Mid-term follow-up results after implementing a new strategy for the diagnosis and management of periprosthetic joint infections

Abstract

Background Periprosthetic joint infections (PJIs) represent one of the most serious complications associated with joint replacement surgeries, a complication also of modern orthopedic surgery despite the efforts that occurred in this field. Frequently PJIs lead to prolonged morbidity, increased costs and mortality. Methods We are conducting a single-center observational cohort ongoing study in the Academic Emergency Hospital Sibiu, Romania, study in which sonication of the retrieved and as a rapid method of bacteria detection, molecular identification of bacteria by 16S rRNA beacon-based fluorescent in situ hybridization (bbFISH) are used. Results A total of 61 patients were enrolled in this study. The diagnosis of aseptic loosening was established in 30 cases (49.1%) and the diagnosis of periprosthetic joint infection was established at 31 patients (50.8%). The mean follow-up period in the subgroup of patients diagnosed with periprosthetic joint infections was 36.06 ± 12.59 months (range: 1–54). The 25-months Kaplan-Meier survival rate as the end point, as a consequence of the period of enrollment and a different follow-up period for each type of surgical procedure, was 75% after debridement and implant retention, 91.7% after one-stage exchange, 92.3% after two-stage exchange, and 100% after three-stage exchange. There were no significant differences in survival percentage. Conclusions Our study has good results similar to previously published data. We cannot recommend one strategy of managing prosthetic joint infections over the other. Definitely, there is a need for prospective randomized controlled trials.

Positivity Trends of Bacterial Cultures from Cases of Acute and Chronic Periprosthetic Joint Infections

“…The diagnosis and management of PJIs require adapted protocols for the treatment of biofilm-related infections and new and rapid diagnostic methods to be able to improve the eradication rate. However, there is no 100% certainty that the infection was eradicated [16].…”

Interactions and Trends of Interleukins, PAI-1, CRP, and TNF-α in Inflammatory Responses during the Perioperative Period of Joint Arthroplasty: Implications for Pain Management—A Narrative Review

“…However, some studies have shown that surgery can also induce immunosuppression. For example, phagocytic activity in specific cells (PMN, monocytes, and macrophages) is reduced during the postoperative period, which makes patients more susceptible to infection [172][173][174][175][176][177][178][179][180][181][182][183][184].…”

Interval between two-stage exchanges: what is optimal and how do you know?

“…Some authors have recommended against antibiotic discontinuation for many years now [ 53 ] and perform the second stage under antibiotic therapy that is maintained for a total of at least 12 weeks, regardless of the duration of the time interval with the spacer. This approach has consistently shown good outcomes [ 54 , 55 ]. Ascione et al [ 56 ] directly compared both strategies in a total of 196 patients with PJI treated with a two-stage protocol.…”

“…Unless the wound was slow to heal or there was extensive bone destruction, Haddad et al [ 58 ] reported no increase in reinfection rates by reducing the interval to 3 weeks. Several other papers have also demonstrated that it is possible to achieve good results with short intervals of 2–4 weeks provided that there are favorable bone and soft tissue conditions and in the absence of drug resistant microorganisms [ 53 – 55 , 59 ]. Furthermore, a number of studies have even shown an increased re-infection risk associated with prolonged time interval between stages [ 60 – 64 ].…”