Infectious complications of hip arthroplasty

The objective of the research is to study the causes and outcomes of infectious complications after total hip arthroplasty. The background of the research is the analysis of outcomes of 364 patients with complications after total hip arthroplasty; 369 cases, from 2005 to 2018. The infectious complications accounted for 21.7% (80 cases). The work involves clinical, radiological, microbiological, and statistical research methods. As a result of research causes of suppurative complications after total hip arthroplasty were: chronic infectious diseases of internal organs (t=3.37, p=0.001), instability of prosthetic components (t=3.14, p=0.002), over two previous surgical interventions involving the affected joint (t=2.43, p=0.005). In the treatment of periprosthetic infections, sanitizing interventions without the prosthetic components’ removal appeared efficient within only up to 3 weeks. If the sanitizing interventions were inconclusive, the double-stage revision prosthetics appeared adequate in a reliable number of cases (t = 11.2, p = 0.0028), namely 24, which amounted to 92.3%. In conclusion, it was concluded that the causes of periprosthetic infections were: diseases of the internal organs, instability of the components, over two surgical operations involving the same joint. The development of various complications after total hip replacements demands surgical revision procedures.

Clinical Application of Antibacterial Hydrogel and Coating in Orthopaedic and Traumatology Surgery

Implant related infection is one of the most frequent complications in orthopaedic and trauma surgery. Local antibiotic treatment strategies are becoming part of the prevention and treatment methodology for this fearful complication. To date, there are two coatings available on the market, both with a polylactic acid base. Current evidence supports the use of these types of coatings in the prophylaxis of periprosthetic infections and fracture-related infections. However, their therapeutic use has been less investigated. The purpose of this article is to summarise recent evidence relating to the clinical application of antibacterial hydrogels and coatings in orthopaedic and traumatology surgery and indicating which future applications may benefit from it.

Efficiency of Surgical Debridement and Implant Retaining in Treatment of Early Postoperative and Acute Hematogenous Periprosthetic Infections of Hip

Background. Periprosthetic infection is a devastating complication that influences the duration of treatment and patients life quality. Debridement, Antibiotics and Implant Retention (DAIR) is considered as least invasive surgery patients with stable implant, except cases of chronical periprosthetic infection. The aim of this study was to evaluate efficiency of surgical debridement and implant retaining in control over infection in group patients with early postoperative and acute hematogenous periprosthetic infections. Materials and Methods.We performed retrospective monocentral cohort study of treatment early postoperative and acute hematogenous periprosthetic infections of hip in 26 patients. The group included cases with stable implants and period between manifestation of infection and DAIR no more than 4 weeks. We have classified infection as early postoperative in 22 patients (84,2%) and as acute hematogenous in 4 cases (15,8%). Results.At mean follow-up 42,8±2,3 mounts five patients underwent removal of implant due to reinfection. We performed successful twostage revision for four of them and had to perform resection arthroplasty in one case. Thus, DAIR protocol was successful in 80,8(%) cases. The mean Harris Hip Score significantly improved compared to preoperative values from 59,2±2,5 to 80,5±1,3 at the last follow-up (p = 0,0002, Z-3,7). Conclusions.The efficiency of DAIR according to our data was 80,8%. These results allow to consider DAIR as a method of treatment of patients with early postoperative and acute hematogenous periprosthetic infections. Exchange of modular components can decrease the reinfection rate.

The role of hydrogen peroxide in hip arthroplasty: A narrative review

Hydrogen peroxide has become more commonly used in hip arthroplasties due to high risk of periprosthetic infections. Its purported roles include irrigation, haemostasis, reduction of aseptic loosening and attachment of antibiotics. However, current literature does not provide conclusive evidence on the efficacy of hydrogen peroxide in preventing aseptic loosening, with some controversy around whether it in fact contributes to aseptic loosening. The complications of hydrogen peroxide across medicine are well distinguished; however, the risks within orthopaedic surgery and hip arthroplasties are not well known. Beyond cytotoxicity, the most dangerous reported risk associated with hydrogen peroxide in hip arthroplasties was an oxygen embolism in an unvented femoral canal and acrylic bone cement, consequentially leading to cardiac arrest. However, it may be inappropriate to solely attribute the oxygen embolism to the use of hydrogen peroxide and thus if used appropriately, hydrogen peroxide may have a justifiable role in hip arthroplasty surgery. In this narrative review, we present the current uses of hydrogen peroxide while evaluating its associated risks. We have summarised the key indications and aggregated recommendations to provide guidelines for the use of hydrogen peroxide in hip arthroplasty.

Outcomes of distal femoral arthroplasty after periprosthetic fractures: minimum 2-year follow-up

Purpose : distal femoral periprosthetic fracture (DFPPF) is a serious complication following total knee arthroplasty (TKA). Recently, treatment of DFPPF with distal femoral arthroplasty (DFA) has gained popularity because of its posited benefits for both patients and the medical system. Short-term follow-up trials investigating DFA have demonstrated acceptable results with regards to function, pain relief and lower postoperative complications than ORIF in elderly patients. The purpose of the current study was to evaluate a consecutive series of DFPPF treated with DFA, with a minimum 2- year follow-up. Methods : We performed a retrospective study asses- sing the outcomes of distal femoral arthroplasty (DFA) for patients diagnosed with DFPPF. Results : Twenty patients were identified. The mean age of patients was 76.3 (SD, 9.41), the average time from the fracture to revision surgery was 6.7 days (SD, 11.35), The average operative time was 93.5 minutes (SD,16.6). The average follow-up time was 50.15 months (SD, 20.87). During this time, two patients (10%) had complications. One patient experienced a knee dislocation and the second patient had recurrent periprosthetic infections. At final follow up, the mean knee society score was 86.25 (SD, 9.44), the mean Forgotten joint score was 62.16(SD, 23.45) and 93.7 percent of patients were ambulatory. Conclusion : DFA following DFPPF is associated with high success rates and provides patients with the opportunity for return of function in a safe and reliable manner.

Management of Modular Mega-Implant Infection of the Lower Extremity

Introduction Revision arthroplasty involving mega-implants is associated with a high complication rate. In particular, infection is a serious complication of revision arthroplasty of hip and knee joints and has been reported to have an average rate of 18%, and for mega-implants, the range is from 3 to 36%. This study was designed to analyze the strategy of treatment of infection of mega-endoprostheses of the lower extremities in our patient cohort, particularly the management of chronic infection. Material and Methods This was a retrospective study that focused on the results of the treatment of periprosthetic infections of mega-implants of the lower extremities. We identified 26 cases with periprosthetic infections out of 212 patients with 220 modular mega-endoprostheses of the lower extremities who were treated in our department between September 2013 and September 2019. As a reinfection or recurrence, we defined clinical and microbiological recurrences of local periprosthetic joint infections after an antibiotic-free period. Results In this study, 200 cases out of 220 were investigated. The average follow-up period was approximately 18 months (6 months to 6 years). Endoprosthesis infections after implantation of mega-implants occurred in 26 cases (13%). This group comprised 2 early infections (within the first 4 weeks) and 24 chronic infections (between 10 weeks and 6 years after implantation). Nineteen cases out of the identified 26 cases with infection (73.1%) belong to the group of patients who were operated on due to major bone loss following explantation of endoprosthetic components due to previous periprosthetic joint infection. The remaining seven cases with infection comprised four cases following management of periprosthetic fracture, two cases following treatment of aseptic loosening, and one case following tumor resection. All infections were treated surgically. In all cases, the duration of continuous antibiotic treatment did not exceed 6 weeks. Both cases with early infection were treated by exchanging polyethylene inlays and performing debridement with lavage (two cases). In two (7.7%) cases with chronic infection, one-stage surgery was performed. In all remaining cases with chronic infection (22 cases; 84.6%), explantation of all components and temporary implantation of cement spacers were carried out prior to reimplantation. Conclusion There is still no gold standard therapeutic regimen for the management of periprosthetic infection of mega-implants, though radical surgical debridement and lavage accompanied by systemic antibiotic therapy are the most important therapeutic tools in all cases of periprosthetic infections, regardless of the time of onset. Further studies are needed to standardize management strategies of such infections. Nevertheless, it is not uncommon for compromises to be made based on the particular condition of the individual.