Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 116 articles

Articles

Antimicrobial Release From Prefabricated Spacers Is Variable and the Dose Is Low

Oren Goltzer MD, Alex McLaren MD, Derek Overstreet PhD, Christopher Galli BS, Ryan McLemore PhD

High-dose antimicrobial-loaded bone cement (ALBC) is recommended to treat orthopaedic infections. Elution characteristics from prefabricated ALBC spacers and how they compare with hand-mixed ALBC are not well described.

The Alpha-defensin Test for Periprosthetic Joint Infection Responds to a Wide Spectrum of Organisms

Carl Deirmengian MD, Keith Kardos PhD, Patrick Kilmartin MS, Simmi Gulati MS, Patrick Citrano BS, Robert E. Booth MD

The alpha-defensin test has been previously demonstrated to be highly accurate in the diagnosis of prosthetic joint infection (PJI), nearly matching the Musculoskeletal Infection Society definition for PJI. However, the relationship between alpha-defensin levels and differing infecting organism has not yet been investigated.

Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection

Alisina Shahi MD, Carl Deirmengian MD, Carlos Higuera MD, Antonia Chen MD, MBA, Camilo Restrepo MD, Benjamin Zmistowski MD, Javad Parvizi MD

In the absence of positive cultures and draining sinuses, the diagnosis of periprosthetic joint infection (PJI) relies on laboratory values. It is unknown if administration of antibiotics within 2 weeks before diagnostic evaluations can affect these tests in patients with PJI.

Novel Antibiotic-loaded Point-of-care Implant Coating Inhibits Biofilm

Jessica Amber Jennings PhD, Daniel P. Carpenter BS, Karen S. Troxel PhD, Karen E. Beenken PhD, Mark S. Smeltzer PhD, Harry S. Courtney PhD, Warren O. Haggard PhD

Orthopaedic biomaterials are susceptible to biofilm formation. A novel lipid-based material has been developed that may be loaded with antibiotics and applied as an implant coating at point of care. However, this material has not been evaluated for antibiotic elution, biofilm inhibition, or in vivo efficacy.

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

James F. Fraser MD, MPH, Simon W. Young FRACS, Kimberly A. Valentine RN, Nicholas E. Probst PA-C, Mark J. Spangehl MD

The original Charnley-type negative-pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty (TJA) decades ago. However, modern positive-pressure surgical helmet systems have not shown similar benefit, and several recent studies have raised the question of whether these gowning systems result in increased wound contamination and infections. The gown-glove interface may be one source of particle contamination.

Addition of Vancomycin to Cefazolin Prophylaxis Is Associated With Acute Kidney Injury After Primary Joint Arthroplasty

P. Maxwell Courtney MD, Christopher M. Melnic MD, Zachary Zimmer MD, Jason Anari MD, Gwo-Chin Lee MD

With increasing prevalence of methicillin-resistant(MRSA) in patients undergoing hip and knee arthroplasty, some have advocated a dual-antibiotic regimen including vancomycin as prophylaxis against surgical site infections. However, routine administration of vancomycin may result in impaired renal functions in susceptible patients.

Local Gentamicin Delivery From Resorbable Viscous Hydrogels Is Therapeutically Effective

Derek Overstreet PhD, Alex McLaren MD, Francis Calara BSE, Brent Vernon PhD, Ryan McLemore PhD

Local delivery can achieve the high antimicrobial concentrations necessary to kill biofilm-related microbes. Degradation times for resorbable carriers are too long. Hydrogels (gels of hydrophilic polymer in water) can degrade faster but release antimicrobials too quickly. We previously developed hydrogels based on the copolymer poly(N-isopropylacrylamide-co-dimethyl-γ-butyrolactone acrylate-co-JeffamineM-1000 acrylamide) (PNDJ) with delivery times of several days with complete degradation in less than 6 weeks.

Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?

Paul H. Yi BA, Michael B. Cross MD, Mario Moric MS, Brett R. Levine MD, MS, Scott M. Sporer MD, Wayne G. Paprosky MD, Joshua J. Jacobs MD, Craig J. Della Valle MD

The diagnosis of periprosthetic joint infection (PJI) in patients with failed metal-on-metal (MoM) bearings and corrosion reactions in hip arthroplasties can be particularly difficult, because the clinical presentation of adverse local tissue reactions may mimic that of PJI, because it can also occur concurrently with PJI, and because common laboratory tests used to diagnose PJI may be elevated in patients with MoM THAs.

The Alpha Defensin-1 Biomarker Assay can be Used to Evaluate the Potentially Infected Total Joint Arthroplasty

Joshua Bingham MD, Henry Clarke MD, Mark Spangehl MD, Adam Schwartz MD, Christopher Beauchamp MD, Brynn Goldberg RN

Diagnosing a periprosthetic joint infection (PJI) requires a complex approach using various laboratory and clinical criteria. A novel approach to diagnosing these infections uses synovial fluid biomarkers. Alpha defensin-1 (AD-1) is one such synovial-fluid biomarker. However little is known about the performance of the AD-1 assay in the diagnosis of PJI.

Is Synovial C-reactive Protein a Useful Marker for Periprosthetic Joint Infection?

Matthew W. Tetreault MD, Nathan G. Wetters MD, Mario Moric MS, Christopher E. Gross MD, Craig J. Della Valle MD

Serum C-reactive protein (CRP) is a general marker of inflammation, and recent studies suggest that measurement of CRP in synovial fluid may be a more accurate method for diagnosing periprosthetic joint infection (PJI).