scholarly journals Antibiotic-loaded cement spacer for treatment of Klebsiella infected total hip and knee arthroplasty

2014 ◽  
Vol 71 (10) ◽  
pp. 957-962 ◽  
Author(s):  
Radoslav Barjaktarovic ◽  
Dragan Radoicic ◽  
Milorad Mitkovic
Keyword(s):  
Effective Treatment ◽  
Clinical Laboratory ◽  
Treatment Algorithm ◽  
Revision Arthroplasty ◽  
Multidrug Resistant ◽  
Cement Spacer ◽  
Two Stage ◽  
Total Hip ◽  
Klebsiella Spp

Background/Aim. Infection following total hip arthroplasty (THA) or total knee arthoplasty (TKA) may have devastating consequences. Some bacterial strains are often encountered as agents of these infections, others occur less frequently but are sometimes burdened with more severe complications. Klebsiella spp. are uncommon causes of THA or TKA infection. The aim of this study was to identify an effective treatment algorithm for multidrug resistant Klebsiella spp. caused THA or TKA infections. Methods. During the 3-year period, from January 1 2009 to December 31 2011, we registered and treated 5 patients with THA or TKA multidrug resistant Klebsiella spp. caused infection. All the patients were primarily operated in other institutions, and were admitted in our clinic after the onset of infection symptoms. In three of the cases Klebsiella infection was complicated by additional infection (Staphyloccocus aureus, Pseudomonas aeruginosa and Serratia marscescens). In 3 of the cases we performed revision arthroplasty after double exchange of antibiotic-loaded articulating cement spacer, and in 2 of the cases the standard two stage revision approach with one antibiotic cement spacer exchange was applied. Results. The mean length of follow-up after reimplantation surgery was 17.1 months (range 2-31 months). One patient died 2 months after the final reimplantation procedure. The initial Klebsiella infection was eradicated in all patients. At the end follow-up after definitive reimplantation, patients had no clinical, laboratory or microbiological parameters positive for active infection. Conclusion. According to our experience with multidrug-resistant Klebsiella TKA/THA infections, two-stage approach, in some cases with double articulating cement spacer exchange prior to definitive reimplantation, is the most effective treatment option.

scholarly journals Two-stage revision arthroplasty in the treatment of periprosthetic hip infections with severe bone loss: Results from 182 cases

2020 ◽  
Vol 12 (2) ◽  
Author(s):  
Jerzy Białecki ◽  
Maciej Kogut ◽  
Sławomir Chaberek ◽  
Paweł Bartosz ◽  
Marcin Obrębski ◽  
...  
Keyword(s):  
Bone Loss ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Bone Defects ◽  
Harris Hip Score ◽  
Two Stage ◽  
Retrospective Assessment ◽  
Severe Bone Loss ◽  
Paprosky Classification

The optimum treatment for periprosthetic joint infection (PJI) of the hip with substantial bone defects remains controversial. A retrospective assessment was performed for 182 patients treated for PJI with a two-stage protocol from 2005 to 2015. Implant removal and debridement were followed by Girdlestone arthroplasty or spacer implantation. The results of the Girdlestone and spacer groups were compared. There were 71 cases that received spacers, and 111 Girdlestone procedures were performed. After the first stage, 26.37% of cultures were negative, and among patients with a detected pathogen, methicillin-sensitive Staphylococcus aureus was the most common organism (41.79%). Acetabular and femoral bone defects, according to the Paprosky classification, were more severe in the Girdlestone group (P<0.05). During the follow-up (mean, 5.95 years), the overall incidence of complications was 21.42%. The mean Harris hip score was significantly lower in the Girdlestone group (68.39 vs 77.79; P<0.0001). The infection recurrence rate reached 8.79%. Despite satisfactory infection control, the number of complications and poor functional outcomes associated with resection arthroplasty indicate the necessity for development of different approaches for patients with advanced bone loss.

Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction

2019 ◽  
Vol 101-B (4) ◽  
pp. 396-402 ◽  
Author(s):  
B. Ji ◽  
T. Wahafu ◽  
G. Li ◽  
X. Zhang ◽  
Y. Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Recurrent Infection ◽  
Multidrug Resistant ◽  
Single Stage ◽  
Inclusion Criteria ◽  
Total Hip ◽  
Multidrug Resistant Organisms ◽  
Culture Negative

Aims Single-stage revision is not widely pursued due to restrictive inclusion criteria. In this study, we evaluated the results of single-stage revision of chronically infected total hip arthroplasty (THA) using broad inclusion criteria and cementless implants. Patients and Methods Between 2010 and 2016, 126 patients underwent routine single-stage revision with cementless reconstruction with powdered vancomycin or imipenem poured into the medullary cavity and re-implantation of cementless components. For patients with a culture-negative hip, fungal infections, and multidrug-resistant organisms, a direct intra-articular infusion of pathogen-sensitive antibiotics was performed postoperatively. Recurrence of infection and clinical outcomes were evaluated. Three patients died and 12 patients (none with known recurrent infection) were lost to follow-up. There were 111 remaining patients (60 male, 51 female) with a mean age of 58.7 (sd 12.7; 20 to 79). Results Of these 111 patients, 99 (89.2%) were free of infection at a mean follow-up time of 58 months (24 to 107). A recurrent infection was observed in four of the 23 patients (17.4%) with culture-negative infected hip. The success rate in patients with multidrug-resistant organisms was 84.2% (16/19). The mean postoperative Harris hip score was 79.6 points (63 to 92) at the most recent assessment. Conclusion Routine single-stage revision with cementless reconstruction can be a viable option for the treatment of chronically infected THA. The results of this study will add to the growing body of evidence supporting routine use of single-stage revision for the treatment of chronically infected THA. Cite this article: Bone Joint J 2019;101-B:396–402.

Results of Cemented Femur Components Application at Total Hip Revision Arthroplasty

2012 ◽  
Vol 19 (3) ◽  
pp. 32-38
Author(s):  
N. V Zagorodniy ◽  
V. I Nuzhdin ◽  
K. M Bukhtin ◽  
S. V Kagramanov
Keyword(s):  
Revision Arthroplasty ◽  
Treatment Results ◽  
Indication For Surgery ◽  
Hip Revision ◽  
Hip Revision Arthroplasty ◽  
Total Hip ◽  
Level 1 ◽  
Type 3 ◽  
Fatigue Fractures

Treatment results for 114 total hip revision arthroplasties (1992—2011) with cemented femur components were analyzed. The most common indication for surgery was aseptic instability of hip implant. In 1 st group (42 operations) cemented stems Bi-Metric (Biomet Orthopaedics) and in 2 nd group (72 operations) cemented stems ESI (Endoservis) were used. Surgical technique was described and causes of complication development were analyzed. Mean follow-up made up 11 years. In the 1 st group excellent results were achieved in 2 (4.76%) cases, good in 34 (80.95%), satisfactory in 3 (7.14%) and poor in 3 (7.14%) cases. In the 2 nd group corresponding results were achieved in 3 (4.17%), 47 (65.28%), 15 (20.83%) and 7(9.72) respectively. Analysis of the reasons for complication development was performed. It was stated that femur defects of type 3 on level 1 by AAOS classification resulted in fatigue fractures of cemented revision stems.

Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer

2003 ◽  
Vol 8 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Naonobu Takahira ◽  
Moritoshi Itoman ◽  
Kei Higashi ◽  
Katsufumi Uchiyama ◽  
Motoi Miyabe ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cement Spacer ◽  
Revision Total Hip Arthroplasty ◽  
Two Stage ◽  
Total Hip

scholarly journals Extensively Coated Non-modular Stem Used in Two-stage Revision for Infected Total Hip Arthroplasty: Mid-term to Long-term Follow-up

2014 ◽  
Vol 6 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Bin Shen ◽  
Qiang Huang ◽  
Jing Yang ◽  
Zong-ke Zhou ◽  
Peng-de Kang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Two Stage ◽  
Total Hip ◽  
Modular Stem ◽  
Long Term Follow Up

scholarly journals Cement Arthrodesis of the Knee with a Custom Long Recon Nail After Failed Total Knee Arthroplasty: Surgical Technique and Results

2018 ◽  
Vol 12 (1) ◽  
pp. 554-566
Author(s):  
Malcolm R. DeBaun ◽  
Stuart B. Goodman ◽  
David W. Lowenberg
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Treatment Algorithm ◽  
Case Series ◽  
Cement Spacer ◽  
Knee Arthrodesis ◽  
Retrospective Case ◽  
Total Knee

Background and Objective: Persistent periprosthetic joint infection (PJI) is a devastating complication after Total Knee Arthroplasty (TKA). We hypothesize that our novel treatment algorithm utilizing a customized knee spanning recon nail combined with an antibiotic eluting cement spacer improves ambulation status and prevents recurrent PJI in patients with failed TKA and severe bone loss. Methods: In a retrospective case series, 15 consecutive patients who underwent knee arthrodesis after failed ipsilateral TKA secondary to infection from 2004-2017 with at least 1 year of follow-up were enrolled. The average age of patients at the time surgery was 68 (range 50-81) years with an average follow-up of 3.2 (range 1-6) years. Post-surgical ambulation status and eradication of index infection were analyzed as primary outcomes using McNemar’s test for before-and-after study design with p<0.05 for significance. Results: Cement arthrodesis significantly improved ambulation with 67% (10/15) of patients unable to ambulate before arthrodesis and 93% (14/15) of patients able to ambulate at final follow-up (p=0.004). The complication rate was 20% (3/15). There were no periprosthetic fractures. Amongst patients who presented with active PJI, 91% (10/11) had eradication of their index infection final follow-up (p=0.002). Overall prevention of recurrent index infection was 93% (14/15) (p=0.0001). Conclusion: Cement arthrodesis utilizing a custom knee spanning recon nail combined with an antibiotic eluting spacer improves ambulation status and prevents or treats recurrent infection in the majority of patients who have failed total knee arthroplasty.

scholarly journals Catastrophic Failure and Metallosis of the Acetabular Component in Total Hip Arthroplasty

2021 ◽  
Author(s):  
FIRAT OZAN ◽  
Murat Kahraman ◽  
Ali Baktır ◽  
Kürşat Gençer
Keyword(s):  
Revision Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Catastrophic Failure ◽  
Total Hip ◽  
Catastrophic Failures ◽  
Revision Tha ◽  
The Mean ◽  
Hip Arthroplasties

Abstract Background: To evaluate the clinical features and results of the revision total hip arthroplasties (THA) in patients with catastrophic failures and metallosis. Methods: Fifteen hips of 14 patients with catastrophic failure and metallosis in hip arthroplasties were evaluated. They were followed for at least 4.2 years after the revision THA. Clinical evaluation was performed using Harris hip score. Osteolysis, loosening or presence of metallosis was evaluated with standard radiographs. Metallosis was evaluated intraoperatively according to the metallosis severity classification. Results: The mean time from failure until revision surgery was 9.4 years. It was observed that in the primary THA, metal-on-ceramic (MoC), ceramic-on-ceramic (CoC) and metal-on-conventional polyethylene (MoCPE) bearings were used in 1, 3 and 11 hips, respectively. Grade III metallosis was observed in all patients during revision surgeries. The mean Harris hip score increased from 55 points before revision THA to 75 points at the final follow-up. In revision arthroplasty, MoCPE and CoC bearings were used in 13 and 2 hips, respectively. The femoral stem was replaced in 5 hips. All acetabular cups, except that of one hip, were revised. Conclusions: Revisions of THAs with catastrophic failures and metallosis are quite challenging. Routine follow-up of arthroplasty patients is beneficial to examine for osteolysis, loosening, and asymmetric wear.

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