Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 116 articles

Articles

Racial Disparities in Above-knee Amputations After TKA: A National Database Study

Jaiben George MBBS, Suparna M. Navale MS, MPH, Nicholas K. Schiltz PhD, Miguel Siccha MD, Alison K. Klika MS, Carlos A. Higuera MD

Above-knee amputation (AKA) is a rare but devastating complication of TKA. Although racial disparities have been previously reported in the utilization of TKA, it is unclear whether disparities exist in the rates of AKA after TKA.

False-positive Cultures After Native Knee Aspiration: True or False

Jason M. Jennings MD, DPT, Douglas A. Dennis MD, Raymond H. Kim MD, Todd M. Miner MD, Charlie C. Yang MD, David C. McNabb MD

Synovial fluid aspiration is a routine practice used by most orthopaedic surgeons to aid in the diagnosis of joint infection. In patients for whom there is a low pretest probability of infection, a positive culture—particularly if it is a broth-only culture—may be considered a contaminant, especially if the bacterial species are skin pathogens. To our knowledge no study has evaluated the incidence of contamination of aspirations from the native knee.

What is the Intraarticular Concentration of Tobramycin Using Low-dose Tobramycin Bone Cement in TKA: An In Vivo Analysis?

Gregory Vrabec MD, FRCS, Willis Stevenson MD, Sameh Elguizaoui MD, Matthew Kirsch MD, John Pinkowski MD

Antibiotic-impregnated bone cement has increased in popularity as an effort to reduce the risk of infection in high-risk TKAs. However, limited data has been reported regarding antibiotic levels achieved when using tobramycin-impregnated bone cement after implanting total knee components.

The Alpha-defensin Test for Periprosthetic Joint Infections Is Not Affected by Prior Antibiotic Administration

Alisina Shahi MD, Javad Parvizi MD, FRCS, Gregory S. Kazarian AB, Carlos Higuera MD, Salvatore Frangiamore MD, Joshua Bingham MD, Christopher Beauchamp MD, Craig Della Valle MD, Carl Deirmengian MD

Previous studies have demonstrated that the administration of antibiotics to patients before performing diagnostic testing for periprosthetic joint infection (PJI) can interfere with the accuracy of test results. Although a single-institution study has suggested that alpha-defensin maintains its concentration and sensitivity even after antibiotic treatment, this has not yet been demonstrated in a larger multiinstitutional study.

The ACS NSQIP Risk Calculator Is a Fair Predictor of Acute Periprosthetic Joint Infection

Nathaniel C. Wingert MD, James Gotoff BA, Edgardo Parrilla BA, BS, Robert Gotoff MD, Laura Hou MSc, Elie Ghanem MD

Periprosthetic joint infection (PJI) is a severe complication from the patient’s perspective and an expensive one in a value-driven healthcare model. Risk stratification can help identify those patients who may have risk factors for complications that can be mitigated in advance of elective surgery. Although numerous surgical risk calculators have been created, their accuracy in predicting outcomes, specifically PJI, has not been tested.

Cathodic Voltage-controlled Electrical Stimulation Plus Prolonged Vancomycin Reduce Bacterial Burden of a Titanium Implant-associated Infection in a Rodent Model

Scott R. Nodzo MD, Menachem Tobias MS, Richard Ahn MD, Lisa Hansen MS, Nicole R. Luke-Marshall PhD, Craig Howard BS, Linda Wild MD, Anthony A. Campagnari PhD, Mark T. Ehrensberger PhD

Cathodic voltage-controlled electrical stimulation (CVCES) of titanium implants, either alone or combined with a short course of vancomycin, has previously been shown to reduce the bone and implant bacterial burden in a rodent model of methicillin-resistant(MRSA) implant-associated infection (IAI). Clinically, the goal is to achieve complete eradication of the IAI; therefore, the rationale for the present study was to evaluate the antimicrobial effects of combining CVCES with prolonged antibiotic therapy with the goal of decreasing the colony-forming units (CFUs) to undetectable levels.

Biofilm Antimicrobial Susceptibility Increases With Antimicrobial Exposure Time

Paulo Castaneda BSE, Alex McLaren MD, Gamuchirai Tavaziva, Derek Overstreet PhD

The antimicrobial concentration required to kill all the bacteria in a biofilm, known as the minimum biofilm eradication concentration (MBEC), is typically determined in vitro by exposing the biofilm to serial concentrations of antimicrobials for 24 hours or less. Local delivery is expected to cause high local levels for longer than 24 hours. It is unknown if longer antimicrobial exposures require the same concentration to eradicate bacteria in biofilm. Questions/purposes Does MBEC change with increased antimicrobial exposure time?

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

Jaiben George MBBS, Grzegorz Kwiecien MD, Alison K. Klika MS, Deepak Ramanathan MBBS, Thomas W. Bauer MD, PhD, Wael K. Barsoum MD, Carlos A. Higuera MD

Frozen section histology is widely used to aid in the diagnosis of periprosthetic joint infection at the second stage of revision arthroplasty, although there are limited data regarding its utility. Moreover, there is no definitive method to assess control of infection at the time of reimplantation. Because failure of a two-stage revision can have serious consequences, it is important to identify the cases that might fail and defer reimplantation if necessary. Thus, a reliable test providing information about the control of infection and risk of subsequent failure is necessary.

Is Vancomycin-only Prophylaxis for Patients With Penicillin Allergy Associated With Increased Risk of Infection After Arthroplasty?

Timothy L. Tan MD, Bryan D. Springer MD, John A. Ruder MD, Michael R. Ruffolo MD, Antonia F. Chen MD, MBA

Preoperative antibiotic prophylaxis remains one of the most important strategies for prevention of postoperative infection. In patients with penicillin allergy, alternative medications such as vancomycin are often used despite reduced antimicrobial coverage and recent literature questioning the efficacy of vancomycin monotherapy.

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

Klemen Bedenčič MD, Martina Kavčič MD, Nataša Faganeli MD, Rene Mihalič MD, Blaž Mavčič MD, PhD, Jožica Dolenc PhD, Zlatka Bajc PhD, Rihard Trebše MD, PhD

Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions.