Prosthetic joint infection (PJI) is a devastating complication of joint replacement, having an impact on morbimortality but also on national health systems and their budgets. The current situation of PJI-related hospitalizations in Spain and their changes over time are unknown. Therefore, we aimed to analyze the hospitalization burden of PJI, including costs and trends in recent decades. Retrospective observational study including data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. During the period 2000–2015, hospitalizations due to PJI (ICD-9-CM 996.66) as main diagnosis were included. Epidemiological trends were evaluated during four periods: P1, 2000–2003; P2, 2004–2007; P3, 2008–2011; P4, 2012–2015. Annual hospitalization rates per 100,000 inhabitants and trends were also calculated.Aim
Methods
A significant number of patients undergoing shoulder arthroplasty surgery have Prospective study including all patients who underwent a reverse shoulder prosthesis from January 2015 to December 2018. In all of them, 5 to 12 cultures were performed during primary surgery. The patients underwent surgery for shoulder arthritis secondary to rotator cuff tears, acute fracture of the proximal humerus, and sequelae of fracture of the proximal humerus. Exclusion criteria included the existence of previous surgeries on the affected shoulder, the presence of signs of infection, having received infiltrations and / or complementary invasive examinations (Arthro-MRI and Arthro-CT). Follow-up from 2 to 5 years. Functional assessment according to the Constant Functional Scale. All complications were also recorded.Aim
Method
The gold standard treatment for late acute hematogenous (LAH) periprosthetic joint infection (PJI) is surgical debridement, antibiotics and implant retention (DAIR). However, this strategy is still controversial in the case of total knee arthroplasty (TKA) as some studies report a higher failure rate. The aim of the present study is to report the functional outcomes and cure rate of LAH PJI following TKA treated by means of DAIR at a long-term follow-up. A consecutive prospective cohort consisting of 2,498 TKA procedures was followed for a minimum of 10 years (implanted between 2005 and 2009). The diagnosis of PJI and classification into LAH was done in accordance with the Zimmerli criteria (NEJM 2004). The primary outcome was the failure rate, defined as death before the end of antibiotic treatment, a further surgical intervention for treatment of infection was needed and life-long antibiotic treatment or chronic infection. The Knee Society Score (KSS) was used to evaluate clinical outcomes. Surgical management, antibiotic treatment, the source of infection (primary focus) and the microorganisms isolated were also assessed.Aim
Method
One of the most severe complications of primary total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). Nowadays, the use of antibiotic-loaded cement for prevention of infection is still controversial. The aim of the present study is to evaluate the use of an antibiotic-loaded cement to reduce the infection rate in primary total knee arthroplasty. Prospective randomized study, with 2893 cemented total knee arthroplasties performed between 2005 and 2010 in our institution. Two different groups were formed depending on which bone cement was used, without antibiotic (the control group) or loaded with erythromycin and colistin (the study group). All patients received the same systemic prophylactic antibiotics. The patients were followed for a minimum of twelve months. The rate of infection was analyzed according to the criteria of the Centers for Disease Control and Prevention (CDC).Aim
Method
The most frequent mechanical failure in the osteosynthesis of intertrochanteric fractures is the cut-out. Fracture pattern, reduction quality, tip-apex distance or the position of the cervico-cephalic screw are some of the factors that have been associated with higher cut-out rates. To date, it has not been established whether underlying bacterial colonization or concomitant infection may be the cause of osteosynthesis failure in proximal femur fractures (PFF). The primary objective of this study is to assess the incidence of infection in patients with cut-out after PFF osteosynthesis. Retrospective cohort study on patients with cut-out after PFF osteosynthesis with endomedullary nail, from January 2007 to December 2020. Demographic data of patients (such as sex, age, ASA), fracture characteristics (pattern, laterality, causal mechanism) and initial surgery parameters were collected (time from fall to intervention, duration of surgery, intraoperative complications). Radiographic parameters were also analyzed (tip-apex distance and Chang criteria). In all cut-out cases, 5 microbiological cultures and 1 anatomopathological sample were taken and the osteosynthesis material was sent for sonication. Fracture-related infection (FRI) was diagnosed based on Metsemakers et al (2018) and McNally et al (2020) diagnostic criteria.Aim
Method
Prospective study including 156 patients undergoing primary shoulder arthroplasty. In all the patients included 5 to 12 tissue samples were obtained and were specifically cultured to detect Aim
Method
The purpose of this study was to compare the
diagnostic accuracy for the detection of infection between the culture of
fluid obtained by sonication (SFC) and the culture of peri-implant
tissues (PITC) in patients with early and delayed implant failure,
and those with unsuspected and suspected septic failure. It was
hypothesised that SFC increases the diagnostic accuracy for infection
in delayed, but not early, implant failure, and in unsuspected septic
failure. The diagnostic accuracy for infection of all consecutive
implants (hardware or prostheses) that were removed for failure was
compared between SFC and PITC. This prospective study included 317
patients with a mean age of 62.7 years (9 to 97). The sensitivity
for detection of infection using SFC was higher than using PITC
in an overall comparison (89.9% Sonication is mainly recommended when there is implant failure
with no clear signs of infection and in patients with delayed implant
failure. In early failure, SFC is not superior to PITC for the diagnosis
of infection and, therefore, is not recommended as a routine diagnostic
test in these patients. Cite this article:
Patients with infected arthroplasties are normally
treated with a two-stage exchange procedure using polymethylmethacrylate
bone cement spacers impregnated with antibiotics. However, spacers
may act as a foreign body to which micro-organisms may adhere and
grow. In this study it was hypothesised that subclinical infection may
be diagnosed with sonication of the surface biofilm of the spacer.
The aims were to assess the presence of subclinical infection through
sonication of the spacer at the time of a second-stage procedure,
and to determine the relationship between subclinical infection
and the clinical outcome. Of 55 patients studied, 11 (20%) were
diagnosed with subclinical infection. At a mean follow-up of 12
months (interquartile range 6 to 18), clinical failure was found in
18 (32.7%) patients. Of the patients previously diagnosed with subclinical
infection, 63% (7 of 11) had failed compared with 25% (11 of 44)
of those without subclinical infection (odds ratio 5.25, 95% confidence
interval 1.29 to 21.4, p = 0.021). Sonication of the biofilm of
the surface of the spacer is useful in order to exclude subclinical infection
and therefore contributes to improving the outcome after two-stage
procedures.
