Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Chang, Moon Jong; Ro, Du Hyun; Kim, Tae Woo; Lee, Yong Seuk; Han, Hyuck; Chang, Chong Bum; Kang, Soon Beom; Lee, Myung Chul

doi:10.1186/s43019-022-00165-z

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…over a total follow-up-period of 2 years (46.0% success in ALI vs. 76.0% in EI) [ 27 ]. Both Chang et al and Vilchez et al have also found that treatment success was higher in postsurgical (acute) PJI compared to hematogenous PJI [ 28 , 29 ]. Similarly, other studies have reported high relapse rates in patients with ALI, ranging from 21.0% up to 55.0% [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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Periprosthetic joint infections (PJI) are serious complications after arthroplasty, associated with high morbidity, mortality, and complex treatment processes. The outcomes of different PJI entities are largely unknown. The aim of this study was to access the early outcomes of different PJI entities. A retrospective, single-center study was conducted. The characteristics and outcomes of patients with PJI treated between 2018 and 2019 were evaluated 12 months after the completion of treatment. Primary endpoints were mortality, relapse free survival (RFS) and postoperative complications (kidney failure, sepsis, admission to ICU). A total of 115 cases were included [19.1% early (EI), 33.0% acute late (ALI), and 47.8% chronic infections (CI)]. Patients with ALI were older (p = 0.023), had higher ASA scores (p = 0.031), preoperative CRP concentrations (p = 0.011), incidence of kidney failure (p = 0.002) and sepsis (p = 0.026). They also tended towards higher in-house mortality (ALI 21.1%, 13.6% EI, 5.5% CI) and admission to ICU (ALI 50.0%, 22.7% EI, 30.9% CI). At 12 months, 15.4% of patients with EI had a relapse, compared to 38.1% in ALI and 36.4% in CI. There are differences in patient characteristics and early outcomes between PJI entities. Patients with EI have better early clinical outcomes. Patients with ALI require special attention during follow-up because they have higher occurrences of relapses and postoperative complications than patients with EI and CI.

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Section: Discussionmentioning

confidence: 99%

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Youssef,

Roschke,

Dietze

et al. 2024

Antibiotics

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“…Another limitation was the length of the follow-up, which was done for a minimum of six months and turned out to be a variable with statistically significant differences between the DACRI and DAPRI groups. Debridement usually fails for recurrences [ 35 ], and even if the authors considered six months of follow-up sufficient to detect the onset of an acute infection recurrence, it may not be enough time to exclude low-grade infection recurrences.…”

Section: Resultsmentioning

confidence: 99%

Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study

De Meo,

Martini,

Pennarola

et al. 2023

Gels

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Periprosthetic joint infections (PJI) are among the most difficult complications to treat in orthopaedic surgery. Debridement, antibiotics, and implant retention (DAIR) represent an efficient strategy for acute PJI, especially when resorbable local antibiotic carriers and coatings are used. The aim of this pilot study was to evaluate the difference between using antibiotic-loaded hydrogel (ALH) and calcium sulphate (CS) beads in the DAIR procedure. We analysed 16 patients who had been treated since 2018 for acute PJI, namely eight patients with knee PJI (50%), seven with hip PJI (43.7%), and one with shoulder PJI (6.2%). Nine patients were treated with the Debridement, Antibiotic Coating and Retention of the Implant (DACRI) method, while seven were treated with the Debridement, Antibiotic Pearls, Retention of the Implant (DAPRI) method. We found no significant differences between the two groups in terms of age, sex, the American Society of Anesthesiologists risk score, Charlson Comorbidity Index, localisation, days from onset to diagnosis and pathogenesis. Furthermore, no differences were found between the DACRI and DAPRI groups in terms of infection control (15 patients, 93.75% with p = 0.36) and last C-Reactive Protein values (p = 0.26), with a mean follow-up of 26.1 ± 7.7 months. Treatment for one patient affected by knee Candida albicans PJI in the DACRI group was not successful. In conclusion, DAPRI and DACRI appear to be safe and effective treatments for PJIs. This evidence will encourage the development of new clinical research into local carriers and coatings for use in acute implant-associated infections.

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“…However, the purpose of this study was to detect loosening using only images. Seventh, most of the patients included in the study were women, as the majority of patients undergoing TKA in Asia are women [ 58 , 59 , 60 , 61 ]. Gender differences may affect the performance of the model, and further studies that include additional male patients are needed.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

et al. 2023

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(1) Background: The purpose of this study was to investigate whether the loosening of total knee arthroplasty (TKA) implants could be detected accurately on plain radiographs using a deep convolution neural network (CNN). (2) Methods: We analyzed data for 100 patients who underwent revision TKA due to prosthetic loosening at a single institution from 2012 to 2020. We extracted 100 patients who underwent primary TKA without loosening through a propensity score, matching for age, gender, body mass index, operation side, and American Society of Anesthesiologists class. Transfer learning was used to prepare a detection model using a pre-trained Visual Geometry Group (VGG) 19. For transfer learning, two methods were used. First, the fully connected layer was removed, and a new fully connected layer was added to construct a new model. The convolutional layer was frozen without training, and only the fully connected layer was trained (transfer learning model 1). Second, a new model was constructed by adding a fully connected layer and varying the range of freezing for the convolutional layer (transfer learning model 2). (3) Results: The transfer learning model 1 gradually increased in accuracy and ultimately reached 87.5%. After processing through the confusion matrix, the sensitivity was 90% and the specificity was 100%. Transfer learning model 2, which was trained on the convolutional layer, gradually increased in accuracy and ultimately reached 97.5%, which represented a better improvement than for model 1. Processing through the confusion matrix affirmed that the sensitivity was 100% and the specificity was 97.5%. (4) Conclusions: The CNN algorithm, through transfer learning, shows high accuracy for detecting the loosening of TKA implants on plain radiographs.

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Worse outcome of debridement, antibiotics, and implant retention in acute hematogenous infections than in postsurgical infections after total knee arthroplasty: a multicenter study

Cited by 5 publications

References 25 publications

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Early-Outcome Differences between Acute and Chronic Periprosthetic Joint Infections—A Retrospective Single-Center Study

Hydrogel Coating versus Calcium Sulphate Beads as a Local Antibiotic Carrier for Debridement Procedures in Acute Periprosthetic Joint Infection: A Preliminary Study

Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs

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