The evolution from the two stage to the one stage procedure for biofilm based periprosthetic joint infections (PJI)

Maale, Gerhard E.; Eager, John J.; Srinivasaraghavan, Aniruth; Mohammadi, Daniel K.; Kennard, Nicole

doi:10.1016/j.bioflm.2020.100033

Cited by 13 publications

(24 citation statements)

References 40 publications

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“…This is a much higher rate than what we reported with stage III-C-3 PJI with 1-stage revision of 500 cases. 8 Four patients required amputation, all of whom had free flaps and proximal placement. This is 3 times higher than what we reported in the same study.…”

Section: Discussionmentioning

confidence: 99%

“…When compared with a cohort of 500 patients with a 1-stage procedure and 12% recurrence rate, the Fisher exact test statistic value is 0.0031 demonstrating a significantly higher risk of reinfection in this group of patients as opposed to other 1-stage procedures treating PJI. 8 Eighteen of the 35 patients (51%) of the patients had enough extensor mechanism to walk with a cane or walker as opposed to needing a drop lock knee brace. The Fisher exact test statistic value is P-value < 0.00001 when comparing this to a 100% rate of drop lock bracing required in patients post a standard revision protocol.…”

Section: Postoperative Managementmentioning

confidence: 99%

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The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects

Maale

Srinivasaraghavan

Mohammadi

et al. 2021

Techniques in Orthopaedics

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Introduction:No good mechanisms are available for reconstruction of large anterior soft tissue defects associated with infected total knees [periprosthetic joint infections of the knee (PJI-K)]. Patellectomy is usually required due to involvement with adjacent large anterior soft tissue defects left after radical debridement, free flaps are required for closure. This type of flap necessitates the use of a drop lock brace in ambulation. Our question is whether the proximal placement of the knee joint with longer tibial segments can reduce the number of free flaps and reduce the need for a drop lock brace by reattaching the quadriceps directly to the hinged tibial component. Methods:We retrospectively analyzed 35 cases with a minimum 2-year follow-up. Of 1-stage total knee revisions for PJI-K with the proximal placement of the knee joint for large anterior soft tissue defects left after debridement. Results:The average knee joint displacement was 85 mm. Eleven recurred with infection and 4 required amputation. Eighteen had enough extensor power to walk with a cane or walker as opposed to requiring a drop lock brace. Fifteen patients did not need any free or local flaps, rather these patients only required adjacent soft tissue transfer during surgery.Discussion: This novel proximal placement of the knee joint in patients with PJI-K who have large anterior soft tissue defects lessens the need for free flaps. The proximal placement also allows for reconstruction of what is left of the quadriceps mechanism into the tibial component and usually provides enough extensor power to lock the hinge joint.

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Section: Discussionmentioning

confidence: 99%

Section: Postoperative Managementmentioning

confidence: 99%

The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects

Maale

Srinivasaraghavan

Mohammadi

et al. 2021

Techniques in Orthopaedics

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“…Some authors have tested the in vitro efficacy of antibiotic combinations against enterococci in biofilms, and they showed how rifampicin-containing antibiotic regimes, rifampicin-tigecycline combinations, and fosfomycin-based combinations were able to reduce the number of bacteria in biofilms formed within 24 h [52][53][54]. However, to date, management strategies in enterococcal PJI are controversial and nonstandardized as well as those in enterococcal endodontic infections, and the disinfection of root canals with commonly used antimicrobial irrigations is very challenging due to cytotoxicity [55][56][57][58].…”

Section: Strainsmentioning

confidence: 99%

Sesquiterpene Lactones from Cotula cinerea with Antibiotic Activity against Clinical Isolates of Enterococcus faecalis

et al. 2021

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Cotula cinerea, belonging to the tribe Anthemideae, is a plant widespread in the Southern hemisphere. It is frequently used in folk medicine in North African countries for several of its medical properties, shown by its extracts and essential oils. The dichloromethane extract obtained from its aerial parts demonstrated antibiotic activity against Enterococcus faecalis and was fractionated by bioguided purification procedures affording five main sesquiterpene lactones. They were identified by spectroscopic methods (NMR and ESIMS data) as guaiantrienolides, i.e., 6-acetoxy-1β-,6-acetoxy-1α-, and 6-acetoxy-10-β-hydroxyguaiantrienolide (1–3), and germacrenolides, i.e., haagenolide and 1,10-epoxyhaagenolide (4 and 5). The absolute configuration was assigned by applying the advanced Mosher’s method to haagenolide and by X-ray diffraction analysis to 1,10-epoxyhaagenolide. The specific antibiotic and antibiofilm activities were tested toward the clinical isolates of Enterococcus faecalis. The results showed that compounds 3–5 have antibacterial activity against all the strains of E. faecalis, while compound 2 exhibited activity only toward some strains. Compound 1 did not show this activity but had only antibiofilm properties. Thus, these metabolites have potential as new antibiotics and antibiofilm against drug resistant opportunistic pathogens.

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“…The severe complication secondary to total joint arthroplasty (TJA) is periprosthetic joint infection (PJI) which may lead to catastrophic results, like limb loss, revision surgery, and even death. [1][2][3] Nonetheless, it is still not easy to diagnose PJI and often gets delayed, in particular in the presence of low-degree or chronic infections, because of the absence of any "gold standard" examinations available and the existing diagnostic approaches fail to achieve high accuracy. [4][5][6] Standard tests, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), are unable to achieve satisfactory diagnostic value.…”

Section: Introductionmentioning

confidence: 99%

Utility of Human Neutrophil Lipocalin as a Diagnosing Biomarker of Prosthetic Joint Infection: A Clinical Pilot Study

Liu¹,

Yu²,

Niu³

2022

IDR

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The discrimination of prosthetic joint infection (PJI) from aseptic failure is regarded as a major clinical challenge. The key function of human neutrophil lipocalin (HNL) in regulating bacterial infection rationalizes its potential as a biomarker to diagnose PJI. This work evaluated the accuracy of serum human neutrophil lipocalin as a biomarker to diagnose PJI. Methods: This prospective cohort study enrolled altogether 58 patients suffering from miserable knee or hip arthroplasty and receiving revision surgery from 2018 to 2020. Related laboratory and clinical information of these patients were retrieved. Following the Musculoskeletal Infection Society (MSIS) criteria, the diagnosis of PJI was conducted. Collecting preoperative blood samples, we measured HNL by the standard assay. Thereafter, plotting the receiver-operating characteristic curve (ROC), the area under the curve (AUC) values were calculated to analyze the diagnosis accuracy. Results: According to the MSIS criteria, 38 cases (65.5%) were classified into the PJI group, while 20 (34.5%) into the aseptic loosening group, with age ranging from 38 to 87 (median, 66.9) years. The median serum HNL level of the PJI patients was 199.01 (range, 85.34-357.79) ng/mL, significantly higher as compared with that of 64.81 (range, 20.73-157.89) ng/mL of the aseptic loosening group. Using the Youden index, the optimal threshold value was 105.1ng/mL, while the specificity, sensitivity, and AUC were 85.0%, 81.6%, and 0.919, respectively. Conclusion: Serum HNL is the creditable test that can be employed as the laboratory biomarker to screen PJI. The threshold HNL level is 105.1 ng/mL, which may distinguish PJI from aseptic failure.

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The evolution from the two stage to the one stage procedure for biofilm based periprosthetic joint infections (PJI)

Cited by 13 publications

References 40 publications

The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects

The Proximal Placement of the Knee Joint in the 1-Stage Treatment of Infected Knee Revisions With Large Anterior Soft Tissue Defects

Sesquiterpene Lactones from Cotula cinerea with Antibiotic Activity against Clinical Isolates of Enterococcus faecalis

Utility of Human Neutrophil Lipocalin as a Diagnosing Biomarker of Prosthetic Joint Infection: A Clinical Pilot Study

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