scholarly journals Nanotechnology as an Anti-Infection Strategy in Periprosthetic Joint Infections (PJI)

2021 ◽  
Vol 6 (2) ◽  
pp. 91
Author(s):  
Pier Francesco Indelli ◽  
Stefano Ghirardelli ◽  
Ferdinando Iannotti ◽  
Alessia Maria Indelli ◽  
Gennaro Pipino
Keyword(s):  
Joint Infection ◽  
Treatment Strategies ◽  
High Morbidity ◽  
Treatment Protocols ◽  
Joint Infections ◽  
Prevention And Treatment ◽  
Efficient Control ◽  
Cement Joint ◽  
Clay Nanotubes

Background: Periprosthetic joint infection (PJI) represents a devastating consequence of total joint arthroplasty (TJA) because of its high morbidity and its high impact on patient quality of life. The lack of standardized preventive and treatment strategies is a major challenge for arthroplasty surgeons. The purpose of this article was to explore the potential and future uses of nanotechnology as a tool for the prevention and treatment of PJI. Methods: Multiple review articles from the PubMed, Scopus and Google Scholar databases were reviewed in order to establish the current efficacy of nanotechnology in PJI preventive or therapeutic scenarios. Results: As a prevention tool, anti-biofilm implants equipped with nanoparticles (silver, silk fibroin, poly nanofibers, nanophase selenium) have shown promising antibacterial functionality. As a therapeutic tool, drug-loaded nanomolecules have been created and a wide variety of carrier materials (chitosan, titanium, calcium phosphate) have shown precise drug targeting and efficient control of drug release. Other nanotechnology-based antibiotic carriers (lipid nanoparticles, silica, clay nanotubes), when added to common bone cements, enhanced prolonged drug delivery, making this technology promising for the creation of antibiotic-added cement joint spacers. Conclusion: Although still in its infancy, nanotechnology has the potential to revolutionize prevention and treatment protocols of PJI. Nevertheless, extensive basic science and clinical research will be needed to investigate the potential toxicities of nanoparticles.

scholarly journals Periprosthetic Joint Infections: Clinical and Bench Research

2013 ◽  
Vol 2013 ◽  
pp. 1-17 ◽  
Author(s):  
Laurence Legout ◽  
Eric Senneville
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnostic Methods ◽  
High Morbidity ◽  
Substantial Cost ◽  
Prosthetic Infection ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Definition Of

Prosthetic joint infection is a devastating complication with high morbidity and substantial cost. The incidence is low but probably underestimated. Despite a significant basic and clinical research in this field, many questions concerning the definition of prosthetic infection as well the diagnosis and the management of these infections remained unanswered. We review the current literature about the new diagnostic methods, the management and the prevention of prosthetic joint infections.

scholarly journals On the Necessity of a Customized Knee Spacer in Peri-Prosthetic Joint Infection Treatment: 3D Numerical Simulation Results

2021 ◽  
Vol 11 (10) ◽  
pp. 1039
Author(s):  
Marco Balato ◽  
Carlo Petrarca ◽  
Vincenzo de Matteo ◽  
Marco Lenzi ◽  
Enrico Festa ◽  
...  
Keyword(s):  
Ad Hoc ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
High Morbidity ◽  
Virtual Planning ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Infection Treatment ◽  
Prosthetic Joint Infections ◽  
Surgical Complexity

Peri-prosthetic joint infections (PJIs) dramatically affect human health, as they are associated with high morbidity and mortality rates. Two-stage revision arthroplasty is currently the gold standard treatment for PJI and consists of infected implant removal, an accurate debridement, and placement of antimicrobial impregnated poly-methyl-metha-acrylate (PMMA) spacer. The use of antibiotic-loaded PMMA (ALPMMA) spacers have showed a success rate that ranges from 85% to 100%. ALPMMA spacers, currently available on the market, demonstrate a series of disadvantages, closely linked to a low propensity to customize, seen as the ability to adapt to the patients’ anatomical characteristics, with consequential increase of surgical complexity, surgery duration, and post-operative complications. Conventionally, ALPMMA spacers are available only in three or four standard sizes, with the impossibility of guaranteeing the perfect matching of ALPMMA spacers with residual bone (no further bone loss) and gap filling. In this paper, a 3D model of an ALPMMA spacer is introduced to evaluate the cause- effect link between the geometric characteristics and the correlated clinical improvements. The result is a multivariable-oriented design able to effectively manage the size, alignment, stability, and the patients’ anatomical matching. The preliminary numerical results, obtained by using an “ad hoc” 3D virtual planning simulator, clearly point out that to restore the joint line, the mechanical and rotational alignment and the surgeon’s control on the thicknesses (distal and posterior thicknesses) of the ALPMMA spacer is mandatory. The numerical simulations campaign involved nineteen patients grouped in three different scenarios (Case N° 1, Case N° 2 and Case N° 3) whose 3D bone models were obtained through an appropriate data management strategy. Each scenario is characterized by a different incidence rate. In particular, the observed rates of occurrence are, respectively, equal to 17% (Case N° 1), 74% (Case N° 2), and 10% (Case N° 3).

scholarly journals Definition of Periprosthetic Hip and Knee Joint Infections and the Economic Burden

2016 ◽  
Vol 10 (1) ◽  
pp. 662-668 ◽  
Author(s):  
Rosamond Tansey ◽  
Yusuf Mirza ◽  
Mohamed Sukeik ◽  
Mohammed Shaath ◽  
Fares Sami Haddad
Keyword(s):  
Knee Joint ◽  
Economic Burden ◽  
Multidisciplinary Approach ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Healthcare Systems ◽  
Joint Infections ◽  
Important Complication ◽  
Knee Replacements ◽  
Definition Of

Periprosthetic Joint infection (PJI) following hip and knee replacements is an important complication causing major concern for patients, operating surgeons and healthcare systems. Therefore, a standardized definition of PJI is required to improve communication and allow for valid comparisons of various diagnostic and treatment strategies. This review summarizes the most commonly used definitions for PJI and the current consensus. It also highlights the economic burden related to PJIs and the importance of a multidisciplinary approach to managing those infections.

scholarly journals Pursuit of the ideal antiseptic irrigation solution in the management of periprosthetic joint infections

2021 ◽  
Vol 6 (6) ◽  
pp. 189-198
Author(s):  
Ahmed Siddiqi ◽  
Zuhdi E. Abdo ◽  
Bryan D. Springer ◽  
Antonia F. Chen
Keyword(s):  
Science Studies ◽  
Hypochlorous Acid ◽  
Joint Infection ◽  
Treatment Protocols ◽  
Advantages And Disadvantages ◽  
Joint Infections ◽  
Integral Role ◽  
Low Cytotoxicity

Abstract. Irrigation and debridement in the treatment of periprosthetic joint infection (PJI) serve an integral role in the eradication of bacterial burden and subsequent re-infection rates. Identifying the optimal irrigation agent, however, remains challenging, as there is limited data on superiority. Direct comparison of different irrigation solutions remains difficult because of variability in treatment protocols. While basic science studies assist in the selection of irrigation fluids, in vitro results do not directly translate into clinical significance once implemented in vivo. Dilute povidone iodine, hydrogen peroxide, chlorhexidine gluconate, acetic acid, sodium hypochlorite, hypochlorous acid, and preformed combination solutions all have potential against a broad spectrum of PJI pathogens with their own unique advantages and disadvantages. Future clinical studies are needed to identify ideal irrigation solutions with optimal bactericidal properties and low cytotoxicity for PJI treatment.

scholarly journals Improved treatment strategies can result in better outcomes following one-stage exchange surgery for MRSA periprosthetic joint infection

2020 ◽  
Vol 69 (8) ◽  
pp. 1100-1104
Author(s):  
Malte Ohlmeier ◽  
Sergei Filitarin ◽  
Giorgio Delgado ◽  
Jannik Frings ◽  
Hussein Abdelaziz ◽  
...  
Keyword(s):  
Revision Rate ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Content Type ◽  
One Stage ◽  
Joint Infections ◽  
The Mean ◽  
The One ◽  
Final Cohort

Introduction. Periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange. Aim. This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs. Methodology. Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1–9 years). Reinfection and complications rates after the one-stage exchange were analysed. Results. Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive Staphyloccocus epidermidis. Conclusion. One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.

scholarly journals Non-Antimicrobial Adjuvant Strategies to Tackle Biofilm-Related Staphylococcus aureus Prosthetic Joint Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1060
Author(s):  
Narayan Pant ◽  
Damon P. Eisen
Keyword(s):  
Staphylococcus Aureus ◽  
Joint Infection ◽  
Treatment Strategies ◽  
Chronic Infections ◽  
Biochemical Processes ◽  
Hospital Acquired Infections ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Hospital Acquired

Staphylococcus aureus frequently causes community- and hospital-acquired infections. S. aureus attachment followed by biofilm formation on tissues and medical devices plays a significant role in the establishment of chronic infections. Staphylococcal biofilms encase bacteria in a matrix and protect the cells from antimicrobials and the immune system, resulting in infections that are highly resistant to treatment. The biology of biofilms is complex and varies between organisms. In this review, we focus our discussion on S. aureus biofilms and describe the stages of their formation. We particularly emphasize genetic and biochemical processes that may be vulnerable to novel treatment approaches. Against this background, we discuss treatment strategies that have been successful in animal models of S. aureus biofilm-related infection and consider their possible use for the prevention and eradication of biofilm-related S. aureus prosthetic joint infection.

Osteonecrosis of the facial skull: clinical picture, diagnosis and treatment

2021 ◽  
pp. 26-34
Author(s):  
Olga Petrovna Arkhangelskaya ◽  
Leonid Grigorievich Tolstunov
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Treatment Strategies ◽  
Osteonecrosis Of The Jaw ◽  
Drug Induced ◽  
Diagnostic Features ◽  
Facial Skull ◽  
Clinical Stages ◽  
Prevention And Treatment

The treatment of patients with bone tissue pathology takes a special place in the practice of dentists. Since the mid-1950s, bisphosphonates, stable synthetic analogs of pyrophosphate, effective in diseases accompanied by increased bone resorption, have been used in the treatment of various disorders of the bone system. The present review is aimed at summarizing the pathogenesis, risk factors, diagnostic features, clinical stages, therapeutic methods, prevention and treatment strategies associated with drug-induced osteonecrosis of the jaw, which may provide a reference when observing such patients and improve their quality of life in the future.

scholarly journals Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals

2020 ◽  
Vol 9 (6) ◽  
pp. 1609 ◽  
Author(s):  
Carlotta Cocchetti ◽  
Jiska Ristori ◽  
Alessia Romani ◽  
Mario Maggi ◽  
Alessandra Daphne Fisher
Keyword(s):  
Treatment Strategies ◽  
Hormonal Treatment ◽  
Well Being ◽  
Clinical Approach ◽  
Treatment Protocols ◽  
Treatment Regimens ◽  
Transgender Persons ◽  
Standardized Treatment ◽  
Current Guidelines

Introduction: To date no standardized hormonal treatment protocols for non-binary transgender individuals have been described in the literature and there is a lack of data regarding their efficacy and safety. Objectives: To suggest possible treatment strategies for non-binary transgender individuals with non-standardized requests and to emphasize the importance of a personalized clinical approach. Methods: A narrative review of pertinent literature on gender-affirming hormonal treatment in transgender persons was performed using PubMed. Results: New hormonal treatment regimens outside those reported in current guidelines should be considered for non-binary transgender individuals, in order to improve psychological well-being and quality of life. In the present review we suggested the use of hormonal and non-hormonal compounds, which—based on their mechanism of action—could be used in these cases depending on clients’ requests. Conclusion: Requests for an individualized hormonal treatment in non-binary transgender individuals represent a future challenge for professionals managing transgender health care. For each case, clinicians should balance the benefits and risks of a personalized non-standardized treatment, actively involving the person in decisions regarding hormonal treatment.

Prevention and Treatment of the Consequences of Head and Neck Radiotherapy

2003 ◽  
Vol 14 (3) ◽  
pp. 213-225 ◽  
Author(s):  
A. Vissink ◽  
F.R. Burlage ◽  
F.K.L. Spijkervet ◽  
J. Jansma ◽  
R.P. Coppes
Keyword(s):  
Head And Neck ◽  
Radiation Treatment ◽  
Treatment Protocols ◽  
Radiation Caries ◽  
Prevention And Treatment ◽  
Radiation Induced ◽  
Node Metastases ◽  
Induced Changes ◽  
Head And Neck Radiotherapy

The location of the primary tumor or lymph node metastases dictates the inclusion of the oral cavity, salivary glands, and jaws in the radiation treatment portals for patients who have head and neck cancer. The clinical sequelae of the radiation treatment include mucositis, hyposalivation, loss of taste, osteoradionecrosis, radiation caries, and trismus. These sequelae may be dose-limiting and have a tremendous effect on the patient’s quality of life. Most treatment protocols to prevent these sequelae are still based on clinical experience, but alternatives based on fundamental basic and clinical research are becoming more and more available. Many of these alternatives either need further study before they can be incorporated into the protocols commonly used to prevent and treat the radiation-related oral sequelae or await implementation of these protocols. In this review, the various possibilities for prevention and/or treatment of radiation-induced changes in healthy oral tissues and their consequences are discussed.

Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

2019 ◽  
Vol 17 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Abdulla Shehab ◽  
Khalid F. AlHabib ◽  
Akshaya S. Bhagavathula ◽  
Ahmad Hersi ◽  
Hussam Alfaleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Quality Of Care ◽  
Middle East ◽  
Clinical Presentation ◽  
Middle Eastern ◽  
High Morbidity ◽  
Inhospital Mortality ◽  
Acute Stemi

Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

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