Archive for October 29, 2016

Concomitant Multiple Joint Arthroplasty Infections: Report on 16 Cases

Journal of Arthroplasty November 2016 V.31 N.11 P.2564-2568

Valérie Zeller, Delphine Dedome, Luc Lhotellier, Wilfrid Graff, Nicole Desplaces, Simon Marmor

Background

Concomitant infections of several prostheses are very rare, serious events that pose particular medical and surgical therapeutic challenges. This study was undertaken to describe epidemiologic, clinical, and microbiological characteristics of concomitant multiple joint arthroplasty infections, their treatments, and outcomes.

Methods

Retrospective (January 2000 and January 2014), single-center, cohort study in a referral center for bone and joint infections. All patients with at least 2 concomitant, microbiologically documented, prosthetic joint infections, that is, during the same septic episode, were included.

Results

Sixteen patients were included. Median (range) age was 78 years (46-93 years), gender ratio was 1, and median (range) body mass index was 27 (21-42). Multiple joint arthroplasties (bilateral hip in 8 patients; bilateral knee in 3 patients; hip and knee in 1 patient; and 2 knees and 1 hip in 1 patient) were contaminated hematogenously in all patients, 2 after early postoperative infections. Eight Staphylococcus aureus, 1 Staphylococcus epidermidis, 6 Streptococcus, and 1 Escherichia coli strains were isolated. A curative strategy was applied to 11 patients: 3 underwent bilateral synovectomies, 6 had successive 1-stage exchange arthroplasties, and 2 were treated with other strategies. After 37 months (range, 24-132 months) of follow-up, reinfection occurred in 1 patient. The 5 other patients received prolonged suppressive antibiotic therapy.

Conclusion

These complex infections occur during staphylococcal or streptococcal bacteremia. Treatment strategies should be discussed by a multidisciplinary team on a case-by-case basis.

 

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00132-7/pdf

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October 29, 2016 at 10:30 am

Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty

Journal of Arthroplasty November 2016 V.31 N.11 P.2473-2441

Omer F. Erkocak, Joanne Y. Yoo, Camilo Restrepo, Mitchell G. Maltenfort, Javad Parvizi

Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania

Background

Patients with chronic renal failure (CRF) may require total joint arthroplasty (TJA) to treat degenerative joint disease, fractures, osteonecrosis, or amyloid arthropathy. There have been conflicting results, however, regarding outcomes of TJA in patients with chronic renal disease. The aim of this case-controlled study was to determine the outcome of TJA in patients with CRF, with particular interest in the incidence of infections and inhospital mortality.

Methods

We queried our electronic database to determine which patients among the 29,389 TJAs performed at our institution between January 2000 and June 2012 had a diagnosis of CRF. A total of 359 CRF patients were identified and matched for procedure, gender, age (±4 years), date of surgery (±2 years), and body mass index (±5 kg/m2) in a 2:1 ratio to 718 control patients.

Results

The incidence of infection and inhospital mortality was not significantly different between the nondialysis CRF patients and controls, whereas it was significantly higher in dialysis-dependent end-stage renal failure patients compared to controls. Of the 50 CRF patients receiving hemodialysis, 10 (20%) developed surgical site infection, of which 4 (8%) were periprosthetic joint infection, and 4 (8%) died during hospital stay. The odds ratio for infection in the dialysis group was 7.54 (95% confidence interval: 2.83-20.12) and 10.46 (95% confidence interval: 1.67-65.34) for the inhospital mortality.

Conclusion

We conclude that end-stage renal failure patients receiving hemodialysis have higher postoperative infection and inhospital mortality rates after an elective TJA procedure, whereas nondialysis CRF patients have similar outcomes compared with the general TJA population.

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)30130-9/pdf

October 29, 2016 at 10:27 am


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