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Good accuracy of the alpha-defensin lateral flow test for hip periprosthetic joint infection: A pilot study in a retrospective cohort of 52 patients

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World Journal of Orthopedics 2020年第1期11卷 36-46页

作者： Jesse WP Kuiper Pieter Pander Stan J Vos Department of Orthopedic Surgery Noordwest ZiekenhuisgroepAlkmaar 1815 JDNetherlands Centre for Orthopedic Research Alkmaar Noordwest ZiekenhuisgroepAlkmaar 1815 JDNetherlands

BACKGROUND The alpha-defensin lateral flow(ADLF)test is a new diagnostic tool for periprosthetic joint infection(PJI).Test accuracy for combined cohorts of hip and knee PJI has been reported to be good.AIM To assess the accuracy of the ADLF test for hip PJI,and to compare three different diagnostic criteria for PJI.METHODS A cohort of 52 patients was identified,with a painful or poor-functioning total hip-or hemi-arthroplasty,that underwent aspiration and a subsequent ADLF test.PJI was diagnosed with Musculoskeletal Infection Society(MSIS)criteria,and sensitivity,specificity,overall accuracy,positive predictive value and negative predictive value were calculated.Furthermore,test specifics were compared with the European Bone and Joint Infection Society(EBJIS)and 2018 International Consensus Meeting(ICM)criteria for PJI.RESULTS Using MSIS criteria,sensitivity was 100%(CI:54%-100%)and specificity was 89%(CI:76%-96%).Six true positives and 5 false positives were found,including one case of metallosis.Using EBJIS criteria,more PJIs were found(11 vs 6),sensitivity was lower(71%,CI:42%-92%)and specificity was higher(97%,CI:86%-100%),with 4 false negatives and one false positive result.Using 2018 ICM criteria,sensitivity was 91%(62%-100%)and specificity 100%(91%-100%).The results in this cohort are comparable to previous studies.CONCLUSION Overall test accuracy of the ADLF test was good in this cohort,with a sensitivity of 100%and specificity of 89%.Using different PJI definition criteria,sensitivity and specificity changed slightly but overall accuracy remained around 90%.Using the ADLF test in metallosis cases can result in false positive results and should be performed with caution.

关键词： periprosthetic Arthroplasty Replacement Hip Infection periprosthetic joint infection Alpha-defensin Synovasure

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Impact of time to surgery from injury on postoperative infection and deep vein thrombosis in periprosthetic knee fractures

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Chinese Journal of Traumatology 2018年第6期21卷 329-332页

作者： Sung Ro Lee Kevin Shrestha Jackson Staggers Peng Li Sameer M.Naranje Ashish Shah University of Alabama at Birmingham 1313 13th Street SouthSuite 226BirminghamAL 35205United States

Purpose:periprosthetic fracture (PPF) is a serious complication that occurs in 0.3%-2.5% of all total knee arthroplasties used to treat end-stage arthritis. To our knowledge, there are no studies in the literature that evaluate the association between time to surgery after PPF and early postoperative infections or deep vein thrombosis (DVT). This study tests our hypothesis that delayed time to surgery increases rates of postoperative infection and DVT after PPF surgery.Methods:Our study cohort included patients undergoing PPF surgery in the American College of Surgeons National Surgical Quality Improvement Program database (2006-2015). The patients were dichotomized based on time to surgery: group 1 with time ≤2 days and group 2 with time >2 days. A 2-by-2 contingency table and Fisher's exact test were used to evaluate the association between complications and time to surgery groups, and multivariate logistic regression was used to adjust for demographics and known risk factors.Results:A total of 263 patients (80% females) with a mean age of 73.9 ± 12.0 years were identified receiving PPF surgery, among which 216 patients were in group 1 and 47 patients in group 2. Complications in group 1 included 3 (1.4%) superficial infections (SI), 1 (0.5%) organ space infection (OSI), 1 (0.5%) wound dehiscence (WD), and 4 (1.9%) deep vein thrombosis (DVT);while complications in group 2 included 1 (2.1%) SI, 1 (2.1%) OSI, 1 (2.1%) DVT, and no WD. No significant difference was detected in postoperative complications between the two groups. However, patients in group 2 were more likely (p = 0.0013) to receive blood transfusions (57.5%) than those in group 1 (32.4%).Conclusion:Our study indicates patients with delayed time to surgery have higher chance to receive blood transfusions, but no significant difference in postoperative complications (SI, OSI, WD, or DVT) between the two groups.

关键词： Total knee arthroplasty periprosthetic fracture Knee Arthroplasty Postoperative wound infection Deep vein thrombosis

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RANK-ligand and osteoprotegerin as biomarkers in the differentiation between periprosthetic joint infection and aseptic prosthesis loosening

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World Journal of Orthopedics 2017年第4期8卷 342-349页

作者： Max J Friedrich Matthias D Wimmer Jan Schmolders Andreas C Strauss Milena M Ploeger Hendrik Kohlhof Dieter C Wirtz Sascha Gravius Thomas M Randau Department of Orthopedics and Trauma Surgery University Clinic of Bonn

AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard tests.METHODS One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal Infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.

关键词： Aseptic loosening Diagnostic RANK-ligand periprosthetic joint infection Biomarker Osteoprotegerin

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Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification

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世界骨科杂志：英文版 2017年第5期8卷 400-411页

作者： David A George Lorenzo Drago Sara Scarponi Enrico Gallazzi Fares S Haddad Carlo L Romano Department of Trauma and Orthopaedics University College London Hospitals Microbiological Laboratory Orthopaedic Re-search Institute Galeazzi Centre for Reconstructive Surgery and Osteoarticular Infections Orthopaedic Research Institute Galeazzi

AIM To undertook a systematic review to determine factors that increase a patient's risk of developing lower limb periprosthetic joint infections(PJI).METHODS This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio(OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias. RESULTS Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies(14.8%) reviewed PJI of the hip, 3(11.21%) of the knee, and 20(74.1%) reviewed both joints. Nineteen studies(70.4%) were retrospective and 8(29.6%) prospective. Record bias was identified in the majority of studies(66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids(OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50(OR = 18.3, P < 0.001), tobacco use(OR = 12.76, 95%CI: 2.47-66.16, P= 0.017), body mass index below 20(OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes(OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease(OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).CONCLUSION We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.

关键词： periprosthetic joint infection Risk factor Predictive Hip arthroplasty Knee arthroplasty

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Managing extremely distal periprosthetic femoral supracondylar fractures of total knee replacements-a new PHILOS-ophy

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World Journal of Orthopedics 2017年第10期8卷 809-813页

作者： Kevin J Donnelly Adam Tucker Angel Ruiz Neville W Thompson Department of Trauma and Orthopaedic Surgery Altnagelvin Hospital

We report two cases where a proximal humeral locking plate was used for the fixation of an extremely distal, type Ⅲ peri-prosthetic femoral fractures in relation to a total knee replacement(TKR). In each case there was concern regarding the fixation that could be achieved using the available anatomic distal femoral plates due to the size and bone quality of distal fragment. The design of the Proximal Humeral Internal Locking System(PHILOS) allows nine 3.5-mm locking screws to be placed over a small area in multiple directions. This allowed a greater number of fixation points to be achieved in the distal fragment. Clinical and radiological short-term follow-up(6-12 mo) has been satisfactory in both cases with no complications. We suggest the use of this implant for extremely distal femoral fractures arising in relation to the femoral component of a TKR.

关键词： Distal Femoral periprosthetic Fracture PHILOS Open reduction and internal fixation

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Two-stage revision arthroplasty for coagulase-negative staphylococcal periprosthetic joint infection of the hip and knee

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World Journal of Orthopedics 2019年第10期10卷 348-355页

作者： Ewout S Veltman Dirk Jan F Moojen Marc L van Ogtrop Rudolf W Poolman Department of Orthopaedic and Trauma Surgery OLVGJoint Research OLVGAmsterdam 1091ACNetherlands Department of Orthopaedic Surgery Leiden University Medical CentreLeiden 2333ZANetherlands Department of Medical Microbiology OLVGAmsterdam 1091ACNetherlands

BACKGROUND periprosthetic joint infections(PJIs)are frequently caused by coagulase-negative Staphylococci(CoNS),which is known to be a hard-to-treat microorganism.Antibiotic resistance among causative pathogens of PJI is increasing.Two-stage revision is the favoured treatment for chronic CoNS infection of a hip or knee prosthesis.We hypothesised that the infection eradication rate of our treatment protocol for two-stage revision surgery for CoNS PJI of the hip and knee would be comparable to eradication rates described in the literature.AIM To evaluate the infection eradication rate of two-stage revision arthroplasty for PJI caused by CoNS.METHODS All patients treated with two-stage revision of a hip or knee prosthesis were retrospectively included.Patients with CoNS infection were included in the study,including polymicrobial cases.Primary outcome was infection eradication at final follow-up.RESULTS Forty-four patients were included in the study.Twenty-nine patients were treated for PJI of the hip and fifteen for PJI of the knee.At final follow-up after a mean of 37 mo,recurrent or persistent infection was present in eleven patients.CONCLUSION PJI with CoNS can be a difficult to treat infection due to increasing antibiotic resistance.Infection eradication rate of 70%-80%may be achieved.

关键词： periprosthetic joint infection Two-stage revision Knee arthroplasty Hip arthroplasty Coagulase-negative Staphylococcus

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Treatment of acute periprosthetic infections with prosthesis retention: Review of current concepts

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世界骨科杂志：英文版 2014年第5期5卷 667-676页

作者： Jesse WP Kuiper Robin Tjeenk Willink Dirk Jan F Moojen Michel PJ van den Bekerom Sascha Colen Center for Orthopaedic Research Alkmaar Medical Center Alkmaar 1815 JD Alkmaar The Netherlands Department of Surgery Spaarne Hospital2134 TM Hoofddorp The Netherlands Department of Orthopaedic Surgery University Hospitals Leuven Department of Orthopaedic Surgery and Traumatology Onze Lieve Vrouwe Gasthuis 1091 AC Amsterdam The Netherlands Department of Orthopedic Surgery and Traumatology Sint Bonifatius Hospital

periprosthetic joint infection(PJI) is a devastating complication after total joint arthroplasty, occurring in approximately 1%-2% of all cases. With growing populations and increasing age, PJI will have a growing effect on health care costs. Many risk factors have been identified that increase the risk of developing PJI, including obesity, immune system deficiencies, malignancy, previous surgery of the same joint and longer operating time. Acute PJI occurs either postoperatively(4 wk to 3 mo after initial arthroplasty, depending on the classification system), or via hematogenous spreading after a period in which the prosthesis had functioned properly. Diagnosis and the choice of treatment are the cornerstones to success. Although different definitions for PJI have been used in the past, most are more or less similar and include the presence of a sinus tract, blood infection values, synovial white blood cell count, signs of infection on histopathological analysis and one ormore positive culture results. Debridement, antibiotics and implant retention(DAIR) is the primary treatment for acute PJI, and should be performed as soon as possible after the development of symptoms. Success rates differ, but most studies report success rates of around 60%-80%. Whether single or multiple debridement procedures are more successful remains unclear. The use of local antibiotics in addition to the administration of systemic antibiotic agents is also subject to debate, and its pro's and con's should be carefully considered. Systemic treatment, based on culture results, is of importance for all PJI treatments. Additionally, rifampin should be given in Staphylococcal PJIs, unless all foreign material is removed. The most important factors contributing to treatment failure are longer duration of symptoms, a longer time after initial arthroplasty, the need for more debridement procedures, the retention of exchangeable components, and PJI caused by Staphylococcus(aureus or coagulase negative). If DAIR treatment is unsuccessful, the fo

关键词： Arthroplasty Prosthesis Infection periprosthetic joint infection Retention Debridement antibiotics and implant retention Debridement Acute

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Identification and preoperative optimization of risk factors to prevent periprosthetic joint infection

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World Journal of Orthopedics 2014年第3期5卷 362-367页

作者： Seung-Hoon Baek Department of Orthopedic Surgery Kyungpook National University HospitalDaegu 700-721South Korea

Despite significant improvements over the past several decades in diagnosis,treatment and prevention of periprosthetic joint infection(PJI),it still remains a major challenge following total joint arthroplasty.Given the devastating nature and accelerated incidence of PJI,prevention is the most important strategy to deal with this challenging problem and should start from identifying risk factors.Understanding and well-organized optimization of these risk factors in individuals before elective arthroplasty are essential to the ultimate success in reducing the incidence of PJI.Even though some risk factors such as demographic characteristics are seldom changeable,they allow more accurate expectation regarding individual risks of PJI and thus,make proper counseling for shared preoperative decision-making possible.Others that increase the risk of PJI,but are potentially modifiable should be optimized prior to elective arthroplasty.Although remarkable advances have been achieved in past decades,many questions regarding standardized practice to prevent this catastrophic complication remain unanswered.The current study provide a comprehensive knowledge regarding risk factors based on general principles to control surgical siteinfection by the review of current literature and also share own practice at our institution to provide practical and better understandings.

关键词： Total joint arthroplasty periprosthetic joint infection Prevention Risk factors Preoperative optimization

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Intraprosthetic fixation techniques in the treatment of periprosthetic fractures: A biomechanical study

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World Journal of Orthopedics 2012年第10期3卷 162-166页

作者： Stephan Brand Johannes Klotz Thomas Hassel Maximilian Petri Carl Haasper Friedrich-Wilhelm Bach Christian Krettek Thomas Goesling Department of Trauma Medical School Hannover (MHH) D-30625 Hannover Germany Department of Material Sciences Leibniz University Hannover D-30625 Hannover Germany

AIM: To develop new fixation techniques for the treatment of periprosthetic fractures using intraprosthetic screw fixation with inserted threaded liners. METHODS: A Vancouver B1 periprosthetic fracture was simulated in femur prosthesis constructs using sawbones and cemented regular straight hip stems. Fixation was then performed with either unicortical locked-screw plating using the less invasive stabilization system-plate or with intraprosthetic screw fixation using inserted liners. Two experimental groups were formed using either prostheses made of titanium alloy or prostheses made of cobalt chrome alloy. Fixation stability was compared in an axial load-to-failure model. Drilling was performed using a specially invented prosthesis drill with constantly applied internal cooling.RESULTS: The intraprosthetic fixation model with titanium prostheses was superior to the unicortical lockedscrew fixation in all tested devices. The intraprosthetic fixation model required 10 456 N ± 1892 N for failure and the unicortical locked-screw plating required 7649 N ± 653 N(P periprosthetic fractures by internal fixation.

关键词： periprosthetic fracture Less invasive stabilization system Plate fixation Intraprosthetic screw fixation Material science Biomechanical testing Axial load-to-failure

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Is two-stage reimplantation effective for virulent pathogenic infection in a periprosthetic hip? A retrospective analysis

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World Journal of Orthopedics 2015年第9期6卷 712-718页

作者： Yong-Cheol Yoon Devendra Lakhotia Jong-Keon Oh Jun Gyu Moon Kumar Prashant Won Yong Shon Orthopedic Trauma Division Gachon University Gil Hospital Department of Orthopedic Surgery Korea University College of MedicineGuro Hospital

AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years(range: 2.5-9 years). RESULTS: The causative pathogens were isolated from 29 patients(76%), 26 of whom were infected with highly virulent organisms. Sixteen patients(42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity(P < 0.001), a lower preoperative Harris hip score(HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection(P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7(20%), 12(34%), 11(32%)and 5(14%) patients receiving excellent, good, fair and poor ratings, respectively. CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients(i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level Ⅳ.

关键词： Two-stage reimplantation periprosthetic infection Antibiotic-loaded bone cement Debridement

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