PJI prevention

BACKGROUND: The incidence of prosthetic joint infection (PJI) is increasing, coincident with the rising volume of joint arthroplasty being performed. With recent controversy regarding the efficacy of surgical helmet systems (SHS) in preventing infection, the focus has turned to the correct donning techniques and usage of surgical hoods. The aim of this study was to compare the bacterial contamination of the operating surgeon's gloves after two common donning techniques of SHS hoods. We also evaluated the baseline sterility of the SHS hoods at the beginning of the procedure...

BACKGROUND: Arthroplasty registers underreport the incidence of periprosthetic joint infections (PJIs). We validated the incidence of reported PJIs in total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) in the Dutch Arthroplasty Register (LROI) using data from the Dutch National Nosocomial Surveillance Network (PREZIES). METHODS: All primary THAs and TKAs from the LROI and all primary THAs and TKAs performed in consenting hospitals from PREZIES between 2012 and 2018 were matched on date of birth, date of surgery, sex, hospital, and type of procedure (THA n = 91,208; TKA n = 80,304)...

Rifampin has been proven to be effective in the treatment of prosthetic infections due to its ability to intercalate into biofilms. The use of rifampin in antibiotic spacers is not well described, which would be especially important in the local periprosthetic environment where parenteral doses have poor penetration. Null hypothesis tests if rifampin use in PMMA cement will show no clinically significant impact on mechanical strength at antibiotic concentrations that remain bactericidal. Test antibiotic cement samples supplemented with 0mg, 30mg, 50mg, 100mg, 150mg or 200mg of rifampin into a standard 40g bag were tested for compression to failure using published ASTM standards...

Periprosthetic joint infection is a major complication of total joint arthroplasty. Even with current treatments, failure rates are unacceptably high with a 5-year mortality rate of 26%. Majority of the literature in the field has focused on development of better biomarkers for diagnostics and treatment strategies including innovate antibiotic delivery systems, anti-biofilm agents, and bacteriophages. Nevertheless, the role of the immune system, our first line of defense during PJI, is not well understood. Evidence of infection in PJI patients is found within circulation, synovial fluid, and tissue and include numerous cytokines, metabolites, antimicrobial peptides, and soluble receptors that are part of the PJI diagnosis workup...

BACKGROUND: Periprosthetic femur fracture (PFF) following total hip arthroplasty (THA) is a leading cause of early reoperation. The objective of this study was to compare rates of periprosthetic joint infection (PJI) and reoperation following PFFs occurring early postoperatively to those that occurred late. METHODS: We retrospectively identified 173 consecutive surgically managed PFFs following primary THA. Cases were categorized as "early" if they occurred within 90 days of THA (n = 117) or "late" if they occurred following the initial 90 days (n = 56)...

Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent a major challenge with a 1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. A therapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies...

OBJECTIVE: To evaluate the effectiveness of prophylactic closed incision negative pressure wound therapy (ciNPWT) compared to conventional dressings in the prevention of periprosthetic joint infection (PJI) post hip and knee revision arthroplasty surgery. METHOD: Five databases (MEDLINE, Embase., Emcare, CINAHL and Scopus) were searched with no date or language limits. Two independent reviewers assessed articles against the inclusion criteria and methodological quality of the 3 included studies...

AIMS: The management of periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. In this study, we aimed to characterize the local bone microstructure and metabolism in a clinical cohort of patients with chronic PJI. METHODS: Periprosthetic femoral trabecular bone specimens were obtained from patients suffering from chronic PJI of the hip and knee (n = 20). Microbiological analysis was performed on preoperative joint aspirates and tissue specimens obtained during revision surgery...

BACKGROUND: This study aims to estimate the incidence, associated burden of disease and healthcare utilisation due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after a primary hip and knee arthroplasty in European centres. METHODS: This study was performed on patients who underwent a primary hip and knee arthroplasty at 19 European hospitals from 2014 to 2016. Global incidence of PJI and SA-PJI was calculated. Associated burden of disease was measured indirectly as infection-related mortality plus loss of function...

OBJECTIVES: To investigate the preventive effect of intraarticularly administered vancomycin on acute postoperative periprosthetic joint infection (PJI) in total joint arthroplasty (TJA). METHODS: Consecutive patients who underwent unilateral primary TJA were prospectively enrolled. The patients were divided into vancomycin group and control group according to whether 1g of vancomycin powder suspended in 30ml normal saline was intraarticularly administered after arthrotomy closure...

BACKGROUND: Perioperative preventive measures are important to further reduce the rate of periprosthetic joint infections (PJI) in patients undergoing total hip arthroplasty (THA). During THA surgery, joint capsule sutures are commonly placed to optimize exposure and reinsertion of the capsule. Bacterial contamination of these sutures during the procedure poses a potential risk for postoperative infection. In this exploratory study, we assessed the contamination rate of capsule sutures compared to the contamination of the remains of exchanged control sutures at the time of closure...

AIM: Large bone defects in patients with chronic deep periprosthetic knee infection is a major problem. It is widely accepted that bone defects filling with polymethylmethacrylate (PMMA) cement could be used only in selected cases of small bone defects (up to 5 mm) and less than 50% of articular surface due to multiple reasons: risk of thermal bone damage, inadequate cement pressurization and bone cement shrinkage, etc. Staged cementing for preventing bone heating and over negative effects of cementing on a thick layer of bone cement has limited support in the literature...

Prosthetic joint infection (PJI) is one of the most devastating complications for a patient following arthroplasty. This scoping review aims to evaluate the burden of PJI on individual patients and the healthcare system regarding the mortality rate, patient-reported quality of life, and healthcare resource utilisation. Patients with PJI have up to a five-fold higher mortality rate than those who have undergone an uninfected primary arthroplasty. There is an increased use of ambulatory aids and reduced joint function scores in patients with PJI...

BACKGROUND: Data regarding the effectiveness of antibiotic-loaded bone cement (ALBC) in preventing prosthetic joint infections (PJI) after total joint arthroplasty (TJA) is inconsistent. The objective of this study was to evaluate if the routine use of ALBC influenced the risk of revision surgery due to PJI. METHODS: This is a retrospective cohort study performed between January 2018 and September 2020. Adult patients aged ≥ 18 years who underwent TJA (knee or hip) and received either ALBC or plain cement (PC) were included...

The optimal treatment of prosthetic joint infection (PJI) remains uncertain. Patients undergoing debridement and implant retention (DAIR) receive extended antimicrobial treatment, and some experts leave patients at perceived highest risk of relapse on suppressive antibiotic therapy (SAT). In this narrative review, we synthesize the literature concerning the role of SAT to prevent treatment failure following DAIR, attempting to answer three key questions: 1) What factors identify patients at highest risk for treatment failure after DAIR (i...

Background: The occurrence of prosthetic joint infection (PJI) subsequent to total knee arthroplasty (TKA), also known as total knee replacement, is a highly detrimental complication. Some studies have concluded that intra-articular antibiotic injection was an effective approach to prevention of PJI, while others have reached the opposite conclusion. However, there is no study performed in one center, by one surgeon, one surgical team, or one type of prosthetic device. Methods: This was a historical cohort study on patients who underwent primary TKA with vancomycin and ceftazidime (652 cases from September 2019 to the end of December 2020) and were compared with a cohort of patients also treated with TKA but without using antibiotic injection (620 controls from March 2018 to the end of August 2019)...

Periprosthetic joint infections (PJIs) in arthroplasty and osteosynthesis-associated infections (OAIs) in reconstructive surgery still represent a challenging complication in orthopaedics and traumatology causing a burden worsening the patient's quality of life, for caregiver and treating physicians, and for healthcare systems. PJIs and OAIs are the result of bacterial adhesion over an implant surface with subsequent biofilm formation. Therefore, the clinical pathological outcome is a difficult-to-eradicate persistent infection...

BACKGROUND: Periprosthetic joint infections (PJI) following joint arthroplasty are now the leading cause of reoperation and are associated with serious morbidity to the patient, often requiring several staged operations and a prolonged course of parenteral antibiotics. Prophylactic administration of intravenous antibiotics before skin incision is arguably the most important measure to prevent PJI; however, the dose effectiveness of cefazolin in target tissue is not well known. We aimed to identify parameters affecting local tissue concentration (LTC) of cefazolin...

Background Periprosthetic joint infections (PJIs) place significant psychological and financial burdens on patients and healthcare systems. One measure to reduce the risk of PJIs is preoperative dental screening, for which there is no current consensus recommendation. This study aims to determine whether there is a difference in the rate of PJI and microorganism profile in patients who did and did not obtain preoperative dental clearance. Methodology A retrospective review was conducted among patients undergoing primary total hip arthroplasty and total knee arthroplasty from 2017 to 2021...

(1) Background: Periprosthetic joint infections (PJIs) represent a small yet important risk when undertaking a joint arthroplasty; they occur in approximately 1-2% of treatments. These infections create a medical and financial burden for patients and healthcare systems. Despite the introduction of recognized best clinical practices during arthroplasty operations, it is not yet possible to further reduce the risk of infection after surgery. The purpose of this review is to raise awareness of the potential role of gut dysbiosis in the development of PJIs and to highlight the potential of the gut bacteriome as a possible target for preventing them...