Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?

Jiranek, William A.; Waligora, Andrew C.; Hess, Shane R.; Golladay, Gregory L.

doi:10.1016/j.arth.2015.03.014

Cited by 69 publications

(39 citation statements)

References 80 publications

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“…; hematogenous pathogenesis), implant stability can be compromised because of bone tissue damage [31]. Excessive removal of infected scar tissue can further compromise the stability of the hip, leading to increased dislocations [32]. Conversely, our DAIR cohort demonstrated a high rate of implant stability in aseptic cases.…”

Section: Discussionmentioning

confidence: 89%

Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection

Clauss

Hunkeler

Manzoni

et al. 2020

J. Bone Joint Infect.

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Abstract. Background: Debridement, antibiotics and implant retention (DAIR) is a valuable option for treating early and acute periprosthetic joint infection (PJI). The inflammation caused by the infection and the surgical intervention during DAIR may influence the long-term stability of the implant. In this study, we analyzed the sequelae of DAIR on implant survival in hip PJI after cure of infection.Methods: Total hip arthroplasties (THAs) from our database implanted between 1992 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome was implant failure over time. It was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening.Results: 57 THAs (56 patients) were included in the DAIR cohort and 170 THAs (168 patients) in the control cohort. The mean follow-up periods in the DAIR and control cohorts were 6.1 and 7.8 years, respectively. During follow-up, 20 (36%) patients in the DAIR cohort and 54 (32%) in the control cohort died after a mean of 4.1 and 7.2 years, respectively. Revision for any reason was performed in 9 (16%) THAs in the DAIR cohort and in 10 (6%) THAs (p=0.03) in the control cohort, and revision for aseptic loosening of any component in 5 (9%) and 8 (5%) THAs (p=0.32), respectively. Radiological analysis included 56 THAs in the DAIR cohort and 168 THAs in the control cohort. Two (4%) stems and 2 (4%) cups in the DAIR cohort and 7 (4%) and 1 (0.6%) in the control cohort, respectively, demonstrated radiological signs of failure (p=1).Conclusions: THAs exposed to DAIR were revised for any reason more frequently than were THAs in the control cohort. The difference was mainly caused by septic failures. After cure of PJI, the difference in revisions for aseptic loosening was not significant. There was no significant difference in radiographic evidence of loosening of any component between cohorts. These data suggest that cured hip PJI previously exposed to DAIR do not fail more frequently for aseptic reasons than do THAs not exposed to DAIR.

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Section: Discussionmentioning

confidence: 89%

Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection

Clauss

Hunkeler

Manzoni

et al. 2020

J. Bone Joint Infect.

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“…Dilute povidone-iodine lavage is frequently used during both primary and revision TJA cases 28,29. Because of the difficulty in isolating a single variable and the overall low incidence of PJIs, there have been no randomized controlled trials evaluating its efficacy in the treatment of PJIs.…”

Section: Results Of Dilute Povidone-iodine In Tjamentioning

confidence: 99%

“…Multiple institutions have now included the dilute povidone-iodine lavage as part of a comprehensive approach to reduce the rate of PJI following primary and revision TJA 29,31. A seven-item checklist was created aimed at reducing the incidence of PJI.…”

Section: Results Of Dilute Povidone-iodine In Tjamentioning

confidence: 99%

“…Dilute povidone-iodine lavage was one of three intraoperative measures on the checklist 32. Dilute povidone-iodine lavage has also been described in multiple studies as part a comprehensive approach to the treatment of PJIs 10,29. It has been utilized for the treatment of acute infections treated with irrigation and debridement and exchange of modular components 33.…”

Section: Results Of Dilute Povidone-iodine In Tjamentioning

confidence: 99%

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Treatment of Periprosthetic Joint Infection Using Antimicrobials: Dilute Povidone-Iodine Lavage

Ruder

Springer

2017

J. Bone Joint Infect.

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Periprosthetic joint infections (PJI) remain a challenge for the orthopaedic surgeon to treat and remain a leading cause of failure of both primary and revision total joint arthroplasty. Once a PJI develops, surgical treatment is generally indicated and includes an aggressive irrigation and debridement. One component of the irrigation and debridement involves the use of an antiseptic irrigating solution. In primary and revision TJA, dilute povidone-iodine lavage can be performed prior to wound closure. Approximately 17.5mL of 10% povidone-iodine is diluted with 500-1000cc of normal saline. The wound is then irrigated with the dilute povidone-iodine for 3 minutes. The dilute povidone-iodine is then thoroughly irrigated and washed out of the wound with normal saline prior to wound closure. The use of dilute povidone-iodine lavage prior to wound closure has been shown to reduce the risk of deep surgical site infection in multiple surgical specialties. In primary TJA, it has been demonstrated to reduce the risk of infection, without any associated adverse effects. It is also included in multiple protocols for the surgical treatment of PJI. Dilute povidone-iodine lavage provides a safe and inexpensive method to reduce the rate of PJI in TJA.

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“…[37,38] Bazı komorbid durumlar (obezite, diyabet, immünsupresyon, renal hastalıklar, sigara kullanımı, şiddetli kalp hastalığı, metastatik karsinom) enfeksiyon için predispozan olduğundan, tek aşama revizyon sonuçlarının başarısını tehlikeye atabilir. [39] Periprostetik eklem enfeksiyon tedavisinde %85'ten fazla oranda tek aşamalı değişimin kullanıldığı, ENDO Klinik merkezli bir derlemede ise; endikasyonlar arasında tecrübeli bir cerrahi ekibin gerekliliği ve cerrahinin özellikle bunun için eğitim almış cerrahlar tarafından gerçekleştirilmesi gerektiği ifade edilmiştir. Kontrendikasyonlar arasında ise, bunlarla sınırlı olmamakla birlikte; operasyon öncesi tanımlanamamış bakterinin varlığı, ikiden fazla tek aşamanın başarısız oluşu, enfeksiyonun nörovasküler demeti içermesi ve uygun antibiyotiğin olmayışı sayılmıştır.…”

Section: Ameli̇yat öNcesi̇ Planlama [9]unclassified

Periprostetik eklem enfeksiyonlarında tek aşamalı revizyon

Yıldırım¹,

İpteç²

2016

TOTBID

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Türk Ortopedi ve Travmatoloji Birliği Derneği ya da kalça eklemi oluşturmaktır. [8] Periprostetik eklem enfeksiyon tedavisinin modern biçimi ancak hasta merkezli yaklaşımla sağlanabilir. [9] Artroplastilerde enfeksiyon, ortopedik cerrahı zorlayan komplikasyonların başında gelir. Değişim artroplastisi, periprostetik enfeksiyon tedavisinde etkin bir yöntem olarak kullanılmaktadır. Kronik enfeksiyonun cerrahi yönetiminde, Kuzey Amerika ve Birleşik Krallık'ta, iki aşamalı değişim altın standart prosedür olarak uygulanmaktadır. Bu prosedür, ilk aşamada; enfekte implantın çıkarılması, radikal debridmanı, geçici antibiyotikli çimentonun ilk aşamada yerleştirilmesini içerir. Sonraki rekonstrüksiyon aşamasında; kalıcı protez ile çimentonun yerleştirilmesini, belirlenmiş bir periyod boyunca, altı hafta veya daha fazla sistemik antibiyotik tedavisini gerektirir. [10,11] Tek aşamalı değişim artroplastisi, ilk olarak 1981'de Bucholz tarafından, sonra da 1985'te Freeman tarafından tanımlanmış ve birçok Avrupa merkezinde umut verici sonuçlarla birlikte popülerlik kazanmıştır. [12-14] B ütün artroplastiler için enfeksiyon oranı ortalama %1,25 olarak bildirilmiştir. [1] Kalça ve diz artroplastisi sonrası periprostetik enfeksiyon oranı, nadir olarak, primer kalça artroplasti hastalarının %0,3-2,9'unda, primer diz artroplastilerinin ise %0,5-2'sinde meydana gelmektedir. [2-4] Yaşam beklentisinin ve yaşlı nüfusun fonksiyonel beklentilerinin artmasının sonucu olarak; Birleşik Devletler'de, 2030 yılında yıllık olarak, primer kalça ve diz artroplasti uygulamalarının sayısının, sırasıyla, %174 ve %673 artacağı tahmin edilmektedir. Bu nedenle, periprostetik eklem enfeksiyonları, gelecekte öngörülebilir bir ekonomik yük ve önemli bir komplikasyon olmaya devam edecektir. [5] Periprostetik eklem enfeksiyonları; total kalça artroplastisi revizyonu için üçüncü en sık (%14,8), total diz artroplastisi için ise en sık (%25,2) revizyon nedeni olarak karşımıza çıkmaktadır. [6,7] Revizyon prosedürünün esas hedefi, enfeksiyonu ortadan kaldırmak ve ağrısız, işlevsel ve stabil bir diz Periprostetik eklem enfeksiyonlarında tek aşamalı revizyon Single stage revision in the treatment of periprosthetic joint infections

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Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?

Cited by 69 publications

References 80 publications

Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection

Debridement, Antibiotics and Implant Retention for Hip Periprosthetic Joint Infection: Analysis of Implant Survival after Cure of Infection

Treatment of Periprosthetic Joint Infection Using Antimicrobials: Dilute Povidone-Iodine Lavage

Periprostetik eklem enfeksiyonlarında tek aşamalı revizyon

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