Treatment of early chronic infections with tumor prosthesis by intermittent negative pressure wound therapy with instillation (original) (raw)
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Peri-Prosthetic Infection in the Orthopedic Tumor Patient
Reconstructive Review, 2014
Background: Infection complicates traditional joint reconstruction prostheses in up to 7% of cases, with even higher rates in oncologic cases. Questions / Purposes: The authors ask if prosthetic infection in bone tumor patients is associated with any epidemiologic, treatment, or outcome variables that could influence management of these difficult conditions. Patients and Methods: Authors retrospectively reviewed 329 consecutive bone tumor (malignant and benign) patients treated with hip or knee tumor resection and subsequent joint reconstruction, comparing infected and non-infected cases. Patients were followed for a mean of 34 months.Results: Of lower extremity tumor reconstructions, 13.1% developed periprosthetic infection, with the knee significantly more involved than the hip (20.5% vs 6.1%). The most common organism cultured was Staphylococcus aureus (33%). The diagnosis of sarcoma was associated with a higher infection rate, and infections were associated with a two-fold incre...
The Journal of Arthroplasty, 2010
Irrigation and debridement (I and D) is a procedure commonly used for the treatment of acute periprosthetic infection. This study retrospectively reviewed clinical records of patients with periprosthetic infection of the hip or knee who underwent I and D with retention of their prostheses between 1997 and 2005 at a single institution. One hundred four patients (44 males and 60 females) were identified. Mean age at time of initial debridement was 65 years. Average follow-up was 5.7 years. Treatment failure was defined as the need for resection arthroplasty or recurrent microbiologically proven infection. According to these criteria, I and D was successful in 46 patients (44%). Patients with staphylococcal infection, elevated American Society of Anesthesiologists score, and purulence around the prosthesis were more likely to fail. The high failure rate of this procedure implies that it should be preferably limited to select healthy patients with low virulence organisms and equivocal intraoperative findings. Keywords: total hip arthroplasty, total knee arthroplasty, periprosthetic infection, irrigation and debridement.
Acta Orthopaedica, 2013
Patients and methods We retrospectively studied 89 deepinfected stable prostheses from 69 total hip replacements and 20 total knee replacements. There were 83 early or delayed postoperative infections and 6 hematogenous. In the postoperative infections, treatment had started 12 days to 2 years after implantation. In the hematogenous infections, symptoms had been present for 6 to 9 days. The patients had been treated with debridement, prosthesis retention, systemic antibiotics, and local antibiotics: gentamicin-PMMA beads or gentamicin collagen fleeces. The minimum follow-up time was 1.5 years. We investigated how the result of the treatment had been influenced by the length of the period the infection was present, and by other variables such as host characteristics, infection stage, and type of bacteria.
Irrigation and Débridement and Prosthesis Retention for Treating Acute Periprosthetic Infections
Clinical Orthopaedics and Related Research®, 2010
Background Infections following hip and knee replacements can compromise the function and durability of arthroplasty. When these infections occur during the immediate postoperative period, irrigation and débridement can be attempted to salvage the implant. Prior studies have reported varying results likely due to lack of consistent inclusion criteria, variations in surgical technique, and lack of uniform treatment protocols. Questions/purposes To supplement this literature we determined the rate at which irrigation and débridement and prosthesis retention would control acute periprosthetic infections. Methods We retrospectively reviewed the medical records of 18 patients with acute periprosthetic infections occurring within 28 days after 13 THAs and 5 TKAs. The mean time to reoperation was 19 days (range, 6-28 days) after arthroplasty. Superficial débridements were performed in five cases, and a polyethylene or ball head exchange was performed in the remaining 13 cases when fascial defects were encountered at the time of surgery.
A Treatment Pathway Variation for Chronic Prosthesis-Associated Infections
JBJS Open Access, 2020
Background: Periprosthetic joint infections (PJIs) are relatively rare but are on the rise because of the increasing total number of implantations performed. Treatment of PJI remains individualized and involves both surgical and medical treatment, with variations depending on the time of implantation, the duration and severity of the infection, tissue damage, and the underlying microorganism. In this case series study, we investigated clinical and functional outcomes of a variation of the Liestal algorithm in patients with PJI following total hip arthroplasty. Methods: This study included 32 patients (33 cases) who were treated for chronic PJI with 2-stage exchange using a cement spacer during the period of 2003 to 2014. In contrast to other treatment pathways, antibiotic therapy was targeted to the causative microorganism as early as possible despite the presence of a cement spacer. Second-look surgery was performed 4 days after removal of the primary implant and a 4-week antibioti...
Techniques in Orthopaedics, 2013
Despite current low rates, the incidence of arthroplastyassociated infections (AAI) is likely to increase over the next few years as the number of joint replacement operations continues to rise worldwide. AAI pose a challenge for both patients and surgeons. They have become a major economic burden on healthcare systems. Debridement and implant retention is not a widely considered option for chronic AAI probably due to low success rates. Negative Pressure Wound Therapy and intra-articular antibiotics instillation using VAC ULTA/VeraFlo system is an alternative strategy in the management of chronic AAI where implant retention is sought. Further evaluations and studies are needed to address the efficacy of this strategy and its cost effectiveness.
Trends in the treatment of orthopaedic prosthetic infections
Journal of Antimicrobial Chemotherapy, 2004
The most commonly used therapy for prosthetic joint infection is a two-stage prosthetic exchange separated by 6 weeks of intravenous antibiotic therapy. This often results in long periods of hospitalization, morbidity, severe functional impairment and sometimes increased mortality. Therefore novel and challenging therapeutic approaches have been attempted, particularly in hip prosthetic infection. This includes, whenever possible, according to the type of microorganism, antibacterial susceptibility and clinical presentation (including age and comorbidities): (i) less aggressive surgical techniques (debridement and prosthesis retention, or re-implantation with a single-stage exchange arthroplasty); and (ii) antibiotic combinations active against biofilm-associated bacteria, including rifampicin (particularly with quinolones) with excellent bio-availability which allow prolonged and efficient oral therapy.
Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?
Journal of Arthroplasty, 2015
Prosthetic joint infection (PJI) of the hip and knee remains one of the most common and feared arthroplasty complications. The impact and cost of PJI is significant, both to the patient and to the health care system. Recent reports of results of different treatment strategies have led many surgeons to modify their approach to management of PJI. This paper will explore apparent paradigm shifts, both to indications and technique, including the importance of waiting for bacterial identification, the decreasing role for irrigation and debridement (I&D) with retention of components, the increased utilization of single stage revision, and conversely a decreasing role for two-stage exchange. Strategies for treating drug-resistant organisms and management of failed treatment will also be examined.
Salvage of infected tumor prostheses
Current Orthopaedic Practice, 2009
Limb salvage in oncologic surgery with endoprosthetic reconstruction results in infection in 5.7-15% of patients. These infections result in subsequent amputation in 46-87% of patients. Through literature review, we evaluated the statistically associated factors, treatments, outcomes and future trends regarding endoprosthetic infection. Infection was more prevalent in periacetabular and proximal tibial reconstructions. Coagulase-negative Staphylococcus was the most common pathogen in seven of eight case series. Factors associated with increased initial and persistent infection included myeloma, radiation therapy, poor soft-tissue condition, revision surgeries, and cementless fixation. Infection was noted to significantly increase 10-year survival in osteosarcoma patients. Recommendations on treatment were mixed, the only significant association with cure was early surgical intervention, and increased salvage rates were seen with both limited one-stage and extensive two-stage procedures. All studies agreed that clinicians and researchers should direct intensive efforts toward the prevention of infection. A number of recent studies showed promising in vitro and in vivo effects of antimicrobial implant surfaces, specifically silver and vancomycin, in retarding the establishment of periprosthetic infection. Infections of oncologic endoprostheses remain challenging problems, with no recent advances in the treatment of established infections. Associated factors have been established, although most are unavoidable in the course of cancer treatment. Most promise comes with the ongoing development of antimicrobial implant surfaces that aim to prevent the establishment and persistence of these difficult infections.