Similar Efficacy of Arthroscopy and Arthrotomy in Infection Eradication in the Treatment of Septic Knee: A Systematic Review and Meta-Analysis

Aim: To compare the arthroscopy vs. arthrotomy for the treatment of native knee septic arthritis.Methods: Electronic databases of PubMed, Embase and Cochrane Library were searched for eligible studies. Retrospective comparative studies comparing arthroscopy or arthrotomy for patients with septic arthritis of the native knee were eligible for this review. The primary outcome was recurrence of infection after first procedure. The secondary outcomes included hospital length of stay, operative time, range of motion of the involved knee after surgery, overall complications and mortality rate,Results: Thirteen trials were included in this study. There were a total of 2,162 septic arthritis knees treated with arthroscopic debridement and irrigation, and 1,889 septic arthritis knees treated with open debridement and irrigation. Arthroscopy and arthrotomy management of the knee septic arthritis showed comparable rate of reinfection (OR = 0.85; 95% CI, 0.57–1.27; P = 0.44). No significant difference was observed in hospital length of stay, operative time and mortality rate between arthroscopy and arthrotomy management group, while arthroscopy treatment was associated with significantly higher knee range of motion and lower complication rate when compared with arthrotomy treatment.Conclusion: Arthroscopy and arthrotomy showed similar efficacy in infection eradication in the treatment of native septic knee. However, arthroscopy treatment was associated with better postoperative functional recovery and lower complication rate.

Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Introduction Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm2 (6–600) and 5.4 cm (1–23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were “very satisfied” with the treatment outcome. Conclusion A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.

Two-Stage Exchange Arthroplasty for Periprosthetic Shoulder Infection Is Associated with High Rate of Failure to Reimplant and Mortality

Background: Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI. Methods: After a retrospective review of our institutional database between 2008 and 2018, 49 patients, who were treated with an intended two-stage exchange for shoulder PJI, were identified. Patients’ demographics, laboratory and health status parameters, along with records of clinical outcome were collected. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival. Results: Reimplantation was completed in only 35 (71%) of 49 cases and eradication of infection was achieved in 85.7% of patients with successful reimplantation after a mean follow-up duration of 5.1 years (1.1 to 10.2 years). Reasons for failure to reimplant were premature death in 36%, high general morbidity in 29%, satisfaction with the current status in 21%, or severe infection with poor bone and soft tissues in 14% of the patients. Of the 14 cases without reimplantation, eradication rate of infection was 57% after a mean follow-up of 5 years (2.6 to 11 years). The overall mortality rate of the entire cohort was 25% at the latest follow-up and 10% within ninety days after implant removal. Patients who deceased or did not undergo reimplantation during the follow-up were significantly older and had a significantly higher Charlson comorbidity index (CCI). Conclusions: While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. Shoulder PJI and its treatment are associated with a high risk of mortality, especially in patients with older age and higher CCI.

Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study

Introduction: Two-stage revision surgery is the most frequently performed procedure in patients with a chronic periprosthetic joint infection (PJI). The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies. The aim of this study was to retrospectively evaluate the infection eradication rate in patients with chronic PJI treated with two-stage revision surgery of the hip or knee in primary and re-revision cases. Methods: All patients treated with a two-stage revision for chronic PJI between 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at last follow-up. Successful eradication is specified as no need for subsequent revision surgery or suppressive antibiotic treatment. Results: Forty-seven patients were treated with a two-stage revision. Infection eradication was achieved in 36 out of 47 cases. Thirty-eight patients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27–186) months. For hip and knee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in 29 out of 38 cases and after re-revision in 7 out of 9 cases. Conclusion: In this study, the infection eradication rate for two-stage revision surgery after PJI of the hip and knee in primary and re-revision cases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infection eradication rates at long-term follow-up of 128 (27–186) months.

ESTIMATION OF SARS COV 2 SPECIFIC ANTIBODIES SEROPREVALENCE IN HEALTHCARE WORKERS IN DISTRICT UDAIPUR, INDIA

Background: Current pandemic caused by Novel coronavirus (COVID-19) causes clinical symptoms from fever to acute respiratory distress syndrome but may remain mild or asymptomatic. To evaluate the cumulative prevalence of SARS-CoV-2 infection in a community and know how immune response develops in the population, reliable assay alongwith RT-PCR for detection of SARS CoV 2 antibodies is needed. Healthcare workers (HCWs) represent a high-risk population for infection with SARS-CoV-2. Methods: We evaluated total antibodies recognizing the SARS CoV 2 receptor binding domain (S1-RBD) or the Spike protein over a period of six months in a total of 310 healthcare workers engaged in hospital using SARS-CoV-2 Total antibody assay kit. The overall Findings: seroprevalence found in our analysis was 41.93%. In case of males the percentage positive was found to be signicantly higher at 43.91%, compared to females at 36.25%. Seroprevalence was signicantly higher in 50 years above age group in comparison to 20-50 years old aged healthcare workers. The seroprevalence was higher in doctors, nursing staff and lab technicians than other healthcare professionals as 44.6%. Conclusions: This study showed high seroprevalence of SARS-CoV-2 in healthcare workers which means remaining proportion of the healthcare workers are still susceptible to the infection. Good compliance to infection eradication and control measures, adequate PPEs, and early detection and isolation of healthcare workers infected with SARS-CoV-2 are mandatory to reduce the risk of SARS-CoV-2 infection

ESTIMATION OF SARS-COV-2 SPECIFIC ANTIBODIES SEROPREVALENCE IN HEALTHCARE WORKERS IN DISTRICT UDAIPUR, INDIA

Background:Current pandemic caused by Novel coronavirus (COVID-19) causes clinical symptoms from fever to acute respiratory distress syndrome but may remain mild or asymptomatic. To evaluate the cumulative prevalence of SARSCoV-2 infection in a community and know how immune response develops in the population, reliable assay alongwith RT-PCR for detection of SARS-CoV 2 antibodies is needed. Healthcare workers (HCWs) represent a high-risk populat - ion for infection with SARS-CoV-2. Methods: We evaluated total antibodies recognizing the SARS CoV 2 receptor binding domain (S1-RBD) - - - or the Spike protein over a period of six months in a total of 310 healthcare workers engaged in hospital using SARS-CoV-2 Total antibody assay kit. Findings: The overall seroprevalence found in our analysis was 41.93%. In case of males the percentage positive was found to be signicantly higher at 43.91%, compared to females at 36.25%. Seroprevalence was signicantly higher in 50 years above age group in comparison to 20-50 years old aged healthcare workers. The seroprevalence was higher in doctors, nursing staff and lab technicians than other healthcare professionals as 44.6%. Conclusions: This study showed high seroprevalence of SARS-CoV-2 in healthcare workers which means remaining proportion of the healthcare workers are still susceptible to the infection. Good compliance to infection eradication and control measures, adequate PPEs, and early detection and isolation of healthcare workers infected with SARS-CoV-2 are mandatory to reduce the risk of SARS-CoV-2 infection.

Periprosthetic hip infections in a Swedish regional hospital between 2012 and 2018: is there a relationship between <i>Cutibacterium acnes</i> infections and uncemented prostheses?

The purpose of this study was to evaluate patients requiring in-patient care due to a periprosthetic joint infection (PJI), with respect to bacterial agents, surgical treatment, antibiotics, and outcome. We retrospectively identified all infected total hip arthroplasties (THAs) in a Swedish regional hospital during a 7-year period (2012–2018) and reviewed medical records and microbiological data. A total of 89 infected THAs in 87 patients were identified. Standardized treatment with debridement with retention of the implant and antibiotics (DAIR) was initially performed in 53 cases (60 %), one or two stage revisions in 33 cases (37 %), and an immediate Girdlestone in 3 cases (3 %). Infection eradication was seen in 77 PJIs (87 %) in addition to six patients (7 %) ending up with a permanent but uninfected Girdlestone. All six patients with manifest failures were infected with Staphylococcus aureus, two of which were also polymicrobial. Cutibacterium acnes was found in 18 of 89 patients (16 %) distributed in 15 uncemented implants but only in 3 hybrids and cemented arthroplasties, while remaining pathogens were equally distributed in uncemented THAs (n=31) and THAs with at least one cemented component (n=40; p=0.003). Eradication was achieved in all 18 patients when Cutibacterium acnes was the only culture (n=14) or clearly dominant among positive cultures (n=4). DAIR was successful in selected postoperative infections up to 6 months after hip replacement. Cutibacterium acnes infections in hip arthroplasty may be underdiagnosed. Cemented components in THAs seem to protect from colonization with Cutibacterium acnes.