Infection In Total Joint Replacement Research Articles

Actinomyces neuii subsp. neuii Associated with Periprosthetic Infection in Total Hip Arthroplasty as Causative Agent

Actinomyces neuii has until now not been described as a pathogen associated with periprosthetic infection in total joint replacement. The case presented here suggests that A. neuii subsp. neuii is a causative pathogen. The discussion and review of the literature indicate the impact that detection of Actinomyces species could have.

Quality of Life after Infection in Total Joint Replacement

To compare the health-related quality of life and functional outcomes of patients with and without periprosthetic infection after total joint replacement (TJR). 62 uncomplicated TJRs and 34 TJRs complicated with deep infection were compared using a visual analogue scale for satisfaction, the Western Ontario and McMaster Universities Osteoarthritis Index, Assessment of Quality of Life, and Short Form-36. Patients with complicated TJR had significantly poorer satisfaction in outcome (p<0.0001) and disease-specific functional outcomes (p<0.0001). Six of the 8 health-related quality-of-life scores were also significantly poorer (p<0.05). These results persisted after controlling for age, sex, and follow-up period in a multiple regression analysis. Infection following TJR reduces patient satisfaction and seriously impairs functional health status and health-related quality of life. When hospitals are balancing the costs of preventative measures with the costs of treating infection in TJR, the effect on patients' quality of life must be considered. Our findings argue strongly for allocation of health care resources to minimise the occurrence of infection after TJR.

Infection in Total Joint Replacement

Although a small number of infections in total joint replacements are blood borne from distant sources, most infections appear to have been derived at operation. Strenuous attempts to reduce this risk by cleaning the air in the wound environment, coupled with prophylactic antibiotics, have reduced infection rates by an order of magnitude in a decade. During that time the potential for exchange arthroplasty in established infection has been shown, and the results are encouraging. Rigorous infection control is the key to containing this difficult and expensive problem.

COST-EFFECTIVENESS ANALYSIS OF PHARMACEUTICALS: ITS INFORMATIONAL CONTENT AND AN EXAMPLE

The importance of cost-effectiveness analysis within the health care sector will increase. This is due to changes in the health care sector where there is an emphasis on improving the efficiency. The changes will influence the incentive structure and, subsequently, the demand for reliable managerial information. Cost-effectiveness analysis of pharmaceuticals is a good example of the state-of-the-art of cost-effectiveness applied to health care. A study on the cost-effectiveness of prophylaxis against infection in total joint replacement is presented as an example of an economic evaluation of pharmaceuticals.

Postoperative Infection of Total Joint Replacement and its Risk Factors The Effect of Bone Cement and Wear Debris upon Leucocyte Function

Postoperative Infection of Total Joint Replacement and its Risk Factors The Effect of Bone Cement and Wear Debris upon Leucocyte Function

How far does prophylaxis against infection in total joint replacement offset its cost?

Selection of a cost effective method of prophylaxis against infection for patients undergoing total joint replacement was shown to depend on the number of arthroplasties performed each year at individual hospitals. When 100 arthroplasties were performed each year the prophylactic use of systemic antibiotics minimised the total costs of the department--that is, the combined costs of prophylaxis and reoperation for deep sepsis. Some departments also used local antibiotic prophylaxis in the form of polymethylmethacrylate cement impregnated with gentamicin or a combination of systemic and local prophylaxis at almost as low a total cost and with comparable effect. Selection of a method of prophylaxis should not be determined solely on the basis of reducing costs. When a value was assigned to the effects of loss of health an economic optimum was established that allowed selection of a more costly method of prophylaxis together with further reductions in the incidence of infection and the need for reoperation.

Late Hematogenous Infection in Total Joint Replacement

Hematogenous infection of total joint replacements was experimentally produced in rabbits with cemented endoprostheses in both knees. One one side the bone cement contained gentamicin. Bacteremia was induced six to eight weeks postoperatively using a strain of Staphylococcus aureus. Twenty-five days after the induction of bacteremia approximately a third of the artificial joints were infected, whereas no bacteria were found in blood and viscera. Although the gentamicin cement still possessed anti-bacterial activity in vitro, it did not prevent hematogenous infection. Thus, gentamicin cement would not protect the joint against delayed hematogenous infection.

Hematogenous infection of total joint replacement. An experimental study in the rabbit.

(1981). Hematogenous Infection of Total Joint Replacement: An Experimental Study in the Rabbit. Acta Orthopaedica Scandinavica: Vol. 52, No. sup187, pp. 1-64.

Late hematogenous infection of total joint replacement.

Late deep wound infection secondary to hematogenous spread of bacteria from a distant focus is an infrequent but devastating complication of total joint replacement. Nine patients (ten implants) with documented late hematogenous infection are reported, all of whom demonstrated several characteristic features. The initial operation was free of clinical evidence of infection and a long asymptomatic interval ensued, followed by a definite febrile illness and acute joint pain. The source of the infection often was not recognized until late and prophylactic antibiotics were not given when it was identified. Seven of the ten implants had to be removed. The primary responsibility for the prevention of this devastating complication lies with the surgeon, who must inform each patient of the risk of late hematogenous seeding from infection elsewhere in the body. It is also important to pay special attention to patients who are at particularly high risk, such as those with rheumatoid arthritis or other systemic diseases. A knowledge of the bacterial flora of the various areas of the human body is essential in choosing the appropriate prophylactic antibiotic.

Hematogenous Infection in Total Joint Replacement

TOTAL joint replacement has been accepted as effective treatment for painful arthritis by the medical community. Indeed, between 1972 and 1976, an estimated 0.5 million joint prostheses were implanted in the United States.¹Infection of a prosthesis is one of the most serious complications of total joint replacement and is associated with serious morbidity and mortality.^2,3The pathogenesis of this infection, including portals of bacterial entry, is currently under debate, but evidence is accumulating to suggest that organisms are introduced by two routes: first, by local contamination at the time of surgery,⁴and later, by the hematogenous route.^5-7Prophylactic antibiotics and local wound care precautions can substantially reduce the incidence of early infections, but appear to have little effect on late sepsis.⁸We report here a case of<i>Staphylococcus aureus</i>hip sepsis occurring five years after total hip replacement, in association with an infected ulcer

Hematogenous infection in total joint replacement. Recommendations for prophylactic antibiotics

Hematogenous infection in total joint replacement. Recommendations for prophylactic antibiotics

Hematogenous Infection in Total Joint Replacement

Hematogenous infections may appear at any time after joint replacement operations. As distinguished from delayed infections where general symptoms of infection are absent, hematogenous infections cause malaise, chills and fever, usually of the septic type. Roentgenograms of the joint at an early stage of hematogenous infection do not show any sign of infection as these take time to develop. Nor is the scintigram positive at an early stage. The diagnosis is beyond doubt only when the same strain of bacteria is cultured from the joint, a primary focus and blood.