Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 119 articles


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.

d -amino Acid Inhibits Biofilm but not New Bone Formation in an Ovine Model

Andrew J. Harmata PhD, Yun Ma PhD, Carlos J. Sanchez PhD, Katarzyna J. Zienkiewicz MS, Florent Elefteriou PhD, Joseph C. Wenke PhD, Scott A. Guelcher PhD

Infectious complications of musculoskeletal trauma are an important factor contributing to patient morbidity. Biofilm-dispersive bone grafts augmented with-amino acids (-AAs) prevent biofilm formation in vitro and in vivo, but the effects of-AAs on osteocompatibility and new bone formation have not been investigated.

Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA

Simon W. Young FRACS, Tim Roberts MBChB, Sarah Johnson BSc, James P. Dalton PhD, Brendan Coleman FRACS, Siouxsie Wiles PhD

In human TKA studies, intraosseous regional administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic administration. However, it is unclear if such high concentrations provide more effective prophylaxis.

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Paul Lichstein MD, MS, Sharlene Su BS, Hakan Hedlund MD, PhD, Gina Suh MD, William J. Maloney MD, Stuart B. Goodman MD, PhD, James I. Huddleston MD

Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication.

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

Akos Zahar MD, Daniel O. Kendoff MD, PhD, Till O. Klatte MD, Thorsten A. Gehrke MD

Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted.

A Diagnostic Serum Antibody Test for Patients With Staphylococcus aureus Osteomyelitis

Kohei Nishitani MD, PhD, Christopher A. Beck PhD, Alexander F. Rosenberg PhD, Stephen L. Kates MD, Edward M. Schwarz PhD, John L. Daiss PhD

Because immunity againsthas not been fully elucidated, there is no diagnostic test to gauge how robust a patient’s host response is likely to be. Therefore, we aimed to develop a test for specific antibodies in serum with diagnostic and prognostic potential.

Can Normal Fracture Healing Be Achieved When the Implant Is Retained on the Basis of Infection? An Experimental Animal Model

Fuat Bilgili MD, Halil Ibrahim Balci MD, Kayahan Karaytug MD, Kerim Sariyilmaz MD, Ata Can Atalar MD, Ergun Bozdag PhD, Meral Tuna PhD, Bilge Bilgic MD, Nezahat Gurler MD

Infection after open fractures is a common complication. Treatment options for infections developed after intramedullary nailing surgery remain a topic of controversy. We therefore used a rat fracture model to evaluate the effects of infection on osseous union when the implant was maintained.

Cathodic Electrical Stimulation Combined With Vancomycin Enhances Treatment of Methicillin-resistant Staphylococcus aureus Implant-associated Infections

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

Effective treatments for implant-associated infections are often lacking. Cathodic voltage-controlled electrical stimulation has shown potential as a treatment of implant-associated infections of methicillin-resistant(MRSA).