Periprosthetic Hip Infection Research Articles

The potential utility of phage therapy in the treatment of periprosthetic infection caused by multidrug-resistant pathogens: a review

Background. One of the main and most costly problems in large joint arthroplasty associated with socially significant losses is periprosthetic infection. Of particular importance is periprosthetic joint infection (PJI) caused by antibiotic-resistant pathogens and followed by the worst treatment results. Currently, when antibiotic-resistant pathogens are spreading rapidly, particularly in health facilities, researchers are constantly looking for alternative treatments for severe cases of PJI. Phage therapy can be one of these methods. The aim of the review was to analyse the application of personalized bacteriophages in the management of periprosthetic infection caused by multidrug-resistant pathogens during arthroplasty of large joints of the lower extremities. Methods. A 20-year literature search (2003-2023) was performed in the eLIBRARY, PubMed, Google Scholar, and Scopus electronic databases. Results. During the search, 1.482 publications meeting the objectives of this review were found. Taking into account the inclusion/non-inclusion criteria adopted by the authors, the review included 12 studies describing 45 cases of the use of bacteriophages in the management of hip and knee PJI caused by multidrug-resistant pathogens. The infection was eradicated without recurrence in 42 cases (89.4%), recurrence was recorded only in 5 cases (10.6%). Conclusions. The analysis of the literature confirms that a combination therapy of personalized phages and antibiotics as adjuvant therapy is safe and effective. Bacteriophage treatment is a promising direction in the fight against resistant pathogens of periprosthetic infection. Its combination with antibiotics seems to be the most promising, as it can significantly increase the effectiveness of therapy for infections caused by multidrug-resistant pathogens due to the synergy of these drug classes.

Cutibacterium acnes periprosthetic joint infections.

Cutibacterium acnes (C. acnes; previously known as Propionibacterium acnes or P. acnes) periprosthetic hip and knee infections are under-reported. While culture contamination with C. acnes occurs, true infections are important to recognize and treat. We sought to describe the demographics and treatment outcomes of patients with C. acnes periprosthetic joint infections (PJIs) of the hip and knee. Patients with C. acnes PJI between January 2005 and December 2018 were retrospectively reviewed utilizing the institutional total joint registry. Patients with monomicrobial PJI and two or more positive cultures were considered to have true C. acnes PJI. Patients with polymicrobial infection or with only one positive culture were excluded. This resulted in 35 PJIs (21 hips and 14 knees); the patients' mean age was 63 years (35 to 84) and 15 (43%) were female. Mean follow-up was five years (1 to 14). The median time to positive culture was five days (IQR 5 to 6) and median synovial fluid cell count was 22,583 cells (IQR 15,200 to 53,231). The median ESR was 25 mm/hr (IQR 7 to 37), and CRP was 15 mg/l (IQR 3 to 29). Of the 35 PJIs, 18 (51%) were treated with chronic antibiotic suppression without surgical intervention, and the remainder were treated with two-stage exchange arthroplasty. The two-year survival free of any revision was 94%. Four patients failed treatment due to symptomatic infection, with three treated with two-stage exchange and one treated with irrigation and debridement with modular component exchange for a survival rate of 89% and 83% at two and five years, respectively. Laboratory evidence of C. acnes PJI in this cohort was typical compared to more conventional organisms. Cultures grew more quickly than previously thought in patients with C. acnes PJI. Treatment with two-stage exchange or chronic antibiotic suppression alone both had few treatment failures at mid-term follow-up.

Efficacy of the preformulated irrigation solution Bactisure® in acute periprosthetic joint infection debridement surgery: study protocol for a randomized controlled trial

BackgroundDespite significant progress in orthopaedic surgery, the prevalence of periprosthetic joint infections (PJIs) remains persistent, and future increases are expected due to the increasing number of joint arthroplasties. PJIs are intricately connected to biofilm-producing bacteria, which encase infected prostheses, impairing the effectiveness of antibiotics and the immune system. Acute PJIs with immature biofilms are traditionally managed with debridement, antibiotics, and implant retention (DAIR). However, to date, there has not been a conclusive direct clinical comparison (in vivo) demonstrating the superiority of one irrigation solution over others. Recently, there has been a growing interest in irrigation solutions with antibiofilm properties demonstrated in in vitro studies, exemplified by the preformulated Bactisure® irrigation solution, which contains ethanol, acetic acid, sodium acetate, benzalkonium chloride, and sterile water. The main objective of this study was to evaluate the effectiveness (infection cure rate) of preformulated Bactisure® irrigation solution in vivo compared with saline solution in a control group of patients with acute knee and/or hip periprosthetic infections treated with DAIR.MethodsProspective single-centre randomized controlled trial involving patients with acute haematogenous PJI who received standard DAIR surgery from December 2022 to December 2024. The type of irrigation solution used during surgery will include two groups allocated at a 1:1 ratio: a control group (n = 25) with saline solution and an experimental group (n = 25) receiving the Bactisure® preformulated solution. The sample size was calculated based on an expected reduction in reinfection rates from 45% in the control group to 10% in the experimental group. Data on baseline patient characteristics, clinical and radiological information, and healthcare questionnaires will be recorded. All patients will be followed for minimum of 12 months. The infection cure rate at 1 year will be the primary outcome.DiscussionThis study is the first to compare the effectiveness of preformulated Bactisure® irrigation solution with that of saline solution in real clinical practice (in vivo) in patients with acute knee and/or hip periprosthetic infections treated with DAIR. Our main hypothesis is that, compared with saline solution, Bactisure® provides a better infection cure rate at 1 year post-DAIR.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN10873696. Registered on December 19, 2023.

Middle-term two-stage treatment results of fistulous and non-fistulous form of chronic hip periprosthetic joint infection

Background: Chronic deep periprosthetic joint infection (PJI) of the hip remains an urgent problem of modern orthopedics. Numerous risk factors are being studied in order to reduce the frequency of relapses among which the role of a functioning fistula remains unclear. Aim: To conduct a comparative analysis of the patients’ somatic status, the infectious process etiology, the treatment effectiveness of chronic hip PJI and its outcomes depending on the presence of a fistula. Materials and methods: The retrospective analysis included 218patients and 2comparison groups were formed— 80 with non-fistulous form (NFF) and 138with fistulous form (FF) of PJI. Treatment results were evaluated in 202patients with a median follow-up of 26months. Results: Patients with FF turned out to be younger than patients without fistula— 58 and 63years old, respectively, p=0.006. The total comorbidity score, duration of surgery and blood loss did not significantly differ in the comparison groups. The duration of hospitalization in the department for patients with fistulas turned out to be less than patients without fistulas by an average of 3days (p=0.03). The monobacterial form of PJI prevailed in both comparison groups with the prevalence of epidermal staphylococcus in the NFF group and staphylococcus aureus in the FF group (p0.001) without significant effect on recurrence. The first sanitation effectiveness was 82% in NFF and 76% in FF, and the second sanitation was 69% in NFF and 58% in FF, respectively (p0.05). The fistulous course significantly increased the likelihood of recurrent relapse of PJI (p=0.048). Conclusion: The fistulous form of chronic PJI does not significantly affect the first recurrence of PJI development, however, it can significantly increase the frequency of the second recurrence release. This circumstance should be taken into account when planning the stage treatment of a recurrent PJI form.

Outcomes, Complications, and Eradication Rates of Two-Stage Revision Surgery for Periprosthetic Shoulder, Elbow, Hip, and Knee Infections: A Systematic Review

Outcomes, Complications, and Eradication Rates of Two-Stage Revision Surgery for Periprosthetic Shoulder, Elbow, Hip, and Knee Infections: A Systematic Review

Estimation of two-year hospital costs of hip and knee periprosthetic joint infection treatments using activity-based costing.

Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months. Using admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients. Costs were aggregated at 24 months post-diagnosis, and are presented in Australian dollars. The mean cost per hip and knee PJI patient was $64,585 (SD $53,550). Single-stage revision mean costs were $67,029 (SD $47,116) and $80,063 (SD $42,438) for hip and knee, respectively. Two-stage revision costs were $113,226 (SD $66,724) and $122,425 (SD $60,874) for hip and knee, respectively. Debridement, antibiotics, and implant retention in hips and knees mean costs were $53,537 (SD$ 39,342) and $48,463 (SD $33,179), respectively. Suppressive antibiotic therapy without surgical management mean costs were $20,296 (SD $8,875) for hip patients and $16,481 (SD $6,712) for knee patients. Hip patients had 16 different treatment pathways and knee patients had 18 treatment pathways. Additional treatment, episodes of care, and length of stay contributed to substantially increased costs up to a maximum of $369,948. Treating PJI incurs a substantial cost burden, which is substantially influenced by management strategy. With an annual PJI incidence of 3,900, the cost burden would be in excess of $250 million to the Australian healthcare system. Treatment pathways with additional surgery, more episodes of care, and a longer length of stay substantially increase the associated hospital costs. Prospectively monitoring individual patient treatment pathways beyond initial management is important when quantifying PJI treatment cost. Our study highlights the importance of optimizing initial surgical treatment, and informs treating hospitals of the resources required to provide care for PJI patients.

High-Dose Compound Betamethasone Used in Local Infiltration Analgesia Does Not Increase Reinfection Rates Following Periprosthetic Joint Infection Treatment

BackgroundCocktails containing glucocorticoids for local infiltration analgesia (LIA) are highly advocated and effective in managing pain in total joint arthroplasty (TJA). However, it remains ambiguous whether this protocol maintains its safety and efficacy in the treatment of periprosthetic joint infection (PJI), a devastating complication of TJA. MethodsA retrospective study was conducted on 299 single-stage revision cases for PJI spanning the years 2010 to 2021. Of these, 127 received LIAs containing high-dose compound betamethasone (CB) were termed the CB group, and the other 172 were termed the non-CB group. The rates of re-infection and other postoperative complications, along with postoperative visual analog scale (VAS) scores, and opioid consumption were compared. ResultsDuring minimum 2-year follow-up, there was no significant difference in the re-infection rate between the non-CB and CB groups (9.3 versus 8.7%; P = 0.85), consistent within the subsets of hip (8.4 versus 4.5%; P = 0.51) and knee (10.4 versus 13.3%; P = 0.60) PJIs individually. The administration of high-dose CB was neither an independent risk factor for reinfection (P > 0.05; 95% CI [confidence interval] including 1) nor was it associated with the occurrence of reinfection (P > 0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the CB group (P < 0.05). In the first 48-hour postoperative period, the CB group exhibited lower mean scores in both resting and movement VAS evaluations (P < 0.05). For knees, the movement VAS scores of the CB group remained lower even at 72 hours post-surgery (P < 0.001). Furthermore, within the first 72 hours post-surgery, the CB group required less additional opioid analgesics than the non-CB group (P < 0.05). ConclusionsA LIA with a high-dose CB reduces postoperative pain, opioid consumption, and the incidence of PONV following a single-stage revision without affecting reinfection and other complication rates.

Modern cementless acetabular cups in total hip arthroplasty performed for primary osteoarthritis: a comparative registry study.

Comparative studies evaluating the different material and surface finishing of acetabular components in total hip arthroplasty (THA) are lacking. Using a regional arthroplasty registry, the survival rates and the hazard ratios of different cups in THA performed for primary osteoarthritis were assessed, using endpoints: (1) every cup failure, (2) cup aseptic loosening, (3) periprosthetic infection. The inclusion criteria were: residing patients, THA for primary osteoarthritis, Delta-on-Delta bearings, head sizes 32mm and 36mm. Only the most implanted cementless cups were considered and were grouped according to material and surface finishing into three cohorts: 3D printed cups (I), ultraporous tantalum or titanium- coated cups (II), second-generation cups (III). 15,737 cups were included in the study: 9,862 cups (62.7%) in cohort I, 2,067 implants (13.1%) in cohort II, 3,808 implants (24.2%) in cohort III. The three cohorts achieved comparable general 10-year survival rates (p = 0.62). In I and II cohorts, the survival rates of the cup types within cohorts were analogous (p = 0.86 and p = 0.31), but not in cohort III (p = 0.004). The hazard ratios for overall failure adjusted for age and sex were similar among the cohorts. Regarding cup aseptic loosening, the three cohorts had similar rates (p = 0.48) and similar adjusted hazard ratios. With periprosthetic hip infection as endpoint, the survival rates and the adjusted hazard ratios of the three cohorts were comparable (p = 0.68). 3D printed cups provided similar 10-year outcomes compared to ultraporous cups and second-generation cups, with no additional risks of aseptic loosening and infection. IV (therapeutic study). - 3D printed cups provided similar 10-year outcomes compared to ultraporous cups and second-generation cups. - There is no additional risks of aseptic loosening and infection.

One-Stage Versus Two-Stage Revision Surgery for Periprosthetic Hip Infection: An Updated Systematic Review and Meta-Analysis of Clinical Outcomes

Introduction: The primary objective of this meta-analysis was to evaluate and compare the functional outcomes, postoperative reinfection rates, and complication rates in patients undergoing one-stage versus two-stage surgical revision for periprosthetic hip infection. Methods: The study population included adult patients who had undergone revision hip arthroplasty. Comparative studies have compared two-stage and one-stage revision strategies. Searches were conducted using the major databases. Review Manager software was used to estimate the effects. A sensitivity analysis was also conducted. Results: Nine cohort studies including 2,502 hips were included. The success rate did not show significant differences between the groups (odds ratio [OR] 0.42, 95% confidence interval 0.05 to 3.37). No difference was noted in reinfection (OR 0.81, 95% CI 0.56-1.19). Life quality per Harris Hip Score was higher for one-stage revision strategies (mean difference [MD] 9.00, 95% CI 2.23-15.78). No differences were noted in mortality, aseptic loosening, or revision rates. Age (MD 2.32, 95% CI 1.34-3.29) and body mass index (BMI) (MD 1.88, 95% CI 0.38-3.38) were lower in the two-stage group. Sinus tract presence was higher in the one-stage group (OR 1.44, 95% CI 1.05-1.95). Paprosky I acetabulum was higher in the one-stage group, and Paprosky III was higher in the two-stage group. Conclusions: The results did not demonstrate notable clinical differences between one-stage and two-stage hip arthroplasties, regardless of the treated microorganism. However, the quality of life may be somewhat better in the one-stage group. Age, body mass index, and Paprosky classification are factors that influence procedure selection.

Can a 1.5-Stage Revision be an Effective Alternative for Chronic Periprosthetic Hip and Knee Infections? A Systematic Review and Meta‐Analysis

BackgroundA 1.5-stage revision could be an alternative to a 2-stage revision for treating hip and knee chronic periprosthetic infections, guaranteeing the maintenance of joint function and infection control and preventing infection-free patients from undergoing further surgery. Our systematic review aimed to answer several questions about the indication, the infection eradication rate, and the long-term functional outcome of 1.5-stage revisions used to treat chronic periprosthetic infections of the hip and knee. MethodsA systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including studies dealing with the use of 1.5-stage and two-stage surgery for chronic periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) or total hip arthroplasty (THA). The Coleman Methodology Score and the Methodological Index for Non-randomized Studies (MINORS) score were used to assess the quality of the studies. A meta-analysis was performed to evaluate the infection eradication rate using either the 1.5-stage revision or the two-stage technique. A total of 494 patients (111 hips and 385 knees) who underwent 1.5-stage with a mean age of 69 years (range, 61 to 82) were identified in the ten included studies. ResultsThe most common cause of reoperation was the conversion to the definitive prosthesis, followed by aseptic loosening. Infection control was reached in 84.6% of the 1.5-stage and 76.1% of the two-stage cohorts. The infection recurrence rate was higher in the two-stage cohort than the 1.5-stage group (21.8 versus 14.3%). ConclusionThe 1.5-stage technique represents a valid treatment option in selected patients who have chronic PJI who cannot undergo further surgeries, adding together the benefits of the one- and two-stage procedures. Furthermore, the 1.5-stage showed a better success rate in the infection resolution than the two-stage technique.

A COMPARATIVE ANALYSIS OF 1.5-STAGE AND TWO-STAGE REVISION FOR PERIPROSTHETIC JOINT INFECTION AFTER TOTAL HIP ARTHROPLASTY: IS 1.5-STAGE REALLY EQUIVALENT?

Two-stage exchange arthroplasty is traditionally used to treat periprosthetic hip infection. Nevertheless, particularly in high-risk patients, there has been increased attention towards alternatives such as 1.5-stage exchange arthroplasty which takes place in one surgery. Therefore, we sought to compare (1) operative time, length-of-stay (LOS), transfusions, (2) causative organism identification and polymicrobial infection rates, (3) re-revision rates and re-revision reasons, (4) mortality, and determine (5) independent predictors of re-revision.Retrospective chart review of 71 patients who underwent either 1.5- (n=38) or 2-stage (n=33) exchange hip arthroplasty at a single institution (03/2019-05/2023). Demographics, surgical, inpatient, and infection characteristics were noted. Main outcomes evaluated were re-revision rates, re-revision reasons, mortality, and cause of death. Independent predictors of re-revision were assessed utilizing logistic regression. Mean follow: 675 days (range, 23–1,715).Demographics were not significantly different except for a higher proportion of 1.5-stage patients classified as American-Society-of-Anesthesiologists (ASA) status 3 or 4 (84.2 vs. 48.5%, p=0.002). Length of follow-up was significantly longer in the 2-stage group (924.4 vs. 458 days, p&lt;0.001) as well as operative time (506 vs. 271 minutes, p&lt;0.001). In the 1.5-stage group, there was a higher proportion of polymicrobial infections (23.7 vs. 3.0%, p=0.016), re-revision rates (28.9 vs. 9.1%, p=0.042) and periprosthetic infections as a cause of revision (90.9 vs. 0%, p=0.007). Mortality rates were not significantly different, and no patient died for causes related to infection. Type of surgery (1.5-stage vs. 2-stage) was the only independent predictor of re-revision (odds-ratio 4.0, 95% confidence-interval 1.02–16.16, p=0.046).Our data suggests that patients who undergo 1.5-stage exchange arthroplasty have a significantly higher re-revision rate (mostly due to infection) when compared to 2-stage patients. We acknowledge potential benefits of the 1.5-stage strategy, especially in high-risk patients since it involves single surgery. However, higher re-revision rates must be considered when counseling patients.

ONE-STAGE VERSUS TWO-STAGE REVISION HIP ARTHROPLASTY: CAN WE CONFIRM THE DATA FROM META-ANALYSIS IN REAL-WORLD REGISTRY DATA?

Studies and meta-analyses worldwide show an increased use of one-stage revisions for treating periprosthetic hip infections, often yielding comparable or better outcomes than two-stage revisions. However, it remains unclear if these successful results can be consistently achieved nationwide besides large centers.This observational cohort study used data from the German Arthroplasty Registry (EPRD) to compare the mortality and re-revision rates between one-stage (n=8183) and two-stage (n=657) first-time revision total hip arthroplasty (RTHA). Kaplan-Meier estimates were applied to evaluate the re-revision rate and cumulative mortality for RTHA.There was a significant difference in mortality between one-stage and two-stage RTHA (p=0.02). One-year post-surgery, the mortality rate was 9.4% for one-stage revisions and 5.5% for two-stage revisions. At the five-year follow-up, the mortality rate for one-stage revisions was 25.5%, compared to 20.0% for two-stage revisions. No significant differences (p=0.30) were found in re-revision rates between one-stage and two-stage revisions after one year (one-stage 16.5% vs. two-stage 13.5%) or five years (one-stage 21.6% vs. two-stage 20.8%). For multiple revisions, the mortality differences were even larger (p&lt;0.001), with a one-year mortality rate of 12.8% for one-stage RTHA and 5.7% for two-stage RTHA.Despite the excellent results of one-stage RTHA in the literature from individual large centers, it shows a significantly higher mortality rate with equal re-revision rate compared to two-stage revision in the nationwide care besides large centers. Significant differences can already be seen within the first year, indicating an increased perioperative mortality for one-stage revision, which might be explained by longer surgery duration, blood-loss and patient selection or maybe a lack of experience concerning proper surgical debridement for one-stage revision. This illustrates the need to establish centers for joint-revision surgery that provide interdisciplinary care and high case numbers to improve perioperative outcomes.

Periprosthetic hip infection: Current concepts and the Wrightington experience

Total hip arthroplasty (THA) is a highly successful operation performed worldwide in increasing numbers for a wide range of indications. There has been a corresponding rise in the incidence of periprosthetic joint infection of the hip (PJIH), which is a devastating complication.There is a significant variation in the definition, diagnosis and management of PJIH largely due to a lack of high-level evidence. The current standard of practice is largely based on cohort studies from high-volume centres, consensus publications amongst subject experts, and national guidance. This review describes our philosophy and practical approach of managing PJIH at a regional tertiary high-volume joint replacement centre.

High Demand for Psychological Support in Patients Who Have Periprosthetic Hip and Knee Joint Infections: An Analysis of 13,976 Patients

BackgroundThere is only sparse knowledge on the psychological burden of patients who have periprosthetic joint infections. The aim of our study was to assess the need for psychological support following total joint arthroplasty of the hip and knee. A special focus was set on patients who had aseptic and septic complications. MethodsA total of 13,976 patients who underwent total hip (n = 6,926) or total knee arthroplasty (n = 7,050) between January 1, 2012 and December 31, 2019 at a single institution were retrospectively evaluated for the postoperative need for a psychological consultation. Data were collected on age, sex, type of surgery, and indications for revision procedures. The need for a psychological consultation was assessed during the daily postoperative visits, which were further coordinated by 2 institutional psychologists. ResultsThe average age was 68 years (range, 12 to 100), and there were 63.5% women. The overall rate of psychological consultations was 1.7%. Patients who had a septic indication for revision surgery had an 18.7-fold higher rate of postoperative psychological consultations compared to patients following primary surgery and a 5.4-fold higher rate compared to patients who had an aseptic indication. In detail, this rate was 1.0% in the primary subgroup, compared to 7.7% following revision arthroplasty (P < .001). In the revision subgroup, the rate was 17.9% for septic and 3.3% for aseptic revision arthroplasty cases (P < .001). Postoperative psychological consultations were twice as frequent in women (2.1%) compared to men (1.0%), P < .001. ConclusionsThe present study raises awareness of the markedly high psychological burden in revision arthroplasty cases, in the view of the high estimated number of unknown cases. There is a significant correlation between periprosthetic joint infectionsand the postoperative need for a psychological consultation, with women being at an even higher risk. Health care providers should aim at offering psychological support for patients who have a septic complication, with affected patients being at risk for psychological stress. Level of EvidenceIV.

The role of BioFire Joint Infection Panel in diagnosing periprosthetic hip and knee joint infections in patients with unclear conventional microbiological results.

This study aimed to evaluate the BioFire Joint Infection (JI) Panel in cases of hip and knee periprosthetic joint infection (PJI) where conventional microbiology is unclear, and to assess its role as a complementary intraoperative diagnostic tool. Five groups representing common microbiological scenarios in hip and knee revision arthroplasty were selected from our arthroplasty registry, prospectively maintained PJI databases, and biobank: 1) unexpected-negative cultures (UNCs), 2) unexpected-positive cultures (UPCs), 3) single-positive intraoperative cultures (SPCs), and 4) clearly septic and 5) aseptic cases. In total, 268 archived synovial fluid samples from 195 patients who underwent acute/chronic revision total hip or knee arthroplasty were included. Cases were classified according to the International Consensus Meeting 2018 criteria. JI panel evaluation of synovial fluid was performed, and the results were compared with cultures. The JI panel detected microorganisms in 7/48 (14.5%) and 15/67 (22.4%) cases related to UNCs and SPCs, respectively, but not in cases of UPCs. The correlation between JI panel detection and infection classification criteria for early/late acute and chronic PJI was 46.6%, 73%, and 40%, respectively. Overall, the JI panel identified 12.6% additional microorganisms and three new species. The JI panel pathogen identification showed a sensitivity and specificity of 41.4% (95% confidence interval (CI) 33.7 to 49.5) and 91.1% (95% CI 84.7 to 94.9), respectively. In total, 19/195 (9.7%) could have been managed differently and more accurately upon JI panel evaluation. Despite its microbial limitation, JI panel demonstrated clinical usefulness by complementing the traditional methods based on multiple cultures, particularly in PJI with unclear microbiological results.

Primary data from the local registry of periprosthetic hip infection at the National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Background. Obtaining accurate data on the epidemiology of periprosthetic joint infection (PJI) of the hip in the Russian Federation is a challenging task, which is associated with the peculiarities of statistical registration of complications and the lack of approved routing schemes. The aim of the study — to provide the results of primary analysis of the data from the local registry of hip periprosthetic infection, which reflects all the treatment cases from 01.01.2020 to 31.12.2020. Methods. Since 2021, the Center has been working on retrospective input of the data on patients PJI of the hip treated at the clinic into the electronic version of the registry. The information was collected by studying archived medical records and a medical information system, by examining patients in the outpatient clinic, and by interviewing patients via mobile phone and e-mail. During the period, we treated 449 patients with hip periprosthetic infection. The mean patients’ age was 55.6±12.6 years (Ме — 57; 95% CI: 54.4-56.8). Male patients accounted for 61.6% (n = 277). Results. We were able to evaluate the treatment results in 84% (n = 377) of patients. The mean follow-up period was 5.92±2.55 years (Me — 6; 95% CI: 2.39-2.73). In more than 90% (n = 407) of cases, the infection was classified as chronic (more than 3 weeks of manifestation). At the admission 76,8% (n = 345) of patients had a fistula communicating with the joint cavity. The percentage of lethal outcomes due to sepsis was 1,7% (8/449); recurrences of hip PJI was observed in 6.2% (28/ 449) of cases. Resolution of infection has been achieved in 67% (300/449) of cases. Conclusions. The primary analysis of the data from the local registry of hip periprosthetic infection of the national Ilizarov Center of Traumatology and Orthopedics showed that the average age of patients with hip PJI in our country is significantly lower than in the known national registries. At the same time, the infectious agents were similar: Gram-positive microorganisms accounted for more than 55%. The analysis of the registry data shows a significant decrease in the PJI recurrence rate over the last 5 years.

Treatment of Hip and Knee Periprosthetic Joint Infection Requires Extensive Administrative Work

BackgroundTreatment of periprosthetic joint infections (PJIs) typically requires more resource utilization than primary total joint arthroplasty. This study quantifies the amount of time spent in the electronic medical record (EMR) for patients who have PJI requiring surgical intervention. MethodsA retrospective analysis of EMR activity for 165 hip and knee PJIs was performed to capture work during the preoperative and postoperative time periods. Independent sample t tests were conducted to compare total time based on procedure, age, insurance, health literacy, sex, race, and ethnicity. ResultsThe EMR work performed by the orthopaedic team was 338.4 minutes (min) (SD 130.3), with 119.4 minutes (SD 62.8) occurring preoperatively and 219.0 minutes (SD 112.9) postoperatively. Preoperatively, the surgeon’s work accounted for 35.7 minutes (SD 25.4), mid-level providers 21.3 minutes (SD 15.9), nurses 38.6 minutes (SD 36.8), and office staff 32.7 minutes (SD 29.9). Infectious disease colleagues independently performed 158.9 minutes (SD 108.5) of postoperative work. Overall, PJI of the knees required more postoperative work. Secondary analysis revealed that patients who have hip PJI and a body mass index <30 and patients <65 years of age required more work when compared to the PJI of heavier and older individuals. There was no difference in total work based on insurance, health literacy, race, or ethnicity. ConclusionsOver 8 hours of administrative work is required for surgical management of PJI. Surgeons alone performed 451% more work for PJI during the preoperative period (7.9 versus 35.7 min) compared to primary total joint arthroplasty. In efforts to provide best care for our sickest patients, much work is required perioperatively. This work is necessary to consider when assigning value and physician reimbursement.

MicroRNA expression analysis in peripheral blood and soft-tissue of patients with periprosthetic hip infection.

Current diagnostic tools are not always able to effectively identify periprosthetic joint infections (PJIs). Recent studies suggest that circulating microRNAs (miRNAs) undergo changes under pathological conditions such as infection. The aim of this study was to analyze miRNA expression in hip arthroplasty PJI patients. This was a prospective pilot study, including 24 patients divided into three groups, with eight patients each undergoing revision of their hip arthroplasty due to aseptic reasons, and low- and high-grade PJI, respectively. The number of intraoperative samples and the incidence of positive cultures were recorded for each patient. Additionally, venous blood samples and periarticular tissue samples were collected from each patient to determine miRNA expressions between the groups. MiRNA screening was performed by small RNA-sequencing using the miRNA next generation sequencing (NGS) discovery (miND) pipeline. Overall, several miRNAs in plasma and tissue were identified to be progressively deregulated according to ongoing PJI. When comparing the plasma samples, patients with a high-grade infection showed significantly higher expression levels for hsa-miR-21-3p, hsa-miR-1290, and hsa-miR-4488, and lower expression levels for hsa-miR-130a-3p and hsa-miR-451a compared to the aseptic group. Furthermore, the high-grade group showed a significantly higher regulated expression level of hsa-miR-1260a and lower expression levels for hsa-miR-26a-5p, hsa-miR-26b-5p, hsa-miR-148b-5p, hsa-miR-301a-3p, hsa-miR-451a, and hsa-miR-454-3p compared to the low-grade group. No significant differences were found between the low-grade and aseptic groups. When comparing the tissue samples, the high-grade group showed significantly higher expression levels for 23 different miRNAs and lower expression levels for hsa-miR-2110 and hsa-miR-3200-3p compared to the aseptic group. No significant differences were found in miRNA expression between the high- and low-grade groups, as well as between the low-grade and aseptic groups. With this prospective pilot study, we were able to identify a circulating miRNA signature correlating with high-grade PJI compared to aseptic patients undergoing hip arthroplasty revision. Our data contribute to establishing miRNA signatures as potential novel diagnostic and prognostic biomarkers for PJI.

Effect of Multiantibiotic-Loaded Bone Cement on the Treatment of Periprosthetic Joint Infections of Hip and Knee Arthroplasties-A Single-Center Retrospective Study.

Two-stage septic revision is the prevailing method for addressing late periprosthetic infections. Using at least dual-antibiotic-impregnated bone cement leads to synergistic effects with a more efficient elution of individual antibiotics. Recent data on the success rates of multiantibiotic cement spacers in two-stage revisions are rare. We conducted a retrospective follow-up single-center study involving 250 patients with late periprosthetic hip infections and 95 patients with prosthetic knee infections who underwent septic two-stage prosthesis revision surgery between 2017 and 2021. In accordance with the antibiotic susceptibility profile of the microorganisms, a specific mixture of antibiotics within the cement spacer was used, complemented by systemic antibiotic treatment. All patients underwent preoperative assessments and subsequent evaluations at 3, 6, 9, 12, 18, and 24 months post operation and at the most recent follow-up. During the observation period, the survival rate after two-step septic revision was 90.7%. Although survival rates tended to be slightly lower for difficult-to-treat (DTT) microorganism, there was no difference between the pathogen groups (easy-to-treat (ETT) pathogens, methicillin-resistant staphylococci (MRS), and difficult-to-treat (DTT) pathogens). Furthermore, there were no differences between monomicrobial and polymicrobial infections. No difference in the survival rate was observed between patients with dual-antibiotic-loaded bone cement without an additional admixture (Copal® G+C and Copal® G+V) and patients with an additional admixture of antibiotics to proprietary cement. Employing multiple antibiotics within spacer cement, tailored to pathogen susceptibility, appears to provide reproducibly favorable success rates, even in instances of infections with DTT pathogens and polymicrobial infections.

Mouldable Collagen-Tricalciumphosphate Is a Safe Carrier for Local Antibiotics-Short-Term Results in Revision Hip Arthroplasty.

Improving local antibiotic delivery is a promising approach to improve infection control and potentially shorten systemic treatment in periprosthetic joint infection (PJI). This study investigates the use of an antibiotic-loaded, mouldable collagen-tricalciumphosphate composite in treatment of hip PJI. 124 application cases in 79 patients were included from a referral centre; systemic adverse infects, local complications, and infection control were analysed. In most cases, either vancomycin or meropenem were used. Pathogens were previously known in 82 (66%) cases with polymicrobial infection in 20 (25%) patients. There were no cases of hypercalcaemia. Acute kidney injure was present in 14 (11%) cases. Chronic kidney failure persisted in two cases. During a mean follow-up of 12 (SD 9.3; range 3-35) months, implant survival was achieved in 73 (92%) patients; revision due to PJI was performed in 19 cases. Mouldable collagen-tricalciumphosphate composite bone substitute as a local antibiotic carrier in revision hip arthroplasty appears to be a valid option for local antibiotic delivery without systemic complications. Implant survival of 92% supports the hypothesis that local antibiotic therapy is an important component in the treatment of PJI.