Diagnosis and Treatment of Periprosthetic Joint Infection

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 5523

Special Issue Editor

*
E-Mail Website
Guest Editor
Associate Professor, Chief of Adult Reconstruction, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
Interests: periprosthetic joint infection; antibiotics; revision surgery; clinical predictors; prevention; diagnostics; therapeutics; pathogenesis
* MD, MBA, FAOA

Special Issue Information

Dear Colleagues,

Periprosthetic joint infection (PJI) after total joint replacement must be treated with revision surgery and is thus often associated with morbidity and compromised mobility. Refractory cases of PJI may require joint fusion or amputation, and recent evidence suggests the five-year mortality rate after PJI is higher than many types of malignancy. The exponentially increasing numbers of total joint replacements make PJI costly not only for patients, but also to healthcare systems worldwide. As a result, it is essential to optimize the prevention, diagnosis, and treatment of PJI both through clinical investigation and basic scientific elucidation of its pathogenesis.

Among the current dilemmas in the arena of total joint replacement PJI are: preventing PJI in high-risk patients who would otherwise be debilitated without undergoing joint replacement; establishing a definitive diagnosis with culture negativity or other ambiguous clinical presentations despite existing formal criteria for PJI; minimizing, and perhaps avoiding, reoperation in the management of PJI; and identifying targets in the pathogenesis of PJI for prevention, diagnosis, and treatment. We invite the submission of articles for this Special Issue that address these and other questions surrounding total joint replacement PJI.

Dr. Sumon Nandi
Guest Editor

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Keywords

  • periprosthetic joint infection
  • antibiotics
  • revision surgery
  • clinical predictors
  • prevention
  • diagnostics
  • therapeutics
  • pathogenesis

Published Papers (4 papers)

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Research

9 pages, 229 KiB  
Article
Validation of a Classification System for Optimal Application of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infections following Total Knee Arthroplasty: A Retrospective Review
by Joyee Tseng, Victoria Oladipo, Siddhartha Dandamudi, Conor M. Jones and Brett R. Levine
Antibiotics 2024, 13(1), 48; https://doi.org/10.3390/antibiotics13010048 - 04 Jan 2024
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Abstract
Introduction: Periprosthetic joint infection (PJI) remains a serious complication after total knee arthroplasty (TKA). While debridement, antibiotics, and implant retention (DAIR) are considered for acute PJI, success rates vary. This study aims to assess a new scoring system’s accuracy in predicting DAIR success. [...] Read more.
Introduction: Periprosthetic joint infection (PJI) remains a serious complication after total knee arthroplasty (TKA). While debridement, antibiotics, and implant retention (DAIR) are considered for acute PJI, success rates vary. This study aims to assess a new scoring system’s accuracy in predicting DAIR success. Methods: 119 TKA patients (2008–2019) diagnosed with PJI who underwent DAIR were included for analysis. Data were collected on demographics, laboratory values, and clinical outcomes. This was used for validation of the novel classification system consisting of PJI acuteness, microorganism classification, and host health for DAIR indication. Statistical analysis was carried out using SPSS programming. Results: Mean follow-up was 2.5 years with an average age of 65.5 ± 9.1 years, BMI of 31.9 ± 6.2 kg/m2, and CCI of 3.04 ± 1.8. Successful infection eradication occurred in 75.6% of patients. The classification system demonstrated 61.1% sensitivity, 72.4% specificity, and 87.3% positive predictive value (PPV) when the DAIR cutoff was a score less than 6. For a cutoff of less than 8, sensitivity was 100%, specificity was 37.9%, and PPV was 83.3%. Conclusions: To date, no consensus exists on a classification system predicting DAIR success. This novel scoring system, with high PPV, shows promise. Further refinement is essential for enhanced predictive accuracy. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Periprosthetic Joint Infection)
13 pages, 1213 KiB  
Article
Racial Disparities in Periprosthetic Joint Infections after Primary Total Joint Arthroplasty: A Retrospective Study
by Jodian A. Pinkney, Joshua B. Davis, Jamie E. Collins, Fatma M. Shebl, Matthew P. Jamison, Jose I. Acosta Julbe, Laura M. Bogart, Bisola O. Ojikutu, Antonia F. Chen and Sandra B. Nelson
Antibiotics 2023, 12(11), 1629; https://doi.org/10.3390/antibiotics12111629 - 16 Nov 2023
Viewed by 1228
Abstract
In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital [...] Read more.
In the United States, racial disparities have been observed in complications following total joint arthroplasty (TJA), including readmissions and mortality. It is unclear whether such disparities also exist for periprosthetic joint infection (PJI). The clinical data registry of a large New England hospital system was used to identify patients who underwent TJA between January 2018 and December 2021. The comorbidities were evaluated using the Elixhauser Comorbidity Index (ECI). We used Poisson regression to assess the relationship between PJI and race by estimating cumulative incidence ratios (cIRs) and 95% confidence intervals (CIs). We adjusted for age and sex and examined whether ECI was a mediator using structural equation modeling. The final analytic dataset included 10,018 TJAs in 9681 individuals [mean age (SD) 69 (10)]. The majority (96.5%) of the TJAs were performed in non-Hispanic (NH) White individuals. The incidence of PJI was higher among NH Black individuals (3.1%) compared with NH White individuals (1.6%) [adjusted cIR = 2.12, 95%CI = 1.16–3.89; p = 0.015]. Comorbidities significantly mediated the association between race and PJI, accounting for 26% of the total effect of race on PJI incidence. Interventions that increase access to high-quality treatments for comorbidities before and after TJA may reduce racial disparities in PJI. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Periprosthetic Joint Infection)
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8 pages, 591 KiB  
Article
The Influence of Patient Sex on Outcomes Following One-Stage and Two-Stage Revision for Periprosthetic Joint Infection in Total Joint Arthroplasty
by Rory W. Metcalf, Taylor Rowe, Megan Tersteeg, Malcolm E. Dombrowski, Susan Odum and Jesse E. Otero
Antibiotics 2023, 12(9), 1392; https://doi.org/10.3390/antibiotics12091392 - 31 Aug 2023
Cited by 1 | Viewed by 891
Abstract
Although females have a higher rate of primary total joint arthroplasty (TJA), males have a higher rate of revision. The literature lacks studies examining the relationship between sex and outcomes following single and two-stage exchange for periprosthetic joint infection (PJI). The purpose of [...] Read more.
Although females have a higher rate of primary total joint arthroplasty (TJA), males have a higher rate of revision. The literature lacks studies examining the relationship between sex and outcomes following single and two-stage exchange for periprosthetic joint infection (PJI). The purpose of this study was to examine if differences exist in outcomes following revision for chronic PJI between sexes. A retrospective review was performed on all patients with an MSIS confirmed PJI who underwent a single or two-stage exchange at our institution from January 2010 to January 2021. Patient demographics, comorbidity characteristics, and outcomes were collected and compared between males and females. The primary outcome variable was disease-free survival at 1 year following definitive revision. Multivariable logistic regression analysis was performed to determine risk factors for failure. Of the 470 patients meeting final eligibility criteria, 250 were male and 226 were female (2 males and 4 females had a joint infection of either the contralateral side or a different joint and were treated as separate records). Of the patients in the cohort, 80% of the males (200/250) and 80% of the females (181/226) were found to be disease-free at 1-year follow-up (p > 0.99). Multivariable logistic regression analysis showed that nicotine use and diabetes, but not sex, were significant predictors of failure. Our study did not find a relationship between sex and outcome of revision for PJI. Further research is required to determine whether differences exist between males and females in the expression of PJI and outcomes following treatment. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Periprosthetic Joint Infection)
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9 pages, 2182 KiB  
Article
Articulating Hip Spacers with a Constrained Acetabular Liner: Effect of Acetabular Bone Loss and Cementation Quality
by Grayson T. Glenn, Andrew E. Apple, Simon C. Mears, C. Lowry Barnes, Benjamin M. Stronach, Eric R. Siegel and Jeffrey B. Stambough
Antibiotics 2023, 12(9), 1384; https://doi.org/10.3390/antibiotics12091384 - 30 Aug 2023
Viewed by 1895
Abstract
Articulating hip spacers for periprosthetic joint infection (PJI) offer numerous advantages over static spacers such as improved patient mobilization, hip functionality, and soft tissue tension. Our study aimed to determine complication rates of a functional articulating spacer using a constrained liner to determine [...] Read more.
Articulating hip spacers for periprosthetic joint infection (PJI) offer numerous advantages over static spacers such as improved patient mobilization, hip functionality, and soft tissue tension. Our study aimed to determine complication rates of a functional articulating spacer using a constrained liner to determine the role of acetabular cementation mantle and bone loss on the need for second-stage surgery. A retrospective review of 103 patients was performed and demographic information, spacer components and longevity, spacer-related complications, reinfection rates, and grade of bone loss and acetabular cement mantle quality were determined. There was no significant difference in spacer-related complications or reinfection rate between PJI and native hip infections. 33 of 103 patients (32.0%) elected to retain their spacers. Between patients who retained their initial spacer and those who underwent reimplantation surgery, there was not a significant difference in cement mantle grade (p = 0.52) or degree of bone loss (p = 0.78). Functional articulating antibiotic spacers with cemented constrained acetabular liners demonstrate promising early results in the treatment of periprosthetic and native hip infections. The rate of dislocation events was low. Further efforts to improve cement fixation may help decrease the need for second-stage reimplantation surgery. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Periprosthetic Joint Infection)
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