Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2012 Musculoskeletal Infection Society 19 articles


Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection

Erik Hansen MD, Matthew Tetreault BS, Benjamin Zmistowski BS, Craig J. Della Valle MD, Javad Parvizi MD, Fares S. Haddad MD, William J. Hozack MD

Acute postoperative infection after total hip arthroplasty (THA) is typically treated with irrigation and débridement and exchange of the modular femoral head and acetabular liner. Given a rate of failure exceeding 50% in some series, a one-stage exchange has been suggested as a potential alternative because it allows more thorough débridement and removal of colonized implants. To date, most studies published on the one-stage exchange have used microbe-specific antibiotic-laden bone cement with only one small single-institution series that reported outcomes after a cementless one-stage exchange.

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Pouya Alijanipour MD, Hooman Bakhshi MD, Javad Parvizi MD, FRCS

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily.

Chitosan Sponges for Local Synergistic Infection Therapy: A Pilot Study

J. Keaton Smith MS, Abteen R. Moshref BS, Jessica A. Jennings PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

Although bacterial antibiotic resistance is increasing, fewer new antibiotics are being developed to compensate. Localized delivery of synergistic antiseptics and antibiotics with a chitosan sponge device may offer an alternative infection treatment.

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Vinay K. Aggarwal BS, Carlos Higuera MD, Gregory Deirmengian MD, Javad Parvizi MD, FRCS, Matthew S. Austin MD

While it is accepted accurate identification of infecting organisms is crucial in guiding treatment of periprosthetic joint infection (PJI), there remains no consensus regarding the best method for obtaining cultures.

Has the Rate of In-hospital Infections After Total Joint Arthroplasty Decreased?

Mohammad R. Rasouli MD, Mitchell Gil Maltenfort PhD, James J. Purtill MD, William J. Hozack MD, Javad Parvizi MD

Although infections are a major cause of morbidity and mortality after total joint arthroplasty (TJA), little is known about nationwide epidemiology and trends of infections after TJA.

A Daptomycin-Xylitol-loaded Polymethylmethacrylate Bone Cement: How Much Xylitol Should Be Used?

Ali Salehi MS, Ashley Cox Parker MS, Gladius Lewis PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

The rate of release of an antibiotic from an antibiotic-loaded polymethylmethacrylate (PMMA) bone cement is low. This may be increased by adding a particulate poragen (eg, xylitol) to the cement powder. However, the appropriate poragen amount is unclear.

Negative Pressure Wound Therapy Is Associated With Resolution of Incisional Drainage in Most Wounds After Hip Arthroplasty

Erik Hansen MD, Joel B. Durinka MD, James A. Costanzo MD, Matthew S. Austin MD, Gregory K. Deirmengian MD

Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty.

Medical Comorbidities Are Independent Preoperative Risk Factors for Surgical Infection After Total Joint Arthroplasty

Joshua S. Everhart BS, Eric Altneu MS, Jason H. Calhoun MD

Surgical site infection (SSI) after total joint arthroplasty (TJA) is a major cause of morbidity. Multiple patient comorbidities have been identified as SSI risk factors including obesity, tobacco use, diabetes, immunosuppression, malnutrition, and coagulopathy. However, the independent effect of multiple individual patient factors on risk of subsequent periprosthetic infection is unclear.

No Infection Reduction Using Chlorhexidine Wipes in Total Joint Arthroplasty

Nicholas J. Farber BS, Antonia F. Chen MD, MBA, Sarah M. Bartsch MPH, Jody L. Feigel MSN, RN, Brian A. Klatt MD

Surgical site infection (SSI) after total joint arthroplasty (TJA) is a rare but devastating complication. Various skin antiseptic applications are used preoperatively to prevent SSI. Recent literature suggests 2% chlorhexidine gluconate (CHG) wipes reduce microbial content at surgical sites, but it is unclear whether they reduce rates of SSI.

The Routine Use of Atypical Cultures in Presumed Aseptic Revisions Is Unnecessary

Anthony T. Tokarski BS, Joseph O’Neil MD, Carl A. Deirmengian MD, Joseph Ferguson BS, Gregory K. Deirmengian MD

In presumed aseptic hip and knee revisions, it is common practice to send intraoperative cultures to screen for occult infection. Currently no guidelines exist for the routine use of acid-fast bacillus (AFB) and fungal cultures in this setting.

Clostridium difficile Colitis in Patients Undergoing Lower-extremity Arthroplasty: Rare Infection With Major Impact

Mitchell Gil Maltenfort PhD, Mohammad R. Rasouli MD, Todd A. Morrison BS, Javad Parvizi MD, FRCS

The prevalence ofcolitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of theinfection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA).

Voriconazole Is Cytotoxic at Locally Delivered Concentrations: A Pilot Study

Kenneth Schmidt MD, Alex McLaren MD, Christine Pauken PhD, Ryan McLemore PhD

Fungal infections are rare but major problems when they involve orthopaedic implants. Preferred treatment in North America is two-staged: resection and then delayed reconstruction, with local delivery of an antifungal between stages. The effect of voriconazole, a hydrophobic antifungal, on local tissues and wound healing is unclear.

Staphylococcus aureus Colonization among Arthroplasty Patients Previously Treated by a Decolonization Protocol: A Pilot Study

Demetri M. Economedes DO, Gregory K. Deirmengian MD, Carl A. Deirmengian MD

Although testing and treatment forcolonization before total joint arthroplasty (TJA) are well described and understood, the durability of decolonization has not been studied extensively.

What is the Rate of Methicillin-resistant Staphylococcus aureus and Gram-negative Infections in Open Fractures?

Antonia F. Chen MD, MBA, Verena M. Schreiber MD, Wesley Washington, Nalini Rao MD, Andrew R. Evans MD

There have been increasing reports of methicillin-resistant(MRSA) infections in the community, but it is unclear whether infectious organisms in open fracture infections have changed and if our current regimen of antibiotic prophylaxis is therefore obsolete.

Cyanoacrylate Microbial Sealant May Reduce the Prevalence of Positive Cultures in Revision Shoulder Arthroplasty

Adam J. Lorenzetti MD, Montri D. Wongworawat MD, Christopher M. Jobe MD, Wesley P. Phipatanakul MD

Cyanoacrylate-based, microbial sealant is an adhesive skin barrier designed to prevent bacterial contamination in surgical wounds. This type of adhesive barrier could have use in decreasing the incidence of positive cultures and subsequent infection in shoulder arthroplasty.

Distribution of Locally Delivered Antimicrobials Is Limited by Cortical Bone: A Pilot Study

Ryan Odgers MD, Keith Jarbo MD, Alex McLaren MD, Ryan McLemore PhD

Local delivery is required to achieve the high antimicrobial concentrations needed to treat biofilm-forming infections. The delivery site is commonly either in the intramedullary canal or at the periosteal surface. It is unknown whether locally delivered antimicrobials are transported transcortically between the endosteal and periosteal surfaces when the infection involves the opposite surface.

Treatment Solutions Are Unclear for Perimegaprosthetic Infections

Lisa B. Ercolano MD, Tyson Christensen BS, Richard McGough MD, Kurt Weiss MD

Infection about a megaprosthesis is a dreaded complication. Treatment options vary from débridement alone to staged revisions, arthrodesis, and amputation. Indications for how to treat this complication are unclear.