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It gained popularity as a treatment for infected hip pros- theses shortly thereafter and was considered a more necessary intervention before the proliferation of antibiotics and reconstruction implants and techniques available today. The historical perspective, surgical technique, current indications and results are described in this chapter.

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Also, alternatives to resection arthroplasty, other than hip joint reconstruction, are discussed, including chronic antibiotic suppression with component retention and amputation. Late infections of the hip joint : Resection arthroplasty and other solutions. N2 - Resection arthroplasty is an acceptable treatment option for an infected hip prosthesis. AB - Resection arthroplasty is an acceptable treatment option for an infected hip prosthesis. Late infections of the hip joint Resection arthroplasty and other solutions. Late onset Mycobacterium tuberculosis infection after total knee arthroplasty: a systematic review and pooled analysis.

Scand J Infect Dis ; 45 12 : The mean patient age was 70 years. Total hip replacement infected with Mycobacterium tuberculosis. A case report with review of literature.

Shotgun Metagenomics: A Promising New Method toward Diagnosing Infections

Acta Orthop Belg ; 73 2 : Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. Molds, yeasts, or dimorphic fungi are part of the fungi kingdom. Hyphae are characteristic of multicellular molds.

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Laboratory diagnosis of invasive mycoses. Infect Dis Clin North Am ; 17 1 : Isolation of fungi from tissues or joint aspirations in symptomatic patients is diagnostic for fungal PJI. Biofilm formation is a critical virulence factor for fungi. Comparison of biofilms formed by Candida albicans and Candida parapsilosis on bioprosthetic surfaces.

Infect Immun ; 70 2 : Management of fungal or atypical periprosthetic joint infections. J Arthroplasty ; 29 2 Suppl. Additionally, immunosuppression, malignancy, drug abuse, prolonged use of antibiotics, presence of indwelling catheters, malnutrition, RA, history of multiple abdominal surgeries, severe burns, and TB are all risk factors for fungal PJI [ 50 Gebauer M, Frommelt L, Achan P, et al.

Acta Orthop ; 84 6 : However, a significant number of culture-negative PJI continue to vex clinicians and patients.

Resection arthroplasty and other solutions

J Bone Joint Surg Am ; 96 17 : For example, in a retrospective review of PJIs treated with 2-stage exchange arthroplasty over a year period at a single institution, Bjerke-Kroll, et al. There are several potential reasons for the prevalence of culture-negative PJI: preemptive antimicrobial therapy, and inadequate culture techniques and protocols. Perhaps the most common cause of culture-negative PJI is administration of antibiotics prior to obtaining fluid or tissue samples from the affected joint [ 53 Berbari EF, Marculescu C, Sia I, et al.

Prosthetic joint infections 1 of 3

Culture-negative prosthetic joint infection. Clin Infect Dis ; 45 9 : Technique and timing of two-stage exchange for infection in TKA. Berbari et al. Diagnosis of periprosthetic joint infection. Culture yields can be improved, if antimicrobial therapy can be safely held at least two weeks before surgical intervention or aspiration [ 54 Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection.

N Engl J Med ; 7 : Furthermore, preemptive antibiotic administration prior to making a definitive PJI diagnosis potentially alters the synovial fluid leukocyte count and differential, further complicating and potentially delaying appropriate treatment [ 53 Berbari EF, Marculescu C, Sia I, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee.

J Bone Joint Surg Am ; 93 14 : Inadequate culture techniques and protocols may fail to isolate the causative pathogen.

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  • Two-stage revision after total knee arthroplasty;
  • First, inappropriate sampling and processing techniques can impede culture yields. The Coventry Award. The value of preoperative aspiration before total knee revision. Is there a role for tissue biopsy in the diagnosis of periprosthetic infection? Clin Orthop Relat Res ; 5 : Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res ; 8 : Propionibacterium spp. Arch Orthop Trauma Surg ; 10 : Sonication of the explanted prosthesis is a method of biofilm disruption which improves culture yields, but it is not broadly utilized [ 54 Trampuz A, Piper KE, Jacobson MJ, et al.

    Diagnosis of infected total knee: findings of a multicenter database.

    Clin Orthop Relat Res ; 11 : J Arthroplasty ; 26 8 : Appearance of septic hip prostheses on plain radiographs. Modifiable risk factors for surgical site infection.


    J Bone Joint Surg Am ; 93 4 : Nuclear medicine and the infected joint replacement. Semin Nucl Med ; 39 1 : For experienced radiologists, magnetic resonance imaging MRI with scan sequences suppressing metal artifact can identify soft tissue collections and sinus tracts. Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging ; 35 5 : Gram stains have limited application in the diagnosis of infected total knee arthroplasty. Int J Infect Dis ; 15 10 : e Serum white blood cell count and differential do not have a role in the diagnosis of periprosthetic joint infection.

    The use of receiver operating characteristics analysis in determining erythrocyte sedimentation rate and C-reactive protein levels in diagnosing periprosthetic infection prior to revision total hip arthroplasty. Int J Infect Dis ; 13 6 : e Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty.

    J Bone Joint Surg Am ; 90 8 : To assist mitigating some of the uncertainty regarding the definition of PJI, the Musculoskeletal Infection Society MSIS issued a consensus statement, to define PJI for research and also clinical practice [ 64 New definition for periprosthetic joint infection. Any major criterion or co-presentation of any 4 of the minor criteria satisfies the PJI definition. The Frank Stinchfield Award: Diagnosis of infection in the early postoperative period after total hip arthroplasty.

    Clin Orthop Relat Res ; 2 : Bedair, et al. Clin Infect Dis ; 41 5 : Histologic analyses are invasive, and their use should probably be limited to tissue samples obtained intraoperatively or to biopsy specimens from patients with a high pretest probability of infection. These assessments have diagnostic value, however. In a recent systematic review and meta-analysis, Tsaras, et al. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.

    Surgeons Are Changing Their Approach to Prosthetic Joint Infection Based on New Evidence

    J Bone Joint Surg Am ; 94 18 : Nearly a quarter of patients had confirmed PJI. The purpose of the study was to determine the utility of intraoperative frozen section analysis for distinguishing between patients with confirmed PJI and those revised for aseptic failure. The authors found that intraoperative frozen section analysis had a very good pooled positive likelihood ratio Multiple positive cultures are most confirmatory for PJI.

    If a negative preoperative aspiration is obtained in the setting of elevated synovial and serum markers suggestive of infection, repeat aspiration should be performed prior to surgery or initiation of antimicrobial treatment [ 57 Barrack RL, Jennings RW, Wolfe MW, Bertot AJ. Expert opinion suggests meticulous soft tissue handling and systematic selection of tissue samples, to prevent false-positive cultures and to improve culture yields, respectively [ 63 Zmistowski B, Della Valle C, Bauer TW, et al.

    Tissue should be dissected sharply from the intramedullary canal and implant-bone interfaces, and specimens should be directly transferred into appropriate culture containers with clean instruments [ 63 Zmistowski B, Della Valle C, Bauer TW, et al. Atkins, et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty.

    J Clin Microbiol ; 36 10 : The mycobacteriology laboratory and new diagnostic techniques. Infect Dis Clin North Am ; 16 1 : If preoperative cultures are negative or if P. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis ; 47 11 : The routine use of atypical cultures in presumed aseptic revisions is unnecessary. If available, sonication of the retrieved prosthesis can retrieve viable microorganisms from biofilm and improve the sensitivity of cultures [ 54 Trampuz A, Piper KE, Jacobson MJ, et al.

    Culture and histology data, on which the MSIS definition partially relies, are not immediately available in the clinic, where the diagnosis may be ambiguous. Antimicrobial peptides and proinflammatory cytokines in periprosthetic joint infection. J Bone Joint Surg Am ; 95 7 : Synovial fluid biomarkers include inflammatory cytokines and host antimicrobial proteins expressed in response to pathogens [ 80 Gollwitzer H, Dombrowski Y, Prodinger PM, et al.

    Leukocyte esterase strips are simple, inexpensive and widely available. In one study, using positive cultures as the reference standard, this test had sensitivity and specificity of Leukocyte esterase reagent strips for the rapid diagnosis of periprosthetic joint infection.