Periprosthetic Propionibacterium granulosum Joint Infection After Direct Anterior Total Hip Arthroplasty

Aims Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA). Different bearing surface materials have different surface properties and it has been suggested that the choice of bearing surface may influence the risk of PJI after THA. The objective of this meta-analysis was to compare the rate of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC) bearings. Patients and Methods Electronic databases (Medline, Embase, Cochrane library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature) were searched for comparative randomized and observational studies that reported the incidence of PJI for different bearing surfaces. Two investigators independently reviewed studies for eligibility, evaluated risk of bias, and performed data extraction. Meta-analysis was performed using the Mantel–Haenzel method and random-effects model in accordance with methods of the Cochrane group. Results Our search strategy revealed 2272 studies, of which 17 met the inclusion criteria and were analyzed. These comprised 11 randomized controlled trials and six observational studies. The overall quality of included studies was high but the observational studies were at high risk of bias due to inadequate adjustment for confounding factors. The overall cumulative incidence of PJI across all studies was 0.78% (1514/193 378). For each bearing combination, the overall incidence was as follows: MoP 0.85% (1353/158 430); CoP 0.38% (67/17 489); and CoC 0.53% (94/17 459). The meta-analysis showed no significant difference between the three bearing combinations in terms of risk of PJI. Conclusion On the basis of the clinical studies available, there is no evidence that bearing choice influences the risk of PJI. Future research, including basic science studies and large, adequately controlled registry studies, may be helpful in determining whether implant materials play a role in determining the risk of PJI following arthroplasty surgery. Cite this article: Bone Joint J 2018;100-B:134–42.

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Recalcitrant Periprosthetic Joint Infection With Iliac Fossa Abscess After Total Hip Arthroplasty

10.21203/rs.3.rs-144908/v1 ◽

2021 ◽

Author(s):

Kuo-Ti Peng ◽

Tsung-Yu Huang ◽

Jiun-Liang Chen ◽

Chiang-Wen Lee ◽

Hsin-Nung Shih

Keyword(s):

Total Hip Arthroplasty ◽

Treatment Failure ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Iliac Fossa ◽

Joint Infection ◽

Treatment Success ◽

Anterolateral Approach ◽

Total Hip ◽

Orthopedic Procedure

Abstract Background: Total hip arthroplasty (THA) is a widely used and successfully performed orthopedic procedure for treating severe hip osteoarthritis, rheumatoid arthritis, and avascular necrosis. However, periprosthetic joint infection (PJI) after THA is a devastating complication for patients and orthopedic surgeons. Although surgical technology has been advanced and antibiotic-loaded cemented spacers or beads have developed, the treatment failure rate of one- or two-stage exchange arthroplasty for PJI is reported to be high, with >10% rate of incidence. Therefore, determining the possible pathogenesis and increasing the treatment success rate is a clinically important and urgent issue. Methods: A total of 256 patients with PJI who had undergone THA from 2005 to 2015 were included in this retrospective review. Seven patients required combined ilioinguinal and anterlateoal approach for debridement of iliac fossa abscess and infected hip lesion, included five patients with intraoperative pus leakage from the acetabular inner wall and the other two patients who underwent pre-operative pelvic computed tomography (CT) because of repeat PJI treatment failure. All available data from the medical records from all patients were retrospectively analyzed.Results: Of the 256 patients, seven (3.1%) patients was combined iliac fossa abscess in our cohort. For the microbiologic analysis, a total of thirteen pathogens were isolated from seven recurrent PJI patients with iliac fossa abscess, and Staphylococus aureus was the most commomly pathogen (4 out of 7 cases). The serum white blood cell (WBC) count was decreased significantly two weeks after debridement with combined the ilioinguinal and anterolateral approach compared to the day before surgery (11840/μL vs. 7370/μL; p<0.01), and level of C-reactive protein (CRP) was decreased at postoperative one week (107 mg/dL vs. 47.31 mg/dL; p=0.03). Furthermore, no recurrent infection was found in six revision THA patient in a follow up of 7.1 year. Conclusion: This result suggests that pre-operative pelvic CT and cautious identification of uncertain pus leakage from the inner wall of the acetabulum is essential for the diagnosis of recurrent PJI. Radical debridement with combined ilioinguinal and anterlateoal approach may aviod treatment failure in recurrent PJI with iliac fossa abscess.

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Surgical selection criteria compliance is associated with a lower risk of periprosthetic joint infection in total hip arthroplasty

Arthroplasty Today ◽

10.1016/j.artd.2019.10.007 ◽

2019 ◽

Vol 5 (4) ◽

pp. 528-531 ◽

Cited By ~ 3

Author(s):

Aidan T. Morrell ◽

Gregory J. Golladay ◽

Stephen L. Kates

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Lower Risk ◽

Selection Criteria ◽

Joint Infection ◽

Total Hip

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Metal on Metal Bearing in Total Hip Arthroplasty and Its Impact on Synovial Cell Count

Journal of Clinical Medicine ◽

10.3390/jcm9103349 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3349

Author(s):

Henrik C. Bäcker ◽

Chia H. Wu ◽

David Krüger ◽

Clemens Gwinner ◽

Carsten Perka ◽

...

Keyword(s):

Synovial Fluid ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Control Group ◽

Total Hip ◽

Metal On Metal ◽

Matching Criteria ◽

The Impact

Introduction: The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid. Methods: We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/−10 years, and time of aspiration (+/−2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology. Results: In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained (n = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures (n = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both p < 0.001), as well as the septic THA group (WBC p = 0.016, PMN% p < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group (p = 0.016). Conclusion: MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.

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Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection

Journal of Orthopaedic Surgery and Research ◽

10.1186/1749-799x-3-31 ◽

2008 ◽

Vol 3 (1) ◽

Cited By ~ 79

Author(s):

Michael Müller ◽

Lars Morawietz ◽

Olaf Hasart ◽

Patrick Strube ◽

Carsten Perka ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

High Probability ◽

Periprosthetic Infection ◽

Joint Infection ◽

Total Hip ◽

Diagnostic Values

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Ceramic bearings for total hip arthroplasty are associated with a reduced risk of revision for infection

Hip International ◽

10.1177/1120700018776464 ◽

2018 ◽

Vol 28 (3) ◽

pp. 222-226 ◽

Cited By ~ 8

Author(s):

Rami Madanat ◽

Inari Laaksonen ◽

Stephen E Graves ◽

Michelle Lorimer ◽

Orhun Muratoglu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Lower Risk ◽

Revision Rate ◽

Joint Infection ◽

Bearing Surface ◽

Related Factors ◽

Total Hip ◽

Reduced Risk ◽

Ceramic On Ceramic

Introduction: Periprosthetic joint infection (PJI) is a serious complication after total hip arthroplasty (THA) and bearing material’s associations to PJI prevalence is largely unknown. The main purposes of this study were to determine if revision for infection varied depending on the type of bearing surface used in primary THA and to study whether patient or implant related factors had an effect on this variation. Methods: A total of 177,237 primary THA procedures from the Australian Registry (AOANJRR) were analysed. 3 bearing surfaces were compared. Metal-on-highly cross-linked polyethylene (MoXP) bearing had been used in 95,129 hips, ceramic-on-highly cross-linked polyethylene (CoXP) in 24,269 hips, and ceramic-on-ceramic (CoC) in 57,839 hips. Revision rates for infection were compared between the 3 groups. Results: Both MoXP and CoXP had a higher revision rate for infection compared to CoC hips (hazard ratio [HR] 1.46 (1.25, 1.72), p < 0.001) and HR 1.42 (1.15, 1.75), p = 0.001 respectively). Patients aged 70 years or less had a lower revision rate for infection when a CoC bearing was used. This difference was independent of sex, and prostheses selection. No difference was evident if the femoral component was cemented or a head size of 28 mm was used. Discussion: In this registry-based material, use of a CoC bearing was associated with a lower risk of revision for infection in patients younger than 70 years when cementless femoral components were used. Further studies are needed to verify this finding.

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