Infection after total hip arthroplasty. Past, present, and future.

Background Successful treatment of an infected joint arthroplasty depends on correctly identifying the responsible pathogens. The value of a preoperative biopsy remains controversial. Questions/purposes We (1) compared the sensitivity and specificity of both tests separately and in combination, and (2) asked whether the combination of tissue biopsy and aspiration would improve our diagnostic yield in the evaluation of periprosthetic joint infections. Patients and Methods We prospectively followed 120 patients with suspected infection of a total joint arthroplasty: 64 with THAs and 56 with TKAs. All patients had aspiration with culture and biopsy. Results The sensitivity was 83% for aspiration, 79% for biopsy, and 90% for the combination of both techniques. The specificity was 100% for aspiration and biopsy and the combination. The overall accuracy was 84%, 81%, and 90%, respectively.

Section: Discussionmentioning

confidence: 99%

Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?

Meermans

Haddad

2010

“…Infection after hip and knee arthroplasty has been associated with diabetes mellitus and chronic disease [4]. The successful management of a patient with an infected shoulder arthroplasty is a challenging problem.…”

Section: Discussionmentioning

confidence: 99%

Infection Associated With Hematoma Formation After Shoulder Arthroplasty

Cheung

Sperling

Cofield

2008

128

Hematoma formation requiring operative treatment after shoulder arthroplasty may be associated with higher patient morbidity. We therefore determined whether there was an association of hematoma formation requiring operative treatment with deep infection after shoulder arthroplasty. Between 1978 and 2006, we performed 4147 shoulder arthroplasties in 3643 patients. Of these, 12 shoulders (0.3%) underwent reoperation for hematoma formation. The mean time interval from arthroplasty to surgery for the hematoma was 7 days (range, 0.5-31 days). Among nine cases in which cultures were taken, six had positive cultures; the organisms included Propionibacterium acnes in three, Staphylococcus epidermidis in one, Streptococcus species in one, and Staphylococcus epidermidis with Peptostreptococcus in one. The minimum followup was 12 months (mean, 68 months; range, 12 to 294 months

“…First, the zirconium and metal particles detected could have originated from the original, infected prostheses, especially because Keen et al [29] reported detection of zirconium particles in the synovial membrane after many years of endoprosthesis implantation. Although this cannot be totally excluded, we assumed most of the abraded material we detected came from the spacers because part of the treatment of a periprosthetic infection usually involves radical débridement and synovectomy before the spacer is implanted [11,14,15,19,24,33,35]. Analyses of synovial controls obtained at the time of prosthesis removal could have addressed this question but we had no such controls.…”

Section: Discussionmentioning

confidence: 99%

“…Periprosthetic infections occur in less than 1% of patients but nevertheless are a serious complication of hip and knee arthroplasties [12,15,26,36,37]. When infections occur within 4 weeks of implantation, the implant can be left in place with a high probability of implant survival of between 80% and 100%, whereas late infections generally require prosthesis revision to control the infection [7,22,44,45].…”

Section: Introductionmentioning

confidence: 99%

“…Survival rates between 90% and 100% are reported for infected hip arthroplasties [11,14,15,33], and between 91% and 96% for infected knee arthroplasties [18,24,35]. The function of the spacer is to release the antibiotic into the infected bed of the prosthesis, minimize soft tissue contractures, and maintain reasonable functionality until a prosthesis can be reimplanted [4].…”

Section: Introductionmentioning

confidence: 99%

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Articulating Spacers Used in Two-stage Revision of Infected Hip and Knee Prostheses Abrade with Time

Fink

Rechtenbach

Büchner

et al. 2011

Background Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis. Questions/purposes We asked whether particulate material abraded from spacers could be detected in the synovial membrane 6 weeks after implantation when the spacers were removed for the second stage of the revision. Patients and Methods Sixteen hip spacers (cemented prosthesis stem articulating with a cement cup) and four knee spacers (customized mobile cement spacers) were explanted 6 weeks after implantation and the synovial membranes were removed at the same time. The membranes were examined by xray fluorescence spectroscopy, xray diffraction for the presence of abraded particles originating from the spacer material, and analyzed in a semiquantitative manner by inductively coupled plasma mass spectrometry. Histologic analyses also were performed.