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B. M. Wroblewski - One of the best experts on this subject based on the ideXlab platform.
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PREOPERATIVE BONE STOCK AND CEMENT-BONE INTERFACE (SHIELDING OF MEDULLARY SPACE) IN Revision TOTAL HIP REPLACEMENT FOR DEEP INFECTION
2006Co-Authors: R. Nagai, P.r. Kay, V.r. Raut, B. M. WroblewskiAbstract:Introduction. Preoperative bone stock and cement-bone interface in Revision total hip replacement (THR) for deep infection have never been investigated while they are both well known to be important for mechanical outcome after Revision THR for aseptic loosening. Purpose. The purpose of this study was to assess pre-operative bone stock and immediate postoperative cement-bone interface as factors affecting infection control after one stage Revision THR for deep infection. Material and methods. This study included 115 cases which satisfied following conditions; a) One stage Revision THRs for deep infection were carried out by a single surgeon. b) Follow-up of more than five years was done. Preoperative bone stock was classified into four grades (Grade 0: No bone loss, Grade 1: Demarcation, Grade 2: Localized cavitation, Grade 3: Extensive bone loss). Immediate postoperative cement-bone interface was also graded into four categories (Grade A: White-out, obscure interface, Grade B: Clear line, no measurable gap, Grade C: Gap within 1mm, Grade D: Gap more than 1mm). These two factors were analyzed in view of infection control after surgery. Results. Preoperative bone stock did not show significant influence on infection control. Immediate postoperative cement-bone interface was an affecting factor for cure of infection. Conclusion. There was a good chance of cure of infection even in cases with significant bone loss. Good cement fixation appeared to be important in view of infection control. The results suggested the importance of shielding of medullary space with antibiotic-loaded cement from infected joint space in Revision THR for infection.
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ONE STAGE Revision TOTAL HIP REPLACEMENT FOR DEEP INFECTION: LONG-TERM FOLLOW-UP STUDY
2005Co-Authors: H. Nagai, R. Nagai, P.d. Siney, P.r. Kay, B. M. WroblewskiAbstract:Introduction and Aims: The aim of this study was to evaluate the efficacy of one stage Revision THA for deep infection with a long-term follow-up. Method: One stage Revision THA for deep infection was carried out in 273 joints on 262 patients by the senior author between 1974 and 2000. All infected hip replacements were primarily treated with one stage Revision THA, regardless of microorganisms at the authors’ unit unless bone stock in the hips was too poor for implant fixation. This study included 162 Revisions in 154 patients for which a minimum follow-up of five years (range 5.1 to 27.6 years; average 12.3 years) had been done. Fifty-two cases (32.1 %) had had discharging sinus by the time of Revision surgery for infection. Results: One hundred and thirty eight (85.2 %) hips were free of infection at the time of the latest follow-up. Twenty cases (12.3 %) had reoperation for recurrent infection. Four hips (2.5%) maintained their implants with the evidence of infection. Twenty-two cases (13.6 %) showed radiological loosening. Thirteen cases (8.0 %) were revised again for reasons other than infection (12 for aseptic loosening and one for dislocation). Conclusion: Deep infection is one of the most serious complications after total hip arthroplasty (THA). This study presented the longest follow-up, with a large number of cases in Revision THA for deep infection. The results suggested that one stage Revision was an effective treatment for deep infection of hip arthroplasty.
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One stage Revision arthroplasty of the hip for deep Gram negative infection
International Orthopaedics, 1996Co-Authors: V. V. Raut, M. S. Orth, Paul D. Siney, B. M. WroblewskiAbstract:We describe the use of one stage Revision arthroplasty of the hip for deep gram negative infections. We have followed up 15 patients for an average of 8 years following operation. Two procedures failed, one at two years due to aseptic loosening and another because of persistent infection. We attribute the low reinfection rate (1/15) to meticulous surgical technique, preoperative parenteral antibiotics and antibiotic loaded cement. Both failures occurred in the two operations performed without antibiotic loaded cement. We do not recommend the use of plain cement for exchange hip arthroplasty in the presence of gram negative infection.
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One-Stage Revision of total hip arthroplasty for deep infection. Long-term followup.
Clinical orthopaedics and related research, 1995Co-Authors: V. V. Raut, B. M. WroblewskiAbstract:One hundred eighty-three total hip arthroplasties were revised for deep infection in a 1-stage procedure using antibiotic containing acrylic cement and systemic perioperative antibiotics. At an average followup of 7 years 9 months, 154 (84.2%) patients were free of infection. The remaining 29 (15.8%) patients had evidence of persistent infection. The quality of pain relief immediately after a Revision for deep infection often is a good predictor of success.
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One-Stage Revision of infected total hip replacements with discharging sinuses
The Journal of bone and joint surgery. British volume, 1994Co-Authors: V. V. Raut, Paul D. Siney, B. M. WroblewskiAbstract:We report a prospective study of 57 One-Stage cemented Revisions of total hip replacement for deep infection with an actively discharging sinus. The average follow-up was 7 years 4 months. Seven patients had required reRevisions, but at latest follow-up, infection was under control in 49 (86%). A discharging sinus is not, in itself, a contraindication to One-Stage Revision of a hip replacement.
Hee Joong Kim - One of the best experts on this subject based on the ideXlab platform.
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One-Stage cementless Revision arthroplasty for infected hip replacements
International Orthopaedics, 2009Co-Authors: Jeong Joon Yoo, Young Sam Kwon, Kyung-hoi Koo, Kang Sup Yoon, Young-min Kim, Hee Joong KimAbstract:Notre hypothèse de travail était la suivante: le changement en un temps par une prothèse sans ciment d’une prothèse totale de hanche infectée, est la bonne indication thérapeutique. Matériel et méthode: nous avons revu de façon rétrospective tous les patients présentant une hanche infectée traitée par une révision en un temps en utilisant un implant sans ciment. 12 patients ont été revus et suivis pendant au moins 3 ans (7,2 ans en moyenne, 3,3 et 11,3 ans post-opératoire). Résultats: nous avons observé une récidive d’infection et un descellement aseptique durant cette période de suivi. L’os greffé chez 8 patients nous apparaît comme ayant consolidé à l’os hôte chez tous les patients. Le pourcentage de succès thérapeutique est de 83,3% si l’on regarde la récurrence de l’infection ou le descellement aseptique. En conclusion: les révisions en un temps en utilisant un implant sans ciment nous apparaissent comme un traitement de choix chez les patients sélectionnés avec soin et présentant une infection de prothèse totale de hanche. We hypothesised that One-Stage cementless Revision hip arthroplasty may have advantages and a role in the treatment of selected patients with an infected hip replacement. We retrospectively reviewed all patients with an infected hip replacement treated with One-Stage Revision using cementless implants. Twelve patients were reviewed and followed up for at least three years (average: 7.2 years, range: 3.3–11.3 years) postoperatively. One recurrence of infection and one aseptic stem loosening were detected during follow-up. Grafted bone, which was used in eight patients, appeared to have united to host bone in all patients. The success rate of treatment was 83.3% when infection recurrence or component loosening were regarded as failure. One-Stage Revision hip arthroplasty using cementless implants appears to have a role in the treatment of carefully selected patients with an infected hip replacement if meticulous débridement is performed and appropriate antibiotics are properly used.
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One-Stage cementless Revision arthroplasty for infected hip replacements
International orthopaedics, 2008Co-Authors: Jeong Joon Yoo, Young Sam Kwon, Kyung-hoi Koo, Kang Sup Yoon, Young-min Kim, Hee Joong KimAbstract:We hypothesised that One-Stage cementless Revision hip arthroplasty may have advantages and a role in the treatment of selected patients with an infected hip replacement. We retrospectively reviewed all patients with an infected hip replacement treated with One-Stage Revision using cementless implants. Twelve patients were reviewed and followed up for at least three years (average: 7.2 years, range: 3.3–11.3 years) postoperatively. One recurrence of infection and one aseptic stem loosening were detected during follow-up. Grafted bone, which was used in eight patients, appeared to have united to host bone in all patients. The success rate of treatment was 83.3% when infection recurrence or component loosening were regarded as failure. One-Stage Revision hip arthroplasty using cementless implants appears to have a role in the treatment of carefully selected patients with an infected hip replacement if meticulous debridement is performed and appropriate antibiotics are properly used.
Marcel E. Roy - One of the best experts on this subject based on the ideXlab platform.
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One-Stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA.
Clinical orthopaedics and related research, 2017Co-Authors: Leo A. Whiteside, Marcel E. RoyAbstract:Two-stage Revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with One-Stage Revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations. We describe a protocol for intraarticular delivery of antibiotics to the hip through an indwelling catheter combined with One-Stage Revision surgery and examine (1) the success as judged by eradication of infection at 1 year when treating chronically infected cemented stems; (2) success in treating late-onset acute infections in well-ingrown cementless stems; and (3) what complications were associated with this approach in a small case series. Between January 2002 and July 2013, 30 patients (30 hips) presented to the senior author for treatment of infected THA. Of those, 21 patients (21 hips) with infected cemented THAs underwent débridement and single-stage Revision to cementless total hip implants followed by catheter infusion of intraarticular antibiotics. Nine patients (nine hips) with late-onset acute infections in cementless THA had bone-ingrown implants. These patients were all more than 2 years from their original surgery and had acute symptoms of infection for 4 to 9 days. Seven had their original THA elsewhere, and two were the author's patients. All were symptom-free until the onset of their infection, and none had postoperative wound complications, fever, or prolonged pain suggestive of a more chronic process. They were treated with débridement and head and liner exchange, again followed by catheter infusion of intraarticular antibiotics. During this time period, this represented all infected THAs treated by the senior author, and all were treated with this protocol; no patient underwent two-stage exchange during this time, and no patients were lost to followup. At the time of the surgery, two Hickman catheters were placed in each hip to begin intraarticular delivery of antibiotics in the early postoperative period. Antibiotics were infused daily into the hip for 6 weeks with the tubes used for infusion only. Eleven of the single-stage Revisions and four of the hips treated with débridement had methicillin-resistant Staphylococcus aureus. Patients were considered free of infection if they had no clinical signs of infection and had a normal C-reactive protein and erythrocyte sedimentation rate at 1 year. Complications were ascertained by chart review. Twenty of 21 (95%) infections in patients who had single-stage Revision for chronically infected cemented THA were apparently free from infection and remained so at a mean followup of 63 months (range, 25-157 months). One case grew Candida albicans in the operative cultures and remained free of signs of infection after reRevision followed by infusion of fluconazole. The nine cementless THAs treated with débridement and head/liner exchange all remained free of signs of infection at a mean followup of 74 months (range, 62-121 months). Few complications were associated with the technique. Four patients had elevated serum levels of vancomycin without renal function changes and two patients had transient blood urea nitrogen/creatinine elevations with normal vancomycin levels that resolved with dosage adjustments. No patient had evidence of permanent renal damage. None of the patients in this study developed a chronic fistula or had significant drainage from the catheter site. Single-stage Revision for chronically infected cemented THA and débridement of bone-ingrown cementless THA with late-onset acute infection followed with indwelling catheter antibiotic infusion can result in infection eradication even when resistant organisms are involved. Larger study groups would better assess this technique and prospective comparisons to more traditional one- and two-stage Revision techniques for infected THA will likely require multi-institutional approaches. Level IV, therapeutic study.
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Methicillin-Resistant Staphylococcus Aureus in Total Knee Arthroplasty Treated With Revision and Direct Intraarticular Antibiotic Infusion
2012Co-Authors: Leo A. Whiteside, Michael Peppers, Tariq Nayfeh, Marcel E. RoyAbstract:Introduction Resistant organisms are difficult to eradicate in infected total knee arthroplasty, and treatment of methicillin-resistant Staphylococcus aureus (MRSA) is especially challenging. Whereas most surgeons use antibiotic-impregnated cement during Revision to treat infection, the delivery of the drug in adequate doses is limited in penetration and duration. This study presents the 2- to 8-year prospective results of One-Stage Revision and intraarticular antibiotic infusion protocol used to treat MRSA. Methods Eighteen knees (18 patients) with methicillin-resistant Staphylococcus aureus were treated between January 2001 and January 2007 with One-Stage Revision protocol that included debridement, uncemented Revision of total knee components, and intraarticular infusion of 500 mg vancomycin via Hickman catheter once or twice daily for 6 weeks. (Figure 1) No intravenous antibiotics were used after the first 24 hours. Serum vancomycin levels were monitored to maintain levels between 3 and 10 μg/mL. The mean serum vancomycin peak concentration was 6 ± 2 μg/mL and the mean serum vancomycin trough concentration was 3 ± 1 μg/mL at 2 weeks postoperative. Results Knee synovial fluid peak and trough vancomycin levels were measured in two knees. Synovial fluid peak concentrations were 10,233 μg/mL and 20,167 μg/mL and trough concentrations were 724 μg/mL and 543μg/mL, respectively. Minimum followup was 27 months (range, 27-75 months). Mean followup was 62 months, (range, 27–96 months). At 2-year followup, mean Knee Society score was 83 ± 9. No radiographic evidence of implant migration has occurred. One knee became reinfected with methicillin-resistant Staphylococcus aureus and was reoperated at 5 months. A necrotic bone segment was found, the knee was debrided and revised, and the antibiotic infusion protocol was readministered. The knee remained free of infection at 42 months postoperatively. Conclusions One-Stage Revision with uncemented components and 6 weeks intraarticular vancomycin administration safely and effectively treated MRSA-infected TKA with no apparent complications.
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Reinfected revised TKA resolves with an aggressive protocol and antibiotic infusion.
Clinical orthopaedics and related research, 2012Co-Authors: Leo A. Whiteside, Tariq Nayfeh, Renée M. Lazear, Marcel E. RoyAbstract:Revision of failed two-stage Revision TKA for infection is challenging, and amputation often is the only alternative. We asked whether reinfection after two-stage Revision for infection could be controlled with an aggressive Revision protocol and intraarticular antibiotic infusion. We retrospectively reviewed 18 patients (12 women, six men) who underwent Revision for failed reimplantation between January 1999 and January 2008. Mean time from Revision for infection to reRevision for reinfection was 5 months (range, 1-18 months). All knees were treated with an individualized protocol that included aggressive exposure, extensive débridement, uncemented components, closure with muscle flaps (seven knees) and other plastic surgery procedures (three knees), and direct antibiotic infusion through Hickman catheters for 6 weeks. Ten knees had One-Stage Revision; five had débridement, cement spacer, and Revision surgery 3 to 4 months later; and three had extensive soft tissue reconstruction before Revision surgery. The minimum followup was 2.3 years (mean, 6.1 years; range, 2.3-12.0 years). The mean Knee Society scores improved from 33 preoperatively to 76. Seventeen of the 18 had control of infection and achieved durable fixation and a closed wound. One patient had recurrent infection 13 months after One-Stage Revision, was revised, and remained asymptomatic 28 months postoperatively after redébridement and vancomycin infusion for 6 weeks. In one patient, soft tissue closure was not obtained and the patient required amputation. Extensile exposure, débridement, and soft tissue flaps for closure combined with uncemented fixation of Revision implants and antibiotic infusion into the knee controlled reinfection after Revision TKA.
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Methicillin-resistant Staphylococcus aureus in TKA Treated With Revision and Direct Intraarticular Antibiotic Infusion
Clinical Orthopaedics and Related Research®, 2011Co-Authors: Leo A. Whiteside, Michael Peppers, Tariq A. Nayfeh, Marcel E. RoyAbstract:Background Resistant organisms are difficult to eradicate in infected total knee arthroplasty. While most surgeons use antibiotic-impregnated cement in these Revisions, the delivery of the drug in adequate doses is limited in penetration and duration. Direct infusion is an alternate technique. Questions/purposes We asked whether single-stage Revision and direct antibiotic infusion for infected TKA would control infection in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. Methods We retrospectively reviewed 18 patients (18 knees) with MRSA with One-Stage Revision protocol that included débridement, uncemented Revision of total knee components, and intraarticular infusion of 500 mg vancomycin via Hickman catheter once or twice daily for 6 weeks; we used no intravenous antibiotics after the first 24 hours. We monitored serum vancomycin levels to maintain levels between 3 and 10 μg/mL. Minimum followup was 27 months (range, 27–75 months). Mean followup was 62 months, (range, 27–96 months). Results Infection was controlled at last followup in all but one patient with a recurrence of the MRSA. The patient was reoperated at 5 months; a necrotic bone fragment was removed, the knee was débrided and revised, and the antibiotic infusion protocol readministered. The patient remained free of infection 42 months postoperatively. At 2-year followup, the mean Knee Society score was 83. We observed no radiographic evidence of implant migration. Conclusions One-Stage Revision and 6 weeks of intraarticular vancomycin administration controlled infection in MRSA infected TKA with no apparent complications. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Mustafa Citak - One of the best experts on this subject based on the ideXlab platform.
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Blood loss and allogeneic transfusion for surgical treatment of periprosthetic joint infection: a comparison of one- vs. two-stage exchange total hip arthroplasty
International Orthopaedics, 2019Co-Authors: Ahmad Shoib Sharqzad, Thorsten Gehrke, Akos Zahar, Daniel Kendoff, Camila Cavalheiro, Christian Lausmann, Javad Parvizi, Mustafa CitakAbstract:Purpose The purpose of the current study was to compare the blood loss and the need for allogeneic transfusion after one- and two-stage exchange arthroplasty for periprosthetic joint infection (PJI) of THA. Methods We performed a retrospective review of all patients undergoing either One-Stage or two-stage septic exchange arthroplasty at two high-volume infection referral centres. The study cohort consists of 90 patients undergoing the two-stage and 184 patients the One-Stage exchange arthroplasty. The difference between pre- and post-operative haemoglobin (Hb) and total blood loss as well as the allogeneic transfusion rate were compared between both groups. Results Both procedures together of the two-stage septic exchange arthroplasty had higher intra-operative blood loss and allogeneic blood transfusion rate compared to the One-Stage septic exchange arthroplasty group. However, among the patients of the two-stage group, there were more smokers and had worse physical status (ASA) and higher mortality risk (CCI) than patients in the One-Stage group. Conclusions Two-stage septic Revision of total hip arthroplasty has higher rates of blood loss and transfusion rates than One-Stage Revision. Therefore, the authors believe that blood loss rate, including its complications, should be considered when decision for the type of staged septic exchange is made.
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What are the Factors Associated with Re-Revision After One-Stage Revision for Periprosthetic Joint Infection of the Hip? A Case-control Study
Clinical orthopaedics and related research, 2019Co-Authors: Hussein Abdelaziz, Hendrik Grüber, Thorsten Gehrke, Jochen Salber, Mustafa CitakAbstract:AbstractBackgroundDespite increased interest in One-Stage Revision arthroplasty for periprosthetic joint infection (PJI) of the hip, the reported infection-free proportions after the One-Stage approach are still comparable to that of two-stage Revision. However, we still lack studies that analyze fa
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One stage conversion of an infected fused knee to total knee replacement - a surgical challenge.
The open orthopaedics journal, 2013Co-Authors: Mukartihal Ravikumar, Thorsten Gehrke, Mustafa Citak, Daniel Kendoff, Stefan Luck, Akos ZaharAbstract:Two-stage Revision arthroplasty is a common technique for the treatment of infected total knee replacement. Few reports have addressed the conversion of a fused knee into a total knee replacement. However, there is no case reported of converting an infected fused knee into a hinge knee using a One-Stage procedure. We report on a 51-year old male patient with an infected fused knee after multiple surgeries. A One-Stage conversion of septic fused knee into total knee arthroplasty by a rotational hinge prosthesis was performed. The case highlights that with profound preoperative assessment, meticulous surgical technique, combined antibiotic treatment and the right implant, One-Stage Revision in a surgical challenge may have a role as a treatment option with good functional outcome.
A. Soriano - One of the best experts on this subject based on the ideXlab platform.
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Preliminary Results After Changing From Two-Stage to One-Stage Revision Arthroplasty Protocol Using Cementless Arthroplasty for Chronic Infected Hip Replacements.
The Journal of arthroplasty, 2017Co-Authors: Guillem Bori, A. Soriano, Guillem Navarro, Laura Morata, Jenaro A. Fernández-valencia, Xavier GallartAbstract:Abstract Background The objective of our study is to evaluate our preliminary results after changing from a 2-stage Revision arthroplasty protocol to a 1-stage Revision arthroplasty protocol using cementless arthroplasty for all patients with chronic infected hip replacements. Methods Prospective study of all hip arthroplasties that were diagnosed with chronic infection and were treated using the 1-stage Revision without taking into account the traditional criteria used to determine the use of a 1-stage Revision was conducted. There were 2 main variables evaluated: infection control and costs. The definitive diagnosis of infection of the Revision was determined using the criteria proposed by the Musculoskeletal Infection Society. The costs were calculated using average cost in USD, excluding social expenses, as described by Klouche (2010) for 1-stage or 2-stage Revisions. Results Nineteen patients were included in the study and the infection was controlled in 18 patients. The total economic savings for our hospital for these 19 patients was 391.609 USD. Conclusion This clinical success has led to an important change in our hospital in treating chronic infected hip replacements and an important cost reduction from an economic point of view.
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One-Stage Revision arthroplasty using cementless stem for infected hip arthroplasties.
The Journal of arthroplasty, 2013Co-Authors: Guillem Bori, Ernesto Muñoz-mahamud, Jordi Cuñé, Xavier Gallart, David Fuster, A. SorianoAbstract:Abstract The objective of this retrospective study was to evaluate our results with One-Stage Revision using cementless femoral stem for infected hip arthroplasties. Twenty-four patients were included in the study. The acetabular component was cemented in 9 cases. In 2 patients a structured bone allograft was necessary to fill an acetabular defect. After a mean follow-up of 44.6months, 23 patients showed no signs of infection (95.8%), the mean functional response according to the Merle d'Aubigne scale was 13.8 and the mean Harris Hip Score was 65.4. One-Stage Revision hip arthroplasty using cementless femoral stem was associated with a high success rate.
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One-Stage Revision arthroplasty for infected hip replacements.
The open orthopaedics journal, 2013Co-Authors: Ernesto Muñoz-mahamud, Xavier Gallart, A. SorianoAbstract:Infection remains a serious complication after total hip arthroplasty (THA) and is a leading cause of hip Revision surgery. It is currently accepted that removal of the prosthesis is essential to curing an infection when facing chronic PJIs with prosthesis loosening. In order to avoid the disadvantages of a two-stage approach, some authors have proposed a One-Stage hip Revision for the treatment of hip prosthesis infection in selected patients using not only antibiotic-loaded cemented components but also cementless implant. In the case of a One-Stage procedure, the patient is exposed to a single major procedure and therefore lower cumulative perioperative risk. A functional prosthesis replacement is completed without exposure to the complications associated with spacers. In addition, there are also benefits both financially and in terms of resource allocation.
