Low-grade periprosthetic knee infection: diagnosis and management

Vasso, Michele; Panni, Alfredo Schiavone

doi:10.1007/s10195-014-0294-y

Cited by 27 publications

(25 citation statements)

References 50 publications

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“…In implant infections lasting for more than 4 weeks, biofilm formation is complete and a PPI has developed [5]. In these cases, removal of the contaminated implant, extensive bone, and tissue debridement as well as prolonged antimicrobial treatment is recommended, demonstrating success rates for eradication between 81.0 and 94.6% [2,[5][6][7]. Our data show that sphingosine not only proved to be effective in preventing Replacing the sphingosine solution after 30 min even resulted in a complete eradication of sessile biofilm-grown S. epidermidis.…”

Section: Discussionmentioning

confidence: 99%

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Sphingosine is able to prevent and eliminate Staphylococcus epidermidis biofilm formation on different orthopedic implant materials in vitro

et al. 2019

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Periprosthetic infection (PPI) is a devastating complication in joint replacement surgery. On the background of an aging population, the number of joint replacements and associated complications is expected to increase. The capability for biofilm formation and the increasing resistance of different microbes to antibiotics have complicated the treatment of PPI, requiring the need for the development of alternative treatment options. The bactericidal effect of the naturally occurring amino alcohol sphingosine has already been reported. In our study, we demonstrate the antimicrobial efficacy of sphingosine on three different strains of biofilm producing Staphylococcus epidermidis, representing one of the most frequent microbes involved in PPI. In an in vitro analysis, sphingosine's capability for prevention and treatment of biofilm-contamination on different common orthopedic implant surfaces was tested. Coating titanium implant samples with sphingosine not only prevented implant contamination but also revealed a significant reduction of biofilm formation on the implant surfaces by 99.942%. When testing the antimicrobial efficacy of sphingosine on sessile biofilm-grown Staphylococcus epidermidis, sphingosine solution was capable to eliminate 99.999% of the bacteria on the different implant surfaces, i.e., titanium, steel, and polymethylmethacrylate. This study provides evidence on the antimicrobial efficacy of sphingosine for both planktonic and sessile biofilm-grown Staphylococcus epidermidis on contaminated orthopedic implants. Sphingosine may provide an effective and cheap treatment option for prevention and reduction of infections in joint replacement surgery. Key messages • Here we established a novel technology for prevention of implant colonization by sphingosine-coating of orthopedic implant materials. • Sphingosine-coating of orthopedic implants prevented bacterial colonization and significantly reduced biofilm formation on implant surfaces by 99.942%. • Moreover, sphingosine solution was capable to eliminate 99.999% of sessile biofilm-grown Staphylococcus epidermidis on different orthopedic implant surfaces.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, radical debridement for PPI compromises function of the affected limb. Currently, single and two stage surgical treatment strategies in PPI have been developed demonstrating success rates for eradication between 81.0 and 94.6 [7].…”

Section: Introductionmentioning

confidence: 99%

Sphingosine is able to prevent and eliminate Staphylococcus epidermidis biofilm formation on different orthopedic implant materials in vitro

et al. 2019

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“…Especially in cases of an assumed low-grade infection a remaining diagnostic uncertainty is possible [18]. In the present study we estimated serum inflammatory markers in every case, performed a diagnostic aspiration in six and a diagnostic arthroscopy in one case.…”

Section: Discussionmentioning

confidence: 93%

Diagnostic value of bone scintigraphy for aseptic loosening after total knee arthroplasty

Claaßen

Ettinger

Plaaß

et al. 2014

THC

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BACKGROUND: Despite technical improvements, aseptic loosening after total knee arthroplasty (TKA) remains a frequent complication. A one-stage revision arthroplasty is the most common therapeutic pathway. OBJECTIVE: The aim of this study was to evaluate the diagnostic value of bone scintigraphy in detecting aseptic loosening after TKA. METHODS: We retrospectively identified 46 cases of one-stage revision TKA performed between January 2011 and December 2012. In each case a bone scintigraphy was performed at least one year after the primary TKA and 3.2 ± 2.2 month prior to revision arthroplasty. Additionally, we evaluated the rate of satisfaction and pain level 16.2 ± 5.4 months after one-stage revision arthroplasty. RESULTS: Bone scintigraphy indicated aseptic loosening in 28 cases. Intraoperative aseptic loosening was verified in 34 cases. Bone scintigraphy had a sensitivity of 0.76 and a specificity of 0.83 in detecting aseptic loosening. The positive predictive value was 0.93, and the negative predictive value 0.56. At follow-up consultation, 35 patients were very satisfied or satisfied, and 31 patients had no pain or occasional pain. CONCLUSIONS: Bone scintigraphy is a helpful tool in detecting aseptic loosening after TKA. Nevertheless, the results from bone scintigraphy should be compared with clinical findings and patients' disorders. Level of evidence: IV, retrospective study

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“…The latest studies were performed by Tibrewal et al [ 22 ] and Haddad et al [ 23 ] with re-infection rates of 2% and 0%, respectively. Other smaller retrospective studies till date have shown rates of between 0%-10% [ 15 , 20 , 22 - 24 ].…”

Section: Resultsmentioning

confidence: 99%

Single Stage Knee Arthroplasty Revision Surgery: A Systematic Review of the Literature

Chew¹,

Khan²,

Agarwal³

et al. 2015

Open Orthopaedics J

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Total Knee Arthroplasty is an increasingly common procedure and revision surgery, particularly for infection, is associated with significant morbidity and healthcare costs. The current gold standard is a two stage revision procedure but single stage revision is increasingly being used in some departments to improve patient outcomes. We conducted a systematic review of the literature to determine the up-to-date evidence underlying the use of a single stage knee approach in revision surgery. A total of 12 studies were included in this review amounting to 433 revision surgeries. This is the largest review of single stage knee revision surgery. The procedures described were heterogenous and included the ‘two-in-one’ technique as well as other single stage revision procedures. There were also differences in implants and antibiotic regimens. The mean re-infection rates described in 10 studies was 9.4% (range 0-19.2%) after a mean follow-up of 40.3 months (range 7-180 months). The re-infection rates in the studies published over the last 30 years are falling, and this is not accounted for by any significant change in duration of follow-up during this period. The outcome scores varied, but patients generally showed an improvement. The Knee Society Score and the Oxford Knee Score were the most commonly used in five and three studies respectively. We conclude that the current evidence for single stage revision is variable and there is a lack of good quality evidence to address whether single stage revisions is thorough enough to eradicate deep infection and is able to restore adequate function. There is a need for larger prospective studies with standardised procedures and protocol, and with adequate follow-up. Till then, patients considered for a single stage approach should be thoroughly assessed and the surgery should be performed by a senior surgeon with experience in single stage knee revisions.

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Low-grade periprosthetic knee infection: diagnosis and management

Cited by 27 publications

References 50 publications

Sphingosine is able to prevent and eliminate Staphylococcus epidermidis biofilm formation on different orthopedic implant materials in vitro

Sphingosine is able to prevent and eliminate Staphylococcus epidermidis biofilm formation on different orthopedic implant materials in vitro

Diagnostic value of bone scintigraphy for aseptic loosening after total knee arthroplasty

Single Stage Knee Arthroplasty Revision Surgery: A Systematic Review of the Literature

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