Diagnosing Infection in Patients Undergoing Conversion of Prior Internal Fixation to Total Hip Arthroplasty

Gittings, Daniel J.; Courtney, P. Maxwell; Ashley, Blair; Hesketh, Patrick; Donegan, Derek J.; Sheth, Neil P.

doi:10.1016/j.arth.2016.06.047

Cited by 22 publications

(30 citation statements)

References 25 publications

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“…Most studies on serum markers in FRI have focused on subgroups of FRI, such as infected non-union or patients undergoing conversion surgery. One study reported on the value of CRP and ESR in diagnosing infection in patients undergoing conversion from internal fixation of a femoral neck fracture to total hip arthroplasty 45 . The authors reported a higher diagnostic accuracy than the current study, with an AUROC of 0.89 for both markers.…”

Section: Discussionmentioning

confidence: 99%

Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

Bosch

Kieboom

Plate

et al. 2018

J. Bone Joint Infect.

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Introduction: Diagnosing Fracture-Related Infections (FRI) based on clinical symptoms alone can be challenging and additional diagnostic tools such as serum inflammatory markers are often utilized. The aims of this study were 1) to determine the individual diagnostic performance of three commonly used serum inflammatory markers: C-Reactive Protein (CRP), Leukocyte Count (LC) and Erythrocyte Sedimentation Rate (ESR), and 2) to determine the diagnostic performance of a combination of these markers, and the additional value of including clinical parameters predictive of FRI.Methods: This cohort study included patients who presented with a suspected FRI at two participating level I academic trauma centers between February 1st 2009 and December 31st 2017. The parameters CRP, LC and ESR, determined at diagnostic work-up of the suspected FRI, were retrieved from hospital records. The gold standard for diagnosing or ruling out FRI was defined as: positive microbiology results of surgically obtained tissue samples, or absence of FRI at a clinical follow-up of at least six months. The diagnostic accuracy of the individual serum inflammatory markers was assessed. Analyses were done with both dichotomized values using hospital thresholds as well as with continuous values. Multivariable logistic regression analyses were performed to obtain the discriminative performance (Area Under the Receiver Operating Characteristic, AUROC) of (1) the combined inflammatory markers, and (2) the added value of these markers to clinical parameters.Results: A total of 168 patients met the inclusion criteria and were included for analysis. CRP had a 38% sensitivity, 34% specificity, 42% positive predictive value (PPV) and 78% negative predictive value (NPV). For LC this was 39%, 74%, 46% and 67% and for ESR 62%, 64%, 45% and 76% respectively. The diagnostic accuracy was 52%, 61% and 80% respectively. The AUROC was 0.64 for CRP, 0.60 for LC and 0.58 for ESR. The AUROC of the combined inflammatory markers was 0.63. Serum inflammatory markers combined with clinical parameters resulted in AUROC of 0.66 as opposed to 0.62 for clinical parameters alone.Conclusion: The added value of CRP, LC and ESR for diagnosing FRI is limited. Clinicians should be cautious when interpreting the results of these tests in patients with suspected FRI.

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Section: Discussionmentioning

confidence: 99%

Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

Bosch

Kieboom

Plate

et al. 2018

J. Bone Joint Infect.

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“…Postoperative infection is one of the worst outcomes of surgery, [41][42][43]. Factors that influence the occurrence of infection after total hip replacement are the presence of a large amount of foreign material, hematoma formation making its removal more difficult, due to insufficient mobility of the joint.…”

Section: Factors Influencing Hip Prosthetic Integrity and Lifementioning

confidence: 99%

The current approach to research and design of the artificial hip prosthesis: a review

Čolić¹,

Sedmak²

2016

Rheumatol Orthop Med

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One of the most successful techniques in restoration of degenerated joint functions is total hip replacement. This surgical approach includes removal of diseased cartilage and bone parts, and replacement by the corresponding joint prostheses. By using metal alloys, high quality plastic and polymer materials, orthopedic surgeons can reconstruct hip fractures, or replace a painful, dysfunctional joint with highly functional, long-lasting prostheses, enabling hundreds of thousands of people to live a more fulfilling and active life. However, most of these implants only last for 10-15 years, and one of the most common problems for both patients and doctors is implant failure. Observed in long-term, implant loosening is the main cause of failure. Occasionally, dislocation or bending of implants may occur. Fatigue fracture and wear were identified as the main problems related to loosening of implants, stress shielding, and final implant failure. There are several factors which contribute to implant integrity, including material and design, implant positioning, cementing technique and patient characteristics. To improve integrity and life of hip implant by using finite element analysis, two major factor should be considered, design and biomaterial. By using this method there are various parameters that should be define, including complex geometry of the bone and an implant, biomaterial properties, and specifics boundary conditions, i.e. contact between the hip prosthesis and the bone depending on fixation method. In orthopedic biomechanics finite element method was first used for the purpose of determining the stresses in human bones. Since then, this method has been more and more frequently applied in determining of stress state in bones and prostheses, as well as fracture fixation devices, including hip implants. This paper presents a review study of factors influencing design process and structural integrity of the hip implant.

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“…Patients with elevated inflammatory markers or clinical suspicion of infection should prompt further evaluation with preoperative diagnostic hip aspiration including white blood cell count, differential and culture prior to conversion THA. 7 In patients without suspicion of infection, conversion THA is typically performed in a standard single-stage procedure without a thorough preoperative work-up. To date, there are no guidelines or consensus on the diagnostic criteria and treatment algorithm of patients undergoing conversion THA.…”

Section: Introductionmentioning

confidence: 99%

“…Besides that, a paucity of literature exists for diagnosing infection in the setting of a conversion THA. Recent studies focused on serological screening and intraoperative tissue sampling, 7 , 11 but at this time no study was investigating on the utility of implant sonication for diagnostic workup of patients undergoing THA after prior internal fixation of the hip.…”

Section: Introductionmentioning

confidence: 99%

Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

et al. 2021

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Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

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Diagnosing Infection in Patients Undergoing Conversion of Prior Internal Fixation to Total Hip Arthroplasty

Cited by 22 publications

References 25 publications

Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

Limited Predictive Value of Serum Inflammatory Markers for Diagnosing Fracture-Related Infections: results of a large retrospective multicenter cohort study

The current approach to research and design of the artificial hip prosthesis: a review

Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

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