Prevention of infection in primary THA and TKA

Dobson, Philip F.; Reed, M

doi:10.1302/2058-5241.5.200004

Cited by 45 publications

(28 citation statements)

References 112 publications

(26 reference statements)

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“…These complications are more likely associated with the surgeon’s experience and expertise in performing the operation, as well as the difficulty of the specific procedure itself. Furthermore, the surgeon’s skills are likewise correlated with the time required for performing the surgery—the longer the duration, the higher the risk for SSI [ 19 , 20 , 21 ]. Nevertheless, by systematically analyzing possible reasons for adverse outcomes, case by case, technical aspects can be discussed during an M&M conference in an intercollegial way.…”

Section: Discussionmentioning

confidence: 99%

The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

Lustenberger

Meier

Verboket

et al. 2020

JCM

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Background: Surgical complications are associated with a significant burden to patients and hospitals and are increasingly discussed in recent literature. This cohort study reviewed surgery-related complications in a Level I trauma center. The effect of a complication avoidance care bundle on the rate of surgical complications was analyzed. Methods: All complications (surgical and nonsurgical) that occur in our trauma department are prospectively captured using a standardized documentation form and are discussed and analyzed in a weekly trauma Morbidity and Mortality (M&M) conference. Surgical complication rates are calculated using the annual surgical procedure numbers. Based on discussions in the M&M conference, a complication avoidance care bundle consisting of five measures was established: (1) Improving team situational awareness; (2) reducing operating room traffic by staff members and limiting door-opening events; (3) preoperative screening for infectious foci; (4) adapted preoperative antibiotic prophylaxis in anatomic regions with a high risk of infectious complications; and (5) use of iodine-impregnated adhesive drape. Results: The number of surgical procedures steadily increased over the study years, from 3587 in 2015 to 3962 in 2019 (an increase of 10.5%). Within this 5-year study period, the overall rate of surgical complications was 0.8%. Surgical site infections were the most frequently found complications (n = 40, 24.8% of all surgical complications), followed by screw malposition (n = 20, 12.4%), postoperative dislocations of arthroplasties (n = 18, 11.2%), and suboptimal fracture reduction (n = 18, 11.2%). Following implementation of the complication avoidance care bundle, the overall rate of surgical complications significantly decreased, from 1.14% in the year 2016 to 0.56% in the study year 2019, which represents a reduction of 51% within a 3-year time period. Conclusions: A multimodal strategy targeted at reducing the surgical complication rate can be successfully established based on a transparent discussion of adverse surgical outcomes. The combination of the different preventive measures was associated with reducing the overall complication rate by half within a 3-year time period.

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Section: Discussionmentioning

confidence: 99%

The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

Lustenberger

Meier

Verboket

et al. 2020

JCM

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“…It is expected that the influence of patient characteristics, comorbidities and medication use is comparable for both THA and TKA. 44 The influence of comorbidities on outcomes is studied together quite often. 3 Furthermore, we tested this assumption by performing the analysis on THA and TKA data only.…”

Section: Discussionmentioning

confidence: 99%

Development of prediction models for complications after primary total hip and knee arthroplasty: a single-centre retrospective cohort study in the Netherlands

Sweerts

Hoogeboom

Wessel³

et al. 2022

BMJ Open

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ObjectiveThe aim of this study was to develop prediction models for patients with total hip arthroplasty (THA) and total knee arthroplasty (TKA) to predict the risk for surgical complications based on personal factors, comorbidities and medication use.DesignRetrospective cohort study.SettingTertiary care in outpatient clinic of university medical centre.Participants3776 patients with a primary THA or TKA between 2004 and 2018.Primary and secondary outcome measuresMultivariable logistic regression models were developed for primary outcome surgical site infection (SSI), and secondary outcomes venous thromboembolism (VTE), postoperative bleeding (POB), luxation, delirium and nerve damage (NER).ResultsFor SSI, age, smoking status, body mass index, presence of immunological disorder, diabetes mellitus, liver disease and use of non-steroidal anti-inflammatory drugs were included. An area under the receiver operating characteristic curve (AUC) of 71.9% (95% CI=69.4% to 74.4%) was found. For this model, liver disease showed to be the strongest predictor with an OR of 10.7 (95% CI=2.4 to 46.6). The models for POB and NER showed AUCs of 73.0% (95% CI=70.7% to 75.4%) and 76.6% (95% CI=73.2% to 80.0%), respectively. For delirium an AUC of 85.9% (95% CI=83.8% to 87.9%) was found, and for the predictive algorithms for luxation and VTE we found least favourable results (AUC=58.4% (95% CI=55.0% to 61.8%) and AUC=66.3% (95% CI=62.7% to 69.9%)).ConclusionsDiscriminative ability was reasonable for SSI and predicted probabilities ranged from 0.01% to 51.0%. We expect this to enhance shared decision-making in considering THA or TKA since current counselling is predicated on population-based probability of risk, rather than using personalised prediction. We consider our models for SSI, delirium and NER appropriate for clinical use when taking underestimation and overestimation of predicted risk into account. For VTE and POB, caution concerning overestimation exceeding a predicted probability of 0.08 for VTE and 0.05 for POB should be taken into account. Furthermore, future studies should evaluate clinical impact and whether the models are feasible in an external population.

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“…Despite great survival rates and improved outcomes of arthroplasties, various failures and complications were reported, including periprosthetic joint infection (PJI), which is one of the most common failure mechanisms. PJI occurs following primary THA and TKA, with rates ranging between 0.3% and 1.9%, and up to 10% in revision cases [2,3]. PJI is a devastating failure with Polymers 2021, 13, 2240 2 of 14 considerable morbidity and large economic burdens, both for affected patients and the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

Influence of Antibiotic-Loaded Acrylic Bone Cement Composition on Drug Release Behavior and Mechanism

Chen

Nien

et al. 2021

Polymers

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Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement with considerable morbidity and large economic burdens. Antibiotic-Loaded Bone Cement (ALBC) has been developed as a valuable tool for local administration and is becoming one of the most effective methods for the prevention and treatment of orthopedic infections. Controlling antibiotic release from ALBC is critical to achieve effective infection control, however, the antibiotic elution rates are generally low, and the mechanisms are poorly understood. Thus, the present study aims to investigate the effects of the basic acrylic bone cement components, including liquid/powder (monomer-to-polymer) ratios, radiopacifier, initiator, and doses of antibiotics on the porosity, antibiotic elution rates and mechanical properties of polymethylmethacrylate (PMMA) based ALBC. The obtained results from the in vitro studies suggested that a reduction in the liquid/powder ratio and an increase in the radiopacifier ratio and gentamicin doses led to increased porosity and release of antibiotic, while the initiator ratio exerted no effect on elution rates. In conclusion, we hope that by varying the composition of ALBC, we could considerably enhance the antibiotic elution rates by increasing porosity, while maintaining an adequate mechanical strength of the bone cements. This finding might provide insights into controlling antibiotic release from ALBC to achieve effective infection control after total joint replacement surgery.

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Prevention of infection in primary THA and TKA

Cited by 45 publications

References 112 publications

The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

The Implementation of a Complication Avoidance Care Bundle Significantly Reduces Adverse Surgical Outcomes in Orthopedic Trauma Patients

Development of prediction models for complications after primary total hip and knee arthroplasty: a single-centre retrospective cohort study in the Netherlands

Influence of Antibiotic-Loaded Acrylic Bone Cement Composition on Drug Release Behavior and Mechanism

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