scholarly journals “Unexpected” Infections in Revision Arthroplasty for Aseptic Loosening

2021 ◽  
Vol 27 (3) ◽  
pp. 56-70
Author(s):  
Nikolay S. Nikolaev ◽  
Nadezhda N. Pchelova ◽  
Elena V. Preobrazhenskaya ◽  
Valentina V. Nazarova ◽  
Natal’ya Yu. Dobrovol’skaya
Keyword(s):  
Knee Joint ◽  
Aseptic Loosening ◽  
Complete Blood Count ◽  
Anaerobic Bacteria ◽  
Revision Arthroplasty ◽  
Infectious Complications ◽  
Coagulase Negative Staphylococci ◽  
Hip Joints ◽  
One Stage ◽  
Aseptic Revision

Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight. The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology. Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection. Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out. Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.

scholarly journals Positive Microbiological Findings at the Site of Presumed Aseptic Revision Arthroplasty Surgery of the Hip and Knee Joint: Is a Surgical Revision Always Necessary?

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Konstantinos Anagnostakos ◽  
Andreas Thiery ◽  
Christof Meyer ◽  
Ismail Sahan
Keyword(s):  
Knee Joint ◽  
Antibiotic Therapy ◽  
Revision Surgery ◽  
Normal Values ◽  
Revision Arthroplasty ◽  
Systemic Antibiotic ◽  
Systemic Antibiotic Therapy ◽  
Aseptic Revision ◽  
Arthroplasty Surgery

Little is known about patients that undergo presumed aseptic revision arthroplasty surgery of the hip and knee joint and having positive microbiological findings of the intraoperatively taken tissue samples. 228 “aseptic” operations were retrospectively analyzed from prospectively collected data with regard to the following parameters: demographic data; reasons for primary and revision surgery, respectively; time between primary and revision surgery; preoperative laboratory findings; microbiological and histopathological findings; type and length of systemic antibiotic therapy; clinical outcome; and follow-up. Identification of microorganisms was present in 8.8% of the cases (9.3% of the hip and 7.8% of the knee cases). Preoperatively, the median CRP value was 8.4 mg/l (normal values 0-5.0 mg/l) and the median WBC count 8,100×106/l (normal values 3,700‐10,100×106/l). The most common identified organism was methicillin-resistant Staphylococcus epidermidis in 30%, followed by viridans streptococci in 15% of the cases. In 7 cases, the microbiological findings were interpreted as a contamination, and no antibiotic therapy was administered. In the other cases, a systemic antibiotic therapy was applied for a time period between 2 weeks and 3 months. 68.4% of the patients did not have any infectious complications at a median follow-up of 20 (3-42) months. The present study indicates that more than 2/3 of the cases with positive microbiological findings at the site of presumed aseptic revision arthroplasty surgery of the hip and knee joint can be successfully treated conservatively and they do not require any further surgical therapy.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

scholarly journals The Prevalence and Clinical Significance of Anaerobic Bacteria in Major Liver Resection

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 139
Author(s):  
Jens Strohäker ◽  
Sophia Bareiß ◽  
Silvio Nadalin ◽  
Alfred Königsrainer ◽  
Ruth Ladurner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anaerobic Bacteria ◽  
Positive Culture ◽  
Infectious Complications ◽  
University Hospital ◽  
Clinical Role ◽  
Liver Resections ◽  
Management Of Complications ◽  
Anaerobic Infections ◽  
Major Hepatectomies

(1) Background: Anaerobic infections in hepatobiliary surgery have rarely been addressed. Whereas infectious complications during the perioperative phase of liver resections are common, there are very limited data on the prevalence and clinical role of anaerobes in this context. Given the risk of contaminated bile in liver resections, the goal of our study was to investigate the prevalence and outcome of anaerobic infections in major hepatectomies. (2) Methods: We retrospectively analyzed the charts of 245 consecutive major hepatectomies that were performed at the department of General, Visceral, and Transplantation Surgery of the University Hospital of Tuebingen between July 2017 and August 2020. All microbiological cultures were screened for the prevalence of anaerobic bacteria and the patients’ clinical characteristics and outcomes were evaluated. (3) Results: Of the 245 patients, 13 patients suffered from anaerobic infections. Seven had positive cultures from the biliary tract during the primary procedure, while six had positive culture results from samples obtained during the management of complications. Risk factors for anaerobic infections were preoperative biliary stenting (p = 0.002) and bile leaks (p = 0.009). All of these infections had to be treated by intervention and adjunct antibiotic treatment with broad spectrum antibiotics. (4) Conclusions: Anaerobic infections are rare in liver resections. Certain risk factors trigger the antibiotic coverage of anaerobes.

Preliminary Results After Changing From Two-Stage to One-Stage Revision Arthroplasty Protocol Using Cementless Arthroplasty for Chronic Infected Hip Replacements

2018 ◽  
Vol 33 (2) ◽  
pp. 527-532 ◽  
Author(s):  
Guillem Bori ◽  
Guillem Navarro ◽  
Laura Morata ◽  
Jenaro A. Fernández-Valencia ◽  
Alex Soriano ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Two Stage ◽  
Preliminary Results ◽  
One Stage ◽  
Hip Replacements ◽  
Cementless Arthroplasty

scholarly journals INFECTIOUS COMPLICATIONS CAUSED BY NON-SPOREFORMING ANAEROBIC BACTERIA IN CANCER PATIENTS. RELEVANCE OF THE PROBLEM

2020 ◽  
Vol 19 (4) ◽  
pp. 146-151
Author(s):  
I. V. Tereshchenko ◽  
Z. V. Grigoryevskaya ◽  
I. N. Petukhova ◽  
N. S. Bagirova ◽  
V. D. Vinnikova ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Anaerobic Bacteria ◽  
Infectious Complications

scholarly journals Local application of vancomycin in one-stage revision of PJI caused by MRSA in a rat model

2021 ◽  
Author(s):  
Jian Wei ◽  
Yinxian Wen ◽  
Kai Tong ◽  
Hui Wang ◽  
Liaobin Chen
Keyword(s):  
Rat Model ◽  
Revision Surgery ◽  
Eradication Rate ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Serum Markers ◽  
Acid Glycoprotein ◽  
One Stage ◽  
Better Than

The eradication rate of periprosthetic joint infection (PJI) caused by methicillin-resistant staphylococcus aureus (MRSA) is still not satisfactory by systemic vancomycin administration in one-stage revision arthroplasty. This study aimed to explore the effectiveness and safety of intra-articular injection of vancomycin in the control of MRSA-PJI after one-stage revision surgery in a rat model. Two weeks of intra-peritoneal (IP) and/or intra-articular (IA) injection of vancomycin were applied to control the infection after one-stage revision surgery. The MRSA-PJI rats treated with IA injection of vancomycin showed a better outcome in skin temperature, bacterial counts, biofilm on the prosthesis, serum alpha-1-acid glycoprotein (α1-AGP), residual bone volume and inflammatory reaction in the joint tissues than those with IP vancomycin, while rats with IP & IA administration showed the best outcomes. However, only the IP & IA administration of vancomycin could eradicate MRSA. Minimal changes of renal pathology were observed in IP and IP & IA groups, rather than IA group, while no obvious changes were observed in the liver, as well as serum markers including creatinine (Cr), alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Therefore, IA use of vancomycin is effective and safe in the MRSA-PJI rat model, better than systematic administration, while IA & systemic vancomycin could eradicate the infection in a two-week treatment course.

Influence of Selective Bowel Decontamination on the Organisms Recovered During Bacteremia in Neutropenic Patients

2004 ◽  
Vol 25 (8) ◽  
pp. 685-689 ◽  
Author(s):  
Florian Daxboeck ◽  
Werner Rabitsch ◽  
Alexander Blacky ◽  
Maria Stadler ◽  
Paul A. Kyrle ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Bone Marrow ◽  
Anaerobic Bacteria ◽  
Blood Cultures ◽  
University Teaching ◽  
Coagulase Negative Staphylococci ◽  
Gram Negative ◽  
Neutropenic Patients ◽  
Care Ward

AbstractObjective:To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).Design:The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.Setting:A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.Results:The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).Conclusions:SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.

Local antibiotic therapy for endoprosthesis site infection (Literature review)

2021 ◽  
Vol 90 (4) ◽  
pp. 78-85
Author(s):  
T.A. Kilmetov ◽  
◽  
I.F. Akhtyamov ◽  
Keyword(s):  
Comparative Analysis ◽  
Literature Review ◽  
Antibiotic Therapy ◽  
Musculoskeletal System ◽  
Treatment Options ◽  
Revision Arthroplasty ◽  
Infectious Complications ◽  
Site Infection ◽  
Local Antibiotic ◽  
Local Antibiotic Therapy

Endoprosthetics of joints has firmly taken its place in a number of orthopedic interventions in the treatment of diseases of the musculoskeletal system. Unfortu-nately, with an increase in the number of operations, the number of complications that develop at various stages of treatment does not decrease. Deep infections in the area of the endoprosthesis (paraprosthetic infection) are especially difficult in treatment, since only 20% of patients, and mainly in early forms of complications, manage to save the implant. The incidence of infectious complications at the stationary stage in specialized endoprosthetics centers does not exceed 1% during primary operations, but their number, as a rule, multiplies several years after the intervention. The most common treatment option for paraprosthetic infection is staged revision arthroplasty. The authors of the review conduct a comparative analysis of the effectiveness of one- and two-stage treatment options. The latter is based on the use of bone cement spacers impregnated with antibiotics.

Development of antibiotic resistance in periprosthetic joint infection after total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 171-176
Author(s):  
Antonio Klasan ◽  
Arne Schermuksnies ◽  
Florian Gerber ◽  
Matt Bowman ◽  
Susanne Fuchs-Winkelmann ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Antibiotic Resistance ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bacterial Strains ◽  
Coagulase Negative Staphylococci ◽  
Primary Arthroplasty ◽  
Total Knee

Aims The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown. Methods A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime. Results We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent. Conclusion Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.

scholarly journals One Stage Conversion of an Infected Fused Knee to Total Knee Replacement - A Surgical Challenge

2013 ◽  
Vol 7 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Mukartihal Ravikumar ◽  
Daniel Kendoff ◽  
Mustafa Citak ◽  
Stefan Luck ◽  
Thorsten Gehrke ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Revision Arthroplasty ◽  
Preoperative Assessment ◽  
Stage Conversion ◽  
One Stage ◽  
Common Technique ◽  
Total Knee ◽  
The Right

Background and Purpose: Two-stage revision arthroplasty is a common technique for the treatment of infected total knee replacement. Few reports have addressed the conversion of a fused knee into a total knee replacement. However, there is no case reported of converting an infected fused knee into a hinge knee using a one-stage procedure. Methods: We report on a 51-year old male patient with an infected fused knee after multiple surgeries. Results and Interpretation: A one-stage conversion of septic fused knee into total knee arthroplasty by a rotational hinge prosthesis was performed. The case highlights that with profound preoperative assessment, meticulous surgical technique, combined antibiotic treatment and the right implant, one-stage revision in a surgical challenge may have a role as a treatment option with good functional outcome.

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