scholarly journals Management strategies for prosthetic joint infection: long-term infection control rates, overall survival rates, functional and quality of life outcomes

2021 ◽  
Vol 6 (9) ◽  
pp. 727-734
Author(s):  
Theofilos Karachalios ◽  
George A. Komnos
Keyword(s):  
Quality Of Life ◽  
Joint Infection ◽  
Management Strategies ◽  
Survival Rates ◽  
Outcome Data ◽  
Life Outcomes ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint

DAIR (debridement, antibiotics, and implant retention), one-stage and two-stage revision surgery are the most common management strategies for prosthetic joint infection (PJI) management. Our knowledge concerning their efficacy is based on short to medium-term low-quality studies. Most studies report infection recurrence rates or infection-free time intervals. However, long-term survival rates of the infection-free joints, functional and quality of life outcome data are of paramount importance. DAIR, one-stage and two-stage revision strategies are not unique surgical techniques, presenting several variables. Infection control rates for the above strategies vary from 75% to 90%, but comparisons are difficult because different indications and patient selection criteria are used in each strategy. Recent outcome data show that DAIR and one-stage revision in selected patients (based on host, bacteriological, soft tissue and type of infection criteria) may present improved functional and quality of life outcomes and reduced costs for health systems as compared to those of two-stage revision. It is expected that health system administrators and providers will apply pressure on surgeons and departments towards the wider use of DAIR and one-stage revision strategies. It is the orthopaedic surgeon’s responsibility to conduct quality studies in order to fully clarify the indications and outcomes of the different revision strategies. Cite this article: EFORT Open Rev 2021;6:727-734. DOI: 10.1302/2058-5241.6.210008

scholarly journals One-stage and two-stage breast reconstruction have no meaningful difference in patient quality of life

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Amer Mansoor
Keyword(s):  
Quality Of Life ◽  
Breast Reconstruction ◽  
Controlled Trial ◽  
Acellular Dermal Matrix ◽  
Clinical Decision ◽  
Two Stage ◽  
Dermal Matrix ◽  
One Stage ◽  
Randomised Controlled

A clinical decision report appraising Negenborn VL, Young-Afat DA, Dikmans REG, et al. Quality of life and patient satisfaction after one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage breast reconstruction (BRIOS): primary outcome of a randomised, controlled trial. Lancet Oncology. 2018;19(9):1205-14. https://doi.org/10.1016/s1470-2045(18)30378-4.

scholarly journals 257. Outcomes in Fungal Prosthetic Joint Infection

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S235-S235
Author(s):  
Caitlyn M Hollingshead ◽  
Joan Duggan ◽  
Roberta Redfern ◽  
Gregory Georgiadis ◽  
Jason Tank
Keyword(s):  
Prosthetic Joint Infection ◽  
Candida Species ◽  
Joint Infection ◽  
Two Stage ◽  
One Stage ◽  
Prosthetic Joint ◽  
Hip Replacements ◽  
Fungal Organisms ◽  
Poor Outcomes ◽  
Wbc Count

Abstract Background There is a paucity of data in the literature regarding the most effective treatment and related outcomes of fungal prosthetic joint infection. The majority of reported cases are treated using a two stage revision method in which the initial prosthesis is removed and the patient is treated with systemic antifungal medications and potentially irrigation of the joint cavity with antifungal and antibacterial agents. Alternately, others have suggested a one-stage revision in order to prevent a period of significant functional impairment and potentially improved functional outcomes and lower overall costs. Cases of radical removal of the prosthesis without replacement have been reported. To date, the largest studies of total hip arthroplasty and total knee arthroplasty have included 37 and 45 patients, respectively. Methods A retrospective record review of patients admitted within two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed. Results Eighteen patients fit criteria. Nine patients had knee replacements and nine patients had hip replacements. The average age at time of infection was 61. Ten patients were female. Average BMI was 32.1. Twelve presented with a painful joint, eight presented with drainage, and one with dehiscence. Average WBC count was 9.3, average ESR was 47, and average CRP was 11.8. All patients were noted with Candida species. Eight patients were treated with two stage revisions, three received one stage revisions as destination therapy. One required amputation. All but one patient was associated with concurrent bacterial infection. Of the twelve patients that had known outcomes, six were noted with cure and six were noted with relapse. All patients that were cured received two stage exchange or girdlestone procedure. Conclusion In our study, fungal prosthetic joint infection was associated with poor outcomes. All of the patients in our study were noted with Candida species, which is in concordance with the known literature. Two stage exchange was associated with better outcomes. Disclosures All Authors: No reported disclosures

scholarly journals Prosthetic Joint Infection: Report on the One versus Two-stage Exchange EBJIS Survey

2016 ◽  
Vol 1 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Pedro Santos Leite ◽  
Sérgio Figueiredo ◽  
Ricardo Sousa
Keyword(s):  
Prosthetic Joint Infection ◽  
Revision Surgery ◽  
Joint Infection ◽  
Clinical Aspects ◽  
Online Questionnaire ◽  
Two Stage ◽  
Significant Group ◽  
One Stage ◽  
Prosthetic Joint ◽  
Multicentre Research

Abstract. Background: Prosthetic Joint Infection (PJI) is one of the most challenging problems in orthopaedic surgery and musculoskeletal infections specifically. Some very important controversies remain and strong evidence-based recommendations are still lacking in many clinical aspects. Therefore, an undisputed methodology of treatment does not exist yet and there are many different valid approaches.Purposes: To draw a picture of the different practice patterns around Europe and understand the motivations of the European Bone & Joint Infection Society (EBJIS) members in choosing between one- or two-stage revision surgery in treating chronic PJI.Methods: The participants of the 34th EBJIS Annual Meeting were surveyed through an online questionnaire. The survey assessed the main philosophy in the treatment of chronic PJI, personal and institutional information as well as the importance of different factors in choosing two-stage or one-stage procedures.Results: One hundred and forty-three participants responded to the survey, including a significant group of skilful orthopaedic surgeons with large experience in treating musculoskeletal infections. Primarily two-stage was the most common philosophy regrading treatment of chronic PJI (60.1%), followed by two-stage or one-stage accordingly (34,8%) and primarily one-stage (5,1%). Significant soft tissue compromise, failure of previous revision surgery attempts, highly resistant or unclear infective microorganism(s) preoperatively and patient presenting with sepsis or immunosuppression, were considered the more relevant factors in choosing two-stage instead one-stage procedures.Interpretation: Treatment of chronic PJI is challenging and demanding. An open dialogue to share the different experiences and a collective effort to plan a major multicentre research in order to establish standardized protocols are essential.

scholarly journals Prosthetic joint infection following total hip replacement: results of one-stage versus two-stage exchange

2014 ◽  
Vol 38 (7) ◽  
pp. 1363-1368 ◽  
Author(s):  
Matthias Wolf ◽  
Heimo Clar ◽  
Jörg Friesenbichler ◽  
Gerold Schwantzer ◽  
Gerwin Bernhardt ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Prosthetic Joint Infection ◽  
Hip Replacement ◽  
Joint Infection ◽  
Stage Versus ◽  
Two Stage ◽  
Total Hip ◽  
One Stage ◽  
Prosthetic Joint

scholarly journals Scheuermann’s disease surgery. Major problems: non-systematic literature review (part I).

2021 ◽  
Vol 18 (3) ◽  
pp. 6-18
Author(s):  
M. V. Mikhaylovskiy ◽  
V. L. Lukinov
Keyword(s):  
Quality Of Life ◽  
Blood Loss ◽  
Intraoperative Blood Loss ◽  
Two Stage ◽  
Scheuermann’S Disease ◽  
Scheuermann's Disease ◽  
One Stage ◽  
Surgery Duration

Objective. To perform multivariate comparison of two surgical strategies in the treatment of patients with severe Scheuermann’s disease.Material and Methods. The search of sources (in Scopus and Web of Science databases) revealed  56 publications containing the required information. The literature data were analyzed in four directions: the results of one- and two-stage interventions are compared in terms of the magnitude of achieved correction and its preservation, the complication rate, the surgery duration and the volume of intraoperative blood loss, and the quality of life of patients in the postoperative period.Results. The magnitude of the achieved correction of kyphotic deformity and postoperative loss of correction in patients after one- and two-stage operations are almost identical. Implant-associated complications are more often observed after one-stage operations, and purulent, neurological and other complications – after two-stage operations. Surgery duration and intraoperative blood loss volume are greater in two-stage operations. The quality of life assessed by various questionnaires is significantly improved, regardless of the type of surgery.Conclusion. Two-stage surgical correction of Scheuermann’s kyphosis has no noticeable advantages over one-stage surgery, however, new studies with long (more than 15–18 years) postoperative follow-up are needed.

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.

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