Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 113 articles


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.

What is the Role of Serological Testing Between Stages of Two-stage Reconstruction of the Infected Prosthetic Knee?

Sharat K. Kusuma MD, MBA, Joseph Ward BA, Marc Jacofsky PhD, Scott M. Sporer MD, Craig J. Della Valle MD

Two-stage exchange arthroplasty is the gold standard for treatment of infected TKA. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count with differential are often used to determine treatment response; however, it is unclear whether these tests can answer the critical question of whether joint sepsis has been controlled between stages and if reimplantation is indicated.

Diagnosing Periprosthetic Infection: False-positive Intraoperative Gram Stains

Margret Oethinger MD, PhD, Debra K. Warner MT(ASCP), Susan A. Schindler MT(ASCP), Hideo Kobayashi MD, PhD, Thomas W. Bauer MD, PhD

Intraoperative Gram stains have a reported low sensitivity but high specificity when used to help diagnose periprosthetic infections. In early 2008, we recognized an unexpectedly high frequency of apparent false-positive Gram stains from revision arthroplasties.

Durable Infection Control and Function With the PROSTALAC Spacer in Two-stage Revision for Infected Knee Arthroplasty

Christopher R. Gooding BSc, MD, FRCS (Tr & Orth), Bassam A. Masri MD, FRCSC, Clive P. Duncan MD, MSc, FRCSC, Nelson V. Greidanus MD, MPH, FRCSC, Donald S. Garbuz MD, MHSc, FRCSC

A two-stage revision total knee arthroplasty is recognized as the gold standard in the treatment of infection. However, traditional spacers limit function in the interval between the two stages and may cause instability, scarring, and bone erosion. The PROSTALAC knee spacer is an antibiotic-loaded cement articulating spacer that allows some movement of the knee between stages. Whether motion enhances long-term function is unknown.

Functional Ability After Above-the-knee Amputation for Infected Total Knee Arthroplasty

Catherine J. Fedorka MD, Antonia F. Chen MD, William M. McGarry BS, Javad Parvizi MD, FRCS, Brian A. Klatt MD

Prosthetic joint infection is an uncommon but serious complication of total knee arthroplasty (TKA). Control of infection after TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA).

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Stefan Collinet-Adler MD, Carlos A. Castro MD, Charles Gerald T. Ledonio MD, Joan E. Bechtold PhD, Dean T. Tsukayama MD

Multidrug resistant Acinetobacter baumannii (MDR AB) with and without Staphylococcus aureus (SA) is a commonly isolated organism in infected segmental bone defects in combat-related trauma in Iraq and Afghanistan. Although MDR AB in visceral infections is a therapeutic challenge, control of infection appears more common for combat-related osteomyelitis.

Articulating Spacers Used in Two-stage Revision of Infected Hip and Knee Prostheses Abrade with Time

Bernd Fink MD, Annett Rechtenbach PhD, Hubert B├╝chner PhD, Sebastian Vogt PhD, Michael Hahn PhD

Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis.