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  • 1
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    Microbiological pathogen analysis in native versus periprosthetic joint infections: a retrospective study
    Springer Science and Business Media LLC ; 2022
    In:  Journal of Orthopaedic Surgery and Research Vol. 17, No. 1 ( 2022-12)
    Details
    In: Journal of Orthopaedic Surgery and Research, Springer Science and Business Media LLC, Vol. 17, No. 1 ( 2022-12)
    Abstract: The presence or absence of an implant has a major impact on the type of joint infection therapy. Thus, the aim of this study was the examination of potential differences in the spectrum of pathogens in patients with periprosthetic joint infections (PJI) as compared to patients with native joint infections (NJI). Methods In this retrospective study, we evaluated culture-positive synovial fluid samples of 192 consecutive patients obtained from January 2018 to January 2020 in a tertiary care university hospital. For metrically distributed parameters, Mann–Whitney U was used for comparison between groups. In case of nominal data, crosstabs and Chi-squared tests were implemented. Results Overall, 132 patients suffered from periprosthetic joint infections and 60 patients had infections of native joints. The most commonly isolated bacteria were coagulase-negative Staphylococci (CNS, 28%), followed by Staphylococcus aureus ( S. aureus , 26.7%), and other bacteria, such as Streptococci (26.3%). We observed a significant dependence between the types of bacteria and the presence of a joint replacement ( p   〈  0.05). Accordingly, detections of CNS occurred 2.5-fold more frequently in prosthetic as compared to native joint infections (33.9% vs. 13.4% p   〈  0.05). In contrast, S. aureus was observed 3.2-fold more often in NJIs as compared to PJIs (52.2% vs. 16.4%, p   〈  0.05). Conclusion The pathogen spectra of periprosthetic and native joint infections differ considerably. However, CNS and S. aureus are the predominant microorganisms in both, PJIs and NJIs, which may guide antimicrobial therapy until microbiologic specification of the causative pathogen.
    Type of Medium: Online Resource
    ISSN: 1749-799X
    URL: Article
    DOI: 10.1186/s13018-021-02850-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2252548-8
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  • 2
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    Large Soft-tissue Mass Formation After Revision Total Knee Arthroplasty: An Unusual Case of Adverse Reaction to Metal Debris and Review of the Literature
    Elsevier BV ; 2021
    In:  Arthroplasty Today Vol. 9 ( 2021-06), p. 122-128
    Details
    In: Arthroplasty Today, Elsevier BV, Vol. 9 ( 2021-06), p. 122-128
    Type of Medium: Online Resource
    ISSN: 2352-3441
    URL: Article
    DOI: 10.1016/j.artd.2021.05.001
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2858808-3
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  • 3
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    Ultrasonic bone cement removal efficiency in total joint arthroplasty revision: A computer tomographic‐based cadaver study
    Wiley ; 2023
    In:  Journal of Orthopaedic Research Vol. 41, No. 6 ( 2023-06), p. 1365-1375
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 41, No. 6 ( 2023-06), p. 1365-1375
    Abstract: Polymethylmethacrylate (PMMA) removal during septic total joint arthroplasty revision is associated with a high fracture and perforation risk. Ultrasonic cement removal is considered a bone‐preserving technique. Currently, there is still a lack of sound data on efficacy as it is difficult to detect smaller residues with reasonable technical effort. However, incomplete removal is associated with the risk of biofilm coverage of the residue. Therefore, the study aimed to investigate the efficiency of ultrasonic‐based PMMA removal in a human cadaver model. The femoral components of a total hip and a total knee prosthesis were implanted in two cadaver femoral canals by 3rd generation cement fixation technique. Implants were then removed. Cement mantle extraction was performed with the OSCAR‐3‐System ultrasonic system (Orthofix®). Quantitative analysis of cement residues was carried out with dual‐energy and microcomputer tomography. With a 20 µm resolution, in vitro microcomputer tomography visualized tiniest PMMA residues. For clinical use, dual‐energy computer tomography tissue decomposition with 0.75 mm resolution is suitable. With ultrasound, more than 99% of PMMA was removed. Seven hundred thirty‐four residues with a mean volume of 0.40 ± 4.95 mm 3 were identified with only 4 exceeding 1 cm in length in at least one axis. Ultrasonic cement removal of PMMA was almost complete and can therefore be considered a highly effective technique. For the first time, PMMA residues in the sub‐millimetre range were detected by computer tomography. Clinical implications of the small remaining PMMA fraction on the eradication rate of periprosthetic joint infection warrants further investigations.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v41.6
    DOI: 10.1002/jor.25465
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2050452-4
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  • 4
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    Treatment of Severe Acetabular Defects With an Antiprotrusio Cage and Trabecular Metal Augments - Clinical and Radiographic Results After a Mean Follow-Up of 6.6 Years
    Elsevier BV ; 2023
    In:  The Journal of Arthroplasty Vol. 38, No. 11 ( 2023-11), p. 2415-2422
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 38, No. 11 ( 2023-11), p. 2415-2422
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2023.05.054
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2041553-9
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  • 5
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    Cementation of a dual mobility cup in a well-fixed acetabular component- a reliable option in revision total hip arthroplasty?
    Springer Science and Business Media LLC ; 2021
    In:  BMC Musculoskeletal Disorders Vol. 22, No. 1 ( 2021-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 22, No. 1 ( 2021-12)
    Abstract: The “cup-in-cup” technique allows for revision of failed total hip arthroplasty (THA) when the cementless cup is well fixed. Furthermore, it can be used for liner wear or mechanical failure where liner replacement may be impossible or impractical. Recently, the “cup-in-cup” technique in combination with dual mobility cups (DMC) has drawn increased attention. Our aim was to report on the clinical and radiographic outcomes following this surgery. Methods From 2015 to 2020, 33 patients treated with the DMC- “cup in cup” technique were retrospectively reviewed. Fourteen patients had died while 19 were available for the final follow-up (FU), of which 15 underwent both a radiograph and a FU visit, 2 underwent a radiograph only and 2 underwent a telephone interview only. Patient-related outcome measures included the HHS and the WOMAC. Radiographs were assessed for implant loosening and positioning. Primary endpoint was revision of any cause and secondary endpoint was loosening of the DMC at the latest FU. The survival analysis was conducted using the Kaplan-Meier method. Results The mean age at surgery was 78.6 ± 7.1 (63–93) years and the mean surgery duration was 124.4 ± 52.0 (60–245) minutes. Recurrent dislocation (42.4%), periprosthetic fracture (39.4%) and polyethylene wear (6.1%) were the most frequent reasons for surgery. The mean FU duration ( n  = 19) was 28.5 ± 17.3 (3–64) months. The mean HHS score at FU was 59.4 ± 22.2 (29–91) and the mean WOMAC score was 59.7 ± 25.6 (15.6–93.8). Two cups were revised due to instability and one revision was performed due to periprosthetic joint infection, accounting for an overall cup survival rate of 86.8% after a mean FU of 22.9 ± 18.0 (1.5–64.6) months. The survival rate free of loosening was 90.9% after a mean FU of 22.3 ± 18.5 (1.5–64.7) months. Conclusions We found that the cementation of a DMC in a well-fixed cup is a promising short- to mid-term treatment addressing THA instability especially in elderly and frail patients, who benefit from a reduced operation time. Proper cementation technique, adequate cup positioning as well as selection of a sufficiently large DMC are crucial for treatment success. Longer FUs will be needed in the future in order to further prove the benefit of this technique.
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-021-04835-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2041355-5
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  • 6
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    How does former Salter innominate osteotomy in patients with Legg–Calvé–Perthes disease influence acetabular orientation? An MRI-based study
    Oxford University Press (OUP) ; 2022
    In:  Journal of Hip Preservation Surgery Vol. 8, No. 3 ( 2022-04-09), p. 240-248
    Details
    In: Journal of Hip Preservation Surgery, Oxford University Press (OUP), Vol. 8, No. 3 ( 2022-04-09), p. 240-248
    Abstract: Salter innominate osteotomy (SIO) has been successfully used in the treatment of Legg–Calvé–Perthes disease (LCPD). Recent studies that have raised concerns about acetabular retroversion after SIO have been based on plain radiographs. In order to assess the true acetabular orientation, the present study uses a specific magnetic resonance imaging (MRI) technique. In addition, the association between acetabular morphology and clinical function as well as health-related quality of life was assessed. Twenty-three patients with 24 operated hips who underwent SIO for LCPD between January 2004 and November 2014 were included. Mean age was 8.5 ± 2.2 years at surgery and 18.5 ± 2.9 years at follow-up. MRIs were conducted at 1.5 T using radial sequences. The analysis included the acetabular version, acetabular sector angles (ASAs) and alpha angles. Plain radiographs were used in order to obtain the Stulberg classification. Patient-related outcome measures included the international Hip Outcome Tool and Euroqol-5 dimensions scores. In comparison to the non-operated side, the MRI of previously operated hips showed no difference of version at the center of the femoral head but significantly decreased version just below the roof level. As a marker for posterior acetabular coverage, the ASAs between 9 and 11 o’clock were significantly decreased when compared with non-operated hips. In hips with a mild acetabular retroversion ( & lt;15°), the function was significantly decreased when compared with non-retroverted hips. The SIO is an effective tool in order to restore acetabular containment in LCPD. When compared with the non-operated hips, our collective displays only moderate changes of acetabular orientation and coverage.
    Type of Medium: Online Resource
    ISSN: 2054-8397
    URL: Article
    DOI: 10.1093/jhps/hnab063
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2773022-0
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  • 7
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    Dual-Mobility Cups in Primary Total Hip Arthroplasty
    Georg Thieme Verlag KG ; 2023
    In:  Zeitschrift für Orthopädie und Unfallchirurgie Vol. 161, No. 01 ( 2023-02), p. 74-84
    Details
    In: Zeitschrift für Orthopädie und Unfallchirurgie, Georg Thieme Verlag KG, Vol. 161, No. 01 ( 2023-02), p. 74-84
    Abstract: Tripolare Pfannen bzw. Dual-Mobility-Pfannen (dual mobility cups, DMCs) wurden bereits vor über 40 Jahren in Frankreich eingeführt und erfahren nun auch in Deutschland zunehmende Anwendung – nicht nur in der Revisionsendoprothetik, sondern auch in der Primärendoprothetik. Durch das simulierte Großkopfprinzip mit doppelter Artikulation sollen DMCs einen hohen Bewegungsumfang im Hüftgelenk mit reduzierter Luxationsgefahr gewährleisten. Inzwischen zeigen zahlreiche Studien geringe Dislokationsraten sowie hohe Überlebensraten im mittelfristigen Follow-up. Es gibt allerdings noch relativ wenige Langzeitdaten, insbesondere zum Einsatz in der Primärendoprothetik und der Stellenwert von Material- bzw. Designvarianten ist bislang noch unklar. Aus diesem Grund werden DMCs in der Primärendoprothetik aktuell vor allem bei Patient*innen mit erhöhtem Instabilitätsrisiko propagiert. Dazu gehören insbesondere eine Insuffizienz der pelvitrochantären Muskulatur, die eingeschränkte spinopelvine Mobilität, neuromuskuläre Erkrankungen oder Adipositas permagna sowie der Einsatz in der Frakturendoprothetik. Basierend auf einer Literaturübersicht zu diesen Indikationen wird der aktuelle Diskussionsstand zusammengefasst.
    Type of Medium: Online Resource
    ISSN: 1864-6697 , 1864-6743
    URL: Article
    DOI: 10.1055/a-1527-7758
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
    detail.hit.zdb_id: 2280747-0
    detail.hit.zdb_id: 2304338-6
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  • 8
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    MRI-based assessment of acetabular version and coverage after previous Pemberton osteotomy in skeletally mature patients
    SAGE Publications ; 2021
    In:  Journal of Children's Orthopaedics Vol. 15, No. 3 ( 2021-06), p. 223-231
    Details
    In: Journal of Children's Orthopaedics, SAGE Publications, Vol. 15, No. 3 ( 2021-06), p. 223-231
    Abstract: In hip dysplasia the Pemberton osteotomy can modify the shape of the acetabulum and is indicated for children aged between two and 12 when the triradiate cartilage is still open. However, there have been concerns about acetabular retroversion following this type of osteotomy. The studies, however, have been based on plain radiographs. The aim of our investigation was to assess the 3D acetabular orientation in patients with previous Pemberton osteotomy after skeletal maturation. Methods Ten patients with 12 operated hips were included who received Pemberton osteotomy for hip dysplasia between January 3, 2005 and March 25, 2011. Mean age at surgery and at follow-up were 7.2 years (sd 3.7) and 19.2 years (sd 3.7), respectively. MRIs were conducted with 1.5 T. Besides the measurement of acetabular version, the analysis included alpha angles, acetabular sector angles (ASAs) as well as modified ASAs (cartilage covered area angles). Furthermore, the presence of osteoarthritis (OA) as well as acetabular retroversion was determined on plain radiographs. Patient-related outcome measures included the international Hip Outcome Tool (iHOT) and EuroQol-5-Dimensions (EQ5D) scores. Results In comparison with the contralateral native and healthy hips the operated hips showed similar version (19.5° (sd 4.6°) versus 18.6° (sd 7.0°); p = 0.974). Also, there were no differences in terms of femoral head sphericity (alpha angles) and acetabular coverage (ASA angles). Five of 12 Pemberton hips showed signs of beginning OA (Kellgren-Lawrence classification I or II) while none of the non-operated hips did. Patients who received surgery before the age of six years had similar functional and radiological results when compared with patients who were older than six years at surgery. Among all patients, iHOT was 91.9 (sd 10.0) and EQ5D was 90.3 (sd 7.3)). Conclusion The Pemberton osteotomy provides good long-term radiographic and functional results without compromising acetabular version or coverage. Level of Evidence Level III: retrospective comparative study
    Type of Medium: Online Resource
    ISSN: 1863-2521 , 1863-2548
    URL: Article
    DOI: 10.1302/1863-2548.15.210010
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 9
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    Facing multidrug‐resistant pathogens in periprosthetic joint infections with self‐administered outpatient parenteral antimicrobial therapy—A prospective cohort study
    Wiley ; 2021
    In:  Journal of Orthopaedic Research Vol. 39, No. 2 ( 2021-02), p. 320-332
    Details
    In: Journal of Orthopaedic Research, Wiley, Vol. 39, No. 2 ( 2021-02), p. 320-332
    Abstract: A key factor in the successful management of periprosthetic joint infection (PJI) besides the surgical regime is a consistent antimicrobial therapy. Recently, oral versus intravenous (IV) antibiotics for bone and joint infection trial demonstrated the noninferiority of oral antimicrobial therapy compared to IV, implying that an early transition to oral administration is reasonable. It is likely that the international consensus meeting of musculoskeletal Infections and the European Bone and Joint Infection Society will consider these findings. However, rising levels of antimicrobial resistance are challenging and recommendations for dealing with multidrug‐resistant (MDR) pathogens resistant to oral antibiotics are lacking. This study focuses on establishing guidance towards their management in PJI. From December 2015 to June 2019, patients with MDR pathogens were included in a single‐center prospective cohort study and treated with self‐administered outpatient parenteral antimicrobial therapy (S‐OPAT) based on a two‐stage revision strategy. Demographics, pathogens, antimicrobial agents, and outcomes were recorded. A total of 1738 outpatient days in 26 patients were analyzed. The incidence of pathogens resistant to oral antibiotics in PJI was 4%, most frequently encountered were staphylococcus epidermidis. The Kaplan–Meier‐estimated infection‐free survival after 3 years was 90% (95% confidence interval, 84.6%–95.5%). We recorded adverse events in 6 of 54 (11%) S‐OPAT episodes (3.45/1000 S‐OPAT days). (i) S‐OPAT in two‐stage revision arthroplasty to counter increasing numbers of MDR pathogens resistant to oral agents can achieve a high infection eradication rate and (ii) should therefore be taken into account at the next society's consensus treatment updates.
    Type of Medium: Online Resource
    ISSN: 0736-0266 , 1554-527X
    URL: Issue
    URL: Article
    DOI: 10.1002/jor.v39.2
    DOI: 10.1002/jor.24906
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2050452-4
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  • 10
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    Sonication of retrieved implants improves sensitivity in the diagnosis of periprosthetic joint infection
    Springer Science and Business Media LLC ; 2019
    In:  BMC Musculoskeletal Disorders Vol. 20, No. 1 ( 2019-12)
    Details
    In: BMC Musculoskeletal Disorders, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2019-12)
    Abstract: Sonication is a valuable tool in the diagnosis of periprosthetic joint infections (PJI). However, conditions and definition criteria for PJI vary among studies. The aim of this study was to determine the diagnostic performance (i.e., specificity, sensitivity) of sonicate fluid culture (SFC) against periprosthetic tissue culture (PTC), when using European Bone and Joint Infection Society (EBJIS) criteria. Methods From March 2017 to April 2018, 257 implants were submitted for sonication. PJI was defined according to the EBJIS criteria as well as according to the International Consensus Meeting criteria of 2018 (ICM 2018). Only cases with at least one corresponding tissue sample were included. Samples were cultured using traditional microbiological plating techniques. Sensitivity and specificity were determined using two-by-two contingency tables. McNemar’s test was used to compare proportions among paired samples. Subgroup analysis was performed dividing the cohort according to the site of PJI, previous antibiotic treatment, and time of manifestation. Prevalence of pathogens was determined for all patients as well as for specific subgroups. Results Among the 257 cases, 145 and 112 were defined as PJI and aseptic failure, respectively. When using the EBJIS criteria, the sensitivity of SFC and PTC was 69.0 and 62.8%, respectively ( p  = .04). Meanwhile, the specificity was 90.2 and 92.9%, respectively ( p  = .65). When adopting ICM 2018 criteria, the sensitivity of SFC and PTC was 87.5 and 84.4% ( p  = .63) respectively, while the specificity was 85.1 and 92.5% ( p  = .05), respectively. The most commonly identified pathogens were coagulase-negative staphylococci (26% overall), while 31% of PJI were culture-negative and 9% polymicrobial. Conclusions SFC exhibited significantly greater sensitivity versus PTC when using the EBJIS criteria. Nevertheless, the diagnosis of PJI remains a difficult challenge and different diagnostic tools are necessary to optimize the outcome.
    Type of Medium: Online Resource
    ISSN: 1471-2474
    URL: Article
    DOI: 10.1186/s12891-019-3006-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2041355-5
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