.Methods: We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018.There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR and interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter.The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated.Results: The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The median of CRP was 66.6 mg/l in the infected group and 8.6mg/l in the uninfected group (p<0.001). The median of ESR was 34.8 mm/hr in the infected group and 17.4mm/hr in the uninfected group (p<0.001). In the infected group and uninfected group, the median of WBC was 8.2X109 /L and 6.1 X109 /L (p = 0.002), respectively; while the median of NLR was 5.2 and 2.1 (p<0.001). The median of IL-6 was 46pg/ml and 6.4pg/ml (p<0.001),respectively. The best parameter for the diagnosis of early PJI was IL-6 (AUC=0.814) followed by the NLR (AUC =0.802), CRP (AUC =0.793), ESR (AUC =0.744) and WBC (AUC = 0.632).Conclusions: This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

scholarly journals Neutrophil to Lymphocyte Ratio as a predictor for diagnosis of early Periprosthetic Joint Infection

2020 ◽  
Author(s):  
BaoZhan Yu ◽  
Jun Fu ◽  
Wei Chai ◽  
LiBo Hao ◽  
Jiying Chen
Keyword(s):  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Predictive Value ◽  
Joint Infection ◽  
Neutrophil To Lymphocyte Ratio ◽  
Optimal Cutoff ◽  
Musculoskeletal Infection ◽  
Cutoff Value ◽  
Lymphocyte Ratio ◽  
Total Knee

Abstract Background Periprosthetic joint infection (PJI) is a catastrophic complication after total knee or hip arthroplasty. The diagnosis of PJI is very difficult, especially in the early postoperative period. The value of the neutrophil to lymphocyte ratio (NLR) is useful for diagnosing infectious diseases. The objective of this study was to investigate the accuracy of the NLR for the diagnosis of early PJI after total knee or hip arthroplasty. Methods We retrospectively evaluated consecutive primary total knee or hip arthroplasty and identified the patients who readmitted within the first 90 days postoperatively between January 2011 and October 2018. There were 20 cases diagnosed early PJI and 101 uninfected cases on the basis of the modified Musculoskeletal Infection Society (MSIS) criteria. The serum parameters including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood-cell (WBC) count, NLR, interleukin-6 (IL-6) were compared between the two groups. Receiver operating characteristic curves were generated to estimate the optimal cutoff values for each parameter. The sensitivity, specificity, positive predictive value and negative predictive value for each parameter were calculated. Results The CRP, ESR, WBC, NLR and IL-6 values were all significally higher in the infected group than the uninfected group. The mean CRP (infected = 59.06, uninfected = 10.09), ESR (infected = 35, uninfected = 17), WBC(infected = 7.95 × 109,uninfected = 6.16 × 109), NLR (infected = 4.89, uninfected = 2.18), IL-6 (infected = 40.68, uninfected = 7.46).. The best parameter for the diagnosis of early PJI was IL-6 (AUC = 81.4%; optimal cutoff value 8.07 pg/ml) followed by the NLR (AUC = 80.2%; optimal cutoff value 2.13), CRP (AUC = 79.3%; optimal cutoff value 9.27 mg/l), ESR (AUC = 74.4%; optimal cutoff value 22 mm/h) and WBC (AUC = 63.2%; optimal cutoff value 8.91 × 109). Conclusions This study is the first to show that NLR values are more accurate than CRP and may be considered as useful parameters for the diagnosis of early PJI because it is a cheap and convenient parameter to be calculated in daily practice without extra costs.

scholarly journals The management of infected shoulder arthroplasty by two-stage revision

2019 ◽  
Vol 12 (1_suppl) ◽  
pp. 70-80
Author(s):  
Matthew Brown ◽  
Kelechi Eseonu ◽  
Will Rudge ◽  
Simon Warren ◽  
Addie Majed ◽  
...  
Keyword(s):  
Joint Infection ◽  
Case Series ◽  
Revision Arthroplasty ◽  
Late Presentation ◽  
Coagulase Negative Staphylococcus ◽  
Cement Spacer ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Second Stage ◽  
Standard Management

Background There remains no gold standard management for deep shoulder periprosthetic joint infection (PJI). This case series aims to present our experience of two-stage revision arthroplasty, including eradication of infection and reoperation rates. Methods We retrospectively reviewed patients undergoing revision arthroplasty for shoulder PJI between 2006 and 2015. Cases were confirmed using Musculoskeletal Infection Society (MSIS) and American Academy of Orthopaedic Surgeons (AAOS) guidelines. TSA removal, debridement and irrigation preceded antibiotic-loaded cement spacer insertion and a minimum of six weeks intravenous antibiotics. Reimplantation was performed as a second stage following a negative aspirate. Results Twenty-eight patients underwent a first stage procedure (mean age 69 years; 16 male, 12 female). Propionibacterium acnes, Methicillin-sensitive Staphylococcus aureus, Coagulase-negative Staphylococcus and Staphylococcus epidermidis were the commonest microorganisms cultured. Five cases had mixed growths and six cases provided no growth. Three patients did not proceed to a second stage. Twenty-five patients underwent reimplantation (mean interval 6.7 months), with 80% remaining infection-free (mean follow-up 38.3 months). Discussion Managing complex and late presentation shoulder PJI with two-stage revision is associated with high rates of infection eradication (80%). In the absence of a management consensus, our experience supports two-stage revision arthroplasty for eradicating infection in this complex patient group.

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