Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 119 articles


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.

Molecular Techniques to Detect Biofilm Bacteria in Long Bone Nonunion: A Case Report

Michael Palmer MD, William Costerton PhD, Jeffrey Sewecke DO, Daniel Altman MD

Biofilms cause chronic infections including those associated with orthopaedic hardware. The only methods that are Food and Drug Administration-approved for detecting and identifying bacterial infections are cultures and selected DNA-based polymerase chain reaction methods that detect only specific pathogens (eg, methicillin-resistant Staphylococcus aureus). New DNA-based technologies enable the detection and identification of all bacteria present in a sample and to determine the antibiotic sensitivities of the organisms.

Propionobacter acnes Infection as an Occult Cause of Postoperative Shoulder Pain: A Case Series

Peter J. Millett MD, MSc, Yi-Meng Yen MD, PhD, Connie S. Price MD, Marilee P. Horan MPH, Olivier A. Meijden MD, Florian Elser MD

Infections after shoulder surgery are potentially devastating complications. Propionibacterium acnes is recognized as a causal agent in shoulder infections. The clinical presentation is usually insidious and nonspecific, but a P. acnes infection could be an occult cause of postoperative shoulder pain.

Infirmity and Injury Complexity are Risk Factors for Surgical-site Infection after Operative Fracture Care

Abdo Bachoura MD, Thierry G. Guitton MSc, R. Malcolm Smith MD, Mark S. Vrahas MD, David Zurakowski PhD, David Ring MD, PhD

Orthopaedic surgical-site infections prolong hospital stays, double rehospitalization rates, and increase healthcare costs. Additionally, patients with orthopaedic surgical-site infections (SSI) have substantially greater physical limitations and reductions in their health-related quality of life. However, the risk factors for SSI after operative fracture care are unclear.

Current Concepts for Clean Air and Total Joint Arthroplasty: Laminar Airflow and Ultraviolet Radiation: A Systematic Review

Richard P. Evans MD

With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic joint infection (PJI), orthopaedic surgeons must reconsider all potential infection control measures. Both airborne and nonairborne bacterial contamination must be reduced in the operating room.

Can Implant Retention be Recommended for Treatment of Infected TKA?

Ho-Rim Choi MD, Fabian Knoch MD, David Zurakowski PhD, Sandra B. Nelson MD, Henrik Malchau MD, PhD

Retention treatment is reportedly associated with lower infection control rates than two-stage revision. However, the studies on which this presumption are based depend on comparisons of historical rather than concurrent controls.

Structural Allograft as an Option for Treating Infected Hip Arthroplasty with Massive Bone Loss

Paul T. H. Lee MB BCh, MA, FRCS (Eng), FRCS (Tr & Orth), Robert A. Clayton MBBS, FRCS (Edin), FRCS (Tr & Orth), Oleg A. Safir MD, FRCSC, MEd, David J. Backstein MD, FRCSC, MEd, Allan E. Gross MD, FRCSC, OOnt

Revision of the infected hip arthroplasty with major bone loss is difficult. Attempts to restore bone stock with structural allograft are controversial.

Intraoperative Molds to Create an Articulating Spacer for the Infected Knee Arthroplasty

Geoffrey S. Thiel MD, MBA, Keith R. Berend MD, Gregg R. Klein MD, Alexander C. Gordon MD, Adolph V. Lombardi MD, Craig J. Della Valle MD

Chronic infections in TKA have been traditionally treated with a two-stage protocol incorporating a temporary antibiotic-loaded cement spacer. The use of a static as opposed to an articulating spacer is controversial. Some surgeons believe a static spacer results in a higher rate of infection eradication, whereas others believe an articulating spacer provides equivalent rates of infection control with improved function between stages and the potential for better eventual range of motion.

Increased Antibiotic Release from a Bone Cement Containing Bacterial Cellulose

Ryuji Mori MD, Takahisa Nakai PhD, Koichi Enomoto PhD, Yuji Uchio MD, Katsumi Yoshino PhD

Major disadvantages of antibiotic bone cements include limited drug release and reduced strength resulting from the addition of high doses of antibiotics. Bacterial cellulose, a three-dimensional hydrophilic mesh, may retain antibiotics and release them gradually. We hypothesized that the addition of cellulose to antibiotic bone cement would improve mechanical strength and antibiotic release.