scholarly journals Timing of debridement, antibiotics, and implant retention (DAIR) for early post-surgical hip and knee prosthetic joint infection (PJI) does not affect 1-year re-revision rates: data from the Dutch Arthroplasty Register

2021 ◽  
Vol 6 (8) ◽  
pp. 329-336
Author(s):  
Barry van der Ende ◽  
Jakob van Oldenrijk ◽  
Max Reijman ◽  
Peter D. Croughs ◽  
Liza N. van Steenbergen ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Joint Infection ◽  
Successful Outcome ◽  
Optimal Timing ◽  
Arthroplasty Register ◽  
Total Hip ◽  
Prosthetic Joint ◽  
Significant Difference ◽  
Primary Procedure ◽  
Implant Retention

Abstract. Debridement, antibiotics, and implant retention (DAIR) is a procedure to treat a periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The timing between the primary procedure and the DAIR is likely a determinant for its successful outcome. However, the optimal timing of a DAIR and the chance of success still remain unclear. We aimed to assess the risk of re-revision within 1 year after a DAIR procedure and to evaluate the timing of the DAIR in primary THA and TKA. We used data from the Dutch Arthroplasty Register (LROI) and selected all primary THA and TKA in the period 2007–2016 which underwent a DAIR within 12 weeks after primary procedure. A DAIR was defined as a revision for infection in which only modular parts were exchanged. A DAIR was defined as successful if not followed by a re-revision within 1 year after DAIR; 207 DAIRs were performed <4 weeks after THA, of which 16 (8 %) received a complete revision within 1 year. DAIR procedures performed between 4 and 12 weeks (n=98) had a failure rate of 9 % (n=9). After TKA 126 DAIRs were performed in less than 4 weeks, of which 11 (9 %) received a complete revision within 1 year; 83 DAIRs were performed between 4 and 12 weeks, of which 14 (17 %) were revised. There was no significant difference in 1-year re-revision rate after a DAIR procedure by timing of the DAIR procedure for total hip and knee arthroplasty based on Dutch registry data.

Fungal prosthetic joint infection in total hip or knee arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 589-595 ◽  
Author(s):  
C. Theil ◽  
T. Schmidt-Braekling ◽  
G. Gosheger ◽  
E. A. Idelevich ◽  
B. Moellenbeck ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Fungal Infections ◽  
Joint Infection ◽  
Treatment Success ◽  
Two Stage ◽  
Musculoskeletal Infection ◽  
Total Hip ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections

Aims Fungal prosthetic joint infections (PJIs) are rare and account for about 1% of total PJIs. Our aim was to present clinical and microbiological results in treating these patients with a two-stage approach and antifungal spacers. Patients and Methods We retrospectively reviewed our institutional database and identified 26 patients with positive fungal cultures and positive Musculoskeletal Infection Society (MSIS) criteria for PJI who were treated between 2009 and 2017. We identified 18 patients with total hip arthroplasty (THA) and eight patients with total knee arthroplasty (TKA). The surgical and antifungal treatment, clinical and demographic patient data, complications, relapses, and survival were recorded and analyzed. Results The median follow-up was 33 months. The success rate was 38.5% (10/26). Fluconazole resistance was found in 15%. Bacterial co-infection was common in 44% of patients for THA and 66% of patients with TKA. Mortality, reoperations, and treatment failure were common complications. Conclusion Treatment with a two-stage exchange is a possible option for treatment, although fungal infections have a high failure rate. Therapeutic factors for treatment success remain unclear. Cite this article: Bone Joint J 2019;101-B:589–595.

Engineered Photo-Chemical Therapeutic Nanocomposites Provide Effective Antibiofilm and Microbicidal Activities against Bacterial Infection in Porous Devices

2021 ◽  
Author(s):  
Yu-Hsiang Lee ◽  
Chen-Chih Chiu ◽  
Chin-Yuan Chang
Keyword(s):  
Bacterial Infection ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Total Hip ◽  
Prosthetic Joint

Today, prosthetic joint infection (PJI) is still a relatively rare but devastating complication following total hip and/or knee arthroplasty. The treatment of PJI is difficult due to a number of...

scholarly journals One-year infection control rates of a DAIR (debridement, antibiotics and implant retention) procedure after primary and prosthetic-joint-infection-related revision arthroplasty – a retrospective cohort study

2021 ◽  
Vol 6 (4) ◽  
pp. 91-97
Author(s):  
F. Ruben H. A. Nurmohamed ◽  
Bruce van Dijk ◽  
Ewout S. Veltman ◽  
Marrit Hoekstra ◽  
Rob J. Rentenaar ◽  
...  
Keyword(s):  
Infection Control ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Musculoskeletal Infection ◽  
Primary Arthroplasty ◽  
Prosthetic Joint ◽  
Successful Infection ◽  
Significant Difference ◽  
Implant Retention

Abstract. Introduction: Debridement, antibiotics and implant retention (DAIR) procedures are effective treatments for acute postoperative or acute hematogenous periprosthetic joint infections. However, literature reporting on the effectiveness of DAIR procedures performed after a one- or two-stage revision because of a prosthetic joint infection (PJI) (PJI-related revision arthroplasty) is scarce. The aim of this study is to retrospectively evaluate the infection control after 1 year of a DAIR procedure in the case of an early postoperative infection either after primary arthroplasty or after PJI-related revision arthroplasty. Materials and methods: All patients treated with a DAIR procedure within 3 months after onset of PJI between 2009 and 2017 were retrospectively included. Data were collected on patient and infection characteristics. All infections were confirmed by applying the Musculoskeletal Infection Society (MSIS) 2014 criteria. The primary outcome was successful control of infection at 1 year after a DAIR procedure, which was defined as the absence of clinical signs, such as pain, swelling, and erythema; radiological signs, such as protheses loosening; or laboratory signs, such as C-reactive protein (CRP) (<10) with no use of antibiotic therapy. Results: Sixty-seven patients were treated with a DAIR procedure (41 hips and 26 knees). Successful infection control rates of a DAIR procedure after primary arthroplasty (n=51) and after prior PJI-related revision arthroplasty (n=16) were 69 % and 56 %, respectively (p=0.38). The successful infection control rates of a DAIR procedure after an early acute infection (n=35) and after a hematogenous infection (n=16) following primary arthroplasty were both 69 % (p=1.00). Conclusion: In this limited study population, no statistically significant difference is found in infection control after 1 year between DAIR procedures after primary arthroplasty and PJI-related revision arthroplasty.

Prosthetic Joint Infection Risk Following Total Hip and Knee Arthroplasty in the Medicare Population

2009 ◽  
Vol 24 (2) ◽  
pp. e4 ◽  
Author(s):  
Steven M. Kurtz ◽  
Kevin Ong ◽  
Edmund Lau ◽  
Kevin J. Bozic ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Infection Risk ◽  
Total Hip ◽  
Medicare Population ◽  
Prosthetic Joint ◽  
Hip And Knee Arthroplasty

Combined total hip and knee arthroplasty during the same hospital admission

2019 ◽  
Vol 101-B (5) ◽  
pp. 573-581
Author(s):  
A. M. Almaguer ◽  
K. H. Cichos ◽  
G. McGwin Jr ◽  
J. M. Pearson ◽  
B. Wilson ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Joint Infection ◽  
Hospital Costs ◽  
Revision Arthroplasty ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
Hip And Knee Arthroplasty ◽  
Deep Vein

Aims The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode. Patients and Methods Data from the National (Nationwide) Inpatient Sample recorded between 2005 and 2014 were used for this retrospective cohort study. Postoperative in-hospital complications, total costs, and discharge destination were reviewed. Logistic and linear regression were used to perform the statistical analyses. p-values less than 0.05 were considered statistically significant. Results Combined TJA was associated with increased risk of deep vein thrombosis, prosthetic joint infection, irrigation and debridement procedures, revision arthroplasty, length of stay (LOS), and in-hospital costs compared with bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJA performed on separate days of the same admission showed no statistically significant differences when compared with same-day combined TJA, but trended towards decreased total costs and total complications despite increased LOS. Conclusion Combined TJA is associated with increased in-hospital complications, LOS, and costs. We do not recommend performing combined TJA during the same hospital stay. Cite this article: Bone Joint J 2019;101-B:573–581.

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