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Steven M. Kurtz - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology of Total Hip and Knee Arthroplasty Infection
Periprosthetic Joint Infection of the Hip and Knee, 2013Co-Authors: David J. Jaekel, Kevin L. Ong, Edmund Lau, Heather N. Watson, Steven M. KurtzAbstract:Prosthetic joint infection (PJI) is an infrequent complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA) but is associated with longer hospital stay, increased hospital cost, and higher morbidity. This chapter critically reviews the literature to form a consensus on the epidemiology of PJI within hip and knee arthroplasty procedures. PJI occurred in 7761 and 16,798 THA and TKA cases in the USA, respectively, in 2010 and is projected to increase to 16,879 and 42,079 cases by 2020. In the USA and internationally, the overall incidence of PJI occurs in 0.7–2.3 % of both THA and TKA procedures. Infection is diagnosed within the first year postoperatively for 60 % of primary surgeries and the vast majority of cases occur within 2 years. Among the reasons for arthroplasty revision, infection is the second most prevalent failure mode in TKA and third for THA, and models project PJI will become the dominant failure mode by 2030. Regardless of revision reason, TKAs that have been previously revised have an increased incidence of infection of 8.3 % and are reported as high as 33 % among arthroplasties previously revised for infection. The most frequently reported risk factors were revealed to be gender, BMI > 50, extended-length procedures, lack of Antibiotic Bone Cement, and comorbidities. Furthermore, treatment for PJI is 2.6–2.8 times more expensive than revision for aseptic loosening and is associated with 1.9–2.2 times longer patient hospital stay.
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The Epidemiology of Total Joint Arthroplasty Infections
Infected Total Joint Arthroplasty, 2012Co-Authors: David J. Jaekel, Kevin L. Ong, Edmund Lau, Steven M. KurtzAbstract:Prosthetic joint infection (PJI) is a rare occurrence following joint arthroplasty, which has a significant impact on the patient population. This chapter critically reviews the literature to form a consensus on the epidemiology of PJI within total joint arthroplasty. PJI occurs in 0.7–1.1 % of total knee (TKA) and hip arthroplasty (THA) cases in the USA and internationally but is projected to grow to 6.5–6.8 % by 2030. The infection rate for TKA is higher than for THA and is performed almost twice as much. Infection is diagnosed within the first year for 60 % of primary surgeries, and the vast majority of cases occur within 2 years. Among reasons for revision, infection is projected to become the most frequent and is currently around 25 % of revisions for TKA and 15 % for THA. Infection is also more prevalent after previous revision for infection and can occur in 10–33 % of those cases. The largest risk factors for concern were found to be gender, BMI > 50, extended length procedures, lack of Antibiotic Bone Cement, and comorbidities. Other arthroplasty procedures such as total disk replaCement and total shoulder arthroplasty have similar infection rates to TKA that range from 1.3 to 3.8 %. In contrast though, total elbow arthroplasty can have infection rates as high as 12 %, which may be a result of the subcutaneous nature of the elbow joint and its surrounding thin soft tissue envelope.
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Do Dynamic Cement-on-Cement Knee Spacers Provide Better Function and Activity During Two-stage Exchange?
Clinical Orthopaedics and Related Research®, 2012Co-Authors: David J. Jaekel, Judd S. Day, Gregg R. Klein, Javad Parvizi, Harlan Levine, Steven M. KurtzAbstract:Background Implantation of an Antibiotic Bone Cement spacer is used to treat infection of a TKA. Dynamic spacers fashioned with Cement-on-Cement articulating surfaces potentially facilitate patient mobility and reduce Bone loss as compared with their static counterparts, while consisting of a biomaterial not traditionally used for load-bearing articulations. However, their direct impact on patient mobility and wear damage while implanted remains poorly understood. Questions/purposes We characterized patient activity, surface damage, and porous structure of dynamic Cement-on-Cement spacers. Methods We collected 22 dynamic and 14 static knee Antibiotic Cement spacers at revision surgeries at times ranging from 0.5 to 13 months from implantation. For these patients, we obtained demographic data and UCLA activity levels. We characterized surface damage using the Hood damage scoring method and used micro-CT analysis to observe the internal structure, cracking, and porosity of the Cement. Results The average UCLA score was higher for patients with dynamic spacers than for patients with static spacers, with no differences in BMI or age. Burnishing was the only prevalent damage mode on all the bearing surfaces. Micro-CT analysis revealed the internal structure of the spacers was porous and highly inhomogeneous, including heterogeneous dispersion of radiopaque material and cavity defects. The average porosity was 8% (range, 1%–29%) and more than ½ of the spacers had pores greater than 1 mm in diameter. Conclusions Our observations suggest dynamic, Cement-on-Cement spacers allow for increased patient activity without catastrophic failure. Despite the Antibiotic loading and internal structural inhomogeneity, burnishing was the only prevalent damage mode that could be consistently classified with no evidence of fracture or delamination. The porous structure of the spacers varied highly across the surfaces without influencing the material failure.
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Do dynamic Cement-on-Cement knee spacers provide better function and activity during two-stage exchange?
Clinical orthopaedics and related research, 2012Co-Authors: David J. Jaekel, Judd S. Day, Gregg R. Klein, Harlan B. Levine, Javad Parvizi, Steven M. KurtzAbstract:Background Implantation of an Antibiotic Bone Cement spacer is used to treat infection of a TKA. Dynamic spacers fashioned with Cement-on-Cement articulating surfaces potentially facilitate patient mobility and reduce Bone loss as compared with their static counterparts, while consisting of a biomaterial not traditionally used for load-bearing articulations. However, their direct impact on patient mobility and wear damage while implanted remains poorly understood.
Thomas P. Sculco - One of the best experts on this subject based on the ideXlab platform.
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routine use of Antibiotic Bone Cement in primary total jointarthroplasty is justified opposes
Orthopaedic Proceedings, 2018Co-Authors: Thomas P. SculcoAbstract:Periprosthetic infection after total joint replaCement is a catastrophic complication. Current rates of infection have been decreasing and in most centers now are in the range of 0.1–1%. Peri-opera...
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ROUTINE USE OF Antibiotic Bone Cement IN PRIMARY TOTAL JOINTARTHROPLASTY IS JUSTIFIED – OPPOSES
2018Co-Authors: Thomas P. SculcoAbstract:Periprosthetic infection after total joint replaCement is a catastrophic complication. Current rates of infection have been decreasing and in most centers now are in the range of 0.1–1%. Peri-opera...
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ROUTINE USE OF Antibiotic Bone Cement IN PRIMARY TOTAL JOINTARTHROPLASTY IS JUSTIFIED – OPPOSES
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: Thomas P. SculcoAbstract:Periprosthetic infection after total joint replaCement is a catastrophic complication. Current rates of infection have been decreasing and in most centers now are in the range of 0.1–1%. Peri-operative intravenous Antibiotic therapy is used routinely in total hip arthroplasty patients at this time. With rates this low and mixed evidence that Antibiotics in Bone Cement for routine total hip replaCement are beneficial at reducing joint infection, routine use of this practice seems unnecessary and has potential disadvantages. Cost of Antibiotics being added to Cement on a routine basis will increase the cost of the arthroplasty $300–$500. Although small addition of Bone Cement also has a negative effect on the mechanical properties of the Cement. The major disadvantage remains the danger of resistant bacterial strains from excessive use of Antibiotics particularly vancomycin resistant organisms when it is used routinely. Although rare with the aminoglycosides, allergic reactions may occur if cephalosporins are used as prophylaxis. Use of Antibiotics in Bone Cement should be considered in high risk patients for infection undergoing total hip replaCement but not routinely because of cost, emergence of resistant organism and possible allergic reaction.
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routine use of Antibiotic Bone Cement in primary total jointarthroplasty is justified opposes
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: Thomas P. SculcoAbstract:Periprosthetic infection after total joint replaCement is a catastrophic complication. Current rates of infection have been decreasing and in most centers now are in the range of 0.1–1%. Peri-operative intravenous Antibiotic therapy is used routinely in total hip arthroplasty patients at this time. With rates this low and mixed evidence that Antibiotics in Bone Cement for routine total hip replaCement are beneficial at reducing joint infection, routine use of this practice seems unnecessary and has potential disadvantages. Cost of Antibiotics being added to Cement on a routine basis will increase the cost of the arthroplasty $300–$500. Although small addition of Bone Cement also has a negative effect on the mechanical properties of the Cement. The major disadvantage remains the danger of resistant bacterial strains from excessive use of Antibiotics particularly vancomycin resistant organisms when it is used routinely. Although rare with the aminoglycosides, allergic reactions may occur if cephalosporins are used as prophylaxis. Use of Antibiotics in Bone Cement should be considered in high risk patients for infection undergoing total hip replaCement but not routinely because of cost, emergence of resistant organism and possible allergic reaction.
David J. Jaekel - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology of Total Hip and Knee Arthroplasty Infection
Periprosthetic Joint Infection of the Hip and Knee, 2013Co-Authors: David J. Jaekel, Kevin L. Ong, Edmund Lau, Heather N. Watson, Steven M. KurtzAbstract:Prosthetic joint infection (PJI) is an infrequent complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA) but is associated with longer hospital stay, increased hospital cost, and higher morbidity. This chapter critically reviews the literature to form a consensus on the epidemiology of PJI within hip and knee arthroplasty procedures. PJI occurred in 7761 and 16,798 THA and TKA cases in the USA, respectively, in 2010 and is projected to increase to 16,879 and 42,079 cases by 2020. In the USA and internationally, the overall incidence of PJI occurs in 0.7–2.3 % of both THA and TKA procedures. Infection is diagnosed within the first year postoperatively for 60 % of primary surgeries and the vast majority of cases occur within 2 years. Among the reasons for arthroplasty revision, infection is the second most prevalent failure mode in TKA and third for THA, and models project PJI will become the dominant failure mode by 2030. Regardless of revision reason, TKAs that have been previously revised have an increased incidence of infection of 8.3 % and are reported as high as 33 % among arthroplasties previously revised for infection. The most frequently reported risk factors were revealed to be gender, BMI > 50, extended-length procedures, lack of Antibiotic Bone Cement, and comorbidities. Furthermore, treatment for PJI is 2.6–2.8 times more expensive than revision for aseptic loosening and is associated with 1.9–2.2 times longer patient hospital stay.
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The Epidemiology of Total Joint Arthroplasty Infections
Infected Total Joint Arthroplasty, 2012Co-Authors: David J. Jaekel, Kevin L. Ong, Edmund Lau, Steven M. KurtzAbstract:Prosthetic joint infection (PJI) is a rare occurrence following joint arthroplasty, which has a significant impact on the patient population. This chapter critically reviews the literature to form a consensus on the epidemiology of PJI within total joint arthroplasty. PJI occurs in 0.7–1.1 % of total knee (TKA) and hip arthroplasty (THA) cases in the USA and internationally but is projected to grow to 6.5–6.8 % by 2030. The infection rate for TKA is higher than for THA and is performed almost twice as much. Infection is diagnosed within the first year for 60 % of primary surgeries, and the vast majority of cases occur within 2 years. Among reasons for revision, infection is projected to become the most frequent and is currently around 25 % of revisions for TKA and 15 % for THA. Infection is also more prevalent after previous revision for infection and can occur in 10–33 % of those cases. The largest risk factors for concern were found to be gender, BMI > 50, extended length procedures, lack of Antibiotic Bone Cement, and comorbidities. Other arthroplasty procedures such as total disk replaCement and total shoulder arthroplasty have similar infection rates to TKA that range from 1.3 to 3.8 %. In contrast though, total elbow arthroplasty can have infection rates as high as 12 %, which may be a result of the subcutaneous nature of the elbow joint and its surrounding thin soft tissue envelope.
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Do Dynamic Cement-on-Cement Knee Spacers Provide Better Function and Activity During Two-stage Exchange?
Clinical Orthopaedics and Related Research®, 2012Co-Authors: David J. Jaekel, Judd S. Day, Gregg R. Klein, Javad Parvizi, Harlan Levine, Steven M. KurtzAbstract:Background Implantation of an Antibiotic Bone Cement spacer is used to treat infection of a TKA. Dynamic spacers fashioned with Cement-on-Cement articulating surfaces potentially facilitate patient mobility and reduce Bone loss as compared with their static counterparts, while consisting of a biomaterial not traditionally used for load-bearing articulations. However, their direct impact on patient mobility and wear damage while implanted remains poorly understood. Questions/purposes We characterized patient activity, surface damage, and porous structure of dynamic Cement-on-Cement spacers. Methods We collected 22 dynamic and 14 static knee Antibiotic Cement spacers at revision surgeries at times ranging from 0.5 to 13 months from implantation. For these patients, we obtained demographic data and UCLA activity levels. We characterized surface damage using the Hood damage scoring method and used micro-CT analysis to observe the internal structure, cracking, and porosity of the Cement. Results The average UCLA score was higher for patients with dynamic spacers than for patients with static spacers, with no differences in BMI or age. Burnishing was the only prevalent damage mode on all the bearing surfaces. Micro-CT analysis revealed the internal structure of the spacers was porous and highly inhomogeneous, including heterogeneous dispersion of radiopaque material and cavity defects. The average porosity was 8% (range, 1%–29%) and more than ½ of the spacers had pores greater than 1 mm in diameter. Conclusions Our observations suggest dynamic, Cement-on-Cement spacers allow for increased patient activity without catastrophic failure. Despite the Antibiotic loading and internal structural inhomogeneity, burnishing was the only prevalent damage mode that could be consistently classified with no evidence of fracture or delamination. The porous structure of the spacers varied highly across the surfaces without influencing the material failure.
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Do dynamic Cement-on-Cement knee spacers provide better function and activity during two-stage exchange?
Clinical orthopaedics and related research, 2012Co-Authors: David J. Jaekel, Judd S. Day, Gregg R. Klein, Harlan B. Levine, Javad Parvizi, Steven M. KurtzAbstract:Background Implantation of an Antibiotic Bone Cement spacer is used to treat infection of a TKA. Dynamic spacers fashioned with Cement-on-Cement articulating surfaces potentially facilitate patient mobility and reduce Bone loss as compared with their static counterparts, while consisting of a biomaterial not traditionally used for load-bearing articulations. However, their direct impact on patient mobility and wear damage while implanted remains poorly understood.
Arlen D Hanssen - One of the best experts on this subject based on the ideXlab platform.
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Prophylactic use of Antibiotic Bone Cement: an emerging standard--in opposition.
The Journal of arthroplasty, 2004Co-Authors: Arlen D HanssenAbstract:Antibiotic-loaded Bone Cement (ABLC) is an effective delivery method of local Antibiotics. ABLC for treatment should be high dose (>3.6 g per 40 g Cement) for beads or spacers and 1 to 2 g Antibiotic per 40 g Cement for prosthesis fixation. Multiple Antibiotics are required for treatment, with Antibiotics being individualized according to culture susceptibilities. This approach requires hand mixing because there are no commercial high-dose products. ABLC should be low dose (< or =1 g per 40 g Cement) for prophylaxis purposes. Concerns with toxicity and Cement mechanical properties are inconsequential with low-dose ABLC. Available clinical evidence supports low-dose ABLC for prophylaxis in revisions and high-risk primary joints, but concerns of emerging drug-resistant organisms probably outweigh routine use of low-dose ABLC in all uncomplicated primary arthroplasties.
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Total Knee Arthroplasty After Prior Bone or Joint Sepsis About the Knee
Clinical orthopaedics and related research, 2002Co-Authors: Gwo Chin Lee, Mark W. Pagnano, Arlen D HanssenAbstract:The current study was done to determine the effect of current methods to diagnose and treat infection on the incidence of deep prosthetic infection after total knee arthroplasty for patients with previous sepsis or osteomyelitis about the knee. Between 1989 and 1999, one surgeon did 20 consecutive primary total knee arthroplasties in 19 patients with a previous history of either septic arthritis or osteomyelitis about the knee. Antibiotic-impregnated Cement was used in all patients. One patient was lost to followup and two patients died before 2 years from the arthroplasty. The remaining 16 patients were followed up for an average of 5 years (range, 2-11 years). There was one (5%) recurrent deep periprosthetic infection for which the patient required resection arthroplasty at 3.5 years. No patients required chronic Antibiotic suppression. With careful preoperative and intraoperative evaluation and the routine use of Antibiotic Bone Cement for fixation, total knee arthroplasty, in patients with prior Bone or joint sepsis about the knee can provide good pain relief, functional improvement, and an acceptably low rate of deep prosthetic infection.
T. Gehrke - One of the best experts on this subject based on the ideXlab platform.
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ROUTINE USE OF Antibiotic Bone Cement IN PRIMARY TOTAL JOINT ARTHROPLASTY IS JUSTIFIED – AFFIRMS
2018Co-Authors: T. GehrkeAbstract:Despite the prophylactic use of Antibiotics and hygienic strategies, surgical site infection following total joint arthroplasty (TJA) is still a severe and unsolved complication. Since Antibiotic-l...
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ROUTINE USE OF Antibiotic Bone Cement IN PRIMARY TOTAL JOINT ARTHROPLASTY IS JUSTIFIED – AFFIRMS
Journal of Bone and Joint Surgery-british Volume, 2017Co-Authors: T. GehrkeAbstract:Despite the prophylactic use of Antibiotics and hygienic strategies, surgical site infection following total joint arthroplasty (TJA) is still a severe and unsolved complication. Since Antibiotic-loaded Bone Cement (ALBC) was introduced by Buchholz in the 1970s, the use of ALBC has been increasingly used for the prevention and treatment of periprosthetic infection (PPI). However, the routine use of ALBC during primary TJA remains controversial. Recent clinical studies have found that ALBC is effective in reducing the risk of PJI following primary TJA. Although ALBC having the advantage of reducing the risk of PJI, the main disadvantages are the possible development of toxicity, Antibiotic resistance, allergic reaction, and possible reduction of the mechanical properties of Bone Cement. Nevertheless, a recent published article demonstrated, that the use of high dose dual-Antibiotic impregnated Cement reduce significantly the rate of surgical site infections compared to standard low dose single ALBC in the setting of a hip fracture treating with hemiarthroplasty. Furthermore, Sanz-Ruiz et al. presented that the use of ALBC in TJA has favorable cost-efficiency profile. In this context, reasons why surgeons should use Antibiotic-loaded Bone Cement during primary TJA are demonstrated.