scholarly journals Early Experiences with Indigenous Medicated Spacers in the Management of Infected Hip Prosthesis.

2013 ◽  
Vol 11 (1) ◽  
pp. 32-36
Author(s):  
Pankaj Chand ◽  
Suchil Rana Magar ◽  
Bishnu Babu Thapa ◽  
Bachhu Ram KC ◽  
Amit Joshi ◽  
...  
Keyword(s):  
Hip Prosthesis ◽  
Revision Arthroplasty ◽  
Recurrent Infection ◽  
Cost Effective ◽  
Deep Infection ◽  
Two Stage ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Walking Capacity ◽  
Postoperative Dislocation

Introduction: Joint replacement surgery, has become one of the most frequent prosthetic surgeries over the past decades due to its success in restoring function to disabled arthritic individual. A two-stage revision arthroplasty is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results of three infected hips with the interim use of an indigenous cemented prosthesis along with gentamycin impregnated cement beads were assessed with a two stage revision. Methods: Three consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of a previous infection, with retained implants, were followed clinically and radiographically for an average of 15 months. Following removal of implants and debridement (first stage), an indigenous medicated prosthesis along with antibiotic coated cement beads were implanted, for an interim phase of six - eight weeks aft er which a new prosthesis was placed ( second stage ).In this period antibiotics ( both intravenous and oral) were administered to the patients. Results: In a mean follow up period of 15 months, there is no evidence of recurrent infection in all three patients, as of now. The use of antibiotic coated cement prosthesis along with gentamycin mixed cement beads was associated with a satisfactory hip score, and better walking capacity in the interim period, a lower transfusion requirement at the time of reimplantation, and no postoperative dislocation. Conclusions: Locally prepared medicated spacer and gentamycin coated beads help in eradicating hip infection, besides being more cost effective. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/32-36 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7765

scholarly journals Recent advances in understanding and managing Paget’s disease

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1485
Author(s):  
Ian R Reid
Keyword(s):  
Disease Progression ◽  
Paget’S Disease ◽  
Cost Effective ◽  
Paget's Disease ◽  
Symptomatic Disease ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Primary Endpoints ◽  
History Of ◽  
Biochemical Indices

Paget’s disease is a condition which continues to challenge and surprise. The dramatic fall in its incidence over the last three decades has been an enormous surprise, as is the capacity of a single infusion of the potent bisphosphonate, zoledronate, to produce biochemical remission in 90% of patients, remissions which usually persist for many years and raise the possibility of a cure in some patients. However, challenges in its management remain. The trials carried out in Paget’s disease have almost always had biochemical indices as their primary endpoints. From these studies, we also know that bone pain is relieved, quality of life improved, bone histology normalised, and radiological lesions healed. Thus, disease progression is halted. Studies have not been powered to assess whether clinically important endpoints such as fracture and the need for joint replacement surgery are diminished, although these complications are well established as part of the natural history of the condition. Since disease progression is prevented by potent bisphosphonates, it is likely that disease complications will also be prevented. Zoledronate also reduces the frequency of follow-up needed and therefore provides a very cost-effective intervention in those who have symptomatic disease or are at risk of complications.

scholarly journals Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260146
Author(s):  
Helen Mary Badge ◽  
Tim Churches ◽  
Justine M. Naylor ◽  
Wei Xuan ◽  
Elizabeth Armstrong ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
High Volume ◽  
Deep Infection ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Post Surgery ◽  
Increased Risk ◽  
Adjusted Logistic Regression ◽  
One Year

Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

MRSA-free Elective Orthopaedic Surgery. A Dedicated Elective Orthopaedic Ward Free from MRSA Alexandra Hospital, Redditch, UK

2005 ◽  
Vol 15 (3) ◽  
pp. 171-176
Author(s):  
A. Datta ◽  
A. Gardner ◽  
K. Bell
Keyword(s):  
Infection Rate ◽  
High Volume ◽  
Deep Infection ◽  
Healthcare Associated Infection ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Hip Replacements ◽  
Great Scrutiny ◽  
Orthopaedic Ward ◽  
Healthcare Associated

Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at £1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny. The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control. Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03). The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002. We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency. We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease.

scholarly journals Prevention of deep infection in joint replacement surgery

2010 ◽  
Vol 81 (6) ◽  
pp. 660-666 ◽  
Author(s):  
Esa Jämsen ◽  
Ove Furnes ◽  
Lars B Engesæter ◽  
Yrjö T Konttinen ◽  
Anders Odgaard ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Deep Infection ◽  
Joint Replacement Surgery ◽  
Replacement Surgery

scholarly journals Revision in Cemented and Cementless Infected Hip Arthroplasty

2013 ◽  
Vol 7 (1) ◽  
pp. 190-196 ◽  
Author(s):  
Paolo Cherubino ◽  
Marco Puricelli ◽  
Fabio D’Angelo
Keyword(s):  
Hip Arthroplasty ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Clinical Approach ◽  
Two Stage ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Length Of Treatment ◽  
Accurate Treatment ◽  
Cause Of Failure

Infection is a frequent cause of failure after joint replacement surgery. The infection rate after total hip arthroplasty (THA) has been reduced to 1-2% in the last years. However, it still represents a challenging problem for the orthopedic surgeon.Difficulty of therapeutic approach, and poor functional outcomes together with length of treatment and overall cost are the main burden of this issue. Even the diagnosis of an infected hip could be challenging although it is the first step of an accurate treatment. At the end, many cases require removing the implants. Afterwards, the treatment strategy varies according to authors with three different procedures: no re-implantation, immediate placement of new implants or a two-stage surgery re-implantation.Based on the most recently systematic review there is no suggestion that one- or two-stage revision methods have different re-infection outcomes.The two-stage implant-exchange protocol remains the gold standard. It is considered as the most efficacious clinical approach for the treatment of periprosthetic infection, especially in patients with sinus tracts, swelling, extended abscess formation in depth and infection of Methicillin ResistantStaphylococcus Aureus(MRSA), and other multidrug-resistant bacteria as reported in recent consensus documents.

Two-stage reimplantation for deep infection after total elbow arthroplasty

2021 ◽  
pp. 175857322110435
Author(s):  
Natalia Martinez-Catalan ◽  
Ngoc Tram V Nguyen ◽  
Mark E Morrey ◽  
Shawn W O’Driscoll ◽  
Joaquín Sanchez-Sotelo
Keyword(s):  
Persistent Infection ◽  
Staphylococcus Epidermidis ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Deep Infection ◽  
Total Elbow Arthroplasty ◽  
Two Stage ◽  
Elbow Arthroplasty ◽  
Associated Risk Factors

Background Persistent infection rate after 2-stage reimplantation complicating elbow arthroplasty has been reported to be as high as 25%. The purposes of this retrospective study were to determine the infection eradication rates, complications and outcomes in a cohort of patients treated with two-stage reimplantation for deep periprosthetic joint infection (PJI) following total elbow arthroplasty (TEA) and to determine possible associated risk factors for treatment failure. Methods Between 2000 and 2017, 52 elbows underwent a two-stage reimplantation for PJI after TEA. There were 22 males and 30 females with a mean age of 61 (range, 25–82) years. The most common bacterium was Staphylococcus epidermidis (28 elbows). Mayo Elbow Performance Scores were calculated at the latest follow-up. Mean follow-up time was 6 years (range, 2–14 years). Results PJI was eradicated in 36 elbows (69%). The remaining 16 elbows were considered treatment failures secondary to recurrent infection. The risk of persistent infection was 3.3 times higher in elbows with retained cement (p 0.04), and 3.5 times higher when the infecting organism was Staphylococcus epidermidis (p 0.06). Conclusion Two-stage reimplantation for PJI after TEA was successful in eradicating deep infection in 69% of cases. The eradication of PJI after TEA still needs to be improved substantially.

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