Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Infection 113 articles

Articles

Sonication of Antibiotic Spacers Predicts Failure during Two-stage Revision for Prosthetic Knee and Hip Infections

Charles L. Nelson MD, Robert B. Jones MD, Nathaniel C. Wingert MD, Michael Foltzer MD, Thomas R. Bowen MD

Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures.

Does Implant Coating With Antibacterial-Loaded Hydrogel Reduce Bacterial Colonization and Biofilm Formation in Vitro?

Lorenzo Drago PhD, Willemijn Boot MSc, Kostantinos Dimas PhD, Kostantinos Malizos PhD, Gertrud M. Hänsch PhD, Jos Stuyck PhD, Debby Gawlitta PhD, Carlo L. Romanò MD

Implant-related infections represent one of the most severe complications in orthopaedics. A fast-resorbable, antibacterial-loaded hydrogel may reduce or prevent bacterial colonization and biofilm formation of implanted biomaterials.

Biofilm Growth Has a Threshold Response to Glucose in Vitro

Robert Waldrop MD, Alex McLaren MD, Francis Calara BSE, Ryan McLemore PhD

Hyperglycemia is a risk factor for nosocomial infections with known host effects. Increased glucose levels also increase pathogenicity of infecting microbes through greater biofilm formation. The dose response of biofilm formation to glucose concentration is not known.

Performance Characteristics of Broth-only Cultures After Revision Total Joint Arthroplasty

Eric B. Smith MD, Jenny Cai BS, Rachael Wynne RN, Mitchell Maltenfort PhD, Robert P. Good MD

Surgeons frequently obtain intraoperative cultures at the time of revision total joint arthroplasty. The use of broth or liquid medium before applying the sample to the agar medium may be associated with contamination and false-positive cultures; however, the degree to which this is the case is not known.

Antimicrobial Distribution From Local Delivery Depends on Dose

Alex McLaren MD, Morgan B. Giers PhD, James Fraser MD, MPH, Luke Hosack MD, Michael R. Caplan PhD, Ryan McLemore PhD

Tissue distribution after local delivery has been quantified over a period of 5 hours on 7-T MRI in a rabbit model using gadolinium-labeled diethylenetriamine pentaacetic acid (Gd-DTPA) as an antimicrobial surrogate; however, it is unknown how the Gd-DTPA load in a local depot will affect the duration of high-concentration Gd-DTPA in local tissues after surgical débridement.

Diagnosis of Periprosthetic Joint Infection in Medicare Patients: Multicriteria Decision Analysis

Claudio Diaz-Ledezma MD, Paul M. Lichstein MD, MS, James G. Dolan MD, Javad Parvizi MD, FRCS

In the setting of finite healthcare resources, developing cost-efficient strategies for periprosthetic joint infection (PJI) diagnosis is paramount. The current levels of knowledge allow for PJI diagnostic recommendations based on scientific evidence but do not consider the benefits, opportunities, costs, and risks of the different diagnostic alternatives.

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

Pablo S. Corona MD, Victor Barro MD, Marye Mendez MD, Enric Cáceres PhD, Xavier Flores MD

Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known.

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

María Eugenia Portillo MD, PhD, Margarita Salvadó MD, PhD, Albert Alier MD, Lluisa Sorli MD, Santos Martínez MD, Juan Pablo Horcajada MD, PhD, Lluis Puig MD, PhD

The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI).

Are Cementless Stems More Durable Than Cemented Stems in Two-stage Revisions of Infected Total Knee Arthroplasties?

Paul K. Edwards MD, Thomas K. Fehring MD, William G. Hamilton MD, Brett Perricelli MD, Walter B. Beaver MD, Susan M. Odum PhD

The routine use of stems in revision TKA improves survival rates by enhancing the stability of the prosthesis. The ideal method of stem fixation (cemented or uncemented) in two-stage reimplantation remains controversial.

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Pouya Alijanipour MD, Hooman Bakhshi MD, Javad Parvizi MD, FRCS

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily.