Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2013 Musculoskeletal Infection Society 9 articles

Articles

Systemic Inflammatory Markers and Aspiration Cell Count May Not Differentiate Bacterial From Fungal Prosthetic Infections

Colten D. Bracken BS, Elie F. Berbari MD, Arlen D. Hanssen MD, Tad M. Mabry MD, Douglas R. Osmon MD, Rafael J. Sierra MD

Fungal periprosthetic joint infections (PJIs) are rare. Fewer than 200 cases have been reported in the literature. The characteristics of systemic inflammatory markers and joint aspirate cell count analysis obtained in patients with fungal PJIs have not been fully assessed. The ability to diagnose involvement of fungal PJI preoperatively may optimize the surgical and medical management of these patients.

Does Implant Coating With Antibacterial-Loaded Hydrogel Reduce Bacterial Colonization and Biofilm Formation in Vitro?

Lorenzo Drago PhD, Willemijn Boot MSc, Kostantinos Dimas PhD, Kostantinos Malizos PhD, Gertrud M. Hänsch PhD, Jos Stuyck PhD, Debby Gawlitta PhD, Carlo L. Romanò MD

Implant-related infections represent one of the most severe complications in orthopaedics. A fast-resorbable, antibacterial-loaded hydrogel may reduce or prevent bacterial colonization and biofilm formation of implanted biomaterials.

Diagnosing Periprosthetic Joint Infection: Has the Era of the Biomarker Arrived?

Carl Deirmengian MD, Keith Kardos PhD, Patrick Kilmartin, Alexander Cameron, Kevin Schiller, Javad Parvizi MD

The diagnosis of periprosthetic joint infection (PJI) remains a serious clinical challenge. There is a pressing need for improved diagnostic testing methods; biomarkers offer one potentially promising approach.

Biofilm Growth Has a Threshold Response to Glucose in Vitro

Robert Waldrop MD, Alex McLaren MD, Francis Calara BSE, Ryan McLemore PhD

Hyperglycemia is a risk factor for nosocomial infections with known host effects. Increased glucose levels also increase pathogenicity of infecting microbes through greater biofilm formation. The dose response of biofilm formation to glucose concentration is not known.

Performance Characteristics of Broth-only Cultures After Revision Total Joint Arthroplasty

Eric B. Smith MD, Jenny Cai BS, Rachael Wynne RN, Mitchell Maltenfort PhD, Robert P. Good MD

Surgeons frequently obtain intraoperative cultures at the time of revision total joint arthroplasty. The use of broth or liquid medium before applying the sample to the agar medium may be associated with contamination and false-positive cultures; however, the degree to which this is the case is not known.

Antimicrobial Distribution From Local Delivery Depends on Dose

Alex McLaren MD, Morgan B. Giers PhD, James Fraser MD, MPH, Luke Hosack MD, Michael R. Caplan PhD, Ryan McLemore PhD

Tissue distribution after local delivery has been quantified over a period of 5 hours on 7-T MRI in a rabbit model using gadolinium-labeled diethylenetriamine pentaacetic acid (Gd-DTPA) as an antimicrobial surrogate; however, it is unknown how the Gd-DTPA load in a local depot will affect the duration of high-concentration Gd-DTPA in local tissues after surgical débridement.

Diagnosis of Periprosthetic Joint Infection in Medicare Patients: Multicriteria Decision Analysis

Claudio Diaz-Ledezma MD, Paul M. Lichstein MD, MS, James G. Dolan MD, Javad Parvizi MD, FRCS

In the setting of finite healthcare resources, developing cost-efficient strategies for periprosthetic joint infection (PJI) diagnosis is paramount. The current levels of knowledge allow for PJI diagnostic recommendations based on scientific evidence but do not consider the benefits, opportunities, costs, and risks of the different diagnostic alternatives.

Arthrodesis Should Be Strongly Considered After Failed Two-stage Reimplantation TKA

Chia H. Wu MD, MBA, Chancellor F. Gray MD, Gwo-Chin Lee MD

A two-stage reimplantation procedure is a well-accepted procedure for management of first-time infected total knee arthroplasty (TKA). However, there is a lack of consensus on the treatment of subsequent reinfections.