A Motion Maintaining Antibiotic Delivery System

Lombardi, Adolph V.; Karnes, Jonathan; Berend, Keith R.

doi:10.1016/j.arth.2007.01.025

Cited by 24 publications

(17 citation statements)

References 39 publications

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“…Although 25% of all RTKAs performed are for infection [11] and the two-stage RTKA is the accepted standard for a prosthetic knee infection [56,63], controversy exists regarding which surgical exposure provides superior clinical results with the lowest risk of extensor mechanism disruption and reinfection [79,104]. One previous prospective study [6] of QS and TTO in patients who had RTKA found similar KSS clinical scores for both groups, better ROM in the QS group, and less extension lag in the TTO group; the authors reported no prosthetic knee infections.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that 6.6% to 38% of RTKAs are attributable to prosthetic knee infections [5,11,23,24,31,41,43,55,58,76,95,96]. Although some [56,63] prefer it, a two-stage procedure for chronic prosthetic knee infection requires temporary cement spacers to preserve limb length and reduce soft tissue retraction. Static spacers have been suggested [7,15,28,30] to be more stable than mobile spacers when these knees have substantial Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Section: Introductionmentioning

confidence: 99%

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Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Bruni

Iacono

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Although 7% to 38% of revision total knee arthroplasties (RTKAs) are attributable to prosthetic knee infections, controversy exists regarding the best surgical approach while reducing the risk of extensor mechanism complications and the reinfection rate. Questions/purposes We compared The Knee Society Score Ó (KSS), incidences of complications, maximum knee flexion, residual extension lag, and reinfection rate in patients with prosthetic knee infections treated with two-stage RTKAs using either the tibial tubercle osteotomy (TTO) or the quadriceps snip (QS) for exposure at the time of reimplantation. Methods We prospectively followed 81 patients with chronic prosthetic knee infections treated between 1997 and 2004. Patients were randomized to receive a TTO or QS for exposure at the time of reimplantation. All patients had the same rehabilitation protocol. The minimum followup was 8 years (mean, 12 years; range, 8-15 years). Results Patients in the TTO group had a higher mean KSS than the QS group (88 versus 70, respectively). Mean maximum knee flexion was greater in the TTO group (113°v ersus 94°); with a lower incidence of extension lag (45% versus 13%). We observed no differences in reinfection rate between groups. Conclusions We found the TTO combined with an early rehabilitation protocol associated with superior KSS did not impair extensor mechanism function or increase the reinfection rate. We believe a two-stage RTKA with TTO is a reasonable approach for treating prosthetic knee infections.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Bruni

Iacono

Sharma

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Two-stage exchange arthroplasty with use of an interim antibiotic cement spacer is the accepted treatment in most circumstances with infection control rates ranging from 74.5% to 100% [23]. Both static and articulating antibiotic spacers have been This material is partially based on work supported (or supported in part) by the Office of Research and Development, Department of Veterans Affairs.…”

Section: Introductionmentioning

confidence: 99%

“…Cement-on-cement articulating spacers can also be used. These were initially hand-made [24], but subsequently silicone molds for intraoperatively fabricating cement components (silicon mold components [SMCs]) have been developed [9,23]. Prefabricated cement spacers are also commercially available [27].…”

Section: Introductionmentioning

confidence: 99%

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

Kalore

Maheshwari

Sharma

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic infection in TKA is a devastating and challenging problem for both patients and surgeons. Two-stage exchange arthroplasty with an interval antibiotic spacer reportedly has the highest infection control rate. Studies comparing static spacers with articulating spacers have reported varying ROM after reimplant, which could be due to differences in articulating spacer technique. Questions/purposes We therefore determined whether one of three articulating spacer techniques was superior in terms of (1)

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“…First, these antibiotics are commonly used to treat orthopedic infections; 28,29 second, they have two distinctly different mechanisms of action. Vancomycin interferes with cell wall synthesis by combining with the D-alanine residues of the peptidoglycan chain and preventing the cross-link required for stable cell wall synthesis, thus being bactericidal against dividing microbes.…”

Section: Discussionmentioning

confidence: 99%

Distinction between intact and antibiotic‐inactivated bacteria by real‐time PCR after treatment with propidium monoazide

Kobayashi

Oethinger

Tuohy

et al. 2010

Journal Orthopaedic Research

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One limitation to the use of the polymerase chain reaction (PCR) to identify orthopedic infections has been apparent falsepositive results, possibly due to the detection of dead bacteria. We recently showed that the use of DNA-binding agent propidium monoazide (PMA) could distinguish viable from heat-inactivated bacteria, and, in this study, we investigated whether the same technique can be applied to bacteria killed by two antibiotics with distinctly different mechanisms of action, a test of greater clinical relevance than thermal inactivation. Staphylococcus aureus and S. epidermidis were inactivated by vancomycin and gentamicin and treated with PMA or left untreated before DNA extraction. The threshold cycle difference of antibiotic-treated bacteria with and without PMA pretreatment was investigated with PCR primers for the 16S rDNA and tuf genes. Our results indicated that PMA effectively inhibited detection by PCR of bacteria, which had been inactivated by either vancomycin or gentamicin. The effect was statistically significant at 24 h after treatment (C t difference consistently >3; p < 0.05) and after 10 days of treatment (C t difference >4; p < 0.01), when compared to viable cells (C t difference 1-2). Vancomycin had a stronger effect on the C t value than gentamicin, reflecting the different mechanism of action of each antibiotic. Techniques of this type may help reduce clinically false-positive PCR results caused by the detection of dead bacteria, and may be especially useful in patients who have received antibiotics, such as patients undergoing the second stage of a two-stage revision for infected arthroplasty. ß

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A Motion Maintaining Antibiotic Delivery System

Cited by 24 publications

References 39 publications

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Tibial Tubercle Osteotomy or Quadriceps Snip in Two-stage Revision for Prosthetic Knee Infection? A Randomized Prospective Study

Is There a Preferred Articulating Spacer Technique for Infected Knee Arthroplasty?: A Preliminary Study

Distinction between intact and antibiotic‐inactivated bacteria by real‐time PCR after treatment with propidium monoazide

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