ireneusz babiak - Academia.edu (original) (raw)
Papers by ireneusz babiak
Chirurgia Narządów Ruchu i Ortopedia Polska
Introduction. We report the results of revision surgery in recurrent infection after anterior cru... more Introduction. We report the results of revision surgery in recurrent infection after anterior cruciate ligament reconstruction (ACLR) consisting of graft canal debridement and the local application of a calcium sulfate bone substitute (CSBS) with the addition of gentamicin and vancomycin in graft canal and infected foci. Materials and methods. Three patients (3 knees) were operated due to a chronic and unsuccessfully treated knee infection after ACLR. Two patients underwent multiple previous revisions (4 and 9, respectively). In all cases, the tibial ACL graft canal and adjacent bone foci were debrided. Post debridement defects in the femur and tibia and the graft tunnel in the tibia were filled with CSBS with an addition of gentamicin and vancomycin. If the absence of the ACL graft was stated, the tibial canal was closed from the joint side with a collagen sponge with gentamicin. Results. After a follow-up of 20 to 26 months, all patients obtained a complete resolution of inflammat...
Aim & introduction Infected knee with bone defect resulting from failed total knee arthroplas... more Aim & introduction Infected knee with bone defect resulting from failed total knee arthroplasty (TKA) or destruction of native joint can necessitate restoration of segmental defect and arthrodesis for therapy of infection and maintenance of walking ability. In segmental knee defect external fixators or KAFO are not suitable, not comfortable and poor tolerated by elderly patients. Both custom-made Femoro-Tibial Nail (FTN) combined with acrylic cement spacer and Knee Arthrodesis Nail System (KANS) offer maintenance of supportive function of extremity and avoidance of leg length discrepance after removal of TKA. Method The group consists of 13 patients. In 12 cases knee arthrodesis have been performed due to infection with bone defect after removal of infected TKA, and in 1case due to inflammatory destruction of native knee joint. In 7 cases FTN with ALAC spacer and in 6 cases KANS (5 cases Orthopedic Salvage System-OSS; 1 case Link KANS) was used. In cases treated with FTN the gap between distal femur and proximal tibia was filled with hand-made acrylic cement spacer loaded with selected antibiotic (2g per 40 g cement) so that the spacer finally gained cylindrical shape. Results Stable knee was noted after 7 years in 4 of 7 knees treated with FTN with ALAC spacer and after 2 years in 6 of 6 after KANS. Infection free knee was gained after 7 years in 4 of 7 cases treated with FTN with ALAC spacer and after 2 years in 5 of 6 cases treated with KANS. Amputation was necessary after 6 years in 3 of 7 cases treated with FTN with ALAC spacer and after 2 years in none case treated with KANS. Complications occurred in 2 cases after FTN with ALAC spacer (1x: FTN breackage, 1x: stress fracture of femoral neck) and in 1 case after KANS (OSS implant failure). Replacement of FTN nail and cement spacer in 1 case and respectively revision of OSS KANS in 1 cases was performed. Conclusions Compared with the KANS, custom-made FTN combined with ALAC spacer proved to be effective up to 6 years, but shoved higher rate of complications and amputations after 6 years. It can be considered as a temporary low-cost salvage procedure for infected TKA with segmental bone defect as 1 st stage in two-stage arthrodesis for infected knee prosthesis.
Journal of Bone and Joint Surgery-british Volume, 2015
The aim of the study is to evaluate the effect of acrylic cement CMW1 (DePuy) containing 2,5% of ... more The aim of the study is to evaluate the effect of acrylic cement CMW1 (DePuy) containing 2,5% of gentamicin and addition of 5 % and 10 % of respective vancomycin, meropeneme and ceftriaxone on growth inhibition of reference strains of MRSA, E. faecalis, S. aureus, P. aeruginosa and E. coli. From every portion of investigated acrylic cement CMW1 discs were cut with a diameter of 15mm and a thickness of 5mm, average weight 1.365 g (+/− 0,257g). Inoculum was prepared with the reference strains: MR3 S. aureus methicillin-resistant (MRSA), ATCC 29219 E. faecalis, ATCC 25923 S. ureus, ATCC 27853 P. aeruginosa and ATCC 25922 E. coli. A colonies of bacteria taken from a 18-hour culture on solid medium were addend to tubes with sterile physiological saline solution to obtain a density of 0.5 McFarland (5 × 105 CFU / ml). The suspension was distributed evenly over the Mueller-Hinton (MH) medium (Biomerieux, France). Prepared discs of CMW1 cement were put with a sterile forceps on the plate wi...
Journal of Bone and Joint Surgery-british Volume, 2015
Infected nonunion of the femur or tibia diaphysis requires resection of infected bone, stabilizat... more Infected nonunion of the femur or tibia diaphysis requires resection of infected bone, stabilization of bone and reconstruction of bone defect. External fixation of the femur is poorly tolerated by patients. In 2004 authors introduced in therapy for infected nonunions of tibia and femur diaphysis coating of IMN with a layer of antibiotic loaded acrylic cement (ALAC) containing 5% of culture specific antibiotic. Seven patients with infected nonunion of the diaphysis of femur (2) and tibia (2) were treated, aged 20–63 years, followed for 2–9 years (average 5,5 years). All have been infected with S. aureus (MSSA: 2 and MRSA: 4) or Staph. epidermidis (1) and in one case with MRSA and Pseudomonas aeruginosa. All patients underwent 3 to 6 operations before authors IMN application. Custom-made IMN coated with acrylic cement (Palamed) loaded fabrically with gentamycin with admixture of 5% of culture-specific antibiotic: vancomycin (7 cases) and meropeneme (1 case) was used for bone stabiliz...
Chirurgia Narządów Ruchu i Ortopedia Polska, 2018
Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a seriou... more Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a serious complication of both total hip replacement (THR) and total knee artthoplasty (TKA). Materials and methods. Results were evaluated in 16 patients (17 prostheses) aged 35-82 years, operated due to infection and fracture after THR (8) and TKA (9). Observation period 3-13 years (average 6.5 years). Etiology of infection: S. aureus (11), Staph. epidermidis (3), VRE (1), Pseudomonas aeruginosa (1), E. Coli (1). Fractures have been stabilised with: cerclage, Partridge tapes, Bridgeplate system with acrylic cement with antibiotic (ALAC), 1-2 plates with screws, cerclage and nail with ALAC (2), Integracja plate, femoro-tibial nail with ALAC spacer as knee arthrodesis, intramedullary ALAC spacer constructed on a nail. There have been performed THR and TKA revisions: 2-stage (8), 1-stage (1), definitive removal of prosthesis (5), spacer without reaimplantation (1), debridement (1), conversion of the total femoral prosthesis into a permanent total femoral ALAC spacer (1). Results. Cure of infection in 12 and fracture healing was achieved in 9 patients. There were performed 2 amputations. 10 prostheses were preserved and 5 were removed. Limb function after treatment: very good (1), good (7), sufficient (6), bad-after amputation (2). Conclusions. In each case of fracture and infection, apart from the fixation of the fracture, revision of the endoprosthesis should be performed, using a spacer or local carriers of antibiotics near the endoprosthesis and fracture ostheosynthesis. A stable fixation of fracture with plate, intramedullary nail or spacer with stem is necessary to get union and cure the infection. In infected periprosthetic fractures with unstable endoprosthesis, good conditions for fracture healing and cure of infection can be obtained by using a spacer extended with a long intramedullary stem covered with ALAC with a 5% addition of a targeted antibiotic.
Chirurgia narzadow ruchu i ortopedia polska
Osteosynthese International
Ortopedia, traumatologia, rehabilitacja
An aim of the management of infection complicating total hip arthroplasty is to control infection... more An aim of the management of infection complicating total hip arthroplasty is to control infection and maintain satisfactory hip function. In the period 1993-2000 effectives of therapy of deep injection after total hip replacement in 91 patients was assessed. Infection without loosening of endoprosthesis was diagnosed in 33 hips, septic loosening in 58. In 33 cases without loosening surgical debridement without removal of prosthesis was done with good control of infection in 25 hips. Permanent removal of prosthesis done in 42 cases resulted in recurrence of infection in 6 hips. One stage reimplantation done in 12 patients succeded in 9 hips. Two-stage reimplantation in 3 hips resulted in recurrence of infection in 2 cases. Antibiotic-embedded cement spacer (gentamycin with vancomycin) was used in I case with unsatisfactory result. Recurrent infection was observed in 13 cases of 48 hips treated without implant removal or by reimplantation of new prosthesis.
Ortopedia, traumatologia, rehabilitacja
Current methods are presented for the management of deep infection of total hip replacements. The... more Current methods are presented for the management of deep infection of total hip replacements. The goal of treatment is to maintain the improvement of function gained by hip replacement. In cases without loosening, precise surgical debridement without removal of implants is indicated. Management in septic loosening depends on the general medical condition of the patient, the local bone stock, and the spread of infection. Satisfactory bone stock allows for reimplantation of a new prosthesis, prefably using antibiotic-loaded cement, after scrupulous removal of all potentially infected tissues and particles. The reimplantationcan be done as a one- or two-stage operation. In the two0stage procedure, antibiotic-loaded cement spacer can be used, but both two- and one-stage reimplantation have similar results as regards infection control. Definitive removal of the prosthesis is indicated in patients whose general medical condition is poor, who have no usable bone stock, or who present with ...
Ortopedia, traumatologia, rehabilitacja
Based on authorial material consisting of 19 patients operated in the period 1993-2000 for infect... more Based on authorial material consisting of 19 patients operated in the period 1993-2000 for infections following total hip replacements, and on information from the literature, the authors discuss the suitability of various diagnostic methods. It is particularly important to diagnose infections with a slow course, without the classic clinical signs. The diagnostic criteria accepted by the Disease Control Center in Atlanta are presented, along with the radiological symptoms of latent infections and scintigraphic methods of varying sensitivity and specificity to regards to hip endoprosthesis infections. The article presents the typical changes in the value of erythrocyte precipitation and CRP concentration during the first year following a non-complicated hip arthroplasty, which has a significant impact on the interpretation of results when there is a suspicion of early infection. The decisive test for the diagnosis of a slow infection in a joint with loosened endoprosthesis with obvio...
Chirurgia narzadów ruchu i ortopedia polska, 2005
Loosening of an artificial joint is a common complication in orthopedic surgery. It is estimated ... more Loosening of an artificial joint is a common complication in orthopedic surgery. It is estimated that bacteriological implant contamination is responsible for its loosening in 2-5 percent of cases, and in most cases aseptic loosening takes place. Despite low percentage of positive microbiological studies, histopathological examinations and modern laboratory techniques, including PCR (Polymerase Chain Reaction) allow to diagnose the bacterial contamination of the loose implant to ca 70 percent. Those observations point out to the high coincidence of bacterial contamination with implant loosening strongly suggesting its influence on activation of the inflammatory process destabilizing an implant. But the question, why in those cases bacterial contamination does not lead to clinically obvious suppuration, remains unknown. The possibility to activate the immune system by the subcellular elements of the bacterial cells leading to persistent inflammation with granulation tissue formation ...
Chirurgia narzadów ruchu i ortopedia polska, 1993
ABSTRACT
Chirurgia narzadów ruchu i ortopedia polska, 1993
The efficiency and safety of use of enoxaparin (clexane Rhone-Poulenc Rorer) in antithrombotic pr... more The efficiency and safety of use of enoxaparin (clexane Rhone-Poulenc Rorer) in antithrombotic prophylaxis after total hip replacement is presented. The subcutaneous dose of 40 mg daily proved to be highly efficient and of minor side-effects.
Chirurgia narzadów ruchu i ortopedia polska, 1993
The authors made clinical evaluation of 35 patients after the removal of the hip endoprosthesis d... more The authors made clinical evaluation of 35 patients after the removal of the hip endoprosthesis due to infection. The age of the patients varied from 18-82 years (average 56 years). Majority of patients (26) estimated the result of treatment as good; only 3 among them wanted a revision hip arthroplasty. Observation revealed good general performance and painless gait in 11 subjects; poor hip stability in 21 cases, and significant functional impairement in 3 patients. Removal of the prosthesis resulted in marked relief of pain, and enhanced the healing of infection.
Chirurgia Narządów Ruchu i Ortopedia Polska
Introduction. We report the results of revision surgery in recurrent infection after anterior cru... more Introduction. We report the results of revision surgery in recurrent infection after anterior cruciate ligament reconstruction (ACLR) consisting of graft canal debridement and the local application of a calcium sulfate bone substitute (CSBS) with the addition of gentamicin and vancomycin in graft canal and infected foci. Materials and methods. Three patients (3 knees) were operated due to a chronic and unsuccessfully treated knee infection after ACLR. Two patients underwent multiple previous revisions (4 and 9, respectively). In all cases, the tibial ACL graft canal and adjacent bone foci were debrided. Post debridement defects in the femur and tibia and the graft tunnel in the tibia were filled with CSBS with an addition of gentamicin and vancomycin. If the absence of the ACL graft was stated, the tibial canal was closed from the joint side with a collagen sponge with gentamicin. Results. After a follow-up of 20 to 26 months, all patients obtained a complete resolution of inflammat...
Aim & introduction Infected knee with bone defect resulting from failed total knee arthroplas... more Aim & introduction Infected knee with bone defect resulting from failed total knee arthroplasty (TKA) or destruction of native joint can necessitate restoration of segmental defect and arthrodesis for therapy of infection and maintenance of walking ability. In segmental knee defect external fixators or KAFO are not suitable, not comfortable and poor tolerated by elderly patients. Both custom-made Femoro-Tibial Nail (FTN) combined with acrylic cement spacer and Knee Arthrodesis Nail System (KANS) offer maintenance of supportive function of extremity and avoidance of leg length discrepance after removal of TKA. Method The group consists of 13 patients. In 12 cases knee arthrodesis have been performed due to infection with bone defect after removal of infected TKA, and in 1case due to inflammatory destruction of native knee joint. In 7 cases FTN with ALAC spacer and in 6 cases KANS (5 cases Orthopedic Salvage System-OSS; 1 case Link KANS) was used. In cases treated with FTN the gap between distal femur and proximal tibia was filled with hand-made acrylic cement spacer loaded with selected antibiotic (2g per 40 g cement) so that the spacer finally gained cylindrical shape. Results Stable knee was noted after 7 years in 4 of 7 knees treated with FTN with ALAC spacer and after 2 years in 6 of 6 after KANS. Infection free knee was gained after 7 years in 4 of 7 cases treated with FTN with ALAC spacer and after 2 years in 5 of 6 cases treated with KANS. Amputation was necessary after 6 years in 3 of 7 cases treated with FTN with ALAC spacer and after 2 years in none case treated with KANS. Complications occurred in 2 cases after FTN with ALAC spacer (1x: FTN breackage, 1x: stress fracture of femoral neck) and in 1 case after KANS (OSS implant failure). Replacement of FTN nail and cement spacer in 1 case and respectively revision of OSS KANS in 1 cases was performed. Conclusions Compared with the KANS, custom-made FTN combined with ALAC spacer proved to be effective up to 6 years, but shoved higher rate of complications and amputations after 6 years. It can be considered as a temporary low-cost salvage procedure for infected TKA with segmental bone defect as 1 st stage in two-stage arthrodesis for infected knee prosthesis.
Journal of Bone and Joint Surgery-british Volume, 2015
The aim of the study is to evaluate the effect of acrylic cement CMW1 (DePuy) containing 2,5% of ... more The aim of the study is to evaluate the effect of acrylic cement CMW1 (DePuy) containing 2,5% of gentamicin and addition of 5 % and 10 % of respective vancomycin, meropeneme and ceftriaxone on growth inhibition of reference strains of MRSA, E. faecalis, S. aureus, P. aeruginosa and E. coli. From every portion of investigated acrylic cement CMW1 discs were cut with a diameter of 15mm and a thickness of 5mm, average weight 1.365 g (+/− 0,257g). Inoculum was prepared with the reference strains: MR3 S. aureus methicillin-resistant (MRSA), ATCC 29219 E. faecalis, ATCC 25923 S. ureus, ATCC 27853 P. aeruginosa and ATCC 25922 E. coli. A colonies of bacteria taken from a 18-hour culture on solid medium were addend to tubes with sterile physiological saline solution to obtain a density of 0.5 McFarland (5 × 105 CFU / ml). The suspension was distributed evenly over the Mueller-Hinton (MH) medium (Biomerieux, France). Prepared discs of CMW1 cement were put with a sterile forceps on the plate wi...
Journal of Bone and Joint Surgery-british Volume, 2015
Infected nonunion of the femur or tibia diaphysis requires resection of infected bone, stabilizat... more Infected nonunion of the femur or tibia diaphysis requires resection of infected bone, stabilization of bone and reconstruction of bone defect. External fixation of the femur is poorly tolerated by patients. In 2004 authors introduced in therapy for infected nonunions of tibia and femur diaphysis coating of IMN with a layer of antibiotic loaded acrylic cement (ALAC) containing 5% of culture specific antibiotic. Seven patients with infected nonunion of the diaphysis of femur (2) and tibia (2) were treated, aged 20–63 years, followed for 2–9 years (average 5,5 years). All have been infected with S. aureus (MSSA: 2 and MRSA: 4) or Staph. epidermidis (1) and in one case with MRSA and Pseudomonas aeruginosa. All patients underwent 3 to 6 operations before authors IMN application. Custom-made IMN coated with acrylic cement (Palamed) loaded fabrically with gentamycin with admixture of 5% of culture-specific antibiotic: vancomycin (7 cases) and meropeneme (1 case) was used for bone stabiliz...
Chirurgia Narządów Ruchu i Ortopedia Polska, 2018
Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a seriou... more Introduction. Periprosthetic fracture (PPF) with periprosthetic joint infection (PJI) is a serious complication of both total hip replacement (THR) and total knee artthoplasty (TKA). Materials and methods. Results were evaluated in 16 patients (17 prostheses) aged 35-82 years, operated due to infection and fracture after THR (8) and TKA (9). Observation period 3-13 years (average 6.5 years). Etiology of infection: S. aureus (11), Staph. epidermidis (3), VRE (1), Pseudomonas aeruginosa (1), E. Coli (1). Fractures have been stabilised with: cerclage, Partridge tapes, Bridgeplate system with acrylic cement with antibiotic (ALAC), 1-2 plates with screws, cerclage and nail with ALAC (2), Integracja plate, femoro-tibial nail with ALAC spacer as knee arthrodesis, intramedullary ALAC spacer constructed on a nail. There have been performed THR and TKA revisions: 2-stage (8), 1-stage (1), definitive removal of prosthesis (5), spacer without reaimplantation (1), debridement (1), conversion of the total femoral prosthesis into a permanent total femoral ALAC spacer (1). Results. Cure of infection in 12 and fracture healing was achieved in 9 patients. There were performed 2 amputations. 10 prostheses were preserved and 5 were removed. Limb function after treatment: very good (1), good (7), sufficient (6), bad-after amputation (2). Conclusions. In each case of fracture and infection, apart from the fixation of the fracture, revision of the endoprosthesis should be performed, using a spacer or local carriers of antibiotics near the endoprosthesis and fracture ostheosynthesis. A stable fixation of fracture with plate, intramedullary nail or spacer with stem is necessary to get union and cure the infection. In infected periprosthetic fractures with unstable endoprosthesis, good conditions for fracture healing and cure of infection can be obtained by using a spacer extended with a long intramedullary stem covered with ALAC with a 5% addition of a targeted antibiotic.
Chirurgia narzadow ruchu i ortopedia polska
Osteosynthese International
Ortopedia, traumatologia, rehabilitacja
An aim of the management of infection complicating total hip arthroplasty is to control infection... more An aim of the management of infection complicating total hip arthroplasty is to control infection and maintain satisfactory hip function. In the period 1993-2000 effectives of therapy of deep injection after total hip replacement in 91 patients was assessed. Infection without loosening of endoprosthesis was diagnosed in 33 hips, septic loosening in 58. In 33 cases without loosening surgical debridement without removal of prosthesis was done with good control of infection in 25 hips. Permanent removal of prosthesis done in 42 cases resulted in recurrence of infection in 6 hips. One stage reimplantation done in 12 patients succeded in 9 hips. Two-stage reimplantation in 3 hips resulted in recurrence of infection in 2 cases. Antibiotic-embedded cement spacer (gentamycin with vancomycin) was used in I case with unsatisfactory result. Recurrent infection was observed in 13 cases of 48 hips treated without implant removal or by reimplantation of new prosthesis.
Ortopedia, traumatologia, rehabilitacja
Current methods are presented for the management of deep infection of total hip replacements. The... more Current methods are presented for the management of deep infection of total hip replacements. The goal of treatment is to maintain the improvement of function gained by hip replacement. In cases without loosening, precise surgical debridement without removal of implants is indicated. Management in septic loosening depends on the general medical condition of the patient, the local bone stock, and the spread of infection. Satisfactory bone stock allows for reimplantation of a new prosthesis, prefably using antibiotic-loaded cement, after scrupulous removal of all potentially infected tissues and particles. The reimplantationcan be done as a one- or two-stage operation. In the two0stage procedure, antibiotic-loaded cement spacer can be used, but both two- and one-stage reimplantation have similar results as regards infection control. Definitive removal of the prosthesis is indicated in patients whose general medical condition is poor, who have no usable bone stock, or who present with ...
Ortopedia, traumatologia, rehabilitacja
Based on authorial material consisting of 19 patients operated in the period 1993-2000 for infect... more Based on authorial material consisting of 19 patients operated in the period 1993-2000 for infections following total hip replacements, and on information from the literature, the authors discuss the suitability of various diagnostic methods. It is particularly important to diagnose infections with a slow course, without the classic clinical signs. The diagnostic criteria accepted by the Disease Control Center in Atlanta are presented, along with the radiological symptoms of latent infections and scintigraphic methods of varying sensitivity and specificity to regards to hip endoprosthesis infections. The article presents the typical changes in the value of erythrocyte precipitation and CRP concentration during the first year following a non-complicated hip arthroplasty, which has a significant impact on the interpretation of results when there is a suspicion of early infection. The decisive test for the diagnosis of a slow infection in a joint with loosened endoprosthesis with obvio...
Chirurgia narzadów ruchu i ortopedia polska, 2005
Loosening of an artificial joint is a common complication in orthopedic surgery. It is estimated ... more Loosening of an artificial joint is a common complication in orthopedic surgery. It is estimated that bacteriological implant contamination is responsible for its loosening in 2-5 percent of cases, and in most cases aseptic loosening takes place. Despite low percentage of positive microbiological studies, histopathological examinations and modern laboratory techniques, including PCR (Polymerase Chain Reaction) allow to diagnose the bacterial contamination of the loose implant to ca 70 percent. Those observations point out to the high coincidence of bacterial contamination with implant loosening strongly suggesting its influence on activation of the inflammatory process destabilizing an implant. But the question, why in those cases bacterial contamination does not lead to clinically obvious suppuration, remains unknown. The possibility to activate the immune system by the subcellular elements of the bacterial cells leading to persistent inflammation with granulation tissue formation ...
Chirurgia narzadów ruchu i ortopedia polska, 1993
ABSTRACT
Chirurgia narzadów ruchu i ortopedia polska, 1993
The efficiency and safety of use of enoxaparin (clexane Rhone-Poulenc Rorer) in antithrombotic pr... more The efficiency and safety of use of enoxaparin (clexane Rhone-Poulenc Rorer) in antithrombotic prophylaxis after total hip replacement is presented. The subcutaneous dose of 40 mg daily proved to be highly efficient and of minor side-effects.
Chirurgia narzadów ruchu i ortopedia polska, 1993
The authors made clinical evaluation of 35 patients after the removal of the hip endoprosthesis d... more The authors made clinical evaluation of 35 patients after the removal of the hip endoprosthesis due to infection. The age of the patients varied from 18-82 years (average 56 years). Majority of patients (26) estimated the result of treatment as good; only 3 among them wanted a revision hip arthroplasty. Observation revealed good general performance and painless gait in 11 subjects; poor hip stability in 21 cases, and significant functional impairement in 3 patients. Removal of the prosthesis resulted in marked relief of pain, and enhanced the healing of infection.