Prosthesis Infection Research Articles

Revision arthroplasty after unicompartimental knee arthroplasty

BackgroundUnicompartimental knee arthroplasty (UKA) is a promising and increasing application to treat unicompartimental knee osteoarthritis. However, revision arthroplasty numbers after UKA are unknown. Therefore, aim of this study was to determine the nationwide burden of revision after UKA by answering the following questions: (1) How did numbers of revision UKA procedures developed over the last decade as a function of age and gender? (2) How high is the percentage of revision UKA procedures due to infection? (3) Which therapy strategy was chosen for surgical treatment of aseptic revision UKA?MethodsRevision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis).ResultsOver the last decade, revision UKA increased by 46.3% up to 3105 procedures in 2018. A trend towards higher numbers in younger patients was observed. Septic interventions constituted 5.7% of all revisions, whereby total procedures increased by 67.1% from 2008 through 2018. The main treatment strategy was an exchange to a bicondylar surface replacement prosthesis, which was done in 63.70% of all cases, followed by exchange to a femoral and tibial shaft-anchored (16.2% of all revisions).ConclusionThe increasing number of revision arthroplasty after UKA in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies beyond UKA to delay primary arthroplasty and avoid periprosthetic joint infection.

Peptide Polymer‐Doped Cement Acting as an Effective Treatment of MRSA‐Infected Chronic Osteomyelitis

AbstractChronic osteomyelitis is a painful and serious disease normally caused by infected surgical prostheses or infected fractures. Currently, antibiotic‐loaded cements are extensively used as the treatment in clinical practice. However, the quick emergence of antibiotic‐resistant bacteria has resulted in a formidable challenge in treating chronic osteomyelitis, such as the chronic osteomyelitis caused by methicillin‐resistant Staphylococcus aureus (MRSA). Aiming to address MRSA‐infected chronic osteomyelitis, an antibacterial peptide polymer doped polymethylmethacrylate bone cement pellets (PMMA@polymer) is prepared. The peptide polymer is designed as the synthetic mimic of host defense peptide and enables PMMA@polymer to have notable advantages, including complete release of antibacterial agent from PMMA, potent and robust activity against MRSA even after autoclave and enzymatic treatment, and low susceptibility to antibacterial resistance. PMMA@polymer showed potent in vitro activities against MRSA, superior in vivo therapeutic efficacy in a rabbit chronic osteomyelitis model, and low toxicity during the treatment. These advantages and the easy preparation of PMMA@polymer altogether suggest the great potential of PMMA@polymer as an effective treatment of MRSA‐infected chronic osteomyelitis. This study opens new avenues in developing antibacterial biomaterials for the treatment of chronic orthopedic infections, frequently caused by drug‐resistant bacteria.

Evaluation of antimicrobial peptide LL-37 for treatment of Staphylococcus aureus biofilm on titanium plate.

The antimicrobial peptide LL-37 belongs to the cathelicidin family and is one of the few human bactericidal peptides with potent antistaphylococcal activity. Staphylococcus aureus is one of the main infection bacteria in orthopedic implant therapy. Biofilm formation after bacterial infection brings more and more severe test for clinical antiinfection treatment.However, there are few studies on LL-37 in S. aureus infection of prosthesis. In this work, addition to research the antibacterial activity and the inhibitory effect on bacterial adhesion of LL-37, an in vitro model of S. aureus biofilm formation on titanium alloy surface was established to observe the inhibitory effect of LL-37.The results showed that LL-37 has a strong antibacterial effect on S. aureus in vitro, and the minimum inhibitory concentration (MIC) is about 0.62 μΜ. Moreover, LL-37 has significant impact on the adhesion of S. aureus when the concentration ≥0.16 μM and significant anti-staphylococcal biofilm effects on static biofilm models at the concentration of 0.31 to 10 μM. Additionally, LL-37 at 5 μM had a significant destructive effect on S. aureus biofilm (P < .05) that formed on the titanium alloy surface.This study further confirmed the role of LL-37 in the process of S. aureus infection, including antimicrobial activities, inhibition of bacterial adhesion, and inhibition of mature biofilm. LL-37 can significantly destroy the stable biofilm structure on the titanium alloy surface in vitro, which may provide a new way for refractory infection caused by S. aureus in titanium alloy prosthesis infection.

Surgical Experience from the Phase III STASEY Trial of Emicizumab Prophylaxis in Persons with Hemophilia A with FVIII Inhibitors: Final Analysis

Surgical Experience from the Phase III STASEY Trial of Emicizumab Prophylaxis in Persons with Hemophilia A with FVIII Inhibitors: Final Analysis

КЛИНИКО-ДЕМОГРАФИЧЕСКАЯ ХАРАКТЕРИСТИКА ПАЦИЕНТОВ И ФАКТОРЫ РИСКА ИНФИЦИРОВАНИЯ ИСКУССТВЕННЫХ СОСУДИСТЫХ ПРОТЕЗОВ ПОСЛЕ РЕКОНСТРУКТИВНЫХ ОПЕРАЦИЙ НА АОРТО-ПОДВЗДОШНО-БЕДРЕННОМ СЕГМЕНТЕ

Objective: to study the clinical and demographic characteristics of patients and risk factors, to analyze their influence on the frequency of infection of artificial vascular prostheses in the aortoiliac-femoral segment. Material and methods. We analyzed 609 medical records of inpatient patients who had undergone vascular reconstructive interventions on the aortoiliac-femoral segment using a synthetic vascular prosthesis. The article presents the clinical and demographic characteristics of patients with lesions of the aortoiliac-femoral segment. The frequency of conduit infection in various major diseases, surgical approaches, types of bypass surgery (prosthetics), types of artificial vascular prosthesis was analysed. Results. The patients who developed lesions of the aortoiliac-femoral segment were mostly males (94.6%), urban residents (78%), unemployed (68.6%), those with chronic obliterating diseases of the arteries of the lower extremities (72.7%) and coronary heart disease (59.4%). The incidence of vascular prostheses in patients with chronic obliterating diseases of the arteries of the lower extremities was 5.5%, and in those with an aneurysm of the infrarenal abdominal aorta – 1.2%. Conclusion. The pattern of developing artificial vascular prosthesis infection has been established. Infection of conduits occurs statistically significantly more often in patients with chronic obliterating diseases of the arteries of the lower extremities than in those with an aneurysm of the infrarenal abdominal aorta.

Rinse But Don't Repeat: Single Application V.A.C. VERAFLO Salvages Infected Breast Prostheses.

Introduction:Existing salvage protocols for infected breast prostheses using negative pressure wound therapy with instillation and dwell (NPWTi-d) require multiple returns to the operating room and prolonged length of stay. We present our expedited salvage protocol and discuss outcomes and associated costs savings.Methods:Using a retrospective review, we identified 25 consecutive patients (27 breasts) with peri-prosthetic breast infection. Nine patients (10 breasts) underwent removal of infected breast prostheses followed by autologous or staged implant-based reconstruction. Sixteen patients (17 breasts) underwent our single application salvage protocol. A cost analysis was performed comparing the two groups, and an economic model was used to project the cost savings associated with using single application NPWTi-d protocol.Results:Fifteen of the 16 patients (94%) who underwent single application NPWTi-d had successful implant salvage. Average duration of NPWTi-d was 2 days, 7 hours, and average length of stay was 4.43 days. Compared to control, patients who received the single application protocol required significantly fewer hospitalizations and office visits. A total savings of $58,275 could have been achieved by using the single application NPWTi-d protocol in the patients who did not undergo NPWTi-d.Conclusions:Single application of NPWTi-d is a simple, safe, and cost-effective technique for salvage of breast prostheses, with 94% success rate, even in immunocompromised patients and severe infection. Compared to previous protocols, ours requires fewer trips to the operating room, shorter length of stay, and more permanent implants placed during salvage. Our protocol is also associated with fewer office visits and fewer returns to the operating room.

Deep Femoral Vein Reconstruction for Abdominal Aortic Graft Infections is Associated with Low Aneurysm Related Mortality and a High Rate of Permanent Discontinuation of Antimicrobial Treatment

Aortic prosthesis infection is a devastating complication of aortic surgery. In situ reconstruction with the neo-aorto-iliac system (NAIS) bypass technique has become increasingly used and is recommended in recent treatment guidelines. The main aim was to evaluate NAIS procedural outcomes when undertaken after previous open or endovascular aortic repair in Sweden. In this retrospective study, The National Quality Registry for Vascular Surgery (Swedvasc) was used to identify Swedish centres that offered the NAIS bypass procedure for aortic prosthesis infection between 2008 and 2018. Variables of special interest were procedural details, short and long term survival, renal and other complications, and the durtion of antimicrobial treatment. Forty patients (36 males, four females [mean age 69 years], 32 open repairs, seven endovascular aortic repairs [EVAR] and one fenestrated EVAR; 21 presented with aorto-enteric fistula) operated on with NAIS bypass were reviewed. The median time from the primary aortic intervention to the NAIS bypass procedure was 32 months (range 0 - 252 months). Mean ± standard deviation operating time was 645 ± 160 minutes, mean blood loss was 6 277 ± 6 525 mL, mean length of intensive care unit stay was 5.3 ± 3.7 days, and mean length of overall hospital stay was 21.2 ± 11.4 days. Thirty-five patients (88%) had a positive microbial culture; the most commonly isolated pathogen was Candida spp. The majority of patients survived for 30 days (n= 35 [88%]), and 33 (83%) and 32 (80%) patients survived for 90 days and one year, respectively. The number of surviving patients free from antimicrobial treatment at 90 days, six months, and one year was 19 (58%), 29 (88%), and 30 (94%). After a mean long term follow up of 69.9 ± 44.7 months, 20 patients were still alive. The NAIS bypass procedure offered reasonable survival and functional outcomes, and was associated with a high cure rate, defined as freedom from any antimicrobial treatment.

Laparoscopic transperitoneal hernia repair (TAPP) in emergency: long-term follow-up in a high volume centre.

Aim of this study was to analyse feasibility, safety and effectiveness of laparoscopic transperitoneal hernia repair (TAPP) approach to inguinal hernias in the emergency setting, with a longer follow-up than the studies present in literature. We retrospectively analysed all patients who underwent emergency TAPP hernia repair in San Marco Hospital (Zingonia, Italy), from September 2010 to June 2020. A prospectively collected database of 685 consecutive TAPP hernia repair was reviewed. Feasibility and safety were evaluated through operative time, conversion rate, perioperative mortality, morbidity and prosthesis infection rate. Effectiveness was assessed by recurrence and complication rate, acute (during admission) and chronic (during follow-up) pain by Visual Analogic Scale (VAS), and recovery to normal activity in a long-term follow-up (mean period 1718days). The final study group included 47 patients. The mean age was 59.6years (range 22-89), 29 patients were male and 18 were female. The mean operation time was 64min. Two cases were converted to open approach (4%). In four cases bowel resection became necessary (8.5%). Appendicectomy and omentectomy occurred once and twice, respectively (2% and 4%), and orchiectomy was required in two patients (4%). Seroma was the only postoperative complication that we registered in four patients.During a mean follow-up period of 1718days, there was no recurrence of the hernia or other complications. Five patients referred mild occasional groin pain (VAS < 3), with quick relief without taking any pain killers. TAPP approach is a safe, feasible and effective therapeutic option for groin hernias in emergency setting. No recurrence or severe complications were reported in over 4years of follow-up.

Skin-reducing mastectomy and pre-pectoral breast reconstruction using the Braxon® ADM: a single-center experience

Breast cancer is the second leading cause of death in women. The most recent and successful advancement in implant-assisted breast reconstruction after mastectomy is the prepectoral approach using an acellular dermal matrix (ADM). Patients with ptotic breasts and macromastia were initially excluded from this type of immediate reconstruction remaining a difficult group to treat. The aim of this paper is to present our experience in performing skin-reducing mastectomy with pre-pectoral implant and complete ADM coverage as a single-stage procedure in patients with large ptotic breasts, evaluating the benefits and complications resulting from the use of this technique. A retrospective analysis of skin-reducing mastectomies and pre-pectoral breast reconstructions using Braxon porcine-derived ADM performed between January 2019 and February 2021 at our Breast Unit. We treated 20 patients and performed a total of 24 skin-reducing mastectomies with pre-pectoral reconstruction. We observed two cases of partial NAC necrosis (8.3%) and one case of total NAC necrosis (4.2%). The incidence of skin flap necrosis was 8.3% (N.=2) healed by secondary intention. No case of prosthesis removal, infection or seroma was reported. Patients scored very good level of satisfaction with breast based on the results of the BREAST- Q questionnaire. Skin-reducing mastectomy and pre-pectoral breast reconstruction can be offered to patients with large and ptotic breasts with good aesthetic and functional results. New prospective observational studies would be desirable to provide an opportunity to evaluate the long-term capabilities and complications of this technique.

In Vitro Evaluation of Calcium Phosphate Bone Cement Composite Hydrogel Beads of Cross-Linked Gelatin-Alginate with Gentamicin-Impregnated Porous Scaffold.

Calcium phosphate bone cement (CPC) is in the form of a paste, and its special advantage is that it can repair small and complex bone defects. In the case of open wounds, tissue debridement is necessary before tissue repair and the subsequent control of wound infection; therefore, CPC composite hydrogel beads containing antibiotics provide an excellent option to fill bone defects and deliver antibiotics locally for a long period. In this study, CPC was composited with the millimeter-sized spherical beads of cross-linked gelatin–alginate hydrogels at the different ratios of 0 (control), 12.5, 25, and 50 vol.%. The hydrogel was impregnated with gentamicin and characterized before compositing with CPC. The physicochemical properties, gentamicin release, antibacterial activity, biocompatibility, and mineralization of the CPC/hydrogel composites were characterized. The compressive strength of the CPC/hydrogel composites gradually decreased as the hydrogel content increased, and the compressive strength of composites containing gentamicin had the largest decrease. The working time and setting time of each group can be adjusted to 8 and 16 min, respectively, using a hardening solution to make the composite suitable for clinical use. The release of gentamicin before the hydrogel beads was composited with CPC varied greatly with immersion time. However, a stable controlled release effect was obtained in the CPC/gentamicin-impregnated hydrogel composite. The 50 vol.% hydrogel/CPC composite had the best antibacterial effect and no cytotoxicity but had reduced cell mineralization. Therefore, the optimal hydrogel beads content can be 25 vol.% to obtain a CPC/gentamicin-impregnated hydrogel composite with adequate strength, antibacterial activity, and bio-reactivity. This CPC/hydrogel containing gentamicin is expected to be used in clinical surgery in the future to accelerate bone regeneration and prevent prosthesis infection after surgery.

Comparison of Two Cutibacterium acnes Biofilm Models.

The study of biofilms in vitro is complex and often limited by technical problems due to simplified models. Here, we compared C. acnes biofilm formation, from species involved in bone and prosthesis infection, in a static model with a dynamic model. Using similar parameters, the percentage of live bacteria within the biofilm was higher in dynamic than in static approach. In both models, bacterial internalization in osteoblast-like cells, playing the role of stress factor, affected this proportion but in opposite ways: increase of live bacteria proportion in the static model (×2.04 ± 0.53) and of dead bacteria proportion (×3.5 ± 1.03) in the dynamic model. This work highlights the huge importance in the selection of a relevant biofilm model in accordance with the environmental or clinical context to effectively improve the understanding of biofilms and the development of better antibiofilm strategies.

A case analysis of a patient with salmonella infection and allergy to antibiotics

Objective Through clinical pharmacists participating in the treatment of hip prosthesis infection, to explore the factors of Salmonella infection and skin itching, and to increase the importance of Salmonella infection and the pharmaceutical monitoring of adverse reactions of antibiotics. Methods The causes and treatment of Salmonella infection were analyzed by reviewing the literature, monitoring indicators and patient's clinical symptoms, and analyzing the cause of the patient's skin itching, to provide the patient with a reasonable anti-infective treatment plan. Results After several antibacterial drug adjustments during hospitalization, the patient's inflammatory indicators decreased, and the clinical symptoms improved. Conclusion Although the prosthetic joint infection caused by Salmonella is very rare, attention should be paid to the detection of Salmonella. At the same time, clinical pharmacists should increase the monitoring of antibiotics in their daily work.

Use of 3D Printing for the Development of Biodegradable Antiplatelet Materials for Cardiovascular Applications.

Small-diameter synthetic vascular grafts are required for surgical bypass grafting when there is a lack of suitable autologous vessels due to different reasons, such as previous operations. Thrombosis is the main cause of failure of small-diameter synthetic vascular grafts when used for this revascularization technique. Therefore, the development of biodegradable vascular grafts capable of providing a localized and sustained antithrombotic drug release mark a major step forward in the fight against cardiovascular diseases, which are the leading cause of death globally. The present paper describes the use of an extrusion-based 3D printing technology for the production of biodegradable antiplatelet tubular grafts for cardiovascular applications. For this purpose, acetylsalicylic acid (ASA) was chosen as a model molecule due to its antiplatelet activity. Poly(caprolactone) and ASA were combined for the fabrication and characterization of ASA-loaded tubular grafts. Moreover, rifampicin (RIF) was added to the formulation containing the higher ASA loading, as a model molecule that can be used to prevent vascular prosthesis infections. The produced tubular grafts were fully characterized through multiple techniques and the last step was to evaluate their drug release, antiplatelet and antimicrobial activity and cytocompatibility. The results suggested that these materials were capable of providing a sustained ASA release for periods of up to 2 weeks. Tubular grafts containing 10% (w/w) of ASA showed lower platelet adhesion onto the surface than the blank and grafts containing 5% (w/w) of ASA. Moreover, tubular grafts scaffolds containing 1% (w/w) of RIF were capable of inhibiting the growth of Staphylococcus aureus. Finally, the evaluation of the cytocompatibility of the scaffold samples revealed that the incorporation of ASA or RIF into the composition did not compromise cell viability and proliferation at short incubation periods (24 h).

Formation of the octadecylphosphonic acid layer on the surface of Ti6Al4V ELI titanium alloy and analysis using Raman spectroscopy

Increasing life expectancy, a sedentary lifestyle and bone diseases all contribute to an increasing demand for endoprostheses. Currently, the service life of a knee prosthesis is 10–17 years on average, depending on the patient’s weight and activity. In addition, the most common reasons for revision operations after implantation are prosthesis loosening and infections resulting from the lack of implant-bone connection. That is why it is so important to constantly search for new materials or improve the current methods of obtaining biomaterials and modifying their surfaces. The main goal of the research is to improve the bonding of hydroxyapatite (HA) on the surface of titanium alloy, which is used in the construction of endoprostheses. At this stage of the research, octadecylphosphonic acid (ODPA) deposited on the surface of the Ti6Al4V ELI alloy was analyzed. To verify the layer, HA attachment (the precipitation process) was first checked, and then the modified plates were immersed in a synthetic body fluid (SBF) to simulate the conditions in the living organism. At each stage of the study, the samples were analyzed using: SEM, EDS and Raman spectroscopy - spectral measurements and surface mapping were performed. The study were supplemented by the measurements of the contact angle - checking the wettability of the surface, which is important for the analysis of biomaterials and surface roughness measurements by confocal microscopy. The results shows that ODPA it increases the amount of precipitation of HA when dipped in SBF. Another interesting finding is that the addition of ODPA to the annealed titanium alloy restricts the precipitation of HA on its surface.

Treatment of bone and periprosthetic infections with bacteriophages : Asystematic review

HintergrundDie Behandlung von Knochen- und Protheseninfektionen bleibt trotz moderner Behandlungskonzepte mit interdisziplinärem Therapieansatz schwierig und weitere Maßnahmen zur Verbesserung des Behandlungsergebnisses sind wünschenswert. Präklinischen Studien liefern ein vielversprechendes Bild der Wirksamkeit von Bakteriophagen zur Behandlung von Knochen- und Protheseninfektionen.Ziel der ArbeitDie vorliegende Arbeit gibt eine systematische Übersicht über die klinische Anwendung von Bakteriophagen zur Behandlung von Knochen- und Protheseninfektionen.Material und MethodenEine systematische Suche wurde in PubMed zur Identifikation von primären klinischen Daten zur Anwendung der Phagentherapie bei Patienten mit Knochen- und Protheseninfektion durchgeführt.ErgebnisseElf Studien wurden eingeschlossen, bestehend aus 8 Fallberichten und 3 Fallserien. Indikationen der Phagentherapie waren periprothetische Infektionen (n = 12, 52,2 %), frakturassoziierte Infektionen (n = 9, 39,1 %), Osteomyelitis (n = 1, 4,4 %) und eine Iliosakralgelenkinfektion nach Zementaugmentation einer Metastase (n = 1, 4,4 %). Die Interventionen waren heterogen, Phagen wurden intravenös verabreicht, intraoperativ ins Gelenk injiziert, intraoperativ lokal angewendet oder über Drainagen appliziert. In Kombination mit Antibiotikatherapie konnte eine vollständige Infekteradikation bei 18 Patienten (78,3 %) erreicht werden. Bei 91,3 % der Patienten wurden keine Nebenwirkungen berichtet.SchlussfolgerungBakteriophagen sind eine vielversprechende Behandlungsmethode von Knochen- und Protheseninfektionen in Kombination mit einer Antibiotikatherapie. Zukünftige klinische Studien mit höherem Evidenzgrad werden benötigt, um eine erfolgreiche Translation der Bakteriophagentherapie in die klinische Praxis weiter zu etablieren.

PD31-12 PENILE PROSTHESIS PLACEMENT USING AN OPTIMIZED METHOD BY A DEDICATED TRANSGENDER SURGERY UNIT: A SLOW DECREASE IN HIGH COMPLICATION RATES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) II (PD31)1 Sep 2021PD31-12 PENILE PROSTHESIS PLACEMENT USING AN OPTIMIZED METHOD BY A DEDICATED TRANSGENDER SURGERY UNIT: A SLOW DECREASE IN HIGH COMPLICATION RATES Ravyn Middleton, Brenna Briles, Kenan Celtik, Curtis Crane, Michael Safir, and Richard Santucci Ravyn MiddletonRavyn Middleton More articles by this author , Brenna BrilesBrenna Briles More articles by this author , Kenan CeltikKenan Celtik More articles by this author , Curtis CraneCurtis Crane More articles by this author , Michael SafirMichael Safir More articles by this author , and Richard SantucciRichard Santucci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002032.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female to male transgender individuals may seek penile prostheses as part of genital gender affirmation surgery for the purpose of achieving penile rigidity, as this is not achieved with phalloplasty alone. This study aims to observe the types and rates of complications of penile prostheses after phalloplasty, over time and across surgical conditions, and to seek improvements in the complication rate by diligent adherence to proven principles. METHODS: Data was gathered via retrospective chart review of 81 patients at our high-volume center. The natural history of each prosthesis was followed through time. RESULTS: There was an overall complication rate of 36% and infection rate of 20%, with 15% experiencing infection requiring removal. Differences in infection rates were not significant across categories of previous surgery or with simultaneous surgery, but we did notice a markedly lower rate for semirigid prostheses compared to inflatable [infection rate 22% (15/67) for inflatable prostheses and 7% (1/14) for semirigid (p=0.19)]. Infection rates decrease with time and surgical experience: the rate of prosthesis infection improved over time, and the slope of the cumulative curves are much lower for infections (r=0.013) than expected for the number of cases performed over time (r=0.082) (p=0.979). The first 40 patients had an overall infection rate of 28% (11/40), a slope of 0.071 for cases vs time, and 0.013 for infections vs time (p=0.975). The most recent set of 41 patients had a lower overall infection rate of 12% (5/41), a slope of 0.079 for cases, and 0.006 for infections (p=0.969). CONCLUSIONS: Improvements were achieved by strict adherence to proven techniques: no touch techniques (Level 3 evidence), appropriate pre-operative intravenous antimicrobial prophylaxis (Level 2), control of blood sugar in diabetics (Level 2), antibiotic soaked implants (Level 2), hair clipping instead of razor shaving (Level 1), and use of chlorhexidine-based surgical scrub (Level 1). Overall, 28% of patients required surgery for complications. This compares favorably to the meta-analysis of penile prosthesis placements in phalloplasty patients, where the overall rate of complications requiring surgery was 45% for inflatable prostheses, and 42% for non-inflatable prostheses. Using careful surgical technique advised by specific knowledge of phalloplasty anatomy, and following proven infection control methods developed in the cisgender population, we hypothesized and then achieved lower rates of complication in this risky procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e543-e543 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ravyn Middleton More articles by this author Brenna Briles More articles by this author Kenan Celtik More articles by this author Curtis Crane More articles by this author Michael Safir More articles by this author Richard Santucci More articles by this author Expand All Advertisement Loading ...

A unique salvage operation strategy: implantation of the ulnar total elbow component to the radius to overcome large ulnar bone defect caused by infection after total elbow arthroplasty.

The elbow joints of patients with rheumatoid arthritis (RA) are often destroyed, and total elbow arthroplasty (TEA) is one treatment for these patients. However, patients with RA tend to develop surgical site infections due to immunosuppression. Once an implant is infected, reoperation may be difficult because of the risk of reinfection. In such patients, the infected site must be debrided thoroughly, although this might reduce the bone scaffold needed for re-TEA. We used a unique method to manage a large ulnar bone defect and an infected implant. The patient with RA had undergone TEA 15 years earlier. Etanercept was initiated to control disease activity; however, this treatment led to infection of the elbow prosthesis. Several surgical debridements were performed to eradicate the bacteria, which improved the symptoms of infection. However, most of the proximal ulna was lost, and it seemed impossible to fix the prosthesis using the remaining small ulna after debridement. Therefore, we planned to implant the ulnar component into the radius as a salvage technique. With this procedure, we provided the patient with elbow mobility and eradicated the infection. This is an alternative method for restoring function in an elbow with a massive bone defect in the ulna.

Epidemiology of oral candidiasis: a household-based population survey in a medium-sized city in Amazonas

There was an increase in the number of elderly people in Brazil and, along with this fact, there was an increase in the incidence of oral candidiasis in this population, so the early identification of the disease and the etiologic agent for effective intervention is essential. The study aimed to describe the prevalence of oral candidiasis and its clinical manifestations, identifying Candida yeast species and their prevalence in the palatine mucosa and dentures in the palatine mucosa and dentures, comparing these factors in rural and urban elderly people in this city. The study was conducted in the city of Tefé, Amazonas, with elderly people aged 65 to 74 years old registered in primary health care services in urban and rural areas, where through sample calculation we had a total sample of 484 elderly people after losses and refusals. These elderly people were randomly selected from within the entire public service network, which enabled the samples to be collected in all municipal Basic Health Units. Data collection included clinical oral examinations (use, duration, and need for dental prosthesis) and collection of biological material with swabs, which were stored in CHROMAgar™ Candida medium, during home visits to determine the prevalence of the species through staining and colony morphology. Statistical analysis was performed with Stata MP software, using relative and absolute frequencies. The prevalence of oral candidiasis was found in 20.7% of the elderly in the different areas of residence studied. A greater number of cases and clinical manifestations of the disease were found in elderly people living in urban areas (p &lt; 0.05). The odds ratios for developing the disease were higher in women, edentulous elderly, and users of dental prostheses. Candida albicans species were prevalent in infection and colonization of prostheses, while oral colonization showed similar percentages among Candida non-albicans (p = 0.657). As for the prevalence of species about the studied area of ​​residence, Candida albicans prevailed in the urban area and Candida non-albicans in the rural area (p &lt;0.05). In conclusion, this study identified a high prevalence of oral candidiasis in elderly participants in the research, who were mainly infected with Candida albicans species, but when comparing the living areas of the elderly, those living in the urban area had more prevalent colonization in the area. urban and Candida non-albicans in the rural area, therefore, species differentiation was found regarding the place where the elderly person lives.

26775 Vancomycin-associated drug-induced hypersensitivity syndrome after IV therapy with vancomycin and implantation of a vancomycin-eluting spacer and absorbable beads

Drug-induced hypersensitivity syndrome (DIHS) is a life-threatening severe cutaneous adverse reaction with multisystem involvement. DIHS usually occurs in the context of orally or intravenously administered medications, but can be reactivated with epicutaneous application of culprit medications. We present a case of a 31-year-old woman who developed vancomycin-induced DIHS after treatment of a prosthetic joint infection. Her total hip arthroplasty prosthesis infection was treated with removal of the prosthesis, IV vancomycin and implantation of a polymethyl methacrylate vancomycin-eluting spacer along with vancomycin-eluting absorbable calcium beads. 26 days after treatment, she developed a pruritic morbilliform exanthema along with malaise, nausea, dysphagia, neck-swelling, chills and was noted to have an AST of 389 and an ALT of 338. IV vancomycin was replaced with daptomycin and patient was started on 100mg of daily prednisolone. After initiation of prednisolone, she had rapid improvement of her neck-swelling and rash, but her AST and ALT remained elevated for 10 days despite treatment with corticosteroids. Given her persistently elevated AST and ALT, multidisciplinary discussions were held to consider removing the implanted vancomycin-eluting spacer. Surgery was deferred due to the patient’s high dose corticosteroids, increased risk of infection and incremental clinical improvement. She continued to improve and eventually tapered off her steroids after discharge. This is the first reported case of DIHS in a patient treated with drug-eluting absorbable beads, implant and IV antibiotics. In conclusion, we recommend careful consideration of the relative risks and benefits along with close clinical monitoring before surgical revision in complex cases of DIHS.

Multifunctional Titanium Surfaces for Orthopedic Implants: Antimicrobial Activity and Enhanced Osseointegration.

The use of implants in orthopedics and dental practice is a widespread surgical procedure to treat diverse diseases. However, peri-implantitis due to infections and/or poor osseointegration can lead to metallic implant failure. The aim of this study was to develop a multifunctional coating on titanium (Ti) surfaces, to simultaneously deal with both issues, by combining antibacterial silver nanoparticles (AgNPs) and regenerative properties of lactoferrin (Lf). A simple and cost-effective methodology that allows the direct multifunctionalization of Ti surfaces was developed. The modified surfaces were characterized by atomic force microscopy (AFM), X-ray photoelectron spectroscopy, and contact angle measurements. Additionally, in vitro preosteoblast cell adhesion, cell viability, and differentiation were evaluated. The antibacterial capability of the surfaces was tested against Staphylococcus aureus as a prosthesis infection model strain. Our results showed that Lf adsorbed on both Ti surfaces and Ti surfaces with adsorbed AgNPs. Simultaneously, the presence of Lf and AgNPs notably improved preosteoblast adhesion, proliferation, and differentiation, whereas it reduced the bacterial colonization by 97.7%. Our findings indicate that this simple method may have potential applications in medical devices to both improve osseointegration and reduce bacterial infection risk, enhancing successful implantation and patients' quality of life.