Aseptic Loosening in Single-Stage Revision Arthroplasty for Periprosthetic Joint Infection
Kranti V. PeddadaBrandon M. WelcomeMitchell C. ParkerConnor M. DelmaChristopher T. HollandMauro GiordaniJohn P. MeehanZachary C. Lum
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Abstract:
We set out to more definitively understand, using a meta-analysis, where we tried to assess the reoperation rates secondary to infection and aseptic loosening in single-stage revision total hips and total knees. Secondarily, we looked at the overall reoperation rate, i.e., survivorship, other etiologies of reoperations and the overall mortality rate.Keywords:
Aseptic processing
Infection rate
Etiology
Joint arthroplasty
Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) is a devastating complication. Despite improvements in our understanding of PJI, the prevalence of this complication has not decreased in recent years, with various authors reporting rates of 1 to 2% after primary TJA and up to 7% following revision TJA. While the volume of publications, symposiums, and presentations on PJI is vast, controversy still remains regarding the prevention, diagnosis, and treatment of patients with PJI. The purpose of this article is to provide a succinct summary of the recent literature on the diagnosis, treatment, and prevention of a PJI after TJA.
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Objective:To investigate the cases of incision infection after orthopedic aseptic operation and discuss the prevention measures. Methods:14 274 patients from Jan 2007 to Dec 2008 were surveyed for retrospective analysis on incision infection after orthopedic aseptic operation. Results:Totally 133 incision infection cases were reported from 14 274 cases. 78 incision infection cases were reported from 5 981 cases in 2007 and the incision infection rate in this cohort was 1.304%,while 55 incision infection cases were reported from 8 293 cases in 2008 and the incision infection rate in this cohort was 0.663%. The rate of incision infection after orthopedic aseptic operation in 2008 was lower than that in 2007(χ2=15.463 5,P0.000 1). On the other hand,there was no statistical difference between 2007 and 2008 on ratio of G+ cocci and G-bacillus which were major pathogens of incision infection after orthopedic aseptic operation(χ2=1.354 9,P=0.244 4).Conclusion:High-risk cases should be pay attention to,and the time before operation should be reduced,and the antibiotic should be used reasonably,and Aseptic and Non-invasive operation should be emphasized,and the ratio of incision infection should be monitored,and all these measures can reduce the ratio of incision infection after orthopedic aseptic operation. Perioperative medication should be based on results of pathogens detection and drug sensitivity test and those effective drugs against both G+ cocci and G-bacillus should be used.
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Infection rate
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Periprosthetic joint infections are a devastating complication of joint arthroplasty procedures, affecting 1% to 4% of patients. With the increasing demand for joint replacement, the clinical and financial burden of periprosthetic joint infections is challenging. This article reviews the diagnosis and treatment of periprosthetic joint infections.
Joint arthroplasty
Joint infections
Joint replacement
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Periprosthetic joint infection (PJI) is one of the most severe postoperative complications of total joint arthroplasty (TJA). It results in high morbidity, substantial financial burden, and significant stress to patients. As a joint arthroplasity surgeon, we should do all the measurements to mitigate the risk of PJI.
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OBJECTIVE To analyze the risk factors of wound infection after abdominal operation,and explore the related preventive measures for clinical diagnosis so as to provide data basis for clinical treatment.METHODS The clinical data of 3 022hospitalized patients with abdominal surgical operation from Jan 2011to Dec 2012were retrospectively analyzed,the common sterile operating room for surgery has 1 592units,laminar flow operating room has 1430sets of surgery;the visitors were divided into no more than 3people and more than 3people,the indoor bacterial colony counts in the air were determined,and the relevant prevention measures were put forward,and the statistical analysis was performed with the use of SPSS 17.0software.RESULTS The infections occured in the patients received operation in the common aseptic operation room was 30cases,with the infection rate of 1.53%,while the infections occurred in 2cases in the strict aseptic operation room with the infection rate of 0.14%.The infection rate was 0.12% when the visiting people were less than 3,while it was 2.21% when the visiting people were more than 3,the infection rate of visiting people less than 3was obviously lower than that of the visiting people more than 3,the differences were significant.The mean operation duration of the patients with infections was(3.69±1.03)h,the mean bacterial colony counts in the operation room air were(123.26±57.72)CFU/m3,the preoperative hospitalization duration was(4.83±1.76)days,significantly higher than the patients without infections,the differences were significant(P0.05).CONCLUSIONThrough the analysis of the risk factors for infections in the operation room and the strict control of each risk factor,the incidence of postoperative incision infections can be effectively reduced,which is conducive to recovery of the patients as well as the improvement of therapeutic effect.
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Abstract Background Concerns exist about the survival and complication rates of highly constrained total knee arthroplasty (TKA) prostheses. The aims of this study were to determine if there were differences between the revision and complication rates of fully stabilized (FSTKA) and hinged (HTKA) TKA, when used in both primary and revision procedures. Methods Survivorship of all highly constrained TKA prostheses implanted over a 17 year period were analysed by the Australian Orthopaedic Association National Joint Replacement Registry. The primary outcome measure was time to first revision using Kaplan Meier estimates of survivorship. Results In the primary setting, the cumulative percent revision at 11 years was higher for HTKA than for FSTKA prostheses ( P = 0.014). However, this finding was only significant for patient >75 years. In the revision setting, there were no differences in the revision rates for either category of prosthesis for any age group. For the indication of periarticular/periprosthetic fracture, HTKA resulted in a lower revision rate than FSTKA in both primary and revision cohorts. There were no differences in the rates of revision for infection and aseptic loosening for either prosthesis type in primary or revision settings. The revision risk for periprosthetic fracture was higher after HTKA prostheses. Conclusion Both FSTKA and HTKA prostheses provide similar outcomes in primary and revision procedures except for the setting of periarticular/periprosthetic fracture, where a HTKA should be used. In elderly patients, a FSTKA prosthesis is recommended as the risk of periprosthetic fracture is higher with a HTKA.
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Abstract This prospective study examined the content of metals released from total joint arthroplasty into joint fluid, whole blood and periprosthetic tissues. We determined the levels of Ti, V, Nb, Co, Cr, and Mo, using inductively coupled plasma mass spectrometry, in samples from patients who underwent reoperation of total hip or knee arthroplasty. All of the patients ( n = 117) included in the study had either metal on polyethylene or ceramic on polyethylene‐bearing pairs. First, our results conclusively showed that the majority of released metals were deposited in periprosthetic tissues. In this context, the bloodstream turned out to be an ineffective biomarker of the effects occurring in local tissues. Second, there was a clear time‐dependent nature of metallic accumulation. Based on our extensive dataset, we found significantly elevated levels of the released metals in joint fluid and periprosthetic tissues originating from loosened implants compared to stable ones, as well as recognizable differences between the groups with stable implants and aseptic loosening. Finally, it was proved that the concentrations of metals decreased dependent on the distance of the tissue from the implant. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 454–462, 2019.
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Objective To explore the risk factors and operating room nursing countermeasures for orthopaedic sterile surgical incision infection,so as to reduce the orthopaedic surgery infection rates. Methods The data of 3634 aseptic surgery patients from Jan 2009 to Dec 2010 were collected and analyzed. Results The orthopaedic sterile surgical incision infections occurred in 20(0.55%)cases,and in which,the infection rate was 0.61%in 2009 and 0. 50% in 2010.The operation time more than two hours occurred in 13 cases,one and two hours were in 5 cases,and less than one hour in 5 cases,accounted for 65.0%,25.0% and 20.0%,respectively.Conclusions The risk factors of orthopaedic sterile surgical incision infection were operation type,surgery location,surgical site and operation time.In order to prevent the incision infection in aseptic surgery,we should pay more attention to the implement of the operating room nursing intervention and should execute the sterile operation.
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Aseptic processing
Infection rate
Surgical incision
Surgical Site Infection
Wound infection
Surgical wound
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» There are limited data that directly compare the efficacy of antiseptic irrigation solutions used for the prevention and treatment of periprosthetic joint infections in orthopaedic procedures; there is a notable lack of prospective data. » For prevention of periprosthetic joint infections, the strongest evidence supports the use of low-pressure povidone-iodine. » For the treatment of periprosthetic joint infections, delivering multiple solutions sequentially may be beneficial.
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