Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Periprosthetic Joint Infection 14 articles


Two-stage Total Hip Arthroplasty: How Often Does It Control Methicillin-resistant Infection?

Fay Leung MD, FRCSC, Corey J. Richards MD, MASc, FRCSC, Donald S. Garbuz MD, MHSc, FRCSC, Bassam A. Masri MD, FRCSC, Clive P. Duncan MB, MSc, FRCSC

Methicillin-resistant hip infections are increasingly common. Reports of the surgical management of these patients using two-stage THA show variable control of infection, but all reports used static spacers.

Current Concepts for Clean Air and Total Joint Arthroplasty: Laminar Airflow and Ultraviolet Radiation: A Systematic Review

Richard P. Evans MD

With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic joint infection (PJI), orthopaedic surgeons must reconsider all potential infection control measures. Both airborne and nonairborne bacterial contamination must be reduced in the operating room.

Can Implant Retention be Recommended for Treatment of Infected TKA?

Ho-Rim Choi MD, Fabian Knoch MD, David Zurakowski PhD, Sandra B. Nelson MD, Henrik Malchau MD, PhD

Retention treatment is reportedly associated with lower infection control rates than two-stage revision. However, the studies on which this presumption are based depend on comparisons of historical rather than concurrent controls.

Structural Allograft as an Option for Treating Infected Hip Arthroplasty with Massive Bone Loss

Paul T. H. Lee MB BCh, MA, FRCS (Eng), FRCS (Tr & Orth), Robert A. Clayton MBBS, FRCS (Edin), FRCS (Tr & Orth), Oleg A. Safir MD, FRCSC, MEd, David J. Backstein MD, FRCSC, MEd, Allan E. Gross MD, FRCSC, OOnt

Revision of the infected hip arthroplasty with major bone loss is difficult. Attempts to restore bone stock with structural allograft are controversial.

Intraoperative Molds to Create an Articulating Spacer for the Infected Knee Arthroplasty

Geoffrey S. Thiel MD, MBA, Keith R. Berend MD, Gregg R. Klein MD, Alexander C. Gordon MD, Adolph V. Lombardi MD, Craig J. Della Valle MD

Chronic infections in TKA have been traditionally treated with a two-stage protocol incorporating a temporary antibiotic-loaded cement spacer. The use of a static as opposed to an articulating spacer is controversial. Some surgeons believe a static spacer results in a higher rate of infection eradication, whereas others believe an articulating spacer provides equivalent rates of infection control with improved function between stages and the potential for better eventual range of motion.

What is the Role of Serological Testing Between Stages of Two-stage Reconstruction of the Infected Prosthetic Knee?

Sharat K. Kusuma MD, MBA, Joseph Ward BA, Marc Jacofsky PhD, Scott M. Sporer MD, Craig J. Della Valle MD

Two-stage exchange arthroplasty is the gold standard for treatment of infected TKA. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and synovial fluid white blood cell (WBC) count with differential are often used to determine treatment response; however, it is unclear whether these tests can answer the critical question of whether joint sepsis has been controlled between stages and if reimplantation is indicated.

Diagnosing Periprosthetic Infection: False-positive Intraoperative Gram Stains

Margret Oethinger MD, PhD, Debra K. Warner MT(ASCP), Susan A. Schindler MT(ASCP), Hideo Kobayashi MD, PhD, Thomas W. Bauer MD, PhD

Intraoperative Gram stains have a reported low sensitivity but high specificity when used to help diagnose periprosthetic infections. In early 2008, we recognized an unexpectedly high frequency of apparent false-positive Gram stains from revision arthroplasties.

Durable Infection Control and Function With the PROSTALAC Spacer in Two-stage Revision for Infected Knee Arthroplasty

Christopher R. Gooding BSc, MD, FRCS (Tr & Orth), Bassam A. Masri MD, FRCSC, Clive P. Duncan MD, MSc, FRCSC, Nelson V. Greidanus MD, MPH, FRCSC, Donald S. Garbuz MD, MHSc, FRCSC

A two-stage revision total knee arthroplasty is recognized as the gold standard in the treatment of infection. However, traditional spacers limit function in the interval between the two stages and may cause instability, scarring, and bone erosion. The PROSTALAC knee spacer is an antibiotic-loaded cement articulating spacer that allows some movement of the knee between stages. Whether motion enhances long-term function is unknown.

Functional Ability After Above-the-knee Amputation for Infected Total Knee Arthroplasty

Catherine J. Fedorka MD, Antonia F. Chen MD, William M. McGarry BS, Javad Parvizi MD, FRCS, Brian A. Klatt MD

Prosthetic joint infection is an uncommon but serious complication of total knee arthroplasty (TKA). Control of infection after TKA is not always possible, and the resolution of infection may require an above-knee amputation (AKA).

Treatment Based on the Type of Infected TKA Improves Infection Control

Young-Hoo Kim MD, Yoowang Choi MD, Jun-Shik Kim MD

A classification system with four types of infected TKAs has been commonly used to determine treatment, especially with regard to whether the prosthesis should be removed or retained.

Can This Prosthesis Be Saved?: Implant Salvage Attempts in Infected Primary TKA

Jeremy Gardner MD, Terence J. Gioe MD, Penny Tatman MPH

Open débridement with polyethylene liner exchange (ODPE) remains a relatively low morbidity option in acute infection of total knee arthroplasty (TKA), but concerns regarding control of infection exist. We sought to identify factors that would predict control of infection after ODPE.