scholarly journals Compared with two-stage revision, retained spacers have a similar infection-relief rate and a higher complication rate

2020 ◽  
Author(s):  
Yuanqing Cai ◽  
Xinyu Fang ◽  
Yi Lin ◽  
Zida Huang ◽  
Chaofan Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Complication Rate ◽  
Joint Infection ◽  
Type I ◽  
Test Results ◽  
Two Stage ◽  
Spacer Group ◽  
Laboratory Test Results ◽  
Comorbidity Index ◽  
Relief Rate

Abstract Background: Periprosthetic joint infection (PJI) is a devastating complication for joint arthroplasty, there are many challenges in therapy. The treatment of PJI including surgery and systemic administration of antibiotics. As for surgery, two-stage revision is regarded as the “gold standard” for PJI treatment presently, in which antibiotic-impregnated spacers play an important role. However, some patients are unable to undergo reimplantation of the prosthesis after spacer implantation, this spacer, namely, “destination joint spacer”. The clinical outcomes of these patients remain unknown. The purpose of this research was to study the infection-relief rate and clinical outcome of these patients.Methods: From January 2006 to December 2017, data from PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. Age, sex, body mass index (BMI) and laboratory test results were recorded, and the infection-relief rate and clinical outcomes were observed.Results: A total of 62 patients who were diagnosed with PJI were enrolled, with an age of 65.13 ±9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group. Our study showed that the infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the incidence of complications was higher than that of two-stage revision, especially for the type I spacer used in this study.Conclusions: The infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the complication rate was higher than that of two-stage revision (especially for the type I spacer).

scholarly journals Compared with two-stage revision, retained spacers have a similar infection-relief rate and a higher complication rate

2020 ◽  
Author(s):  
Yuanqing Cai ◽  
Xinyu Fang ◽  
Yi Lin ◽  
Zida Huang ◽  
Chaofan Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Complication Rate ◽  
Joint Infection ◽  
Type I ◽  
Test Results ◽  
Two Stage ◽  
Spacer Group ◽  
Laboratory Test Results ◽  
Comorbidity Index ◽  
Relief Rate

Abstract Background: Periprosthetic joint infection (PJI) is a devastating complication for joint arthroplasty, there are many challenges in therapy. The treatment of PJI including surgery and systemic administration of antibiotics. As for surgery, two-stage revision is regarded as the “gold standard” for PJI treatment presently, in which antibiotic-impregnated spacers play an important role. However, some patients are unable to undergo reimplantation of the prosthesis after spacer implantation, this spacer, namely, “destination joint spacer”. The clinical outcomes of these patients remain unknown. The purpose of this research was to study the infection-relief rate and clinical outcome of these patients.Methods: From January 2006 to December 2017, data from PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. Age, sex, body mass index (BMI) and laboratory test results were recorded, and the infection-relief rate and clinical outcomes were observed.Results: A total of 62 patients who were diagnosed with PJI were enrolled, with an age of 65.13 ±9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group. Our study showed that the infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the incidence of complications was higher than that of two-stage revision, especially for the type I spacer used in this study.Conclusions: The infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the complication rate was higher than that of two-stage revision (especially for the type I spacer).

scholarly journals Compared with Two-Stage Revision, Destination Joint Spacers Have a Similar Infection-Relief Rate and a Higher Complication Rate

2020 ◽  
Author(s):  
Yuanqing Cai ◽  
Xinyu Fang ◽  
Yi Lin ◽  
Zida Huang ◽  
Chaofan Zhang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Complication Rate ◽  
Joint Infection ◽  
Type I ◽  
Test Results ◽  
Two Stage ◽  
Spacer Group ◽  
Laboratory Test Results ◽  
Comorbidity Index ◽  
Relief Rate

Abstract Background: Two-stage revision is regarded as the “gold standard” for periprosthetic joint infection (PJI) treatment, in which antibiotic-impregnated spacers play an important role. However, some patients are unable to undergo reimplantation of the prosthesis after spacer implantation. The clinical outcomes of these patients remain unknown. The purpose of this research was to study the infection-relief rate and clinical outcome of these patients.Methods: From January 2006 to December 2017, data from PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. Age, sex, body mass index (BMI) and laboratory test results were recorded, and the infection-relief rate and clinical outcomes were observed.Results: A total of 62 patients who were diagnosed with PJI were enrolled, with an age of 65.13 ±9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group. Our study showed that the infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the incidence of complications was higher than that of two-stage revision, especially for the type I spacer used in this study.Conclusions: The infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the complication rate was higher than that of two-stage revision (especially for the type I spacer).

scholarly journals Destination Joint Spacers: A Similar Infection‐Relief Rate But Higher Complication Rate Compared with Two‐Stage Revision

2021 ◽  
Author(s):  
Yuan‐qing Cai ◽  
Xin‐yu Fang ◽  
Chang‐yu Huang ◽  
Zi‐ming Li ◽  
Zi‐da Huang ◽  
...  
Keyword(s):  
Complication Rate ◽  
Two Stage ◽  
Relief Rate

scholarly journals Hip Spacers with a Metal-on-Cement Articulation Did Not Show Significant Surface Alterations of the Metal Femoral Head in Two-Stage Revision for Periprosthetic Joint Infection

Materials ◽  
2020 ◽  
Vol 13 (17) ◽  
pp. 3882
Author(s):  
Andre Lunz ◽  
Robert Sonntag ◽  
J. Philippe Kretzer ◽  
Sebastian Jaeger ◽  
Therese Bormann ◽  
...  
Keyword(s):  
Surface Roughness ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Two Stage ◽  
Spacer Group ◽  
Metal Head ◽  
Pmma Bone Cement ◽  
Femoral Heads ◽  
Interim Period

Two-stage revision is considered the gold standard treatment for chronic periprosthetic joint infection (PJI). During the interim period, between explantation of the infected hip endoprosthesis and revision arthroplasty, individually formed articulating hip spacers made of polymethylmethacrylate (PMMA) bone cement can be used to provide better soft tissue preservation, local antibiotic release, and improved postoperative mobilization. If effective prevention from luxation is achieved, hip function and hence overall patient satisfaction is improved. Zirconium oxide particles inside conventional PMMA bone cement, however, are known to enhance third-body wear, which may cause alterations of the metal head in the articulating spacer and hence become a serious risk for the patient. Therefore, the aim of our study was to analyze whether the articular surface of cobalt-chrome (CoCr) femoral heads is significantly altered in the setting of a metal-on-cement articulation during the interim period of two-stage revision for PJI. We analyzed a consecutive series of 23 spacer cases and compared them with femoral heads from two series of conventional hip arthroplasty revisions with metal-on-polyethylene articulations and different time intervals in situ. To investigate metallic wear, the femoral heads were thoroughly examined, and their surface roughness was measured and analyzed. We found no significant differences between the two conventional hip arthroplasty groups, despite their very different times in situ. Furthermore, the individually different times in situ within the spacer group had no significant impact on surface roughness, either. Compared with the spacer group, the surface roughness of the metal femoral heads from both conventional hip arthroplasty groups were even higher. Within the spacer group, roughness parameters did not show significant differences regarding the five predefined locations on the metal head. We conclude that metal-on-cement articulations do not cause enhanced surface alterations of the metal femoral head and hence do not limit the application in articulating hip spacers in the setting of two-stage revision for PJI.

scholarly journals Two-Stage Revision Total Knee Arthroplasty in Cases of Periprosthetic Joint Infection: An Analysis of 50 Cases

2015 ◽  
Vol 9 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Leif Claassen ◽  
Christian Plaass ◽  
Kiriakos Daniilidis ◽  
Tilman Calliess ◽  
Gabriela von Lewinski
Keyword(s):  
Total Knee Arthroplasty ◽  
Success Rate ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Two Stage ◽  
Comorbidity Index ◽  
Total Knee

Objectives: A periprosthetic joint infection (PJI) is a significant complication after total knee arthroplasty (TKA). Still there is no agreement on a perfect diagnosis and treatment algorithm. The aim of this study was to evaluate the success and revision rates after two-stage revision total knee arthroplasty (TKA) and factors that affect the success rate.Material and Methods:50 consecutive two-stage revision TKAs were performed between January 2011 and December 2012. We retrospectively reviewed study patient's charts including demographics, prior surgeries, comorbidities, incidence of persistent infection and revisions. At the final follow-up examination the patient's satisfaction, pain level and disorders were evaluated. A successful clinical outcome was defined as a functioning prosthesis without wound healing disorders, no sinuses tracts or other clinical evidence of a persistent infection.Results: Re-implantation of prosthesis was performed in 47 cases; three patients received a septic arthrodesis. Twelve patients had a persistent infection despite two-stage re-implantation resulting in a success rate of 76.0%. In eight of these twelve patients an infecting germ was isolated during second-stage procedure. Three patients received another two-stage revision arthroplasty and one patient an above knee amputation. A revision was performed in 23 of 50 patients (46.0%). Factors that diminish the success rate were further operations after primary TKA (p = 0.048), prior revision arthroplasties after TKA (p = 0.045), nicotine abuse (p = 0.048), Charlson comorbidity index above a score of 2 (p = 0.031) and a mixed flora during first-stage procedure (p < 0.001). Age, sex, immune status, chronic anticoagulant use, rheumatoid arthritis, body mass index and the presence of multidrug resistant germs showed no significant effect on success rate (p > 0.05).Conclusion: We found that patients who required surgery after the primary TKA, had a higher Charlson comorbidity index or were found to have mixed flora during explantation. The treatment of PJI remains difficult, both for the patient and for the treating surgeons.

scholarly journals Socio-demographic and Clinical Characteristics of Adults with SARS-CoV-2 Infection in Two Hospitals in Bogota, Colombia.

2020 ◽  
Author(s):  
Alejandro Moscoso ◽  
Alejandra Sanchez ◽  
Adriana Aya ◽  
Carolina Gomez ◽  
Yazmin Rodriguez ◽  
...  
Keyword(s):  
Laboratory Test ◽  
Clinical Outcomes ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Adult Patients ◽  
Therapeutic Management ◽  
Test Results ◽  
Private Hospitals ◽  
Economic Information ◽  
Laboratory Test Results

This study is a retrospective cohort of 122 adult patients with SARS-CoV-2 diagnosed and managed at two medium-sized, tertiary private Hospitals. The analysis includes demographic and socio-economic information, symptoms, comorbidities, laboratory test results, therapeutic management, clinical outcomes and complications.

scholarly journals Use of a Biomimetic Scaffold for the Treatment of Osteochondral Lesions in Early Osteoarthritis

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Vincenzo Condello ◽  
Giuseppe Filardo ◽  
Vincenzo Madonna ◽  
Luca Andriolo ◽  
Daniele Screpis ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Complication Rate ◽  
Cartilage Defects ◽  
Osteochondral Lesions ◽  
Type I ◽  
Patient’S Satisfaction ◽  
Osteochondral Scaffold ◽  
Biomimetic Scaffold ◽  
Early Oa

The aim of this study is to investigate clinical and radiographic outcomes of a biomimetic scaffold for the treatment of osteochondral knee lesions in patients with early OA. Study population was represented by 26 patients with a mean age of 44 years affected by early OA. Inclusion criteria were two episodes of knee pain for more than 10 days in the last year, Kellgren-Lawrence OA grade 0 or I or II, and arthroscopic findings of cartilage defects. Nineteen patients had a previous surgery, 11 of which were revision surgeries of osteochondral unit. All patients were treated with a biomimetic scaffold with a tri-layered structure of type I equine collagen and magnesium-enriched hydroxyapatite. Clinical outcomes were evaluated using the IKDC, Lysholm, VAS, KOOS, and Tegner scores at baseline and at an average follow-up of 35 months. Magnetic resonance imaging (MRI) was performed at follow-up time in 19 patients. Clinical outcomes showed significant improvement in VAS, Lysholm, IKDC subjective score, and KOOS subscales in 69% of the patients. Complication rate of this cases series was 11%, with no surgical failure, although 31% of patients did not reach a significant improvement and were thus considered as clinical failure. MRI analysis showed integration of the scaffold only in 47% of the patients, with partial regeneration of the subchondral bone. No correlation between clinics and radiological images was found. The use of a biomimetic osteochondral scaffold in the setting of an early OA, alone or associated with other procedures, appeared to be a valid and safe option, able to provide good and stable clinical outcomes with high patient’s satisfaction and low complication rate.

scholarly journals Two Stage Hip Revision in Periprosthetic Infection: Results of 41 Cases

2010 ◽  
Vol 4 (1) ◽  
pp. 193-200 ◽  
Author(s):  
Giovanni Pignatti ◽  
Shingo Nitta ◽  
Nicola Rani ◽  
Dante Dallari ◽  
Giacomo Sabbioni ◽  
...  
Keyword(s):  
Joint Infection ◽  
Treatment Protocol ◽  
Revision Arthroplasty ◽  
Harris Hip Score ◽  
Radiographic Evaluation ◽  
Cement Spacer ◽  
Two Stage ◽  
Hip Prostheses ◽  
Spacer Group ◽  
The One

Background:two-stage revision is considered the best treatment approach for the eradication of chronic joint infection. We report the outcome of 41 consecutive patients with infected hip prostheses, treated between 2000 and 2005, with two-stage revision using an antibiotic-loaded cement spacer.Methods:Patients underwent a treatment protocol which included clinical and radiographic evaluation, laboratory investigations, hip aspiration, 99mTc-MDP and 99mTc-leukocyte-labeled scintigraphy and intraoperative assessment. All patients were diagnosed with a late chronic infection and classified as B-host according to the Cierny-Mader classification system. 9 patients out of 41 (22%) required a second interim treatment period, with exchange of the spacer. The proportion of methicillin-resistant Staphylococcus was similar between the one-spacer group and two-spacer group (28%vs33%), whereas the proportion of patients with three or more risk factors was significantly higher in the two-spacer group than in the one-spacer group (28%vs55%, respectively).Results:Forty patients had final reimplantation, one patient had a resection arthroplasty. At an average follow-up of 5.3 years no recurrence of infection occurred. The average post-operative Harris hip score improved from 41 to 80.Conclusions:In the treatment of two-stage revision arthroplasty the adherence to the protocol proved to be effective for infection eradication and final reimplantation.

scholarly journals The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jun Fu ◽  
Yi Xiang ◽  
Ming Ni ◽  
Jiying Chen ◽  
Xiang Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Bone Defect ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Cement Spacer ◽  
Two Stage ◽  
Acetabular Bone ◽  
Wall Defect ◽  
Second Stage ◽  
Acetabular Bone Defect

Abstract Background Spacer complications may affect final clinical outcome of the two-stage approach in periprosthetic joint infection (PJI) patients. This study aimed to investigate clinical outcomes and complications of augmented antibiotic-loaded cement spacer in PJI patients with acetabular bone defect. Methods Data on PJI patients with acetabular bone defect receiving two-stage revision from January 2009 to December 2016, in our hospital were retrospectively reviewed. Screw-cement-shell was used to improve the stability of the hip with acetabular wall defect. Handmade acetabular spacer could prevent femoral spacer entering into pelvis in patients with acetabular internal wall defect. A total of 26 patients (11 males and 15 females) were included in the current study. Their mean age was 46.7 ± 15.4 years old. Clinical outcomes and complications were measured. Results Twenty-one of total 26 hips (21/26, 80.8%) showed positive cultures and 15/26 (57.7%) samples were cultured with staphylococcus. Of enrolled patients, 5/26 (19.2%) developed mixed infection. There was one patient (3.8%) with spacer dislocation and two (7.7%) with spacer fracture. One patient developed acute PJI 5 years after the second-stage revision, so overall success rate among these patients was 96.2%. Differences in Paprosky classifications before the first and second stage did not reach significant level (p > 0.05). Hip Harris score was raised from 40.9 ± 14.0 to 81.2 ± 11.2 (p < 0.05). Conclusions Augmented antibiotic-loaded cement spacer could achieve satisfactory clinical outcomes in PJI patients with acetabular bone defect. It provided joint mobility, increased additional joint stability, and decreased iatrogenic bone defect caused by acetabular wear.

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