On the Necessity of a Customized Knee Spacer in Peri-Prosthetic Joint Infection Treatment: 3D Numerical Simulation Results

Peri-prosthetic joint infections (PJIs) dramatically affect human health, as they are associated with high morbidity and mortality rates. Two-stage revision arthroplasty is currently the gold standard treatment for PJI and consists of infected implant removal, an accurate debridement, and placement of antimicrobial impregnated poly-methyl-metha-acrylate (PMMA) spacer. The use of antibiotic-loaded PMMA (ALPMMA) spacers have showed a success rate that ranges from 85% to 100%. ALPMMA spacers, currently available on the market, demonstrate a series of disadvantages, closely linked to a low propensity to customize, seen as the ability to adapt to the patients’ anatomical characteristics, with consequential increase of surgical complexity, surgery duration, and post-operative complications. Conventionally, ALPMMA spacers are available only in three or four standard sizes, with the impossibility of guaranteeing the perfect matching of ALPMMA spacers with residual bone (no further bone loss) and gap filling. In this paper, a 3D model of an ALPMMA spacer is introduced to evaluate the cause- effect link between the geometric characteristics and the correlated clinical improvements. The result is a multivariable-oriented design able to effectively manage the size, alignment, stability, and the patients’ anatomical matching. The preliminary numerical results, obtained by using an “ad hoc” 3D virtual planning simulator, clearly point out that to restore the joint line, the mechanical and rotational alignment and the surgeon’s control on the thicknesses (distal and posterior thicknesses) of the ALPMMA spacer is mandatory. The numerical simulations campaign involved nineteen patients grouped in three different scenarios (Case N° 1, Case N° 2 and Case N° 3) whose 3D bone models were obtained through an appropriate data management strategy. Each scenario is characterized by a different incidence rate. In particular, the observed rates of occurrence are, respectively, equal to 17% (Case N° 1), 74% (Case N° 2), and 10% (Case N° 3).

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Periprosthetic Joint Infections: Clinical and Bench Research

The Scientific World JOURNAL ◽

10.1155/2013/549091 ◽

2013 ◽

Vol 2013 ◽

pp. 1-17 ◽

Cited By ~ 15

Author(s):

Laurence Legout ◽

Eric Senneville

Keyword(s):

Prosthetic Joint Infection ◽

Joint Infection ◽

Diagnostic Methods ◽

High Morbidity ◽

Substantial Cost ◽

Prosthetic Infection ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Definition Of

Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.

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779. Mycobacterium tuberculosis Prosthetic Joint Infections: A Case Series and Literature Review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.786 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S279-S279

Author(s):

Fabrice Uhel ◽

Grégory Corvaisier ◽

Yves Poinsignon ◽

Catherine Chirouze ◽

Guillaume Béraud ◽

...

Keyword(s):

Mycobacterium Tuberculosis ◽

Literature Review ◽

Joint Infection ◽

Case Series ◽

Revision Arthroplasty ◽

Joint Infections ◽

Prosthesis Retention ◽

Antituberculosis Treatment ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract Background Mycobacterium tuberculosis is a rare cause of prosthetic joint infection (PJI), as most countries with high prevalence of tuberculosis have limited access to arthroplasty. We aimed to characterize the diagnosis, the management, and the outcome of M. tuberculosis PJI. Methods All cases of M. tuberculosis PJI documented in a network of 7 referral centers in France were retrospectively reviewed. Data were collected from medical files on a standardized questionnaire, including diagnosis, management, and outcome. In addition, we performed a systematic literature review using the keywords”prosthetic joint,” and”tuberculosis.” Results During years 1997–2016, we managed 13 patients (8 males, 5 females, median age 79 years [range, 60–86]) with documented M. tuberculosis PJI, involving hip (n = 6), knee (n = 6), or shoulder (n = 1). Median time from arthroplasty to PJI diagnosis was 9 years [0.4–20]. The diagnosis was obtained on joint aspirates (n = 9), or synovial tissue (n = 4). PCR was positive in all cases tested (5/5). Median duration of antituberculosis treatment was 14 months [6–32]). Nine patients underwent surgery: debridement (n = 4), definitive resection arthroplasty (n = 3), and revision arthroplasty (1-stage exchange, n = 2). PJI was controlled in 12 patients. One patient died of disseminated tuberculosis. The literature review identified 70 additional cases of documented M. tuberculosis PJI, with a favorable outcome in 79% (11/14) of patients with no surgery, 85% (11/13) with debridement and prosthesis retention, 86% (19/22) with revision arthroplasty, and 81% (17/21) with definitive prosthesis resection (NS). Conclusion M. tuberculosis PJI can be controlled with prolonged antituberculosis treatment in most cases, with or without surgical treatment.This case series and literature review suggest that the paradigms for the management of M. tuberculosis PJI may differ from PJI related to other pathogens, for which surgery is required. Disclosures All authors: No reported disclosures.

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Do Prosthetic Joint Infections Worsen the Functional Ambulatory Outcome of Patients with Joint Replacements? A Retrospective Matched Cohort Study

Antibiotics ◽

10.3390/antibiotics9120872 ◽

2020 ◽

Vol 9 (12) ◽

pp. 872

Author(s):

Isabel Mur ◽

Marcos Jordán ◽

Alba Rivera ◽

Virginia Pomar ◽

José Carlos González ◽

...

Keyword(s):

Cohort Study ◽

Joint Infection ◽

Assistive Device ◽

Matched Cohort ◽

Knee Prostheses ◽

Matched Cohort Study ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Hip Arthroplasties

Objectives: To assess the effect on the functional ambulatory outcome of postoperative joint infection (PJI) cured at the first treatment attempt versus not developing PJI in patients with hip and knee prostheses. Methods: In a single-hospital retrospectively matched cohort study, each patient with PJI between 2007 and 2016 was matched on age, sex, type of prosthesis and year of implantation with two other patients with uninfected arthroplasties. The definition of a PJI cure included infection eradication, no further surgical procedures, no PJI-related mortality and no suppressive antibiotics. Functional ambulatory status evaluated one year after the last surgery was classified into four simple categories: able to walk without assistance, able to walk with one crutch, able to walk with two crutches, and unable to walk. Patients with total hip arthroplasties (THAs), total knee arthroplasties (TKAs) and partial hip arthroplasties (PHAs) were analysed separately. Results: A total of 109 PJI patients (38 TKA, 41 THA, 30 PHA) and 218 non-PJI patients were included. In a model adjusted for clinically relevant variables, PJI was associated with a higher risk of needing an assistive device for ambulation (vs. walking without aid) among THA (adjusted odds ratio (OR) 3.10, 95% confidence interval (95% CI) 1.26–7.57; p = 0.014) and TKA patients (OR 5.40, 95% CI 2.12–13.67; p < 0.001), and with requiring two crutches to walk or being unable to walk (vs. walking unaided or with one crutch) among PHA patients (OR 3.05, 95% CI 1.01–9.20; p = 0.047). Conclusions: Ambulatory outcome in patients with hip and knee prostheses with postoperative PJI is worse than in patients who do not have PJI.

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The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Journal of Clinical Medicine ◽

10.3390/jcm8122113 ◽

2019 ◽

Vol 8 (12) ◽

pp. 2113 ◽

Cited By ~ 2

Author(s):

Deroche ◽

Bémer ◽

Valentin ◽

Jolivet-Gougeon ◽

Tandé ◽

...

Keyword(s):

Joint Infection ◽

Antimicrobial Treatment ◽

Microbiological Diagnosis ◽

Joint Infections ◽

Time To Positivity ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Two Samples ◽

The Right ◽

Polymicrobial Infections

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

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Is Gram staining still useful in prosthetic joint infections?

Journal of Bone and Joint Infection ◽

10.7150/jbji.31312 ◽

2019 ◽

Vol 4 (2) ◽

pp. 56-59 ◽

Cited By ~ 1

Author(s):

Marjan Wouthuyzen-Bakker ◽

Noam Shohat ◽

Marine Sebillotte ◽

Cédric Arvieux ◽

Javad Parvizi ◽

...

Keyword(s):

Revision Surgery ◽

Joint Infection ◽

Individual Case ◽

Gram Stain ◽

Reactive Protein ◽

Joint Infections ◽

Gram Staining ◽

Causative Microorganism ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Abstract. Introduction: Staphylococcus aureus is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute S. aureus PJI.Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.Results: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.

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Prosthetic Joint Infections

10.1093/med/9780199976805.003.0048 ◽

2016 ◽

Author(s):

David Mabey ◽

Hasan E. Baydoun ◽

Jamil D. Bayram

Keyword(s):

Antimicrobial Prophylaxis ◽

Joint Infection ◽

Treatment Options ◽

Joint Fluid ◽

Care Providers ◽

Joint Replacement Surgery ◽

Fluid Analysis ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections

Prosthetic joint infection (PJI), a complication of joint replacement surgery, presents with fever, joint pain, erythema, effusion, and joint loosening. Many advances have decreased the risk of infection, such as the use of perioperative antimicrobial prophylaxis and intraoperative laminar airflow. Joint fluid analysis should be pursued by the orthopedic surgeons; primary and acute care providers should consult the definitive care team and refer these patients for admission. Organisms causing prosthetic joint infections often grow in biofilms, which make them difficult to treat. Surgical treatment options include one or two-stage prosthesis exchange, debridement with retention of the prosthesis, resection arthroplasty, arthrodesis, or amputation. Antibiotic therapy should be guided by intraoperative cultures and selected in consultation with the infectious disease service.

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Handling of Doubtful WBC Scintigraphies in Patients with Suspected Prosthetic Joint Infections

Journal of Clinical Medicine ◽

10.3390/jcm9124031 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4031

Author(s):

Chiara Lauri ◽

Giancarlo Lauretti ◽

Filippo Galli ◽

Giuseppe Campagna ◽

Simone Tetti ◽

...

Keyword(s):

Visual Analysis ◽

Joint Infection ◽

White Blood Cells ◽

Final Diagnosis ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Significant Difference ◽

Sensitivity Specificity

Despite the application of EANM recommendations for radiolabelled white-blood-cells (WBC) scintigraphy, some cases still remain doubtful based only on visual analysis. The aim of this study was to investigate the role of semi-quantitative analysis and bone marrow scan (BMS) in solving doubtful cases. We retrospectively evaluated all [99mTc]HMPAO-WBC scintigraphies performed, in the last 7 years, for a suspected monolateral prosthetic joint infection (PJI). In doubtful cases, we used five different thresholds of increase of target-to-background (T/B) ratio, between delayed and late images, as criteria of positivity (5%, 10%, 15%, 20% and 30%). BMS were also analysed and sensitivity, specificity and accuracy of different methods were calculated according to final diagnosis. The sensitivity, specificity and accuracy were, respectively, 77.8%, 43.8% and 53.0% for the cut-off at 5%; 72.2%, 66.7% and 68.2% for the cut-off at 10%; 66.7%, 75.0% and 72.7% for the cut-off at 15%; 66.7%, 85.4% and 80.3% for the cut-off at 20%; 33.3%, 93.8% and 77.3% for the cut-off at 30%. BMS provided a significantly higher diagnostic performance than 5%, 10% and 15% thresholds. Conversely, we did not observe any statistically significant difference between BMS and the cut-off of more than 20%. Therefore, doubtful cases should be analysed semi-quantitatively. An increase in T/B ratio of more than 20% between delayed and late images, should be considered as a criterion of positivity, thus avoiding BMS.

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Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles

mBio ◽

10.1128/mbio.01776-15 ◽

2016 ◽

Vol 7 (1) ◽

Cited By ~ 55

Author(s):

Trisha N. Peel ◽

Brenda L. Dylla ◽

John G. Hughes ◽

David T. Lynch ◽

Kerryl E. Greenwood-Quaintance ◽

...

Keyword(s):

Blood Culture ◽

Prosthetic Joint Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Broth Culture ◽

Periprosthetic Tissue ◽

Tissue Samples ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Tissue Specimens

ABSTRACTDespite known low sensitivity, culture of periprosthetic tissue specimens on agars and in broths is routine. Culture of periprosthetic tissue samples in blood culture bottles (BCBs) is potentially more convenient, but it has been evaluated in a limited way and has not been widely adopted. The aim of this study was to compare the sensitivity and specificity of inoculation of periprosthetic tissue specimens into blood culture bottles with standard agar and thioglycolate broth culture, applying Bayesian latent class modeling (LCM) in addition to applying the Infectious Diseases Society of America (IDSA) criteria for prosthetic joint infection. This prospective cohort study was conducted over a 9-month period (August 2013 to April 2014) at the Mayo Clinic, Rochester, MN, and included all consecutive patients undergoing revision arthroplasty. Overall, 369 subjects were studied; 117 (32%) met IDSA criteria for prosthetic joint infection, and 82% had late chronic infection. Applying LCM, inoculation of tissues into BCBs was associated with a 47% improvement in sensitivity compared to the sensitivity of conventional agar and broth cultures (92.1 versus 62.6%, respectively); this magnitude of change was similar when IDSA criteria were applied (60.7 versus 44.4%, respectively;P= 0.003). The time to microorganism detection was shorter with BCBs than with standard media (P< 0.0001), with aerobic and anaerobic BCBs yielding positive results within a median of 21 and 23 h, respectively. Results of our study demonstrate that the semiautomated method of periprosthetic tissue culture in blood culture bottles is more sensitive than and as specific as agar and thioglycolate broth cultures and yields results faster.IMPORTANCEProsthetic joint infections are a devastating complication of arthroplasty surgery. Despite this, current microbiological techniques to detect and diagnose infections are imperfect. This study examined a new approach to diagnosing infections, through the inoculation of tissue samples from around the prosthetic joint into blood culture bottles. This study demonstrated that, compared to current laboratory practices, this new technique increased the detection of infection. These findings are important for patient care to allow timely and accurate diagnosis of infection.

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Prosthetic Joint Infection Due to Histoplasma capsulatum Complicating a Total Knee Arthroplasty

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx118 ◽

2017 ◽

Vol 4 (3) ◽

Cited By ~ 2

Author(s):

Cima Nowbakht ◽

Katherine Garrity ◽

Nicholas Webber ◽

Jairo Eraso ◽

Luis Ostrosky-Zeichner

Keyword(s):

Total Knee Arthroplasty ◽

Prosthetic Joint Infection ◽

Histoplasma Capsulatum ◽

Joint Infection ◽

Stage Management ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Oral Itraconazole ◽

Total Knee

Abstract Histoplasmosis is a common pathogen but rarely reported in prosthetic joint infections. We present a case of Histoplasmosis capsulatum prosthetic joint infection along with a literature review revealing no guidelines or consensus on surgical and antifungal management. We chose the 2-stage management with an antifungal spacer and systemic oral itraconazole.

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Micromonas micros Infection of a Prosthetic Hip Joint: A Case Report and Review of the Literature

Case Reports in Infectious Diseases ◽

10.1155/2021/9042790 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Abhimanyu Aggarwal ◽

Durane Walker

Keyword(s):

Antibiotic Prophylaxis ◽

Hip Joint ◽

Joint Infection ◽

Dental Procedure ◽

Joint Infections ◽

Prosthetic Joints ◽

Prosthetic Joint ◽

Dental Procedures ◽

Prosthetic Joint Infections ◽

Hematogenous Seeding

Micromonas micros is an oral anaerobic Gram-positive coccus and is a commensal of the mouth, and it is rarely isolated in prosthetic joint infections (PJIs) and even less frequently related to a preceding dental procedure with eventual hematogenous seeding of the prosthetic joint. Here, we present a case of a 56-year-old male with a prosthetic hip joint who developed Micromonas micros prosthetic hip joint infection with symptoms starting a few days after a dental procedure and not having received periprocedural antibiotic prophylaxis. He recovered well with surgical intervention and antimicrobial therapy. We conducted a literature review of prosthetic hip joint infections caused by Micromonas micros as well as briefly discuss current guidelines on antibiotic prophylaxis in patients with prosthetic joints undergoing dental procedures and some knowledge gaps.

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