Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Papers Presented at the 2010 Meeting of the Musculoskeletal Infection Society 11 articles

Articles

New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

Javad Parvizi MD, Benjamin Zmistowski BS, Elie F. Berbari MD, Thomas W. Bauer MD, PhD, Bryan D. Springer MD, Craig J. Della Valle MD, Kevin L. Garvin MD, Michael A. Mont MD, Montri D. Wongworawat MD, Charalampos G. Zalavras MD

Two-stage Exchange Arthroplasty for Infected Total Knee Arthroplasty: Predictors of Failure

S. M. Javad Mortazavi MD, David Vegari MD, Anthony Ho BA, Benjamin Zmistowski BS, Javad Parvizi MD, FRCS

In North America, a two-stage exchange arthroplasty remains the preferred surgical treatment for chronic periprosthetic joint infection (PJI). Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage exchange or the appropriate conditions in which to reimplant.

Definition of Periprosthetic Joint Infection: Is There a Consensus?

Javad Parvizi MD, FRCS, Christina Jacovides BS, Benjamin Zmistowski BS, Kwang Am Jung MD

The diagnosis of periprosthetic joint infection (PJI) continues to pose a challenge. While many diagnostic criteria have been proposed, a gold standard for diagnosis is lacking. Use of multiple diagnostic criteria within the joint arthroplasty community raises concerns in patient treatment and comparison of research pertaining to PJI.

Surfactant-stabilized Emulsion Increases Gentamicin Elution From Bone Cement

Ryan B. Miller MD, Alex C. McLaren MD, Christine M. Leon MS, Brent L. Vernon PhD, Ryan McLemore PhD

Liquid antimicrobial use for antimicrobial-loaded bone cement is limited because of decreased strength and small volume that can be loaded. Emulsifying the liquid antimicrobial into the monomer may address both issues.

Amphotericin B Delivery From Bone Cement Increases With Porosity but Strength Decreases

Chris Kweon MD, Alex C. McLaren MD, Christine Leon MS, Ryan McLemore PhD

Amphotericin B is a highly hydrophobic antifungal used for orthopaedic infections. There is disagreement about whether amphotericin B is released when it is loaded in polymethylmethacrylate (PMMA). It is unknown how much a poragen will increase amphotericin B release or decrease the compressive strength of the PMMA.

Evaluation of Two Sources of Calcium Sulfate for a Local Drug Delivery System: A Pilot Study

Ashley C. Parker BS, J. Keaton Smith MS, Harry S. Courtney PhD, Warren O. Haggard PhD

Local drug delivery has substantial potential to prevent infections compared with systemic delivery. Although calcium sulfate (CaSO) has been studied for local drug delivery and two types are commercially available, it is unknown whether they differentially release antibiotics.

Infection Control Rate of Irrigation and Débridement for Periprosthetic Joint Infection

Loukas Koyonos MD, Benjamin Zmistowski BS, Craig J. Della Valle MD, Javad Parvizi MD, FRCS

Irrigation and débridement with retention of prosthesis is commonly performed for periprosthetic joint infection. Infection control is reportedly dependent on timing of irrigation and débridement relative to the index procedure.

An Articulating Antibiotic Spacer Controls Infection and Improves Pain and Function in a Degenerative Septic Hip

Erin E. Fleck MD, Mark J. Spangehl MD, Venkat R. Rapuri MD, FRCS, Christopher P. Beauchamp MD

Treating septic arthritis of the hip with coexisting advanced degenerative disease is challenging. The use of primary total hip arthroplasty (THA) has led to postoperative infection rates as high as 22%. Insertion of antibiotic spacers with subsequent reimplantation of a THA controls infection and improves pain and function in patients with periprosthetic infections.

Amphotericin B Is Cytotoxic at Locally Delivered Concentrations

Samuel Harmsen MD, Alex C. McLaren MD, Christine Pauken PhD, Ryan McLemore PhD

Orthopaedic fungal infections are commonly treated with systemic amphotericin, which has a narrow therapeutic index and is associated with systemic toxicities. Local delivery of amphotericin has been described yet is poorly understood. As with bacterial infections, fungal infections are associated with biofilm. However, it is unclear whether experience with local delivery of antibacterials can be applied to local antifungal delivery.

Leukocytosis Is Common After Total Hip and Knee Arthroplasty

Gregory K. Deirmengian MD, Benjamin Zmistowski BS, Christina Jacovides BS, Joseph O’Neil BA, Javad Parvizi MD, FRCS

Postoperative infection is a potentially devastating complication after THA and TKA. In the early postoperative period, clinicians often find nonspecific indicators of infection. Although leukocytosis may be a sign of a developing infection in the early postoperative period, it may also be part of a normal surgical response.