Prevention Of Prosthetic Joint Infection Research Articles

Dyslipidaemia is associated with Cutibacterium acnes hip and knee prosthetic joint infection.

Optimization of medical factors including diabetes and obesity is a cornerstone in the prevention of prosthetic joint infection (PJI). Dyslipidaemia is another component of metabolic syndrome which has not been thoroughly investigated as an individual, modifiable risk factor. This study examined the association of dyslipidaemia with PJI caused by the lipophilic microbe Cutibacterium acnes (C. acnes). A retrospective chart review examined patients with positive C. acnes culture at hip or knee arthroplasty explantation. A control group with methicillin-sensitive Staphylococcus aureus (MSSA) positive cultures at explantation was matched for age, sex, and surgical site, as well as a second control group with no infection. A total of 80 patients were included, 16 with C. acnes, 32 with MSSA, and 32 with no infection. All patients had a lipid panel performed within oneyear of surgery. Lipid values and categories were compared using multinomial logistic regressions. High or borderline triglycerides (TG) (relative risk ratio (RRR) = 0.13; P = 0.013) and low high-density lipoprotein (HDL) (RRR = 0.13; P = 0.025) were significantly associated with C. acnes PJI compared to MSSA-PJI. High or borderline TG (RRR = 0.21; P = 0.041) and low HDL (RRR = 0.17; P = 0.043) were also associated with a greater probability of C. acnes infection compared to no infection. The presence of elevated TG and low HDL were both associated at a statistically significant level with C. acnes hip or knee PJI compared to controls with either MSSA PJI or no infection. This may represent a specific risk factor for C. acnes PJI that is modifiable.

Efficacy and safety of locally applied vancomycin powder injection for the prevention of prosthetic joint infection

Purpose: To determine the efficacy and safety of locally-applied vancomycin powder injection as precaution against prosthetic joint infection (PJI).
 Methods: A total of ninety subjects on admission in Department of Limb and Joint Surgery, PLA Medical Center, who underwent surgery for arthroplasty of knee and hip, were selected for this study. They were divided into two groups comprising control group (n = 45) given routine preventive antibiotic therapy as well as treatment group (n = 45) which received routine prophylactic antibiotics in combination with vancomycin therapy. PJI and the incidence of adverse reactions within 3 months after surgery were recorded. Body temperature of the patients was recorded with a thermometer. The number of neutrophils was measured by flow cytometry, while the expression levels of IL-6 and hs-CRP in peripheral blood were determined using enzyme-linked immunosorbent assay (ELISA) preoperatively and at 24, 72 and 168 h post- therapy.
 Results: At 90 days post-therapy, there was obviously significant reduction in the degree of PJI in the vancomycin-treated subjects compared with control group (p > 0.05). Moreover, within 3 days, normothermia, lowered neutrophil population and downregulated expressions of Il-6 and hs-CRP were seen in the vancomycin group, when compared to control subjects (p < 0.05). However, there was no significant difference in the incidence of adverse reactions between the treatment and control groups after therapy (p > 0.05).
 Conclusion: Topical application of vancomycin powder injection is safe, and regulates the body temperature of PJI patients in the short-term after surgery. Moreover, it decreases the levels of inflammatory indices. However, further clinical trials should be carried out prior to application in clinical practice.

ANTIMICROBIAL ACTIVITY OF ION-SUBSTITUTED CALCIUM PHOSPHATES: A SYSTEMATIC REVIEW

Prosthetic Joint Infection (PJI) is a devastating complication that can occur after total joint replacement surgery. With increasing antimicrobial resistance, there is a need for non-antibiotic approaches to treat and prevent PJI. Doping calcium phosphates with antimicrobial ions shows promise for these purposes. This systematic review aims to search and summarise the evidence-base for the potential of calcium phosphates doped with different antimicrobial ions.A systematic review was conducted on PubMed, Embase, Web-Of-Science, Cochrane Library and Emcare of in vitro and animal studies on the antimicrobial activity of (co)substituted calcium phosphates according to PRIMSA guidelines.. The research protocol, listing search terms and in/exclusion criteria, was registered a priori at https://doi.org/10.7910/DVN/HEP18U. Data was extracted regarding ions, micro-organisms and antimicrobial activity.The search retrieved 1017 hits of which 148 papers were included. The substitution of 33 different ions was reported. Silver (n= 46), zinc (n=39), copper (n=18) and magnesium (n=14) were the most commonly doped ions. 36 different micro-organisms were studied of which E. coli (n=109), S. aureus (n=99), and C. albicans (n=22) were the most common. 6 different outcomes were reported, most commonly the K-ratio (n=53), the log CFU (n=41) and the bacterial inhibition zone (n=39). A validated outcome for the evaluation of biofilm prevention was lacking.There was considerable heterogeneity in studied ions, micro-organisms and reported outcomes. A lack of clearly defined reporting guidelines in the field of antimicrobial materials has led to the use of clinically irrelevant micro-organisms and a general lack of consistency of the methods used and the reported results. Currently, there is no universally accepted measure for the effectiveness required from biomaterials for treatment and prevention of PJI.

A biodegradable and antimicrobial polymer coating for metal implants for the prevention of prosthetic joint infection

The aim of this project is to produce antibiotic-loaded poly (lactic-co-glycolic acid) (PLGA) polymer films by airbrush onto orthopaedic implants to address prosthetic joint infections (PJIs). It covered the development of an airbrush spray-coating technique, the selection and assessment of polymers and antibiotics, sample characterisation and antibacterial studies. The initial results are encouraging as the PLGA coatings exhibited a sustained drug release pattern and antibacterial ability against causative pathogens. Moreover, these PLGA coatings also possessed rapid degradation within 4 weeks which could provide favourable conditions for osseointegration. Furthermore, cytotoxicity assessment of final coatings will need to be conducted to ensure biocompatibility, as well as to determine the effect of each coating on osseointegration. Finally, the development of alternative coating techniques which are more cost-effective and suitable for large-scale production might be the direction of future research. 

Prophylaxis for the Prevention of PJI after TAA: Is It Economically Justifiable?

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Prosthetic joint infection (PJI) is a costly and potentially fatal complication in total ankle arthroplasty (TAA). Some surgeons will use intraoperative vancomycin powder or copiously irrigate the surgical site with Povidone-iodine to prevent this outcome. Additionally, many surgeons will prescribe a short course of postoperative antibiotics. However, the efficacy of such prophylaxis continues to be debated, and little is known about the cost-effectiveness of these agents. Therefore, the purpose of this study was to perform a 'break-even' analysis to determine the number of cases that could be performed while only preventing a single PJI and still breaking even on cost. Methods: The literature was searched to determine the rate of PJI and the mean cost of total ankle replacement. The prices of topical vancomycin powder and Povidone-iodine were obtained from our institution's purchasing records. An online drug database was then used to determine the cost of a 14 day twice daily course of Sulfamethoxazole/Trimethoprim (800/160 mg), Cephalexin (500 mg), and Amoxicillin/Potassium Clavulanate (875/125 mg). A break-even analysis was then performed to determine the absolute risk reduction (ARR) necessary to make a drug cost-effective. Using the ARR, we calculated the number of patients that would need to be treated with these agents to prevent a single PJI (NNT). Results: The price of intraoperative vancomycin powder was found to be $3.06 while povidone-iodine was found to cost $3.64. Sulfamethoxazole/Trimethoprim (800/160 mg), Cephalexin (500 mg), and Amoxicillin/Potassium Clavulanate (875/125 mg) were determined to cost $3.00, $3.64, and $14.51, respectively. At the prices obtained Vancomycin Powder, Povidone-iodine, Sulfamethoxazole/Trimethoprim, and Cephalexin were all cost-effective if the initial rate decreased by ARRs of 0.01%. Likewise, Amoxicillin/Potassium Clavulanate was cost-effective if the initial rate decreased by an ARR of 0.03%. Additional analyses run found that all drugs-maintained cost-effectiveness even if the initial rate of PJI was as low as 0.1%. Conclusion: PJI following TAA is devastating and costly. Despite the ongoing debate regarding the efficacy of prophylactic measures to reduce the risk of PJI in TAA, limited is known about their cost-effectiveness. Our study demonstrates that intraoperative vancomycin powder, povidone-iodine lavage, and multiple commonly prescribed antibiotics are all highly cost- effective to prevent PJI following TAA. We feel that a tailored approach to taking measures to reduce PJI with cost-effectiveness in mind is crucial to providing value-based care.

Irrigation Solutions in Total Joint Arthroplasty.

INTRODUCTIONDespite advancements in the field of adult reconstruction, prosthetic joint infection (PJI) remains a common and devastating complication of total joint arthroplasty. Eradication of these infections can often prove difficult, and they remain a source of considerable morbidity and mortality. This clinical review paper will focus on some of the more commonly used irrigation solutions; povidone-iodine (PI), chlorhexidine (CHG), acetic acid (AA), hydrogen peroxide (HP), antibiotic irrigations, taurolidine, and polyhexanide-betaine (PB)SUMMARY OF THE EVIDENCESignificant research has been performed on the prevention of PJI, including use of intraoperative joint irrigation solutions. Several solutions have been theorized to aid in infection prevention, but no evidence-based practice guidelines in this area of orthopaedics have been established. There is a paucity of prospective randomized control trials to compare the efficacy of these joint irrigation solutions.CONCLUSIONSThe authors present a review regarding seven major categories of commonly used intraoperative joint irrigation solutions. The current literature fails to demonstrate a clear consensus for a preferred solution and concentration for povidone-iodine, chlorhexidine, hydrogen peroxide, acetic acid, antibiotic irrigations, taurolidine, and polyhexanide-betaine. Prospective, randomized control trials directly comparing these different irrigation solutions are needed.

Effectiveness and safety of vancomycin powder injection locally applied in theprevention of prosthetic joint infection

Prosthetic joint infection is a rare but serious complication that is associated with considerable morbidity and financialburdens and other hardships for the individual. The available treatment options for PJI include both surgery andantimicrobial therapy. The surgical option includes debridement, antibiotics and implant retention (DAIR), that is usuallyrecommended at initial stages, one stage or two stage revision arthroplasty at advanced stages. These treatments are muchexpensive and time consuming and have around 11-30% failure rate. Therefore, there is an urgent need for a appropriate andaffordable treatment strategy. Vancomycin serves as an active agent against the pathogens that have ability to causepotential damage to the wounds after surgery. In its powder form, it ensures adequate surgical site concentrations whileminimizing the adverse effects caused by undetectable systemic distribution. Thus, we explored the effectiveness and safetyof vancomycin powder injection locally applied in the prevention of prosthetic joint infection (PJI). A total of 90 inpatientswho underwent total hip and knee arthroplasty from January 2018 to December 2019 were selected and randomly dividedinto control group (routine preventive antibiotic therapy) and treatment group (vancomycin applied based on the treatmentof control group). The incidence of PJI and adverse reactions within 3 months after operation was observed. The changes inbody temperature, neutrophil count, interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) levels wererecorded before operation and 1, 3 and 7 days after treatment. Ninety days after treatment, the incidence rate of PJI intreatment group (0.00) was significantly lower than that of control group (8.89%) (P <0.05). Within a short period of time (1d and 3 d) after treatment, the body temperature, neutrophil count, IL-6 and hs-CRP levels were all lower in treatment groupthan those in control group (P <0.05). However, the above indices had no significant differences between the two groups at1 week (7 d) after treatment (P >0.05). There were 3 cases (6.67%) and 2 cases (4.44%) of adverse reactions in treatmentgroup and control group, respectively. The incidence rates of adverse reactions were similar (χ2=0.212, P=0.645).Vancomycin powder injection locally applied can control the body temperature, and reduce the neutrophil count, IL-6 andhs-CRP levels within a short period of time after operation, which is superior to routine preventive antibiotic therapy. It candecrease the incidence rate of PJI after arthroplasty.

Effect of Tranexamic Acid against Staphylococcus spp. and Cutibacterium acnes Associated with Peri-Implant Infection: Results from an In Vitro Study

ABSTRACTTranexamic acid (TXA) is extensively used in orthopedic surgery and traumatology as an antifibrinolytic agent to control intra- and postoperative bleeding and, therefore, indirectly, to reduce postsurgery infection rates. The hypothesis of an additional antibiotic effect against microorganisms associated with periprosthetic joint infection needs to be further evaluated. We aimed to assess whether TXA could reduce bacterial growth using an in vitro model. ATCC and clinical strains of staphylococci and Cutibacterium acnes were tested against TXA in both planktonic and sessile forms. We recorded the percent reduction in the following variables: log CFU/mL by microbiological culture, percentage of live cells by confocal laser scanning microscopy, and, additionally in sessile cells, metabolic activity by the 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt (XTT) assay. Variables were compared between groups using the Kruskal-Wallis test, and the results were reported as median (interquartile range [IQR]). Statistical significance was set at a P value of <0.05. Clinical significance was defined as a reduction of ≥25%. TXA at 50 mg/mL led to a slight reduction in CFU counts (4.5%). However, it was at 10 mg/mL that the reduction reached 27.2% and 33.0% for log CFU/mL counts and percentage of live cells, respectively. TXA was not efficacious for reducing preformed 24-h mature staphylococci and 48-h mature C. acnes biofilms, regardless of its concentration. TXA did not exert an antimicrobial effect against bacterial biofilms. However, when bacteria were in the planktonic form, it led to a clinically and statistically significant reduction in bacterial growth at 10 mg/mL.IMPORTANCE The possible use of TXA as an antibiotic agent in addition to its antifibrinolytic effect may play an important role in the prevention of prosthetic joint infection.

Silver Coatings in Reconstructive Orthopaedics: Basic Science and Clinical Rationale

Prosthetic joint infection (PJI) is one of the most devastating complications that can occur following total hip and total knee arthroplasty. Despite the remarkable advances that have been made in surgical techniques and implant technology, the incidence of PJI has remained largely unchanged over the past two decades. One approach that has been described in the literature to minimize the risk of PJI has been the use of silver-coated prostheses. Silver has been reported to have antimicrobial properties when added to a variety of orthopaedic materials including bone cement, hydroxyapatite coatings and wound dressings. Silver is also being increasingly used as a surface coating for endoprostheses used for reconstruction around the hip and the knee with the specific aim of reducing the incidence of prosthetic joint infection. Despite the increasing adoption of this technology, the use of silver coatings remains controversial. The optimal method for preparation and the thickness of the coating, as well as the mechanism(s) of action in reducing the incidence of PJI, are unclear. The issue of silver toxicity is also an important consideration. This paper provides an overview of the use of silver coatings in reconstructive orthopaedics, as well as the types available and techniques used to coat endoprostheses. We also review the basic science as well as the clinical applications of silver coatings in the prevention of PJIs.

Vancomycin bone and tissue concentrations following tibial intraosseous administration - evaluated in a porcine model.

Introduction. Systemic perioperative vancomycin may not provide sufficient prophylactic target-site concentrations in the prevention of prosthetic joint infections. Intraosseous vancomycin potentially provides high target-site concentrations. The objective of the present study was to evaluate the local bone and tissue concentrations following tibial intraosseous vancomycin administration in a porcine model. Methods. Eight pigs received 500 mg diluted vancomycin (50 mg/mL) through an intraosseous cannula into the proximal tibial cancellous bone. No tourniquet was applied. Microdialysis was applied for sampling of vancomycin concentrations in adjacent tibial cancellous bone, in cortical bone, in the intramedullary canal of the diaphysis, in the synovial fluid of the knee joint, and in the subcutaneous tissue. Plasma samples were obtained as a systemic reference. Samples were collected for 12 h. Results. High vancomycin concentrations were found in the tibial cancellous bone with a mean peak drug concentration of 1236 (range 28–5295) , which remained high throughout the sampling period. The mean (standard deviation) peak drug concentration in plasma was 19 (2) , which was obtained immediately after administration. Peak drug concentration, time to peak drug concentration, and area under the concentration–time curve were within the same range in the intramedullary canal, the synovial fluid of the knee, and the subcutaneous tissue. Conclusion. Tibial intraosseous administration of vancomycin provided high concentrations in tibial cancellous bone throughout a 12 h period but with an unpredictable and wide range of peak concentration. The systemic absorption was high and immediate, thus mirroring an intravenous administration. Low mean concentrations were found in all the remaining compartments.

Infection and periprosthetic fracture are the leading causes of failure after aseptic revision total knee arthroplasty.

The purpose of this study was to clarify the medium to long term survival of aseptic revision total knee arthroplasty (RTKAs) and identify the common modes of failure following RTKAs. A multi-center, retrospective study included all aseptic RTKAs performed at three tertiary referral hospitals between 2003 and 2016. Patients were excluded if the revision was for prosthetic joint infection (PJI) or they had previously undergone revision surgery. Minor revisions not involving the tibial or femoral components were also excluded. Demographics, surgical data and post-operative outcomes were recorded and analyzed. Survival analysis was performed and the reasons for revision failure identified. Of 235 aseptic RTKAs identified, 14.8% underwent re-revision at mean follow-up of 8.3years. Survivorship of RTKA was 93% at 2years and 83% at 8years. Average age at revision was 72.9years (range 53-91.5). The most common reasons for failure following RTKA were periprosthetic joint infection (PJI) (40%), periprosthetic fracture (25.7%) and aseptic loosening (14.3%). Of those whose RTKA failed, the average survival was 3.33years (8days-11.4years). No demographic or surgical factors were found to influence RTKA survival on univariate or multivariate analysis. PJI and periprosthetic fracture are the leading causes of re-revision surgery following aseptic revision TKA. Efforts to improve outcomes of aseptic revision TKA should focus on these areas, particularly prevention of PJI.

Intraoperative Bacterial Contamination and Activity of Different Antimicrobial Prophylaxis Regimens in Primary Knee and Hip Replacement.

Surgical antimicrobial prophylaxis (SAP) is important for the prevention of prosthetic joint infections (PJIs) and must be effective against the microorganisms most likely to contaminate the surgical site. Our aim was to compare different SAP regimens (cefazolin, cefuroxime, or vancomycin, alone or combined with gentamicin) in patients undergoing total knee (TKA) and hip (THA) arthroplasty. In this preclinical exploratory analysis, we analyzed the results of intraoperative sample cultures, the ratio of plasma antibiotic levels to the minimum inhibitory concentrations (MICs) for bacteria isolated at the surgical wound and ATCC strains, and serum bactericidal titers (SBT) against the same microorganisms. A total of 132 surgical procedures (68 TKA, 64 THA) in 128 patients were included. Cultures were positive in 57 (43.2%) procedures (mostly for coagulase-negative staphylococci and Cutibacterium spp.); the rate was lower in the group of patients receiving combination SAP (adjusted OR 0.475, CI95% 0.229–0.987). The SAP regimens evaluated achieved plasma levels above the MICs in almost all of intraoperative isolates (93/94, 98.9%) and showed bactericidal activity against all of them (SBT range 1:8–1:1024), although SBTs were higher in patients receiving cefazolin and gentamicin-containing regimens. The potential clinical relevance of these findings in the prevention of PJIs remains to be determined.

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining.

A projected increased use of total joint arthroplasties will naturally result in a related increase in the number of prosthetic joint infections (PJIs). Suppression of the local peri-implant immune response counters efforts to eradicate bacteria, allowing the formation of biofilms and compromising preventive measures taken in the operating room. For these reasons, the prevention of PJI should focus concurrently on the following targets: (i) identifying at-risk patients; (ii) reducing “bacterial load” perioperatively; (iii) creating an antibacterial/antibiofilm environment at the site of surgery; and (iv) stimulating the local immune response. Despite considerable recent progress made in experimental and clinical research, a large discrepancy persists between proposed and clinically implemented preventative strategies. The ultimate anti-infective strategy lies in an optimal combination of all preventative approaches into a single “clinical pack”, applied rigorously in all settings involving prosthetic joint implantation. In addition, “anti-infective” implants might be a choice in patients who have an increased risk for PJI. However, further progress in the prevention of PJI is not imaginable without a close commitment to using quality improvement tools in combination with continual data mining, reflecting the efficacy of the preventative strategy in a particular clinical setting.

Local Vancomycin Concentrations after Intra-articular Injection into the Knee Joint: An Experimental Porcine Study.

Intra-articular injection of vancomycin may be an important antimicrobial prophylactic supplement to systemic administration in the prevention of prosthetic joint infections. In eight female pigs, 500 mg of diluted vancomycin was given by intra-articular injection into the knee joint. Microdialysis was used for dense sampling of vancomycin concentrations over 12 hours in the synovial fluid of the knee joint, and in the adjacent femoral and tibial cancellous bone and subcutaneous tissue. Venous blood samples were obtained as reference. The mean (standard deviation [SD]) peak drug concentration of vancomycin in the synovial fluid of the knee joint was 5,277 (5,668) μg/mL. Only one pig failed to reach a peak drug concentration above 1,000 μg/mL. The concentration remained high throughout the sampling interval with a mean (SD) concentration of 337 (259) μg/mL after 690 minutes. For all extraarticular compartments, the pharmacokinetic parameters (area under the concentration time-curve, peak drug concentration, and time to peak drug concentration) were comparable. The highest extraarticular mean (SD) peak drug concentration of 4.4 (2.3) μg/mL was found in subcutaneous tissue. An intra-articular injection of 500 mg diluted vancomycin was found to provide significant prophylactic mean concentrations for at least 12 hours in the synovial fluid of the knee joint. Correspondingly, the adjacent tissue and plasma concentrations were low but remained stable, signifying low risk of systemic toxic side effects and a slow release or uptake from the synovium to the systemic circulation.

Perioperative Chlorhexidine Gluconate Wash During Joint Arthroplasty Has Equivalent Periprosthetic Joint Infection Rates in Comparison to Betadine Wash

BackgroundDilute betadine wash has been used for the prevention of prosthetic joint infection (PJI). Appropriateness for this purpose has recently come into question as the Food and Drug Administration determined that several commercial products did not pass the standards of proper sterility. The goal of this study is to determine if change in our institution’s perioperative infection protocol to sterile chlorhexidine gluconate wash affected rates of PJI. MethodsThis is a retrospective study of prospectively collected data for patients who underwent unilateral primary total knee arthroplasty and total hip arthroplasty. Chart review was performed to determine 90-day and 1-year readmissions and the development of PJI as per the diagnostic criteria of the Musculoskeletal Infection Society. ResultsA total of 2386 consecutive patients were included in this study. There were no significant demographic differences between the 2 groups. There was no statistically significant difference in the rate of PJI requiring a return trip to the operating room between the 2 cohorts: 4 in chlorhexidine vs 7 in betadine at 3 months (P = .61); and 9 in chlorhexidine and 14 in betadine at 1 year (P = .48, respectively). There was also no difference in the rate of wound complications between the betadine and chlorhexidine use (P = .93). ConclusionWhen comparing patients who received a betadine wash intraoperatively to those who received a chlorhexidine gluconate wash, there were no statistically significant differences in the rate of postoperative PJIs or return trips to the operating room. Although chlorhexidine gluconate and betadine have equal efficacy in the prevention of PJI, betadine is a far less expensive alternative if their sterility concerns are unwarranted Level of EvidenceTherapeutic Level III.

Dual prophylaxis with teicoplanin and cefazolin in the prevention of prosthetic joint infection

IntroductionThere is a growing increase in prosthetic joint infection (PJI) incidence due to cephalosporin-resistant bacteria, used in surgical prophylaxis. The replacement of these with glycopeptides has not been shown to improve the results, but they have been shown to improve with their combination. MethodsComparative study of combination of teicoplanin and cefazolin before arthroplasty surgery against cefazolin alone from a previous control group. ResultsDuring the control period, there were 16 PJIs from 585 surgeries, while in the intervention group there were 6 from 579 (incidence 2.7% vs. 1.03%, RR 0.4, p=0.04). In control group, 11 of the infections were caused by Gram-positive bacteria vs. 4 in the intervention group (1.8% vs. 0.7%, p=0.08). ConclusionsThe addition of teicoplanin to cefazolin in the prophylaxis of arthroplasty surgery was associated with a reduction in the incidence of PJI, thanks to a decrease in infections caused by Gram-positive bacteria.

Implant Fixation and Risk of Prosthetic Joint Infection Following Primary Total Hip Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies.

Prosthetic joint infection (PJI), although uncommon, is a dreaded and devastating complication of total hip replacement (THR). Whether implant-related factors, such as the fixation method, influences the risk of PJI following THR is contentious. We conducted a systematic review and meta-analysis to evaluate the body of evidence linking fixation methods (cemented, uncemented, hybrid, or reverse hybrid) with the risk of PJI following primary THR. Observational studies and randomised controlled trials (RCTs) comparing fixation methods, and reporting PJI incidence following THR, were identified through MEDLINE, Embase, Web of Science, Cochrane Library, and reference lists of relevant studies up to 24 April 2019. Summary measures were relative risks (RRs) (95% confidence intervals, CIs). We identified 22 eligible articles (based on 11 distinct observational cohort studies comprising 2,260,428 THRs and 4 RCTs comprising 945 THRs). In pooled analyses of observational studies, all cemented fixations (plain and antibiotic combined), plain cemented fixations, hybrid fixations, and reverse hybrid fixations were each associated with an increased overall PJI risk when compared with uncemented fixations: 1.10 (95% CI: 1.04–1.17), 1.50 (95% CI: 1.27–1.77), 1.49 (95% CI: 1.36–1.64), and 1.49 (95% CI: 1.14–1.95), respectively. However, in the first six months, uncemented fixations were associated with increased PJI risk when compared to all cemented fixations. Compared to antibiotic-loaded cemented fixations, plain cemented fixations were associated with an increased PJI risk (1.52; 95% CI: 1.36–1.70). One RCT showed an increased PJI risk comparing plain cemented fixations with antibiotic-loaded cemented fixations. Uncemented and antibiotic-loaded cemented fixations remain options for the prevention of PJI in primary THR.

Prevention of prosthetic joint infection in total hip and knee arthroplasties: Evidence based recommendations

Prosthetic joint infection is a dreaded complication of Total Joint Arthroplasty. Prevention, which is far more cost effective, should be of paramount importance to the arthroplasty surgeon. Proper patient selection and preparation as well as strict asepsis and antisepsis are the basic principles of prevention.

MP10-15 THE IMPACT OF COMMON UROLOGIC COMPLICATIONS ON THE RISK OF A PROSTHETIC JOINT INFECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I1 Apr 2018MP10-15 THE IMPACT OF COMMON UROLOGIC COMPLICATIONS ON THE RISK OF A PROSTHETIC JOINT INFECTION Nahid Punjani, Brent Lanting, Andrew McClure, Jennifer Winick-Ng, and Blayne Welk Nahid PunjaniNahid Punjani More articles by this author , Brent LantingBrent Lanting More articles by this author , Andrew McClureAndrew McClure More articles by this author , Jennifer Winick-NgJennifer Winick-Ng More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.361AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prosthetic infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) are significant complications, and there are conflicting reports of their association with urologic complications. The purpose of this study is to determine if urinary tract infection (UTI) and acute urinary retention (AUR) are significant risk factors for joint infections after THA or TKA. METHODS This study is a population-based retrospective cohort study of all patients greater than 66 years of age undergoing a THA or TKA in Ontario, Canada between April 1, 2003 and March 31, 2013 (n = 113,061). Cases were reviewed for post-operative UTI requiring presentation to the emergency department or hospital admission within 2 years of joint replacement, as well as acute urinary retention within 30 days of THA/TKA. The primary outcome is joint infection requiring hospital admission following THA and TKA. We hypothesized that both UTI and AUR would increase the risk of subsequent joint infection after arthroplasty. RESULTS A total of 113,061 patients met inclusion criteria and had arthroplasties during the study period (44,495 with THA and 68,566 with TKA). Median age was 74 (IQR 70-79). A total of 28,256 (25.0%) had at least one UTI, and were more likely to be older, female, have previous antibiotic exposure, cystoscopy or retention, and have atrial fibrillation. A total of 2,516 (2.2%) patients had AUR within 30 days of procedure, and were more likely to be older, male, have medical comorbidities, previous transurethral procedures or cystoscopy, previous Urology visits and a general anesthetic during their procedure. A total of 1,262 (1.1%) patients had joint infection requiring hospital admission at a median of 86 days (IQR 21-377). In multivariate Cox regression analysis, UTI was associated with an increased risk of joint infection (HR 1.21, 95% CI 1.14-1.28, p<0.01). However multivariate analysis did not demonstrate an association with AUR and joint infection (HR 0.99, 95% CI 0.60-1.64, p=0.98). CONCLUSIONS UTI is associated with increased risk of peri-prosthetic joint infection of THA or TKA, whereas acute urinary retention is not a significant risk factor. Timely and appropriate treatment of symptomatic UTIs in this patient population may be important in prevention of prosthetic joint infection. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e122-e123 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nahid Punjani More articles by this author Brent Lanting More articles by this author Andrew McClure More articles by this author Jennifer Winick-Ng More articles by this author Blayne Welk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bactericidal activity of the Ti–13Nb–13Zr alloy against different species of bacteria related with implant infection

The Ti–6Al–4V alloy is one of the most commonly used in orthopedic surgery. Despite its advantages, there is an increasing need to use new titanium alloys with no toxic elements and improved biomechanical properties, such as Ti–13Nb–13Zr. Prosthetic joint infections (PJI) are mainly caused by Gram-positive bacteria; however, Gram-negative bacteria are a growing problem due to associated multidrug resistance. In this study, the bacterial adherence and viability on the Ti–13Nb–13Zr alloy have been compared to that of the Ti–6Al–4V alloy using 16 collection and clinical strains of bacterial species related to PJI: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa. When compared with the Ti–6Al–4V alloy, bacterial adherence on the Ti–13Nb–13Zr alloy was significantly higher in most staphylococcal and P. aeruginosa strains and lower for E. coli strains. The proportion of live bacteria was significantly lower for both Gram-negative species on the Ti–13Nb–13Zr alloy than on the Ti–6Al–4V alloy pointing to some bactericidal effect of the Ti–13Nb–13Zr alloy. This bactericidal effect appears to be a consequence of the formation of hydroxyl radicals, since this effect is neutralized when dimethylsulfoxide was added to both the saline solution and water used to wash the stain. The antibacterial effect of the Ti–13Nb–13Zr alloy against Gram-negative bacteria is an interesting property useful for the prevention of PJI caused by these bacteria on this potential alternative to the Ti–6Al–4V alloy for orthopedic surgery.