The Infected Implant (eBook)

Foreword 5
Table of Contents 6
List of Contributors 8
1 The Importance of European Registers in Respect to Infections in Arthroplasty 10
2 Increasing Incidence of Infected THA in Norway Despite Improved Antibiotic Prophylaxis 12
Methods Introduction 12
Results 13
Discussion 14
Conclusions 14
References 15
3 Update from the Swedish Arthroplasty Registers with Special Reference to Infections 16
Material Introduction 16
Results 18
Discussion 20
Conclusion 20
References 20
4 Status and Prospect of an European Arthroplasty Register ( EAR) 22
Possible Prospects for EAR and International Approaches to Arthroplasty Registers Online Solution to Bring Together Research Findings and Proposals for Collaborative, Interdisciplinary and Multi- Register Studies 22
Introduction 22
Humans Resources: Learning Curve, Training and Surgeon Shortage 23
Registers – Determine a Way to Finance It 23
Industry Product Database 24
Conclusion 24
References 24
5 The Infected Implant – Microbiology and Clinical Strategies 25
Management of Prosthetic Joint Infection 25
Pathophysiology of Joint Infections 25
6 Infection of Joint Prosthesis and Local Drug Delivery 27
Introduction 27
Prevalence, Nature and Consequences of Periprosthetic Infection 27
Diagnosis and Therapy of Periprosthetic Infection 28
Local Antibiotic Delivery Systems 29
Prophylactic Measures Against Colonization and Development of Biofilm 32
References 33
7 Clinical Strategy for the Treatment of Deep Infection of Hip Arthroplasty 35
Single Antibiotic Therapy ( Chronic Suppressive Therapy) 39
Debridement and Rinse Lavage 39
One-Stage Exchange 41
Two-Stage Exchange 42
Resection Arthroplasty 46
Conclusions 47
References 48
8 Infection after Total Knee Artroplasty: Diagnosis, Management Strategies and Outcomes 51
Classification of Infection 51
Identifying Organisms 51
Management Options 51
Introduction 51
Diagnosis of Infection 51
Materials and Methods 52
Results/Clinical Studies Diagnosis of Infection 52
Classification of Infection 53
Infecting Organisms ( and Host Factors) 53
Management Options Antibiotic Suppression +/– Debridement 55
Resection Arthroplasty 55
Single-Stage Treatment 55
Two-Stage Treatment 56
Discussion 63
Conclusion 65
References 65
9 Spacer Management in Periprosthetic Infections 68
Introduction 68
Non-Articulating Spacers 69
Articulating Spacers Spacer Prosthesis 71
All PMMA Spacers 71
Concerns 73
Advantages of Mobile Spacers 75
Conclusion 76
References 77
10 Observational Study of Bone Cement with Two Antibiotics in Revision Arthroplasty of Knee and Hip 79
Introduction 79
Methods 80
Results Reasons for Revision 81
Preoperative Symptoms and Diagnoses Revision Operation 81
Postoperative Situation 83
Rehabilitation and Result of Revision 84
Discussion 84
Literature 87
11 Treatment of an Infected Joint Prosthesis: Difficult Challenge for an Orthopedist Surgeon 89
12 Low- Grade Infection and Multiresistant Gram- Positive Cocci 91
Diagnosis of Low- Grade Infections Introduction 91
Isolated Microorganisms 92
Emergence of Resistance 92
Biofilm 93
Treatment of Low- Grade Infections 93
References 94
13 Antibiotic Strategies in Septic Arthroplasties 96
Metals 96
Treatment 96
Introduction 96
Biomaterials Reduce Immune System Efficiency Polymethylmetacrylate ( PMMA) 96
Biofilm Biofilm Formation 97
Demonstrating Biofilm in Orthopaedic Infection 97
Biofilm as a Defensive Barrier 97
Treatment of Biofilms 97
Antibiotic-Loaded PMMA for Biofilm 98
Intracellular Bacteria Crisis of Classical Immune Mechanisms 98
Facultative Intracellular 98
Demonstration of Intracellular 98
Antibiotics Ineffective for Intracellular Bacteria 98
Antibiotics Efficient for Intracellular Bacteria 99
Results in Clinical Infections in Orthopaedic Surgery 99
Future 100
References 100
14 Introduction: Revision Cemented Versus Uncemented 102
15 Cemented revision THA 104
Introduction 104
Material and Methods 104
Discussion 105
Conclusion 107
References 108
16 Pro Uncemented Revision 109
Material and Methods 109
Introduction 109
Results 110
Discussion 112
Conclusion 114
References 115
17 The Infected Implant: Revision One Stage Versus Two Stage – Introduction To Crossfire Session 116
Septic Hip Prosthesis – One-Stage Revision 117
Septic Hip Prosthesis – Two-Stage Revision: Reasons of a Choice 119
Conclusions 119
References 120
18 One Stage Revision – Favourite Option? 121
Method of One-Staged Revision 121
Prerequisites for One-Staged Revision 121
Introduction 121
Diagnostic of the Pathogen 122
Choice of Antimicrobial Agents 123
Patient’s Condition 123
Surgeon and the Team Behind 123
Technique of One-Staged Revision Including Pre- Operative Precautions and Postoperative Nursery 123
Case Report 1 123
Case Report 2 125
Impact of Debridement and Removal of Bone Cement 125
Antimicrobial Agents in One-Staged Revision 126
Advantages of One-Staged Revision 126
Limits of One-Staged Revision 126
Discussion 127
Conclusion 127
References 128
19 Advantages of Two-Stage Revision Arthroplasty 129
Background 129
Total Hip Replacement Deep Infection Management 131
One-Stage Revision 131
Two-Stage Revision 132
Conclusion 134
References 134
Subject Index 137