Infected Joint Replacement Research Articles

Antimicrobial release from a lipid bilayer titanium implant coating is triggered by Staphylococcus aureus alpha-haemolysin

Infections represent a significant challenge in joint replacements, often leading to the need for high-risk revision surgeries. There is an unmet need for novel technologies that are triggered by pathogens to prevent long-term joint replacement infections. The use of supported lipid bilayers (SLBs) with encapsulated antimicrobial agents, which are responsive to bacterial virulence factors, offers an exciting approach to achieving this goal. In this study, Ti was functionalised using octadecylphosphonic acid (ODPA) to form an SLB with an encapsulated antibiotic (novobiocin), effective against methicillin-resistant Staphylococcus aureus. Using the solvent-assisted method, the SLB with encapsulated novobiocin was developed on the surface of ODPA-modified Ti quartz crystal microbalance (QCM) sensors. QCM monitoring and fluorescence microscopy supported the successful formation of a planar SLB with encapsulated novobiocin. Incorporation of novobiocin in the SLB resulted in significantly reduced attachment and viability of S. aureus NCTC 7791, with no significant reduction in human bone marrow stromal cell viability. Additionally, in the presence of varying concentrations of α-haemolysin, a virulence factor from S. aureus, the SLB demonstrated a dose-dependent release pattern. The findings indicate the possibility of creating a biocompatible implant coating that releases an antimicrobial in the presence of a bacterial virulence factor, in a dose-dependent manner.

Using nanopore sequencing to identify bacterial infection in joint replacements: a preliminary study.

This project investigates if third-generation genomic sequencing can be used to identify the species of bacteria causing prosthetic joint infections (PJIs) at the time of revision surgery. Samples of prosthetic fluid were taken during revision surgery from patients with known PJIs. Samples from revision surgeries from non-infected patients acted as negative controls. Genomic sequencing was performed using the MinION device and the rapid sequencing kit from Oxford Nanopore Technologies. Bioinformatic analysis pipelines to identify bacteria included Basic Local Alignment Search Tool, Kraken2 and MinION Detection Software, and the results were compared with standard of care microbiological cultures. Furthermore, there was an attempt to predict antibiotic resistance using computational tools including ResFinder, AMRFinderPlus and Comprehensive Antibiotic Resistance Database. Bacteria identified using microbiological cultures were successfully identified using bioinformatic analysis pipelines. Nanopore sequencing and genomic classification could be completed in the time it takes to perform joint revision surgery (2-3h). Genomic sequencing in this study was not able to predict antibiotic resistance in this time frame, this is thought to be due to a short-read length and low read depth. It can be concluded that genomic sequencing can be useful to identify bacterial species in infected joint replacements. However, further work is required to investigate if it can be used to predict antibiotic resistance within clinically relevant timeframes.

Acidity Is an Excellent Marker of Infection in Hip and Knee Arthroplasty

Background: The diagnosis of joint replacement infection is a difficult clinical challenge that often occurs when the implant cannot be salvaged. We hypothesize that the pH value of synovial fluid could be an important indicator of the inflammatory status of the joint. However, in the literature, there is a lack of data on the pH changes in hip and knee joint replacements and their relation to infection and implant failure. In this study, we aimed to measure the pH levels of synovial fluid in patients with hip and knee joint replacements. We also investigated the potential of pH measurement as a diagnostic tool for joint replacement infection. In this study, we recorded the pH values to be 7.55 and 7.46 in patients where Pseudomonas aeruginosa was identified as the cause of the prosthetic joint infection. We attribute this to the different environments created by this specific bacterium. In other cases where the pH was higher, chronic mitigated infections were diagnosed, caused by strains of Staphylococcus aureus, Streptococcus agalactiase, and coagulase negative staphylococcus. Materials and methods: In our cohort of 155 patients with implanted hip (THA; n = 85) or knee (TKA; n = 70) joint replacements, we conducted a prospective study with a pH measurement. Out of the whole cohort, 44 patients had confirmed joint replacement infection (28.4%) (44/155). In 111 patients, infection was ruled out (71.6%) (111/155). Joint replacement infection was classified according to the criteria of the Musculoskeletal Infection Society (MSIS) from 2018. Based on the measured values, we determined the cut-off level for the probability of ongoing inflammation. We also determined the sensitivity and specificity of the measurement. Results: The group of patients with infection (n = 44) had a significantly lower synovial fluid pH (pH = 6.98 ± 0.48) than the group of patients with no infection (n = 111, pH = 7.82 ± 0.29, p < 0.001). The corresponding median pH values were 7.08 for the patients with infection and 7.83 for the patients with no infection. When we determined the cut-off level of pH 7.4, the sensitivity level of infected replacements was 88.6%, and the specificity level of the measurement was 95.5%. The predictive value of a positive test was 88.6%, and the predictive value of a negative test was 95.5%. Conclusions: Our results confirm that it is appropriate to include a pH measurement in the diagnostic spectrum of hip and knee replacements. This diagnostic approach has the potential to provide continuous in vivo feedback, facilitated by specialized biosensors. The advantage of this method is the future incorporation of a pH-detecting sensor into intelligent knee and hip replacements that will assess pH levels over time. By integrating these biosensors into intelligent implants, the early detection of joint replacement infections could be achieved, enhancing proactive intervention strategies.

Bacterial Contamination in Total Joint Replacement: Should We Change into a New Set of Clean Scrub Suits Whenever Entering the Operating Room?

The aims of this study are as follows: (1) to investigate the level and probability of bacterial contamination on scrub suits over time for medical personnel working inside and/or outside the operating room (OR) area; (2) to discuss the protective role of cover gowns against bacterial contamination; and (3) to consider the necessity of changing into clean suits whenever entering the OR in terms of preventing periprosthetic joint infection (PJI) in total joint replacement (TJR). The bacterial colony count was examined on the chest area of the scrub suits worn during various daily clinical practices. The genus/species of the contaminants were identified by matrix-assisted laser deposition ionization-time of flight mass spectrometry (MALDI-TOF MS). The scrub suits worn outside the OR area showed a greater level of bacterial contamination than those worn inside the OR area, although the colony counts tended to increase over time both in and out of the area. The probability of contamination involving coagulase-negative staphylococci (CNS) (known as the primary cause of PJI) did not increase significantly in the scrubs worn inside the OR area, but did increase significantly after a long-time departure from the OR area. Our results suggest that wearing scrub suits outside and/or the long duration of wearing the same suits can significantly increase the level and probability of any bacterial contamination (including CNS) on scrub suits. We also found that wearing a cover gown over scrub suits outside the OR area may have only a limited protective role against bacterial contamination.

DEVELOPMENT OF AN ANTIMICROBIAL LIPID COATING TO PREVENT INFECTIONS IN UNCEMENTED JOINT REPLACEMENTS

Preventing infections in joint replacements is a major ongoing challenge, with limited effective clinical technologies currently available for uncemented knee and hip prostheses. This research aims to develop a coating for titanium implants, consisting of a supported lipid bilayer (SLB) encapsulating an antimicrobial agent. The SLB will be robustly tethered to the titanium using self-assembled monolayers (SAMs) of octadecylphosphonic acid (ODPA). The chosen antimicrobial is Novobiocin, a coumarin-derived antibiotic known to be effective against resistant strains of Staphylococcus aureus.ODPA SAMs were deposited on TiO2-coated quartz crystal microbalance (QCM) sensors using two environmentally friendly non-polar solvents (anisole and cyclopentyl methyl ether, CPME), two concentrations of ODPA (0.5mM and 1mM) and two processing temperatures (21°C and 60°C). QCM, water contact angle measurements, X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM) and temperature-programmed desorption mass spectrometry (TPD-MS) were used to characterise the ODPA SAM. A SLB with encapsulated Novobiocin was subsequently developed on the surface of the ODPA SAM using fluorescent lipids and a solvent assisted method. The prototype implant surface was tested for antimicrobial activity against S. aureus.A well-ordered, uniform ODPA SAM was rapidly formed using 0.5 mM ODPA in CPME at 21°C during 10 min, as confirmed by high Sauerbrey mass (≍285-290 ng/cm2), high atomic percentage phosphorus (detected using XPS) and high water contact angles (117.6±2.5°). QCM measurements combined with fluorescence microscopy provided evidence of complete planar lipid bilayer formation on the titanium surface using a solvent assisted method. Incorporation of Novobiocin into the SLB resulted in reduced attachment and viability of S. aureus.Key parameters were established for the rapid, robust and uniform formation of an ODPA SAM on titanium (solvent, temperature and concentration). This allowed the successful formation of an antimicrobial SLB, which demonstrated potential for reducing attachment and viability of pathogens associated with joint replacement infections.

Allogeneic Bone Impregnated with Biodegradable Depot Delivery Systems for the Local Treatment of Joint Replacement Infections: An In Vitro Study.

Although progress is evident in the effective treatment of joint replacement-related infections, it still remains a serious issue in orthopedics. As an example, the local application of antibiotics-impregnated bone grafts supplies the high drug levels without systemic side effects. However, antibiotics in the powder or solution form could be a risk for local toxicity and do not allow sustained drug release. The present study evaluated the use of an antibiotic gel, a water-in-oil emulsion, and a PLGA microparticulate solid dispersion as depot delivery systems impregnating bone grafts for the treatment of joint replacement-related infections. The results of rheological and bioadhesive tests revealed the suitability of these formulations for the impregnation of bone grafts. Moreover, no negative effect on proliferation and viability of bone marrow mesenchymal stem cells was detected. An ex vivo dissolution test of vancomycin hydrochloride and gentamicin sulphate from the impregnated bone grafts showed a reduced burst and prolonged drug release. The PLGA-based formulation proved to be particularly promising, as one-day burst release drugs was only 15% followed with sustained antibiotics release with zero-order kinetics. The results of this study will be the basis for the development of a new product in the Tissue Section of the University Hospital for the treatment of bone defects and infections of joint replacements.

Effects of Hypercarbia on Lower Extremity Primary Total Joint Replacement Infections.

Introduction: Prosthetic joint infection (PJI) is a serious complication after total joint replacement (TJR). Adequate wound oxygenation is critical for wound healing and infection prevention. As carbon dioxide (CO2) is exchanged for oxygen (O2) in the lungs, serum bicarbonate (HCO3-) may be used as a marker for predicting relative serum O2 levels, and therefore, healing potential. No currently published literature explores the relationship between serum bicarbonate levels and PJI in TJR patients.Methods: We performed this retrospective review of lower extremity TJR patients to determine whether the risk of PJI and wound complications within one year was correlated with hypercarbia, which was defined as a preoperative serum bicarbonate level >30 mEq/L.Results: Out of 1,690 TJR procedures, 1.6% (N=27) had a PJI or superficial wound infection within one year postoperatively. The average preoperative serum bicarbonate was 26.9 (SD 2.6) among patients without PJI and 27.2 (SD 2.1) among patients with PJI (p=0.46). Hypercarbia was present in 9.2% of non-PJI patients and in 7.4% of PJI patients. The relative risk of PJI and wound complications did not differ for patients with vs without hypercarbia (RR = 0.79, 95% CI = 0.19-3.31, p=0.75).Conclusion: The results of this study provide preliminary evidence that preoperative hypercarbia may not be correlated with an increase in the risk of PJI or wound complications. However, due to the rarity of both PJI and hypercarbia, a larger patient population is needed to ensure adequate power to detect clinically meaningful effect sizes.

Effect of synthetic bone replacement material of different size on shear stress resistance within impacted native and thermodisinfected cancellous bone: an in vitro femoral impaction bone grafting model

Antibiotic carrier particles of variable size might influence mechanic properties within impacted thermodisinfected and native cancellous bone different. Herafill®G containing calciumsulfate and calciumcarbonate provides high local concentrations of gentamicin being important for revision surgery in infected joint replacements. Native and thermodisinfected cancellous bone derived from 6 to 7 months old piglets was used for in vitro impaction bone grafting and supplemented each with Herafill®G granules of two different sizes. Micromovement of implants related to shear force was measured in 29 specimens distributed in 6 groups. Thermodisinfected cancellous bone revealed a significant higher shear force resistance than native bone with a mean difference of 423.8 mdeg/Nm (p < 0.001) ranging within 95% confidence interval from 181.5 to 666.0 mdeg/Nm. Adding small granules to thermodisinfected bone did not reduce shear force resistance significantly since adding large granules to native bone improved it by 344.0 mdeg/Nm (p < 0.003). Shear force resistance was found higher at the distal region of the implant compared to a proximal point of measurement throughout all specimens. Less impaction impulses were necessary for thermodisinfected bone. Thermodisinfected cancellous bone might achieve a higher degree of impaction compared with native bone resulting in increased resistance against shear force since impaction was found increased distally. Supplementation of thermodisinfected bone with small granules of Herafill®G might be considered for application of local antibiotics. Large granules appeared more beneficial for supplementation of native bone. Heterogeneity of bone graft and technical aspects of the impaction procedure have to be considered regarding the reproducibility of femoral impaction bone grafting.

Comparing the use of preformed vs hand-made antibiotic spacer cement in two stages revision of hip periprosthetic infection

BackgroundThe number of periprosthetic joint infections (PJI) is continuously increasing because of the increasing number of arthroprostheses performed every year. Two-stage revision, using antibiotic-loaded spacers, remains the gold standard for their treatment. The aim of our study is to compare the use of preformed vs hand-made spacers in hip arthroplasty infections evaluating infection eradication, bone loss and clinical/functional outcomes. MethodsFrom January 2010 to December 2017 we performed a prospective nonrandomized study. We pooled 50 patients affected by infected hip joint replacements, and divided them in 2 groups, one receiving commercially preformed spacers and the other receiving hand-made spacers. The study endpoint was set at 12 months. Intra-operative and peri-operative complications, Harris Hip Score (HHS), Short Form 12 Health Survey, intra-operative and radiological evaluation of bone loss were collected. Data were analyzed using descriptive statistics, T-test and Fisher Exact test. ResultsWe found a statistically significant differences (p < 0.05) between the two groups in favour of the VancogenX group for the following variables: surgical time, first and second stage intraoperative complication rates, infection eradication. Moreover, the preformed-spacers group had better results in the preservation of bone stock, even though the difference was not statistically significant (p > 0.05). ConclusionOur results support the use of preformed antibiotic spacers, even though more studies are needed.

The Use of Antibiotic Impregnated Cement Spacers in the Treatment of Infected Total Joint Replacement: Challenges and Achievements.

Two stage total hip arthroplasty revision surgery includes foreign material debridment, insertion of antibiotic impregnated cement spacer, and finally, reimplantation of the prosthesis. This review has aimed to evaluate the efficacy of antibiotic impregnated cement spacers in infection control and eradication in arthroplasties. A total of 85 articles on total hip arthroplasty were used in this narrative literature review. High concentrations of the antibiotic in targeted drug delivery by means of using antibiotic impregnated cement spacers is effective against infections while reduces the side effects of systemic antibiotic therapy. This results in prevention of bone and muscle atrophy as well as size discrepancy. Also, antibiotic impregnated cement spacers reduce dead space and help stabilize the limb in total hip arthroplasty. Despite all reported drawbacks, antibiotic impregnated cement spacers seem effective in eradicationg infections, although a consensus has not been yet achieved.

Kinetics of Elution of Gentamicin from a Gentamicin-Loaded PMMA Bone Cement

Antibiotic-loaded poly (methyl methacrylate) bone cement (ALBC) is widely used for anchoring joint replacements as a means of reducing the potential for peri-prosthetic joint infection (primary cases) and treating a patient who has an infected joint replacement (revision cases). One shortcoming of the cement is the high maximum exothermic temperature experienced upon polymerization (Tmax), a phenomenon that, it has been postulated, may cause or be implicated in thermal necrosis of peri-prosthetic tissues. There are many reports in the literature on methods of reducing Tmax, with one such study involving the addition of a phase change material (microencapsulated paraffin) (MEPAR) to the cement powder or adding a chain-stopping chemical (1-dodecyl mercaptan) (DDM) to the liquid. In that report, the results of gentamicin elution tests were presented. In the present work, those results were used to calculate various indices of gentamicin elution kinetics, namely 1) diffusion coefficient (Dgent); and 2) values of the coefficients in four equations that are widely used to model antibiotic elution from ALBCs. We found 1) the difference in Dgent of either a MEPAR- or DDM-containing formulation, on the one hand, and that of the control cement, on the other, was not significant; and 2) a consistent trend in the value of only one coefficient in one of the four model equations, with this change suggesting insignificant difference in gentamicin elution mechanism between an experimental cement formulation and the control cement. The implications of these findings for guiding selection of additives that simultaneously produce significant reduction of Tmax but minimal effect on gentamicin elution kinetics are discussed. This guide is a novel contribution to the literature.

The current role of glycopeptides in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in not neutropenic adults: the viewpoint of a group of Italian experts

Staphylococcus aureus is still an important problem in clinical and therapeutic area, worldwide. In Italy, in recent years, methicillin resistance remained stable, yet considerably high, the percentage of strains of MRSA being around 40%. It was deemed interesting and timely to carry out a consensus conference using the RAND/UCLA method to collect the opinion of a group of experts in infectious diseases on the role of glycopeptides in the management of MRSA infections within several clinical scenarios and namely in pneumonia, bacteremia and endocarditis, joint replacement infections, skin and soft tissue infections, diabetic foot, abdominal infections and central nervous system infections. The scenarios proposed by the Scientific Committee have been validated by a group of experts in infectious diseases and then voted in three meetings of infectious disease specialists. The results obtained on each individual condition were analyzed and therapeutic recommendations on each of these were released.

Postoperative infection of elbow joint replacement

Currently, elbow arthroplasty is used to treat elbow joint fracture, tumor, arthritis, and many other elbow-related diseases. However, due to the characteristics of the elbow joint, the success rate of elbow arthroplasty is lower than knee arthroplasty. The most common complication of this surgery is prosthesis infection and loosening. The focus of this case is on prosthesis infection after the elbow arthroplasty surgery.

White cell and marrow imaging: subtracting uncertainty.

A subtraction method for assessments of dual-isotope indium-111 (In)-labelled white cell and Tc-nanocoll was proposed, and following a pilot study was introduced in routine service to improve the confidence of reporters. This technical note describes a simple technique to produce subtraction images from routinely acquired images to investigate and exclude post joint replacement infection. Labelled leucocytes (with In) show areas of increased white cell accumulation, whereas Tc-nanocoll images show bone marrow distribution. Images resulting from the subtraction protocol highlight any areas of white cell activity which is not concurrent with the marrow distribution indicative of infection. Fusion images produced from these images sets also assists in localization of white cell accumulation(s). Key to the success of this technique is the use of simultaneous acquisition of both white cell and marrow images; thus removing any issues with patient movement and/or repositioning. Reporting clinicians convey a clear preference for the inclusion of the subtracted and fused images at clinical review.

Testing the efficacy of antimicrobial peptides in the topical treatment of induced osteomyelitis in rats.

Joint replacement infections and osteomyelitis are among the most serious complications in orthopaedics and traumatology. The risk factors for these infections are often bacterial resistance to antimicrobials. One of the few solutions available to control bacterial resistance involves antimicrobials, which have a different mechanism of action from traditional antibiotics. Antimicrobial peptides (AMP) appear to be highly promising candidates in the treatment of resistant infections. We have identified several AMP in the venom of various wild bees and designed analogues that show potent antimicrobial activity and low toxicity against eukaryotic cells. The aim of the present study was to test the efficacy of one of those synthetic peptide analogues for the treatment of acute osteomyelitis invoked in laboratory rats. Femoral cavities of 20 laboratory Wistar rats were infected with Staphylococcus aureus. After 1week, eight rats received an injectable calcium phosphate carrier alone, another eight rats were treated with a calcium phosphate mixed with AMP, and four rats were left without any further treatment. After another week, all rats were euthanized and radiographs were made of both the operated and healthy limbs. The animals with the carrier alone exhibited more severe acute osteomyelitis on radiographs in comparison to the recipients of the calcium phosphate carrier loaded AMP and untreated infected individuals. Based on the results of the above mentioned experiment, it was concluded that when injected directly into the site of femoral acute osteomyelitis, the calcium phosphate carrier mixed with AMP reduced osteomyelitis signs visible on radiographs.

Periprosthetic Infection in Joint Replacement.

The volume of joint replacement surgery has risen steadily in recent years, because the population is aging and increasingly wishes to reserve a high functional status onward into old age. Infection is among the more common complications of joint replacement surgery, arising in 0.2% to 2% of patients, or as many as 9% in special situations such as the implantation of megaprostheses. The associated morbidity and mortality are high. It is thus very important to minimize risk factors for infection and to optimize the relevant diagnostic and therapeutic strategies. This review is based on pertinent publications retrieved by a selective search in PubMed, including current guidelines and expert recommendations. The crucial diagnostic step is joint biopsy for the identification of the pathogenic organism, which succeeds with over 90% sensitivity and specificity. If the prosthesis is firmly anchored in bone, the pathogen is of a type that responds well to treatment, and symptomatic infection has been present only for a short time, then rapidly initiated treatment can save the prosthesis in 35-90% of cases. The pillars of treatment are thorough surgical care (radical débridement) and targeted antibiotic therapy. On the other hand, if the prosthesis is loose or the pathogen is of a poorly treatable type, the infection can generally only be cured by a change of the prosthesis. This can be performed in either one or two procedures, always in conjunction with systemic antibiotic therapy tailored to the specific sensitivity and resistance pattern of the pathogen. The risk of infection of an artificial joint is low, but the overall prevalence of such infections is significant, as the number of implanted joints is steadily rising. Artificial joint infections should be treated by a standardized algorithm oriented toward the recommendations of current guidelines. Many of these recommendations, however, are based only on expert opinion, as informative studies providing high-grade evidence are lacking. Thus, for any particular clinical situation, there may now be multiple therapeutic approaches with apparently comparable efficacy. Randomized trials are urgently needed.

The role of three-phase 99mTc-MDP bone scintigraphy in the diagnosis of periprosthetic joint infection of the hip and knee

Background/Aim. In the last five decades primary hip and knee arthroplasty is the most common and effective surgical intervention worldwide. Infection, although unfrequented, is the most serious complication. Nuclear medicine imaging, not affected by metallic hardware, is the current imaging modality of choice for the evaluation of suspected joint replacement infection. The aim of this study was to estimate the diagnostic accuracy of three phase 99m technetium methylene diphosphonate (99mTc-MDP) bone scintigraphy in periprosthetic hip and knee joint infection. Methods. Inclusion criteria of patients in the study were suspected knee or hip periprosthetic joint infections. In this study, we examined 45 patients (14 men and 31 women) with 39 hip and 24 knee prosthesis (total 63). In all patients, three-phase bone scintigraphy was performed after intravenous application of 555 MBq of 99mTc-MDP. The final confirmation of infection was microbiological or pathohistology finding. Results. Infection was confirmed in 29 prosthetic joints, in 13 (44.8%) knee and 16 (55.2%) hip joints while there was no infection in 34 prosthetic joints. The connection of different modalities of negative and positive findings 99mTc-MDP three-phase bone scintigraphy with the final confirmation of infection showed a high statistical significance (p &lt; 0.001). Three phase bone scintigraphy showed a high sensitivity of 90% but a modest specificity of 69.7% in the detection of periprosthetic infection with the diagnostic accuracy of 79%. The calculated positive predictive value was 73% but the negative predictive value was high 89%. Our results of three-phase bone scintigraphy with calculated sensitivity, specificity and diagnostic accuracy of 79% are in consent with the majority of published studies, or even slightly better. Conclusion. Bone scintigraphy is sensitive in the diagnosis of periprosthetic infection but insufficiently specific. In the detection of periprosthetic infections three-phase bone scan can be used as a diagnostic method of the first line only aimed at its exclusion. The only reasonable use of bone scintigraphy is in combination with other radionuclide methods with high specificity.

Prosthetic Joint Infections Due to Coagulase-Negative Staphylococci

Context: Staphylococcus aureus and coagulase-negative staphylococci (CoNS) are the most frequently isolated pathogens and are responsible for approximately two-thirds of joint replacement infections. Evidence Acquisition: Although both belong to the staphylococci genus, there are several epidemiological and therapeutic differences between S. aureus and the heterogenous group of CoNS. In general, however, preventive and therapeutic recommendations for Prosthetic Joint Infection PJI due to CoNS do not differ from PJI caused by other pathogens. Results: The main differences between the pathogens lie in the clinical presentation of PJI, the presumed origin of infection, and the presence of a higher proportion of methicillin-resistant strains leading to a limited choice of antibiotic agents. Conclusions: Fortunately, due to its lower virulence as compared to its cousin S. aureus, PJI due to CoNS may display higher remission rates than S. aureus-caused PJI after combined surgical and medical management.

From Bench to Bedside: Alpha-defensing--The Biggest Thing in Joint Replacement Infections Since Prophylactic Antibiotics?

We have been awaiting the arrival of 21st century biomarker-, gene- or sequence-driven personalized medicine since well before the millennium. Yet the “Golden Age” of personalized medicine has proven elusive. While total joint arthroplasty (TJA) alleviates suffering perhaps better than any other orthopaedic intervention [8], patients whose arthroplasties have been complicated by infection have a very different experience. The condition is painful, the treatments are inconsistent, and most vexingly, our approaches to diagnosing the condition fall well short of what our patients expect from us in the second decade of the 21st century.

Forced-air warming: An effective method?

British Journal of Healthcare ManagementVol. 21, No. 1 Patient WarmingForced-air warming: An effective method?Arwinder SinghArwinder SinghSearch for more papers by this authorArwinder SinghPublished Online:15 Jan 2015https://doi.org/10.12968/bjhc.2015.21.1.26AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bräuer A, Pacholik L, Perl T, English MJ et al. (2004) Conductive heat exchange with a gelcoated circulating water mattress. Anesth Analg 99(6): 1742–6 Crossref, Google ScholarCamus Y, Delva E, Just B, Lienhart A (1993) Leg warming minimizes core hypothermia during abdominal surgery. Anesth Analg 77(5): 995–9 Crossref, Google ScholarEngelen S, Himpe D, Borms S et al. (2010) A comparison of under-body forced-air and resistive heating during hypothermic bypass. ASA abstracts, A075. http://tinyurl.com/nrq72ra (accessed 16 September 2014) Google ScholarKim JY, Shinn H, Oh YJ, Hong YW et al. 2006) The effect of skin surface warming during anesthesia preparation on preventing redistribution hypothermia in the early operative period of off-pump coronary artery bypass surgery. Eur J Cardiothorac Surg 29(3): 343–7 Crossref, Google ScholarMahoney CB, Odom J (1999) Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA J 67(2): 155–63 Google ScholarMatsuzaki Y, Matsukawa T, Ohki K, Yamamoto Y et al. (2003) Warming by resistive heating maintains perioperative normothermia as well as forced air heating. Br J Anaesth 90(5): 689–91 Crossref, Google ScholarMcGovern PD, Albrecht M, Belani KG, Nachtsheim C et al. (2011) Forced air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br 93(11): 1537–44. doi: https://doi.org/10.1302/0301-620X.93B11.27124 Crossref, Google ScholarPlattner O, Rodner G, Schopper C et al. (2010) Comparison of forced-air and a new resistive warming device for intraoperative rewarming. ASA abstracts, A076. http://tinyurl.com/q2hnngf (accessed 16 September 2014) Google ScholarTaguchi A, Ratnaraj J, Kabon B, Sharma N et al. (2004) Effects of a circulating-water garment and forced-air warming on body heat content and core temperature. Anesthesiology 100(5): 1058–64 Crossref, Google ScholarWinkler M, Akça O, Birkenberg B, Hetz H et al. (2009) Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg 91(4): 978–84 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 January 2015Volume 21Issue 1ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 15 January 2015 Published in print 2 January 2015 Information© MA Healthcare LimitedPDF download