General Assembly, Prevention, Host Related General: Proceedings of International Consensus on Orthopedic Infections

Zainul‐Abidin, Suraya; Amanatullah, Derek F.; Anderson, Mike B.; Austin, Matthew S.; Barretto, João Maurício; Battenberg, Andrew K.; Bedard, Nicholas A.; Bell, Kevin; Blevins, Kier; Callaghan, John J.; Li, Cao; Certain, Laura; Chang, Yuhan; Chen, Jui-Ping; Cizmic, Zlatan; Coward, Jonathan; DeMik, David E.; Diaz-Borjon, Efrain; Enayatollahi, Mohammad Ali; Feng, James E.; Fernando, Navin; Gililland, Jeremy M.; Goodman, Stuart B.; Goodman, Susan M.; Greenky, Max; Hwang, Katherine; Iorio, Richard; Karas, Vasili; Khan, Riaz J.K.; Kheir, Matthew; Klement, Mitchell R.; Kunutsor, Setor K; Limas, Ruben; Maldonado, Ruben Alejandro Morales; Manrique, Jorge; Matar, Wadih Y.; Mokete, Lipalo; Nung, Ngai; Pelt, Christopher E.; Pietrzak, J; Premkumar, Ajay; Rondon, Alexander J.; Sánchez, Marisa; Santana, Camila Novaes de; Sheth, Neil P.; Singh, Jasvinder; Springer, Bryan D.; Tay, Kae Sian; Varin, Daniel; Wellman, Samuel S.; Wu, Lidong; Xu, Chi; Yates, Adolph J.

doi:10.1016/j.arth.2018.09.050

Cited by 22 publications

(22 citation statements)

References 337 publications

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“…Similarly, a retrospective review of approximately 28 000 patients aimed to evaluate pre-operative risks for PJI after THA concluded that HIV-infection was amongst the most influential risk factors and should be considered when counselling patients for surgery [17]. The 2018 International Consensus on Orthopaedic Infections determined that although HIV is an independent risk for PJI, this significance is negated once HAART is initiated and viral suppression is achieved [18].…”

Section: Introductionmentioning

confidence: 99%

The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

Maharaj

Pietrzak

Sikhauli

et al. 2020

SICOT-J

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Aim: The aim was to assess the seroprevalence of Human Immunodeficiency Virus (HIV) in non-haemophilic patients undergoing primary Total Joint Arthroplasty (TJA) at an academic hospital in South Africa. Methods: A retrospective review of all Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) patients from January 2017 to December 2018 was conducted. All patients awaiting TJA were offered HIV screening and their demographic data were recorded. Consenting patients were tested or the refusal of testing was documented. The CD4+ T-cell count (CD4+) and viral load (VL) was measured for all HIV-positive patients and newly diagnosed patients were initiated on Highly Active Antiretroviral Treatment (HAART). Results: We included 1007 patients in the study. The TJA population HIV seroprevalence was 10.7% (n = 108). The seroprevalence for THA was 14.9% (n = 78) and that for TKA was 6.2% (n = 30). There were 93 patients (9.2%) who refused screening. There were 12 (15.4%) and 3 patients (10%) that were newly diagnosed in the THA and TKA seropositive populations, respectively. The average CD4+ for THA and TKA was 569 cells/mm3 (105–1320) and 691 cells/mm3 (98–1406), respectively. The VL was undetectable in 75.9% (n = 82) of HIV-positive patients. Overall 12 HIV-positive patients (11.12%) had CD4+ <200 cells/mm3, 8 of these patients (66%) were newly diagnosed. The average age of the seropositive population was 58 ± 6.5 years and 66 ± 8.5 years for THA and TKA, respectively (p = 0.03). Femoral head osteonecrosis was the underlying pathology for 65.38% (n = 51) of seropositive patients for THA. Conclusion: The seroprevalence of HIV in patients undergoing THA in our South African institution is greater than the seroprevalence in the general population. The seroprevalence of HIV in THA is significantly greater than that in TKA. This may reflect the association between HIV, HAART and hip joint degeneration. Our findings draw attention to the significant burden HIV has on TJA.

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Section: Introductionmentioning

confidence: 99%

The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

Maharaj

Pietrzak

Sikhauli

et al. 2020

SICOT-J

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“…21 Furthermore, the 2018 International Consensus on Orthopaedic Infections determined that HIV is an independent risk for PJI. 23 This emphasises the importance of ASB in HIV-positive patients that may determine a further predisposing risk factor for PJI. Screening for ASB may allow healthcare providers to identify patients at increased risk for PJIs to guide management of evolving perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

et al. 2021

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BACKGROUND: Periprosthetic joint infections (PJIs) are a leading cause of revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA), worldwide. Asymptomatic bacteriuria (ASB) is an independent risk factor for PJIs; however, a paucity of data relevant to developing countries exists. The aim of this study was to describe the prevalence of preoperative ASB and the subsequent incidence of PJIs in patients undergoing total joint arthroplasty (TJA) in South Africa. METHODS: We retrospectively reviewed primary THA and TKA patients. All patients were screened for ASB preoperatively. Patients with positive urinalysis for ASB were identified and treated prior to surgery (treated-ASB). The primary outcome was ASB prevalence and the incidence of PJIs and other perioperative complications. Secondary outcomes included risk factors for ASB and subsequent PJIs in treated-ASB patients, respectively, compared to those with no evidence of ASB (non-ASB). Lastly, we aimed to compare the infective microorganisms cultured from preoperative urinalysis and perioperative sampling of PJIs. RESULTS: We included 179 patients (67 THA; 80% female) with mean follow-up of 2.45 years. ASB prevalence was 22% (n = 39). Patients older than 70 years were 3.5 times more likely to have ASB compared to younger patients (p = 0.005). The prevalence of ASB was 22% (n = 10) for human immunodeficiency virus (HIV) positive and 22% (n = 29) for HIV-negative patients (p = 0.084). PJI incidence was 8% (n = 3) in the treated-ASB and 1% (n = 1) in non-ASB. Treated-ASB patients had an 11.6-fold increased likelihood of PJIs than non-ASB patients (p = 0.046). pJi microorganisms cultured did not correlate to isolates from urine cultures. CONCLUSION: The prevalence of ASB in a TJA population in South Africa is 22% which is higher than reported findings worldwide. Although the value of preoperative antibiotic therapy for ASB remains controversial, there is a role for routine urinalysis preoperatively to identify patients predisposed to PJI. This is of specific significance in the management of HIV-positive patients and in developing countries to guide healthcare providers in resource-constrained environments. Level of evidence: Level 2. Keywords: total hip arthroplasty, total knee arthroplasty, asymptomatic bacteriuria, periprosthetic joint infection, developing country

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“…These are patients who have recently undergone at least two surgeries, prosthesis implantation surgery and DAIR, before developing chronic PJI. This implies that they are patients who cannot be optimized preoperatively, as opposed to patients with chronic infection occurring months or years after the first surgery [ 28 ]. In addition, patients with a previous DAIR failure had recently received various antibiotic treatments, many of the broad-spectrum types, for the treatment of acute PJI.…”

Section: Discussionmentioning

confidence: 99%

Experiences during Switching from Two-Stage to One-Stage Revision Arthroplasty for Chronic Total Knee Arthroplasty Infection

et al. 2021

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The objective of this study was to evaluate our preliminary results after changing our surgical strategy from 2-stage revision arthroplasty to 1-stage revision arthroplasty for patients with chronic knee periprosthetic joint infection. We conducted a prospective study of knee arthroplasty patients that had been diagnosed with chronic infection and treated using a 1-stage revision regardless of the traditional criteria applied for indication thereof. We evaluated two main variables: infection control and economic costs. The definitive diagnosis of infection of the revision was determined by using the criteria proposed by the Musculoskeletal Infection Society. The costs were calculated as average costs in USD, as described by Srivastava (2019), for 1-stage or 2-stage revisions. Eighteen patients were included in the study, and infection was controlled in 17 patients. The total economic savings for our hospital from these 18 patients amounted to USD 291,152. This clinical success has led to major changes in how our hospital approaches the treatment of chronically infected knee replacements, in addition to substantial economic advantages for the hospital.

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General Assembly, Prevention, Host Related General: Proceedings of International Consensus on Orthopedic Infections

Cited by 22 publications

References 337 publications

The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

The seroprevalence of HIV in patients undergoing lower limb Total Joint Arthroplasty (TJA) in South Africa

Preoperative asymptomatic bacteriuria in patients undergoing total joint arthroplasty in South Africa

Experiences during Switching from Two-Stage to One-Stage Revision Arthroplasty for Chronic Total Knee Arthroplasty Infection

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