• Hip & pelvis
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• 제34권4호
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• pp.255-261
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• 2022

The purpose of this case report and review of the literature is to provide documentation on periprosthetic hip joint infection with Flavonifractor plautii (formerly known as Eubacterium plautii), a strictly anaerobic bacterium, and to report on a successful pathway for management including staged surgical revisions and extended antibiotic therapy. A systematic review of the literature was conducted, which identified this case as only the fifth documented case of human infection with this organism; as a result, conduct of further research is warranted, based on the paucity of reports in the literature addressing anaerobic periprosthetic joint infection.

• 대한의생명과학회지
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• 제28권1호
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• pp.1-8
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• 2022

Total joint arthroplasty is a successful joint replacement treatment that improves joint function and overall quality of life and provides pain relief. However, the prevalence of periprosthetic joint infection (PJI) has become prevalent with the rise in the incidence of arthroplasty surgery. PJI occurs rarely following arthroplasty however presents with serious complications, including high morbidity. The identification of causative microorganisms is essential for the treatment of PJI. Managing PJI requires complex treatment strategies, including long-term antibacterial treatment, and significant medical costs can be incurred. The American Academy of Orthopedic Surgeons, the Centers for Disease Control and Prevention, and Surgical Care Improvement Project guidelines recommend that prophylactic antibiotics such as first-generation cephalosporins be infused completely 1 hour before surgical incision. However, these preventative antibiotics are very limited, therefore risk factors must be identified to diagnosis and treat patients effectively. Moreover, determining antimicrobial susceptibility during artificial joint surgery and choosing the most appropriate treatment strategy following an accurate diagnosis of microbial infections are essential. In the present review, we describe the management, including the etiology, diagnosis, and classification of PJI, and approaches to its diagnosis using the available novel molecular diagnostic methods.

• Hip & pelvis
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• 제35권2호
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• pp.142-146
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• 2023

Stenotrophomonas maltophilia, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by S. maltophilia. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.

• Hip & pelvis
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• 제34권4호
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• pp.236-244
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• 2022

Purpose: The most recent diagnostic criteria for periprosthetic joint infection (PJI) include the use of the alpha-defensin (AD) lateral-flow (LF) test, but hip and knee arthroplasties were usually combined in previous studies. This prospective study was designed to examine the accuracy of the AD-LF test for diagnosis of PJI in chronic painful total hip arthroplasties (THA). Materials and Methods: Patients with chronic painful hip arthroplasties were prospectively enrolled between March 2018 and May 2020. Exclusion criteria included acute PJI or an insufficient amount of synovial fluid. The modified Musculoskeletal Infection Society (MSIS) criteria were primarily used for PJI diagnosis. Fifty-seven patients were included in the analysis group. Revision surgery was not performed in 38 patients, for different reasons (clinical group); these patients remain "Schrödinger's hips": in such cases PJI cannot be excluded nor confirmed until you "open the box". Results: The result of the AD-LF test was positive in nine patients and negative in 48 patients. Six patients were diagnosed with PJI. AD-LF sensitivity (MSIS criteria) was 83% (95% confidence interval [CI] 36-100%) and specificity was 92% (95% CI 81-98%). The positive and negative predictive value were 56% and 98%, respectively. Conclusion: The AD test is useful in addition to the existing arsenal of diagnostic tools, and can be helpful in the decision-making process. Not all patients with chronical painful THA will undergo revision surgery. Consequently, in order to determine the reliable diagnostic accuracy of this test, future PJI diagnostic studies should include a second arm of "Schrödinger's hips".

• Hip & pelvis
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• 제35권4호
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• pp.277-280
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• 2023

Dislocation after a total hip arthroplasty occurs in approximately 1% of patients; however, the frequency is much higher after revision surgery. To prevent dislocation, use of a larger femoral head is recommended, and a dual mobility femoral head has been introduced. However, reducing the dual mobility femoral head to the acetabular component is difficult in cases involving contracture in the soft tissue around the joint. A 72-year-old male patient who developed a periprosthetic joint infection underwent two-stage revision surgery using MUTARS^®. Two months after the revision, the hip joint became dislocated and manual reduction was attempted; however, dislocation occurred again. During another revision using a dual mobility bearing, the soft tissue around the hip joint was too tight to reduce. The problem was overcome by first repositioning the dual mobility head into the acetabular socket, followed by assembly of the diaphyseal portion of the implant.

• Clinics in Shoulder and Elbow
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• 제25권2호
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• pp.154-157
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• 2022

Periprosthetic joint infection (PJI) is one of the most devastating complications that can occur after shoulder arthroplasty. Although staged revision arthroplasty is the standard treatment in many cases, surgical intervention with debridement, antibiotics, and implant retention (DAIR) can be an effective option for acute PJI. We report a complex case of infected reverse shoulder arthroplasty (RSA) in a 73-year-old male. The patient had been previously treated for infected nonunion of a proximal humerus fracture caused by methicillin-resistant Staphylococcus epidermidis. He presented with a sinus tract 16 days after the implantation of RSA and was diagnosed with PJI caused by Serratia marcescens. The patient was successfully treated with DAIR and was free of infection at the last follow-up visit at 4 years postoperatively.

• 대한의생명과학회지
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• 제27권2호
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• pp.45-50
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• 2021

Coagulase-negative staphylococci (CoNS) are a typical group of microorganisms, and the recent advances in laboratory technology and medicine has dramatically modified their significance in medical practice. CoNS, which were previously classified as normal bacterial flora, have recently been reported to be associated with serious infectious diseases, such as surgical wound infection or periprosthetic joint infection. Representative CoNS include Staphylococcus epidermidis, S. haemolyticus, and S. saprophyticus, which are known to cause serious problems in biomaterial-based and prosthetic device infections, as well as to cause simple urinary tract infections in sexually active women. Over the last decade, the clinical isolation rate of CoNS has been increasing, and antibiotic resistance has also been occurring. This review aimed to investigate the incidence of CoNS infection and to use the results as basic data for the management of CoNS, with a focus on the isolation rate and antibiotic resistance in clinical surgery.

• Clinics in Shoulder and Elbow
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• 제14권1호
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• pp.146-152
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• 2011

목적: 주관절 전지환 성형술의 최근 수술 결과와 합병증에 대하여 문헌을 토대로 기술하고자 한다. 대상 및 방법: 주관절 전치환술의 적응증은 다른 수술 방법으로 관절 기능의 회복이 불가능한 류마토이드 관절염, 외상후 관절염, 관절 강직, 종양 제거 후 상태, 그리고 고령의 원위 상완골 분쇄 골절 등이 있다. 합병증으로는 가장 심각한 합병증인 감염을 비롯하여 삽입물 이완, 삽입물 골절, 삽입물 주위 골절, 척골 신경병증, 이소성 골화, 상완 삼두근 손상, 탈구를 포함한 불안정, bushing의 마모 등이 있다. 결과 및 결론: 재치환술을 기준으로 한 주관절 치환술의 수명은 10년을 기준으로 85% 정도인 것으로 알려져 있다. 염증성 관절염이 가장 예후가 좋으며 외상후 관절염의 이완율이 비교적 높다. 합병증은 다른 관절의 치환술에 비해 많이 발생하는 경향이 있으며 특히 심부 감염은 3~5% 정도로 높은 편이다. 주관절 치환술은 재건술로 관절 기능을 회복할 가능성이 없는 활동력이 높지 않은 환자에 대해 신중하고 적절하게 시행한다면 만족스러운 기능 회복을 기대할 수 있다.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.202-209
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• 2022

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection. Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12-48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs. Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1-35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation were improved from 50.0°, 50.9°, 17.7°, and sacrum level before RTSA to 127.3°, 110.0°, 51.8°, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.244-254
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• 2022

Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA-namely, periprosthetic joint infection-as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts.