Revision Total Knee Arthroplasty Infection: Incidence and Predictors

Mortazavi, Seyed Mohammad Javad; Schwartzenberger, Justin; Austin, Matthew S.; Purtill, James J.; Parvızı, Javad

doi:10.1007/s11999-010-1308-6

Cited by 214 publications

(158 citation statements)

References 35 publications

Supporting

Mentioning

132

Contrasting

Unclassified

Order By: Relevance

“…Infections are the main cause of failure after prosthetic revision as revealed by recent studies with a risk that may be 10-fold higher than primary procedures [54,55]. We recommend the use of synthetic materials to reinforce the apparatus, when a direct repair is not possible.…”

Section: Discussionmentioning

confidence: 91%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

View full text Add to dashboard Cite

Introduction: Latest advances made in joint replacement implants allows reconstruction of entire limbs. These special prostheses or megaprostheses were originally designed for the treatment of severe oncological bone loss. Nowadays, however, the indications and applications of these devices are expanding to other orthopaedic and trauma clinical conditions. Since 2008 we have implanted 152 megaprostheses in non-oncological conditions: 87 were implanted for post-traumatic failures aseptic/septic (represented by complex non-unions and critical size bone defects); 26 total femur, 52 distal femur and 9 proximal tibia. In this group of patients bone and soft tissues conditions are completely different compared to patients with oncological back ground. The presence of infection and previous surgeries can lead to adhesion, scar interference, muscular and tendon impairment and skin problems that lead to reduced function and severe joint stiffness. The purpose of this study is to evaluate the results of treatment of reconstruction of patellar tendon during implantation of proximal tibia megaprosthesis for the treatment of septic post traumatic critical bone defects. Patients and methods: In this retrospective study, we evaluated 9 patients treated with proximal tibia megaprosthesis who underwent patellar tendon reconstruction. All patients presented a complete patellar tendon disruption at the time of prosthesis implantation. Procedures of reconstruction included a tendon-plasty of quadriceps and/or patellar tendons, a pie crusting of quadriceps fascia, a reinforcement of the apparatus with synthetic tendon graft substitutes (LARS) and a medial gastrocnemius muscular flap to reconstruct the extensor mechanism and obtain skin coverage when needed. The average follow up was 18 months (9-36). For each of the cases, we analysed the complications occurred regarding septic recurrence, patellar fracture, quadriceps and patellar tendon rupture and number of reinterventions. The clinical outcome was assessed by the WOMAC Score. Results: In all cases there was no infection recurrence or skin related problems. None of the patients require prosthesis revision due to loosening or device failure. No patellar fracture or quadriceps tendon failure was recorded. One patient presented a rupture of the reconstructed patellar tendon due to a trauma incident 18 months after the implantation and he required revision surgery. From a clinical point of view the average WOMAC score was 62.4 at 1 month rising to 72.6 at 3 months, 78.2 at 6 months, 76.4 at 1 year and 74.8 at 18 months. Conclusion: When proximal tibia megaprosthesis is implanted and there are soft tissue and patellar tendon deficiency, soft tissue reconstruction can be achieved by appropriate lengthening of the tendon and a gastrocnemius flap reinforced by LARS. Such an approach allows restoration of the extensor mechanism and coverage of the prosthesis in an area where skin problems are frequently very common.

show abstract

Section: Discussionmentioning

confidence: 91%

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Mazza

Vaienti

Mazzola

et al. 2016

Injury

View full text Add to dashboard Cite

show abstract

“…Tempo cirúrgico prolongado (superior a 150 minutos), transfusão sanguínea e realização de artroplastia bilateral em um mesmo tempo cirúrgico são outros fatores relacionados a maior ocorrência de infecção. Qualquer fator que retarde a cicatrização da ferida cirúrgica como necrose isquêmica, hematoma, celulite ou abscesso de ferida, aumenta o risco de infecção, uma vez que os tecidos profundos contíguos à prótese estão desprovidos das barreiras locais de defesa (1,2,4) . É importante salientar que a presença da prótese articular leva a um prejuízo da função dos granulócitos locais, que se acumulam ao redor do implante e são parcialmente degranulados, com diminuição na produção de superóxido desmutase e prejuízo na capacidade de defesa contra bactérias, particularmente contra Staphylococcus aureus.…”

Section: Fatores De Risco E Fisiopatogeniaunclassified

“…O sucesso do tratamento das infecções das próteses articulares depende do extenso desbridamento cirúrgico e da antibioticoterapia adequada e efetiva (2,4) . Os quadros infecciosos que se desenvolvem no primeiro ano de pós-operatório são considerados infecções hospitalares e devem ser tratados até os resultados das culturas colhidas em centro cirúrgico com antibióticos que tenham ação na microbiota hospitalar do serviço onde foi realizada a cirurgia.…”

Section: Tratamentounclassified

See 1 more Smart Citation

Atualização em infecções em próteses articulares

Lima¹,

Oliveira²

2010

Rev. bras. ortop.

View full text Add to dashboard Cite

RESuMOO implante de próteses articulares, principalmente de quadril e joelho, vem se tornando cada vez mais frequente, representando significante redução no desconforto e imensurável melhora na mobilidade dos pacientes. As revisões da literatura mundial revelam que 1 a 5% destas próteses tornam-se infectadas, sendo importante lembrar que, conforme cresce o número de cirurgias para implantação destas próteses, cresce também o número de casos deste tipo de infecção. As bactérias gram-positivas são predominantes nas contaminações das próteses articulares, em especial o Staphylococcus aureus e o Staphylococcus epidermidis. As infecções causadas por bacilos gram-negativos e fungos como Candida sp vêm sendo relatadas com maior frequência em todo o mundo. As infecções de próteses articulares apresentam sinais característicos que podem ser divididos em manifestações agudas (dor severa, febre alta, toxemia, calor, rubor e secreção na ferida operatória) e crônicas (dor progressiva, formação de fístulas cutâneas, com drenagem de secreção purulenta, sem febre). O diagnóstico definitivo da infecção deve ser realizado através do isolamento em cultura do micro-organismo obtido a partir da punção do líquido articular, secreção da ferida cirúrgica e materiais colhidos durante desbridamento cirúrgico. É fundamental a cobertura de S.aureus meticilinoresistente, visto a importância epidemiológica deste agente nessas infecções. O tempo total da antibioticoterapia varia de seis semanas a seis meses, sendo que o tratamento deve ser readequado quando necessário, com base nos resultados das culturas colhidas. descritores -

show abstract

“…Murray et al [6] reported that when a patient presents with periprosthetic joint infection (PJI) at a single site, there is an approximately 15% risk of PJI in a second site of a preexisting prosthetic joint [4]. This risk of PJI in a preexisting site is much greater than the infection risk in primary THA and TKA commonly reported to be approximately 1% [5,7].…”

Section: Introductionmentioning

confidence: 99%

A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection

Bedair

Goyal²,

Dietz

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background After the successful treatment of periprosthetic joint infection (PJI), patients may present with degenerative joint disease in another joint with symptoms severe enough to warrant arthroplasty. However, it is not known whether patients with a history of treated PJI at one site will have an increased risk of PJI in the second arthroplasty site.Questions/purposes The primary objective of this study is to determine if there is a difference in the risk of developing a PJI after a second total hip arthroplasty (THA) or total knee arthroplasty (TKA) in patients who have had a previous PJI at another anatomic site compared with patients who have had no history of PJI. The secondary objective is to determine other potential risk factors that may predict PJI at the site of the second arthroplasty. Methods A retrospective matched cohort study was performed to identify all patients at four academic institutions successfully treated for PJI who subsequently underwent a second primary THA or TKA (n = 90), constituting our study group. Patients were matched (one-to-one) to control subjects who had no history of PJI after their first arthroplasty (n = 90); they were matched based on age, sex, diabetic status, BMI, American Society of Anesthesiologists, institution, joint of interest, and year of surgery (± 2 years). We compared the case and control groups to determine whether a prior infection increased the relative risk of a subsequent PJI at another anatomic site. To identify other potential risk factors for subsequent PJI, a subgroup univariate analysis of our study group (n = 90) Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

show abstract

Revision Total Knee Arthroplasty Infection: Incidence and Predictors

Cited by 214 publications

References 35 publications

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Reconstruction of patellar tendon following implantation of proximal tibia megaprosthesis for the treatment of post-traumatic septic bone defects

Atualização em infecções em próteses articulares

A History of Treated Periprosthetic Joint Infection Increases the Risk of Subsequent Different Site Infection

Contact Info

Product

Resources

About