Prosthetic joint infection development of an evidence-based diagnostic algorithm

Mühlhofer, Heinrich; Pohlig, Florian; Kanz, Karl‐Georg; Lenze, Ulrich; Lenze, Florian; Toepfer, Andreas; Kelch, Sarah; Harrasser, Norbert; Eisenhart-Rothe, Rüdiger von; Schauwecker, Johannes

doi:10.1186/s40001-017-0245-1

Cited by 26 publications

(23 citation statements)

References 115 publications

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“…They occur as a result of contamination during or immediately after surgery or at later periods following hematogenic spread [1][2][3]. Numbers of implantations, in general, are growing because of an aging population, increasing obesity, and other predisposing factors [4][5][6][7]. In addition, worldwide rising bacterial resistance against antibiotics [8][9][10][11] and further, the irreversible adhesion of bacteria and production of extracellular matrix in biofilm formation on the implant surface (infection cause) complicate a successful treatment [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Biodistribution, biocompatibility and targeted accumulation of magnetic nanoporous silica nanoparticles as drug carrier in orthopedics

et al. 2020

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Background: In orthopedics, the treatment of implant-associated infections represents a high challenge. Especially, potent antibacterial effects at implant surfaces can only be achieved by the use of high doses of antibiotics, and still often fail. Drug-loaded magnetic nanoparticles are very promising for local selective therapy, enabling lower systemic antibiotic doses and reducing adverse side effects. The idea of the following study was the local accumulation of such nanoparticles by an externally applied magnetic field combined with a magnetizable implant. The examination of the biodistribution of the nanoparticles, their effective accumulation at the implant and possible adverse side effects were the focus. In a BALB/c mouse model (n = 50) ferritic steel 1.4521 and Ti90Al6V4 (control) implants were inserted subcutaneously at the hindlimbs. Afterwards, magnetic nanoporous silica nanoparticles (MNPSNPs), modified with rhodamine B isothiocyanate and polyethylene glycol-silane (PEG), were administered intravenously. Directly/1/7/21/42 day(s) after subsequent application of a magnetic field gradient produced by an electromagnet, the nanoparticle biodistribution was evaluated by smear samples, histology and multiphoton microscopy of organs. Additionally, a pathohistological examination was performed. Accumulation on and around implants was evaluated by droplet samples and histology.

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Section: Introductionmentioning

confidence: 99%

Biodistribution, biocompatibility and targeted accumulation of magnetic nanoporous silica nanoparticles as drug carrier in orthopedics

et al. 2020

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“…Determining the plasma CRP level is recommended for the diagnosing of prosthetic joint infection [8]. Kim et al [9] showed that a high preoperative CRP level (> 100 mg L -1 ), a history of malignancy, a high ASA PS grade, and postoperative ICU admission were predominant risk factors for 1-year mortality after hip surgery in geriatric patients.…”

Section: The Dependence Of Drainage Blood Crp Levels On the Methods Ofmentioning

confidence: 99%

C-reactive protein level in plasma and drainage blood depends on the method of anaesthesia and post-operative analgesia after hip surgery

Kolomachenko¹

2018

Anaesthesiol Intensive Ther

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Background: Serum C-reactive protein (CRP) detects the inflammatory response to surgical trauma in hip surgery. It corresponds to the type of surgery, with a higher level of CRP being found in surgery techniques with greater tissue damage. The aim of our study was to analyze the CRP level in serum and drainage blood after hip surgery in patients with coxarthrosis depending on the method of anaesthesia and post-operative analgesia. Methods: 65 patients, 58 ± 12 years old, were included in the study. All patients underwent hip replacement surgery due to coxarthrosis. Serum CRP was measured before surgery and on the 1 st , 3 rd and 7 th postoperative days. The CRP level in drainage blood was detected on the 1 st , 2 nd and 3 rd postoperative days. Patients were divided into six groups according to the techniques of intraoperative anaesthesia and postoperative analgesia. Results: Before surgery, plasma CRP did not differ significantly among the groups. The smallest increase in plasma CRP was found in patients operated on under regional anaesthesia compared with those operated on under general anaesthesia. Postoperatively, the plasma CRP level was higher in patients treated with the systemic administration of opioids+NSAID, than in patients treated with regional analgesia. A significant increase in CRP levels in drainage blood for three days postoperatively was seen in all groups. In patients operated on under general anaesthesia and receiving systemic opioids+NSAID postoperatively, CRP in drainage blood was higher in comparison with those operated on under regional anaesthesia and treated with regional methods of postoperative analgesia. Conclusion: C-reactive protein levels in plasma and drainage blood depends on the method of anaesthesia and postoperative analgesia after hip surgery. Regional anaesthesia/analgesia methods limit one's inflammatory response to surgical trauma detected by CRP.

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“…Die Indikation zur Zupfbiopsie wurde anhand eines vom Autorenteam bereits publizierten evidenzbasierten Algorithmus zur Abklärung chronisch schmerzhafter Knieprothesen und nicht auszuschließender Low-Grade-Infektion durchgeführt (▶ Abb. 1) [32]. Der Algorithmus wird mittlerweile seit 3 Jahren an unserer Klinik eingesetzt.…”

Section: Evidenzbasierter Algorithmusunclassified

“…Die Indikation zur Zupfbiopsie war bei Vorliegen einer chronisch (> 6 Monate) schmerzhaften Knieprothese ohne Hinweis auf eine mechanische Ursache (Ausschluss Rotationsfehler im Rotations-CT, Stressröntgenaufnahme mediolateral in 20°Flexion bzw. a.-p. in 90°Flexion ohne Hinweis für höhergradige Instabilität), dem Vorhandensein von Risikofaktoren für eine PPI und einem negativen Keimnachweis nach Punktion des Gelenks gegeben [32]. Die Kniegelenkpunktion erfolgte zuvor als ambulanter Eingriff in den klinikeigenen Ambulanzräumen unter sterilen Kautelen.…”

Section: Präoperative Diagnostikunclassified

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Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm

et al. 2019

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Background Periprosthetic joint infection (PPI) is one of the most common reasons for revision in total knee arthroplasty (TKA). Percutaneous synovial biopsy is considered as a well-established diagnostic tool in ambiguous cases of chronic pain after TKA. The exact number of undetected low-grade infections remains unclear. Objectives The aim of this prospective study was to compare the diagnostic accuracy of arthroscopically guided and unguided synovial biopsy. Additionally, the prevalence of initially undetected PPI during synovial biopsy and revision surgery was assessed. Materials and Methods 40 patients suffering from chronic pain after TKA and the clinical suspicion of PPI were included in the study. Synovial biopsies were collected in a standardized manner first without and then with arthroscopic visual control. Using both techniques, six samples were collected each (5 for microbiology, 1 for histology). 19 patients, initially classified aseptic, underwent revision surgery later. Results The diagnosis of PPI was made in 10.0% of unguided biopsies (4 cases, 2× microbiologically, 2× histologically), 7.5% of arthroscopic biopsies (3 cases, 3× histologically) and 12.5% (5 cases, 3× histologically, 2× microbiologically) of all cases. Only histologic evaluation led to concordant positive findings using both techniques in two patients. The proportion of non-representative biopsies was twice as high after unguided tissue collection than after arthroscopic biopsy (30.0 vs. 15.0%). Microbiologic evaluation of arthroscopically collected biopsies did not lead to the diagnosis of PPI, which might have been essential to the selection of the appropriate antimicrobial therapy. During revision surgery the diagnosis of PPI was made in 22.2% of cases. Conclusions In patients suffering from chronic pain after TKA, periprosthetic low-grade infection was diagnosed in a relevant proportion of cases. Therefore, synovial biopsies for histological and microbiological evaluation should be collected whenever thereʼs clinical suspicion of PPI. For histological evaluation, samples should be collected using arthroscopic control and ideally multiple biopsies should be taken. For microbiological evaluation, excessive joint lavage should be avoided.

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Prosthetic joint infection development of an evidence-based diagnostic algorithm

Cited by 26 publications

References 115 publications

Biodistribution, biocompatibility and targeted accumulation of magnetic nanoporous silica nanoparticles as drug carrier in orthopedics

Biodistribution, biocompatibility and targeted accumulation of magnetic nanoporous silica nanoparticles as drug carrier in orthopedics

C-reactive protein level in plasma and drainage blood depends on the method of anaesthesia and post-operative analgesia after hip surgery

Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm

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