Hip and Knee Section, Diagnosis, Reimplantation: Proceedings of International Consensus on Orthopedic Infections

Aalirezaie, Arash; Bauer, Thomas W.; Fayaz, H. C.; Griffin, William L.; Higuera, Carlos A.; Krenn, Veit; Krenn, V.; Molano, Miguel; Moojen, Dirk-Jan; Restrepo, Camilo; Shahi, Alisina; Shubnyakov, I. I.; Sporer, Scott M.; Tanavalee, Aree; Telöken, Marco Aurélio; Moreno, Job Diego Velázquez

doi:10.1016/j.arth.2018.09.021

Cited by 59 publications

(69 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In cases of particulate deposits, the particle algorithm had been used 28 which allows a descriptive particle identification of endogenous and exogenous particulate materials and is the basis for particle diagnosis in peri-implant tissue. Both published scoring and typing systems are well accepted scoring systems in diagnostic histopathology 25,29,30 .…”

Section: Methodsmentioning

confidence: 99%

Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Ohlmeier

Krenn

Thiesen

et al. 2019

Sci Rep

View full text Add to dashboard Cite

Heterotopic Ossification (HO) is a potential long-term complication in orthopaedic surgery. It is commonly classified according to the Brooker classification, which is based on radiological findings. To our knowledge the correlation of histological features to the Brooker grade is unknown as is the association between HO and the indication for revision. The aim of this paper is to analyze the ossification grade of HO tissue in patients undergoing revision hip and knee arthroplasty and to propose a histologically based classification system for HO. We also assess the relationship between the grade of HO and the indication for revision (septic and aseptic revision). From January to May 2019 we collected 50 human HO samples from hip and knee revision arthroplasty cases. These tissue samples were doubleblinded and sent for histopathological diagnostic. Based on these results, we developed a classification system for the progression of HO. The grade of ossification was based on three characteristics: Grade of heterotopic ossification (Grade 1-3), presence of necrosis (N0 or N1) and the presence of osteomyelitis (HOES-Score Type 1 to 5). Demographic data as well as surgical details and indication for surgery was prospectively collected from clinical records. Fifty tissue samples were harvested from 44 hips and 6 knee joints. Of these 33 exhibited Grade I ossifications (66%), followed by 11 Grade II (22%) and one Grade III (2%). Necrosis was noted in two tissue samples (4%) and 2 more had osteomyelitis findings according to HOES-Score. Six samples (12%) with radiologically suggestive of HO turned out to be wear-induced synovitis, SLIM Type 1. Of these cases 16 were septic (32%) and 34 aseptic (68%) revisions. Most of the HO tissue samples were classified as a low-grade. High-grade ossification-Score is rare. Higher grades of ossification seem to be associated with septic revision cases. Wear-induced synovitis potentially influences HO development. A histological scoring system for ossification grading can be derived from the data presented in this study. Heterotopic Ossification (HO) or Myositis ossificans (MO) is a recognized complication of total hip and total knee arthroplasty surgery. It is more commonly noted in revision arthroplasty cases and its etiology is poorly understood and thought to be multifactorial 1-3 (Fig. 1). The incidence of HO has been reported to be as high as 26-41% 4-6 and can lead to painful restriction of joint motion 7,8. Effective therapy strategies have been found with the use of nonsteroidal antiinflammatory drugs (NSAID) and focused radiotherapy 9-11. It has been proposed that mesenchymal progenitor cells are responsible for the development of HO 2,12. These progenitor cells transform into osteoblasts under the influence of morphogenes 2. The concentrations of morphogene can be elevated in muscle and soft tissue after any kind of trauma, so that an enchondromal ossification leads to formation and maturation of lamellar bone 2. This is the proposed mechanism by which HO occurs following maj...

show abstract

Section: Methodsmentioning

confidence: 99%

Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Ohlmeier

Krenn

Thiesen

et al. 2019

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Vancomycin, daptomycin or linezolid are suitable options for this application [6][7][8]. Bacterial identification tools allow a faster diagnosis, but no recommendation provides guidelines on the duration of this EAT and the right time to re-evaluate it [2,3,9]. The probabilistic antibiotics often used are not harmless, and severe adverse effects can occur, such as nephrotoxicity when the vancomycin being used is associated with piperacillin/tazobactam [10,11].…”

Section: Introductionmentioning

confidence: 99%

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Deroche

Bémer

Valentin

et al. 2019

JCM

View full text Add to dashboard Cite

Currently, no guideline provides recommendations on the duration of empirical antimicrobial treatment (EAT) in prosthetic joint infection (PJI). The aim of our study was to describe the time to growth of bacteria involved in PJI, rendering possible decreased duration of EAT. Based on a French multicentre prospective cohort study, culture data from patients with confirmed hip or knee PJI were analysed. For each patient, five samples were processed. Time to positivity was defined as the first positive medium in at least one sample for virulent pathogens and as the first positive medium in at least two samples for commensals. Definitive diagnosis of polymicrobial infections was considered the day the last bacteria were identified. Among the 183 PJIs, including 28 polymicrobial infections, microbiological diagnosis was carried out between Day 1 (D1) and D5 for 96.7% of cases. There was no difference in the average time to positivity between acute and chronic PJI (p = 0.8871). Microbiological diagnosis was given earlier for monomicrobial than for polymicrobial infections (p = 0.0034). When an optimized culture of peroperative samples was carried out, almost all cases of PJI were diagnosed within five days, including polymicrobial infections. EAT can be re-evaluated at D5 according to microbiological documentation.

show abstract

“…No gold standard in the management of fPJI has been established. This includes the surgical procedure and the antimicrobial therapy or the duration of treatment, as noticed at the last International Consensus Meeting on Prosthetic Joint Infection [14].…”

Section: Discussionmentioning

confidence: 99%

Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection

et al. 2020

View full text Add to dashboard Cite

A 58-year-old female treated at an outside facility with knee arthrodesis due to persistent periprosthetic joint infection fulfilled all prerequisites for a conversion back to arthroplasty, as part of a 2-stage revision. Owing to the detection of Candida parapsilosis , the treatment concept was converted to a three-stage procedure. A scheduled spacer exchange with additional amphotericin B–loaded polymethylmethacrylate was conducted as an intermediate revision before reimplantation. Conversion in the setting of fungal periprosthetic joint infection presents a challenge, and successful treatment hinges on the use of proper antifungal and antimicrobial protocols, advanced surgical techniques, and a multidisciplinary team approach. At the 3-year follow-up, successful infection eradication as measured by the Delphi-based consensus definition was achieved with a range of motion of 0°-100°.

show abstract

Hip and Knee Section, Diagnosis, Reimplantation: Proceedings of International Consensus on Orthopedic Infections

Cited by 59 publications

References 103 publications

Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

Heterotopic Ossification in Orthopaedic and Trauma surgery: A Histopathological Ossification Score

The Right Time to Safely Re-Evaluate Empirical Antimicrobial Treatment of Hip or Knee Prosthetic Joint Infections

Conversion From Knee Arthrodesis Back to Arthroplasty: A Particular Challenge in Combination With Fungal Periprosthetic Joint Infection

Contact Info

Product

Resources

About