scholarly journals The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing

2021 ◽  
Vol 10 (3) ◽  
pp. 434
Author(s):  
Wen-Chi Su ◽  
Yu-Chin Lai ◽  
Cheng-Hung Lee ◽  
Cheng-Min Shih ◽  
Chao-Ping Chen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Statistical Significance ◽  
Joint Infection ◽  
Chlorhexidine Gluconate ◽  
Control Group ◽  
Skin Preparation ◽  
Total Hip ◽  
Chlorhexidine Bathing

Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA.

scholarly journals Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

2020 ◽  
Vol 9 (10) ◽  
pp. 3349
Author(s):  
Henrik C. Bäcker ◽  
Chia H. Wu ◽  
David Krüger ◽  
Clemens Gwinner ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Control Group ◽  
Total Hip ◽  
Metal On Metal ◽  
Matching Criteria ◽  
The Impact

Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.

scholarly journals Decreased Incidence of Periprosthetic Joint Infection in Total Hip Arthroplasty with Use of Topical Vancomycin

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
David A Crawford ◽  
Keith R Berend ◽  
Joanne B Adams ◽  
Adolph V Lombardi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Anterior Approach ◽  
Joint Infection ◽  
Lateral Approach ◽  
Control Group ◽  
Total Hip ◽  
Joint Infections ◽  
Direct Lateral Approach

Background: Periprosthetic joint infections following total hip arthroplasty (THA) can cause significant patient morbidity and carry with them a substantial cost burden to the healthcare system.  The purpose of this study was to assess whether the addition of topical vancomycin decreased the incidence of superficial and deep infections after primary total hip arthroplasty?    Methods: We performed a retrospective analysis of patients who underwent primary THA with (1070 hips) and without (815 hips) the use of topical vancomycin.  Records were reviewed to determine incidence of PJI. Infections were categorized as deep or superficial. Medical comorbidity data was evaluated for known risk factors including diabetes, rheumatoid arthritis, and BMI. Records were further reviewed to determine surgical approach used and bacterial cause of PJI.    Results: The overall incidence of infection in the control group was 1.47% (12 hips) and significantly decreased to 0.47% (5 hips) with the addition of topical vancomycin (p=0.022). Deep infections also decreased from 0.86% (7 hips) in the control group to 0.09% (1 hip) in the vancomycin group (p=0.011).  There was no difference in BMI or percent of patients with diabetes between groups.       In all patients, regardless of vancomycin use, the incidence of infection in the direct lateral approach was higher (2.04%, 9 hips) than the anterior approach (0.055%, 8 hips)  (p=0.004). Conclusions:  We found a lower incidence of periprosthetic joint infection after THA with the addition of topical vancomycin. We also found a decreased incidence of infection in patients who had surgery through an anterior approach compared with those who had a direct lateral approach.

Treatment for Chronic Hepatitis C Prior to Total Hip Arthroplasty Significantly Reduces Periprosthetic Joint Infection

2019 ◽  
Vol 34 (1) ◽  
pp. 132-135 ◽  
Author(s):  
Hany S. Bedair ◽  
Brian M. Schurko ◽  
Maureen K. Dwyer ◽  
David Novikov ◽  
Afshin A. Anoushiravani ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Total Hip Arthroplasty ◽  
Chronic Hepatitis C ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Hip

The effect of bearing surface on risk of periprosthetic joint infection in total hip arthroplasty

2018 ◽  
Vol 100-B (2) ◽  
pp. 134-142 ◽  
Author(s):  
A. T. Hexter ◽  
S. M. Hislop ◽  
G. W. Blunn ◽  
A. D. Liddle
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Observational Studies ◽  
Meta Analysis ◽  
Joint Infection ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Bearing Surface ◽  
Total Hip

Aims Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA). Different bearing surface materials have different surface properties and it has been suggested that the choice of bearing surface may influence the risk of PJI after THA. The objective of this meta-analysis was to compare the rate of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC) bearings. Patients and Methods Electronic databases (Medline, Embase, Cochrane library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature) were searched for comparative randomized and observational studies that reported the incidence of PJI for different bearing surfaces. Two investigators independently reviewed studies for eligibility, evaluated risk of bias, and performed data extraction. Meta-analysis was performed using the Mantel–Haenzel method and random-effects model in accordance with methods of the Cochrane group. Results Our search strategy revealed 2272 studies, of which 17 met the inclusion criteria and were analyzed. These comprised 11 randomized controlled trials and six observational studies. The overall quality of included studies was high but the observational studies were at high risk of bias due to inadequate adjustment for confounding factors. The overall cumulative incidence of PJI across all studies was 0.78% (1514/193 378). For each bearing combination, the overall incidence was as follows: MoP 0.85% (1353/158 430); CoP 0.38% (67/17 489); and CoC 0.53% (94/17 459). The meta-analysis showed no significant difference between the three bearing combinations in terms of risk of PJI. Conclusion On the basis of the clinical studies available, there is no evidence that bearing choice influences the risk of PJI. Future research, including basic science studies and large, adequately controlled registry studies, may be helpful in determining whether implant materials play a role in determining the risk of PJI following arthroplasty surgery. Cite this article: Bone Joint J 2018;100-B:134–42.

Recalcitrant Periprosthetic Joint Infection With Iliac Fossa Abscess After Total Hip Arthroplasty

2021 ◽  
Author(s):  
Kuo-Ti Peng ◽  
Tsung-Yu Huang ◽  
Jiun-Liang Chen ◽  
Chiang-Wen Lee ◽  
Hsin-Nung Shih
Keyword(s):  
Total Hip Arthroplasty ◽  
Treatment Failure ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Iliac Fossa ◽  
Joint Infection ◽  
Treatment Success ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Orthopedic Procedure

Abstract Background: Total hip arthroplasty (THA) is a widely used and successfully performed orthopedic procedure for treating severe hip osteoarthritis, rheumatoid arthritis, and avascular necrosis. However, periprosthetic joint infection (PJI) after THA is a devastating complication for patients and orthopedic surgeons. Although surgical technology has been advanced and antibiotic-loaded cemented spacers or beads have developed, the treatment failure rate of one- or two-stage exchange arthroplasty for PJI is reported to be high, with >10% rate of incidence. Therefore, determining the possible pathogenesis and increasing the treatment success rate is a clinically important and urgent issue. Methods: A total of 256 patients with PJI who had undergone THA from 2005 to 2015 were included in this retrospective review. Seven patients required combined ilioinguinal and anterlateoal approach for debridement of iliac fossa abscess and infected hip lesion, included five patients with intraoperative pus leakage from the acetabular inner wall and the other two patients who underwent pre-operative pelvic computed tomography (CT) because of repeat PJI treatment failure. All available data from the medical records from all patients were retrospectively analyzed.Results: Of the 256 patients, seven (3.1%) patients was combined iliac fossa abscess in our cohort. For the microbiologic analysis, a total of thirteen pathogens were isolated from seven recurrent PJI patients with iliac fossa abscess, and Staphylococus aureus was the most commomly pathogen (4 out of 7 cases). The serum white blood cell (WBC) count was decreased significantly two weeks after debridement with combined the ilioinguinal and anterolateral approach compared to the day before surgery (11840/μL vs. 7370/μL; p<0.01), and level of C-reactive protein (CRP) was decreased at postoperative one week (107 mg/dL vs. 47.31 mg/dL; p=0.03). Furthermore, no recurrent infection was found in six revision THA patient in a follow up of 7.1 year. Conclusion: This result suggests that pre-operative pelvic CT and cautious identification of uncertain pus leakage from the inner wall of the acetabulum is essential for the diagnosis of recurrent PJI. Radical debridement with combined ilioinguinal and anterlateoal approach may aviod treatment failure in recurrent PJI with iliac fossa abscess.

scholarly journals Periprosthetic joint infection of a total hip arthroplasty with Candida parapsilosis

2020 ◽  
Vol 69 ◽  
pp. 72-75 ◽  
Author(s):  
Laurence Vergison ◽  
Alexander Schepens ◽  
Koen Liekens ◽  
Renata De Kesel ◽  
Hans Van der Bracht ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Candida Parapsilosis ◽  
Joint Infection ◽  
Total Hip

scholarly journals DOES TOPICAL USE OF GENTAMICIN REDUCE THE INFECTION RATE IN PRIMARY TOTAL HIP ARTHROPLASTY?

2019 ◽  
Vol 27 (4) ◽  
pp. 197-201 ◽  
Author(s):  
Caio Luiz de Toledo Oliveira ◽  
Felipe Abrahão Elias ◽  
André dos Santos Ribacionka ◽  
Celso Hermínio Ferraz Picado ◽  
Flávio Luís Garcia
Keyword(s):  
Total Hip Arthroplasty ◽  
Antibiotic Prophylaxis ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
University Hospital ◽  
Fisher Exact Test ◽  
Infection Rates ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

ABSTRACT Objective: To determine whether the topical use of gentamicin reduces periprosthetic joint infection rates in primary total hip arthroplasty (THA). Methods: We retrospectively evaluated two cohorts of patients who underwent primary THA in a university hospital, with a minimum of 1-year postoperative follow-up and full clinical, laboratory, and radiological documentation. Patients who underwent operation in the first 59 months of the study period (263 hips) received only intravenous cefazolin as antibiotic prophylaxis (Cef group), and those who underwent operation in the following 43 months (170 hips) received intravenous cefazolin plus topical gentamicin directly applied on the wound as antibiotic prophylaxis (Cef + Gen group). For the diagnosis of periprosthetic joint infection, we used the criteria of the Centers for Disease Control and Prevention. Data were analyzed using the Fisher exact test, and p values of <0.05 were considered significant. Results: Thirteen hips (4.9%) in the Cef group and eight hips (4.7%) in the Cef + Gen group presented periprosthetic joint infection. Statistical analysis revealed no difference between the infection rates (p = 1.0). Conclusion: Topical gentamicin as used in this study did not reduce periprosthetic joint infection rates in primary THA. Level of Evidence III, Retrospective comparative study.

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