Assessing risks of developing and persistence of infectious process in knee joint replacement

Despite of intensive work on improving endoprosthetic replacement constructions, using minimally invasive techniques, developing methods of prevention for and treatment of periprosthetic joint infection, relapse of infection process can reach up to 52 % after treatment.The aim of the study: to show the importance of identifying the risks of development and recurrence of periprosthetic infection after implantation of a knee joint endoprosthesis. A clinical case of the development of a deep periprosthetic infection in a patient after primary knee replacement and successful treatment of the resulting complication was demonstrated. The analysis of this case of an infectious complication using the proposed prognosis for the development of periprosthetic infection showed that before surgical treatment of the patient, the risk of an infectious process was not assessed, and appropriate preventive and therapeutic measures were not carried out.Materials and methods. In the treatment of developed periprosthetic infection of the knee joint, the author’s algorithm for choosing surgical tactics was used, which allowed to determine the high risk of recurrence of periprosthetic infection, evaluate additional criteria and choose the optimal type of surgical intervention – two-stage revision endoprosthetic, which allowed to stop the infectious process.New was the use of the proposed prognosis for the development of periprosthetic infection and the algorithm for choosing surgical tactics for periprosthetic infection, which make it possible to determine the necessary preventive measures to reduce the risk of an infectious complication and to apply the optimal type of surgical intervention to relieve periprosthetic knee infection.

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Poor Outcome of Above-Knee Amputation after Septic Failure of Revision Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1716416 ◽

2020 ◽

Author(s):

Sabrina Böhle ◽

Sebastian Rohe ◽

Julia Kirschberg ◽

Olaf Brinkmann ◽

Jörn Seeger ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Joint ◽

Knee Arthroplasty ◽

Periprosthetic Infection ◽

Short Form ◽

Joint Infection ◽

Treatment Strategies ◽

Primary Total Knee Arthroplasty ◽

Knee Amputation ◽

Total Knee

AbstractPersistent periprosthetic infection following total knee arthroplasty is one of the most dreaded complications of orthopaedic surgery. Treatment strategies include arthrodesis of the knee joint, stable fistula, long-lasting antibiotic therapy, or above-knee amputation. The advantage of amputation in comparison to other treatment options is the possible cure of infection, because the source of infection is removed and no foreign material left in situ. The aim of the study is to examine whether a septic amputation of the femur in case of persistent periprosthetic infection at the knee joint leads to the healing of the patient. Moreover, the physical and mental state should be evaluated. All patients with above-knee amputation because of periprosthetic joint infection after primary total knee arthroplasty between 2016 and 2018 were included in this retrospective study. A questionnaire with the clinical scores visual analog scale, modified Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index and 36-Item Short Form Survey has been designed. In addition, all characteristics and perioperative data were documented. Eleven patients were included in the study. One patient died after above-knee amputation; all other patients live with a marked impairment of quality of life but with absence of the infection of the leg. Two out of ten are able to walk regularly with an exoprosthesis with forearm crutches, 50% are in a wheelchair, while 30% are bedridden. Patients with above-knee amputation after persistent periprosthetic infections were free of infection and without signs of inflammation. However, this is associated with worse mobility and high mortality rate.

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Clinical and microbiological characteristics of periprosthetic hip and knee infections

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2020.3.237-240 ◽

2020 ◽

pp. 237-240

Author(s):

Vladimir A. Ivantsov ◽

I.P. Bogdanovich ◽

V.V. Lashkovskiy ◽

V.S. Anosov

Keyword(s):

Surgical Treatment ◽

Knee Joint ◽

Hip Joint ◽

Joint Replacement ◽

Periprosthetic Infection ◽

Joint Infection ◽

Knee Joints ◽

Knee Joint Replacement ◽

Hip Joint Replacement ◽

Total Knee

Objective. To characterize periprosthetic joint infection in patients undergoing a total hip and knee joint replacement. Materials and Methods. A total of 77 patients with periprosthetic infection following hip and knee joint replacement hospitalized in Grodno City Clinical Hospital were studied over the period of 2014-2018. Wound discharge, tissue samples, and fistula’s wall swab were used for microbiological tests. The analysis of surgical treatment of patients with deep periprosthetic knee and hip joint infection has been performed. Results. Periprosthetic infection after hip joint arthroplasty was observed in 32 (41.6%) patients, and after total knee joint arthroplasty in 45 (58.4%) patients. Surgical treatment was performed in 18 (56.3%) and 32 (71.1%) patients with periprosthetic infection following total knee and hip joint replacement, respectively. A total of 10 (31.2%) of 32 cultures from patients with periprosthetic infection after total hip joint replacement and 8 (17.8%) of 45 cultures from patients with periprosthetic infection after total knee joint replacement were positive. Overall, Staphylococcus aureus was detected in 9 (50%) of 18 positive cultures. Gram-negative aerobic bacteria (Acinetobacter baumannii, Klebsiella pneumoniae Pseudomonas aeruginosa) were detected in 4⁄10 and 5⁄8 of positive cultures from patients with periprosthetic infection of hip and knee joints, respectively. Conclusions. The most common pathogens causing periprosthetic infection of hip and knee joints were S. aureus (50%) and Gram-negative bacteria. The surgical treatment was performed in 71.4% of patients with periprosthetic joint infection.

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Immunity status in patients with periprosthetic knee joint infection

10.1101/2021.08.23.21261316 ◽

2021 ◽

Author(s):

Irina A. Mamonova ◽

Irina. V. Babushkina ◽

Aleksandr S. Bondarenko ◽

Vladimir Yu. Ulyanov

Keyword(s):

Knee Joint ◽

Immune Status ◽

Periprosthetic Infection ◽

Joint Infection ◽

False Negative ◽

Knee Joints ◽

Clinical Aspects ◽

Total Replacement ◽

Knee Joint Infection ◽

Diagnostic Approaches

AbstractImplant-associated infection is one of the most severe complications after total replacement of larger joints. The diagnosis of periprosthetic infection are often impeded as 5-34% of bacteriological tests are false-negative. Now the investigations of the immune status of patients suspected of periprosthetic infection are considered perspective as these are aimed at finding the most significant indicators for underlying the diagnosis of this pathology. In this research, we assessed immunology indicators in peripheral blood of patients with periprosthetic infection in their knee joints. We determined immunology characteristics associated with the clinical aspects of the progressing pathology. Our findings can be used as the basis for further search of pathophysiological mechanisms of periprosthetic infection progress in the knee joint as well as defining new diagnostic approaches.Reviewers:Ivanov A.N., MD, DSc;Prof. Puchinyan D.M., MD, DSc

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ENDOPROSTHETIC REPLACEMENTIN PATIENTS WITH TUMORS OF BONES AND JOINTS: REVISION SURGERY

Archiv Euromedica ◽

10.35630/2199-885x/2021/11/1.14 ◽

2021 ◽

Vol 11 (1) ◽

pp. 66-72

Author(s):

Volodymyr Protsenko ◽

Olexandr Burianov ◽

Obada Bishtawi ◽

Yevgen Solonitsyn

Keyword(s):

Knee Joint ◽

Hip Joint ◽

Intramedullary Nail ◽

Revision Surgery ◽

Elbow Joint ◽

Infectious Complication ◽

Periprosthetic Infection ◽

Cement Spacer ◽

Tibial Shaft ◽

Revision Operations

The article analyzes complications after individual oncological endoprosthesis replacement in tumor lesions of bones and joints, which led to repeated endoprosthesis replacement. After operations of endoprosthesis replacement of bones and joints with tumor lesions, the following complications were observed: periprosthetic infection — 7.4%, aseptic instability of the stem of endoprosthesis —13.1%, destruction of the endoprosthesis structure - 2.3%, wear of polyethylene inserts — 1.7%. Revision endoprosthesis replacement due to complications after endoprosthesis replacement of bones and joints for tumors was performed in 38 (21.7%) cases. Repeated endoprosthesis replacement of knee joint was performed in 22 cases, repeated endoprosthesis replacement of hip joint was performed in 6 cases, repeated endoprosthesis replacement of elbow joint was performed in 4 cases, repeated endoprosthesis replacement of shoulder joint was performed in 3 cases, repeated endoprosthesis replacement of tibial shaft was performed in 2 cases, repeated endoprosthesis replacement of ankle joint was performed in 1 case. The factors that led to complications and repeated endoprosthesis replacement were presented. In case of an infectious complication, it was recommended to install a metal-on-cement spacer, followed by repeated endoprosthesis replacement; in case of aseptic instability of the stem of endoprosthesis, repeated endoprosthesis replacement was performed with replacement of only one (loose) component of the endoprosthesis using a long intramedullary nail or replacement of the entire endoprosthesis; in case of the destruction of endoprosthesis structure, the repeated endoprosthesis replacement of the joint was effected with replacement of the entire endoprosthesis structure; when the polyethylene inserts were worn out, the repeated endoprosthesis replacement was performed with the replacement of the polyethylene inserts. After repeated endoprosthesis replacement, repeated revision operations were performed in 10 (26.3%) cases.

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3D Printing as a Way of Integrating Mathematical Models in Arthroscopic Knee Surgery

Revista de Chimie ◽

10.37358/rc.18.9.6563 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2501-2507

Author(s):

Anca Plavitu ◽

Mark Edward Pogarasteanu ◽

Marius Moga ◽

Mircea Lupusoru ◽

Florentina Ionita Radu ◽

...

Keyword(s):

Knee Joint ◽

Osteochondral Defect ◽

Surgical Intervention ◽

Operating Time ◽

Vascular Pathology ◽

Osteochondral Lesions ◽

Joint Surfaces ◽

Novel Method ◽

Technological Means ◽

Arthroscopic Knee

Our objective is to develop a novel method of approaching the arthroscopic treatment of osteochondral lesions within the knee joint by using mathematics as a way of understanding the geometry involved in the knee, both in normal and degenerated knee joint surfaces. Bone and cartilage lesions are frequent, whether as a result of trauma, degenerative pathology, vascular pathology (osteocondritis dissecans) or tumoral. In all cases, a defect can be repaired arthroscopically, if it has manageable dimensions and if the surgeon has the technological means and the necessary skills, through the use of grafts (autografts or allografts). Alternatively, a lesion that may be approached arthroscopically initially could prove to be too great for repair and may need a second intervention for reconstruction with an endoprosthesis. We aim to further deepen the surgeon�s understanding of this pathology, through the use of 3D technology as a way of representing the osteochondral defect. Thus, its dimensions and position may be better understood, and the surgical intervention may be better planned out, potentially resulting in a shorter operating time and an overall superior outcome for the patient, and even potentially diminishing the number of unnecessary surgeries performed.

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Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0038-1675794 ◽

2018 ◽

Vol 32 (11) ◽

pp. 1111-1120

Author(s):

Robin Otchwemah ◽

Jan-Hendrik Naendrup ◽

Frauke Mattner ◽

Thorsten Tjardes ◽

Holger Bäthis ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Joint ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Joint Infection ◽

Standard Protocol ◽

Standardized Protocol ◽

Graft Preservation ◽

Knee Joint Infection ◽

Anterior Cruciate

AbstractKnee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ± 9.9) years and admitted 14 ( ± 7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

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Life-threatening spontaneous hematoma of the chest wall treated with packing and delayed chest closure

10.36811/osjs.2019.110001 ◽

2019 ◽

pp. 01-03

Author(s):

Francesco Mongelli ◽

Francesco Proietti ◽

Miriam Patella ◽

Stefano Cafarotti

Keyword(s):

Conservative Treatment ◽

Minimally Invasive ◽

Surgical Intervention ◽

Endovascular Embolization ◽

Minimally Invasive Techniques ◽

Life Threatening ◽

Thoracic And Abdominal ◽

Invasive Techniques ◽

Anticoagulated Patients ◽

Spontaneous Hematoma

Bleeding of the thoracic and abdominal wall most commonly occur in anticoagulated patients [1]. The management is based on anticoagulant therapy reversal which is mostly effective [2]. If conservative treatment is insufficient, good results are provided by endovascular embolization techniques [2,3]. The need of surgical intervention is extremely rare and limited to cases in which minimally invasive techniques are unsuccessful or somehow contraindicated [4].

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FEATURES OF EMERGENCY SURGERY IN PATIENTS WITH LOCALLY ADVANCED GASTRIC CANCER

Kharkiv Surgical School ◽

10.37699/2308-7005.2.2020.22 ◽

2020 ◽

pp. 108-112

Author(s):

V. V. Boyko ◽

I. V. Krivorotko ◽

V. A. Lazirsky

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Surgical Intervention ◽

Locally Advanced ◽

Postoperative Mortality ◽

Surgical Interventions ◽

Second Stage ◽

Locally Advanced Gastric Cancer ◽

Surgical Tactics ◽

Gastric Cancer Patients

Summary. Materials and methods. The work is based on an analysis of the results of surgical treatment of 418 patients with complicated locally advanced gastric cancer. Patients are divided into two groups: comparisons — 212, and the main — 206 patients who were treated from 2006 to 2010. and from 2011 to 2015 respectively. The complications rating was: bleeding in 252 (60.3 %) patients, stenosis in 89 (21.3 %), perforation in 15 (3.5 %), and their combination in 62 (14.8 %). Results and discussion. Radical operations were performed in 212 (50.7 %) patients, in 145 (34.6 %) — palliative and symptomatic. Postoperative complications occurred in 82 patients (19.6 %), postoperative mortality was 7.2 % (30 patients). A two-stage surgical tactics has been developed, which involves the implementation of minimally invasive endoscopic and endovascular surgical interventions at the first stage with the implementation of a delayed or planned surgical intervention at the second stage. Conclusions. Urgent operations decreased from 21.7 to 6.3 %, which reduced the number of palliative and symptomatic operations from 50.4 to 18.4 %.

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Sigmoido-rectal intussusception

SAGE Open Medical Case Reports ◽

10.1177/2050313x19856242 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1985624

Author(s):

Amanda C Filiberto ◽

Tyler J Loftus ◽

Sanda A Tan ◽

Thomas E Read ◽

Atif Iqbal

Keyword(s):

Rectal Prolapse ◽

Low Anterior Resection ◽

Surgical Intervention ◽

Rectal Intussusception ◽

Lead Point ◽

High Grade ◽

Resonance Imaging ◽

Underlying Malignancy ◽

Invasive Techniques ◽

Sigmoid Cancer

Rectal prolapse is usually of benign etiology. Rarely, sigmoido-rectal intussusception results from a malignant lead-point. We report the case of a patient with a partially obstructing sigmoid cancer causing a full thickness rectal prolapse requiring surgical intervention. An 82-year-old woman presented with 1 week of rectal bleeding, fecal incontinence, and weight loss. Computed tomography identified sigmoido-rectal intussusception. Colonoscopic biopsy revealed high-grade dysplasia. Magnetic resonance imaging demonstrated a 6-cm mass forming the lead point of the intussusceptum with epiploic appendages seen within the rectal lumen. She underwent laparoscopic low anterior resection with final pathology consistent with T2N0 adenocarcinoma, and recovered well. Among adult patients with rectal prolapse, suspicion for underlying malignancy should prompt a thorough investigation to inform the decision for resection, which may be safely performed by minimally invasive techniques.

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