scholarly journals Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

2020 ◽  
Vol 5 (3) ◽  
pp. 128-132
Author(s):  
Marrit Hoekstra ◽  
Ewout S. Veltman ◽  
Ruben F.R.H.A Nurmohamed ◽  
Bruce van Dijk ◽  
Rob J. Rentenaar ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Sensitivity And Specificity ◽  
Periprosthetic Joint Infection ◽  
Hip Prosthesis ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Clinical Importance ◽  
Tissue Cultures ◽  
Knee Joint Infection ◽  
Total Knee

Abstract. Background: Diagnosis of periprosthetic joint infection (PJI) can be troublesome. Sonication can be a helpful tool in culturing bacteria that are difficult to detect with standard tissue cultures. Aim of this study is to evaluate the clinical importance of our standardized sonication protocol in detecting periprosthetic joint infection.Materials and methods: All patients with revision surgery of a hip or knee prosthesis between 2011 and 2016 were retrospectively reviewed and divided in two groups: clinically suspected of infection or not suspected of infection. For both tissue culture and implant sonication, calculations of sensitivity and specificity were performed. Clinical relevance of sonication was evaluated by calculating in which percentage of patients' sonication influenced clinical treatment.Results: 226 patients with revision of a total hip prosthesis (122 patients) or a total knee prosthesis (104 patients) were included. Sensitivity of perioperatively taken tissue cultures was 94.3% and specificity was 99.3%. For sonication sensitivity was 80.5% and specificity was 97.8%.In the infection group eight patients (9%) with only one positive tissue culture and a positive sonication fluid culture with the same pathogen were found.Interpretation: Although sensitivity and specificity of sonication was lower compared to tissue cultures, periprosthetic joint infection could only be established in 8 patients (9%) suspected of infection because of a positive result of the sonication fluid culture.Sonication leads to clinically relevant changes in treatment and seems therefore to be a helpful diagnostic tool in clinical practice.

scholarly journals Conversion Knee Arthroplasty Using a Rotating Hinge as a Salvage Prosthesis Following Periprosthetic Joint Infection and Ligamentous Insufficiency: A Case Report

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Jon E. Minter
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Knee Prosthesis ◽  
Joint Infection ◽  
Extensor Mechanism ◽  
Physical Constraint ◽  
Total Knee ◽  
Ligamentous Instability ◽  
Revision Tka

BackgroundIn the event of a complex revision TKA in which there is extensor mechanism involvement and ligamentous instability or insufficiency, non-linked levels of constraint may not be adequate for achieving restoration of patient function. Total knee arthroplasty devices that incorporate a linked level of constraint are successful alternatives to unlinked devices (PS and PS-Constrained) in this clinical context.Case PresentationWe present the case of a 62 year-old male patient that required a non-articulating knee fusion and multiple total knee arthroplasty revisions in conjunction with a ruptured and repaired extensor mechanism, ligamentous instability, bone loss and periprosthetic joint infection.  (Revision knee prosthesis that includes a increasing degree of nodularity and physical constraint).  The subsequent risk factors associated with the loss of bone and ligamentous insufficiency required performing conversion arthroplasty with a knee prosthesis that includes an increasing degree of modularity and physical constraint not commonly used in revision total knee arthroplasty.DiscussionThe authors report on a patient who underwent multiple operative procedures, we outline the step wise decision making progression that lead to the successful eradication of the PJI and reimplant device strategy based on the confounding factors presented.  We assess the use of revision TKA systems that offer extreme degrees of constraint which should be considered in complex revision knee revision procedures.

Current Insights in the Evaluation and Treatment of Infected Total Knee Arthroplasty

2021 ◽  
Author(s):  
Blair S. Ashley ◽  
Javad Parvizi
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Difficult Problem ◽  
Postoperative Course ◽  
Infected Total Knee Arthroplasty ◽  
Treatment Considerations ◽  
Total Knee

AbstractTotal knee arthroplasty is a widely successful procedure, but a small percentage of patients have a postoperative course complicated by periprosthetic joint infection (PJI). PJI is a difficult problem to diagnose and to treat, and the management of PJI differs, depending on the acuity of the infection. This paper discusses the established and newer technologies developed for the diagnosis of PJI as well as different treatment considerations and surgical solutions currently available.

Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 191-195
Author(s):  
Elizabeth B. Gausden ◽  
Matthew B. Shirley ◽  
Matthew P. Abdel ◽  
Rafael J. Sierra
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Significant Risk ◽  
Wound Dehiscence ◽  
Increased Risk ◽  
Primary Tkas ◽  
Traumatic Wound ◽  
Total Knee

Aims To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA). Methods From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed. Results Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component. Conclusion Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J 2021;103-B(6 Supple A):191–195.

scholarly journals Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

2018 ◽  
Vol 57 (2) ◽  
Author(s):  
Eric Gomez-Urena ◽  
Rafael J. Sierra ◽  
Kerryl E. Greenwood-Quiantance ◽  
Melissa J. Karau ◽  
James M. Steckelberg ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Antimicrobial Agent ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Similar Proportion ◽  
Tissue Cultures ◽  
Periprosthetic Tissue ◽  
Prosthetic Joint ◽  
Sonication Culture

ABSTRACT Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.

scholarly journals The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0252322
Author(s):  
Taiana Cunha Ribeiro ◽  
Emerson Kiyoshi Honda ◽  
Daniel Daniachi ◽  
Ricardo de Paula Leite Cury ◽  
Cely Barreto da Silva ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Diagnostic Criteria ◽  
Gold Standard ◽  
Joint Infection ◽  
Clinical Criterion ◽  
Tissue Cultures ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Impact ◽  
Sonication Culture

Background In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition. Methods Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value. Results Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8–100%), respectively (p = 0.024). Conclusions In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

Mortality During Total Knee Periprosthetic Joint Infection

2018 ◽  
Vol 33 (12) ◽  
pp. 3783-3788 ◽  
Author(s):  
Zachary C. Lum ◽  
Kyle M. Natsuhara ◽  
Trevor J. Shelton ◽  
Mauro Giordani ◽  
Gavin C. Pereira ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Knee
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