scholarly journals Evaluation of The Standard Procedure for the Treatment of Periprosthetic Joint Infections (PJI) in Germany - Results of a Survey within the EndoCert Initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Selection Of Patients ◽  
Selection Of

Abstract Background: The PJI is a severe complication in the field of arthroplasty.Despite the rising number of primary joint replacements, no therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use DAIR. A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The rising number of primary joint replacements underlines the importance of developing standards and harmonized definitions for the treatment of PJI. These standards have not yet been fully achieved. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment option in Germany. This summary of principles could serve as a basis for the development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - results of a survey within the EndoCert initiative

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet. Methods A survey on the principles of treatment of PJI in Germany was conducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%. Results For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI. Conclusion The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of the standard procedure for the treatment of periprosthetic joint infections (PJI) in Germany - Results of a survey within the EndoCert initiative

2020 ◽  
Author(s):  
Christina Rimke ◽  
Andreas Enz ◽  
Hermann Josef Bail ◽  
Peter Heppt ◽  
Bernd Kladny ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Joint Replacements ◽  
Joint Infections ◽  
Standardized Treatment ◽  
Principles Of Treatment ◽  
Further Development

Abstract Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.

scholarly journals Evaluation of The Standard Procedure For Treatment of Periprosthetic Joint Infections of Total Knee and Hip Arthroplasty: A Comparison of The 2015 and 2020 Census in Total Joint Replacement Centres in Germany

2021 ◽  
Author(s):  
Katrin Osmanski-Zenk ◽  
Annett Klinder ◽  
Christina Rimke ◽  
Dieter C. Wirtz ◽  
Christoph H. Lohmann ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Total Joint Replacement ◽  
Standard Procedure ◽  
Joint Infection ◽  
Treatment Options ◽  
Two Stage ◽  
Clear Trend ◽  
One Stage ◽  
Revision Arthroplasties ◽  
Therapeutic Algorithms

Abstract Background Since there are no national or international algorithms there are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI). Therefore, the present paper evaluates the respective protocols from different centres on the basis of an EndoCert questionnaire to treat PJI in certified total joint replacement centres (EPZ).Materials and methodsA questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the principles to treat septic revision arthroplasties in EPZ including questions on various treatment options: prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and sampling prior to reimplantation. All certified EPZ were included (n = 504). The results of the current survey 2020 were compared to those of a previous analysis.ResultsThe number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery has clearly decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option has increased (hip: +6.3%; knee: +6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the interval between prosthesis removal and reimplantation for two-stage replacement for both, hip and knee revisions. Amongst centres with a higher number of revision surgeries (>200 revisions/year), there were even more that opted for the 4-8 week period (92.3%). The Girdlestone situation, but also metal-based spacers with/without reinforcement with antibiotic-containing cement, are less frequently used. When exchanging knee replacements, there was a clear trend towards cemented anchoring, whereas cementless anchorage was preferred for hip replacements. Overall, the number of EPZ with a standardised protocol for the procedure continues to increase. In addition, more samples for microbiological testing are taken when removing the endoprosthesis, 72% of the centres take 5 or more samples.ConclusionWhile there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.

scholarly journals Topical and Oral Therapies for Childhood Atopic Dermatitis and Plaque Psoriasis

Children ◽  
2019 ◽  
Vol 6 (11) ◽  
pp. 125
Author(s):  
Travis Frantz ◽  
Ellen G. Wright ◽  
Esther A. Balogh ◽  
Abigail Cline ◽  
Adrienne L. Adler-Neal ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Treatment Guidelines ◽  
Oral Treatment ◽  
Treatment Options ◽  
Current Treatment ◽  
Expert Advice ◽  
Off Label ◽  
Systemic Treatments ◽  
Standardized Treatment

Background: Treatment of atopic dermatitis and psoriasis in children is difficult due to lack of standardized treatment guidelines and few FDA-approved treatment options. Treatments approved for adults may be used off-label in pediatric patients. Objective: This review evaluates the topical and oral treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric atopic dermatitis and psoriasis. Methods: A PubMed review of topical and systemic treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments. Results: The search identified seven topical and five systemic treatments that are routinely employed to treat pediatric atopic dermatitis and psoriasis. Limitations: Standardized guidelines regarding treatment choice, dosing, and long-term safety are scarce. Reviews may be subject to ascertainment bias. Conclusions: Current treatment guidelines are based on clinical experience and expert advice with few treatments officially approved for atopic dermatitis and psoriasis in children.

scholarly journals Biologic Treatment Options for Pediatric Psoriasis and Atopic Dermatitis

Children ◽  
2019 ◽  
Vol 6 (9) ◽  
pp. 103 ◽  
Author(s):  
Abigail Cline ◽  
Gregory J. Bartos ◽  
Lindsay C. Strowd ◽  
Steven R. Feldman
Keyword(s):  
Atopic Dermatitis ◽  
Biological Treatment ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
European Medicines Agency ◽  
High Morbidity ◽  
Biologic Treatment ◽  
Off Label ◽  
Standardized Treatment ◽  
Post Marketing

Background and Objectives: Severe, recalcitrant cases of pediatric psoriasis or atopic dermatitis may necessitate treatment with biological agents; however, this may be difficult due to lack of treatment options and standardized treatment guidelines. This review evaluates the biological treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric psoriasis and atopic dermatitis. Materials and Methods: A PubMed review of biological treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments. Results: Currently there are three European Medicines Agency (EMA)-approved biological treatment options for pediatric psoriasis: etanercept, ustekinumab, and adalimumab. While dupilumab was recently Food and Drug Administration (FDA)- and EMA-approved for adult atopic dermatitis, it is still not yet approved for pediatric atopic dermatitis. Conclusions: Given the high morbidity associated with pediatric atopic dermatitis and psoriasis, there is a need for more treatment options. Further research and post-marketing registries are needed to extend the use of biologics into pediatric patients.

scholarly journals Recent Treatments of Interstitial Lung Disease with Systemic Sclerosis

2015 ◽  
Vol 9s1 ◽  
pp. CCRPM.S23315 ◽  
Author(s):  
Hidekata Yasuoka
Keyword(s):  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Treatment Options ◽  
Immune Dysfunction ◽  
Pulmonary Involvement ◽  
Current Treatment ◽  
Microvascular Injury ◽  
Selection Of Patients ◽  
Selection Of

Systemic sclerosis (SSc) is a disorder characterized by immune dysfunction, microvascular injury, and fibrosis. Organ involvement in patients with SSc is variable; however, pulmonary involvement occurs in up to 90% of patients with SSc. Interstitial lung disease (ILD) is a major cause of mortality and, thus, a major determinant in the prognosis of patients with SSc. This review summarizes current findings about the characteristics of ILD in patients with SSc, selection of patients with SSc-ILD who are candidates for the treatment, and current treatment options.

scholarly journals Treatment of Infected Hip Arthroplasty

2010 ◽  
Vol 4 (1) ◽  
pp. 126-131 ◽  
Author(s):  
Philippe Hernigou ◽  
C.-H. Flouzat-Lachianette ◽  
R. Jalil ◽  
Sobrinho Uirassu Batista ◽  
I. Guissou ◽  
...  
Keyword(s):  
Treatment Options ◽  
Acute Infection ◽  
Treatment Method ◽  
Single Stage ◽  
Consecutive Series ◽  
Success Rates ◽  
Two Stage ◽  
Joint Infections ◽  
Exchange Arthroplasty ◽  
Prosthesis Removal

The clinical outcomes of a consecutive series of deep total joint infections treated with a prosthesis retaining protocol were reviewed. The treatment of deep periprosthetic joint infections is challenging. In recent years, two-stage exchange arthroplasty has emerged as the gold standard for successful elimination of infection. With success rates averaging 82% to 96%, this treatment method has both the highest and most consistent rate of infection eradication. Another alternative in the treatment of the deep periprosthetic infection is the single-stage exchange arthroplasty. Successful eradication of infection after single-stage exchange arthroplasty has been reported to average from 60% to 83% after total hip infections. While both the single and two-stage exchange arthroplasty are viable treatment options, they are associated with negative factors such as they are time consuming, expensive, and may entail a 6- to 12-week period with a minimally functioning extremity after prosthesis removal. This paper reports the general principles of management, the treatment of acute infection occurring in the postoperative period or later, and the treatment of chronic infection by exchange arthroplasty or resection arthroplasty.

scholarly journals Assessment of risk of loss of the implant in two-stage breast reconstruction

2021 ◽  
Vol 16 (3) ◽  
pp. 12-17
Author(s):  
E. V. Shivilov ◽  
G. E. Kvetenadze ◽  
Kh. S. Arslanov ◽  
O. E. Tseplina
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Breast Reconstruction ◽  
Good Cosmetic Result ◽  
Two Stage ◽  
Good Cosmetic ◽  
Reconstructive Plastic Surgery ◽  
Reconstructive Plastic ◽  
Selection Of Patients ◽  
Selection Of

Surgical treatment remains one of the leading methods in the treatment of breast cancer. Every year, the number of breast reconstruction operations is steadily increasing. But the number of possible complications associated with performing such operations also increases. Breast reconstruction using an expander may be one of the acceptable options for patients who are planning radiation therapy. The article analyzes the results of two-stage reconstructive plastic surgery on the breast in the complex treatment of patients diagnosed with breast cancer. In 90.5 % of cases, a good cosmetic result was obtained. The risk of losing the implant after chemotherapy was 4.8 % and 13.9 % for chemotherapy combined with radiation therapy, respectively. Two-stage breast reconstruction can be used with careful selection of patients.

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