Orthopaedic Knowledge Update®: Musculoskeletal Infection 2 Print + Ebook (AAOS - American Academy of Orthopaedic Surgeons)

Chapter 16: Surgical Treatment of Hip and Knee Prosthetic Joint Infections

36. Aalirezaie A, Bauer TW, Fayaz H, et al: Hip and knee sec tion, diagnosis, reimplantation: Proceedings of international consensus on orthopedic infections. J Arthroplasty 2019;34(2 suppl):S369-S379. This is an article on the proceedings of the ICM, with liter ature review. 37. Frangiamore SJ, Siqueira MB, Saleh A, Daly T, Higuera CA, Barsoum WK: Synovial cytokines and the MSIS criteria are not useful for determining infection resolution after peri prosthetic joint infection explantation. Clin Orthop Relat Res 2016;474(7):1630-1639. 38. Kusuma SK, Ward J, Jacofsky M, Sporer SM, Della Valle CJ: What is the role of serological testing between stages of two stage reconstruction of the infected prosthetic knee? Clin Orthop Relat Res 2011;469(4):1002-1008. 39. Stambough JB, Curtin BM, Odum SM, Cross MB, Martin JR, Fehring TK: Does change in ESR and CRP guide the timing of two-stage arthroplasty reimplantation? Clin Orthop Relat Res 2019;477(2):364-371. This retrospective review of 300 patients found that the per cent change in serum erythrocyte sedimentation rate and C-reactive protein inflammatory markers before and after two-stage reimplantation for PJI was not associated with reinfection risk. Level of evidence: III. 40. Ghanem E, Azzam K, Seeley M, Joshi A, Parvizi J: Staged revision for knee arthroplasty infection: What is the role of serologic tests before reimplantation? Clin Orthop Relat Res 2009;467(7):1699-1705. 41. Pannu TS, Villa JM, Corces A, Riesgo AM, Higuera CA: Synovial white blood cell count and differential to predict successful infection management in a two-stage revision. J Arthroplasty 2022;37(6):1159-1164. This retrospective study attempts to define thresholds for synovial white blood cell and polymorphonuclear leukocyte percentage to determine reimplantation survival, with a pro posed white blood cell count of 2,733/μL and polymorpho nuclear leukocyte percentage of 62%. In general, these tests had higher negative predictive values of approximately 75%. These tests had high specificity, but not very high overall accuracy. Level of evidence: IV. 42. Samuel LT, Sultan AA, Kheir M, et al: Positive alpha-defensin at reimplantation of a two-stage revision arthroplasty is not associated with infection at 1 year. Clin Orthop Relat Res 2019;477(7):1615-1621. This multicenter retrospective analysis of 69 patients showed poor correlation with positive alpha-defensin and infection at 1 year. Level of evidence: IV. 43. Owens JM, Dennis DA, Abila PM, Johnson RM, Jennings JM: Alpha-defensin offers limited utility in work-up prior to reimplantation in chronic periprosthetic joint infec tion in total joint arthroplasty patients. J Arthroplasty 2022;37(12):2431-2436.

in eradicating infection in two-stage resection for septic total knee arthroplasty? J Arthroplasty 2019;34(10):2461-2465. This study analyzed spacers with and without intramedul lary dowels and found that those with dowels did not have lower infection rates. Treatment was successful in 85.7% of articulating spacers with intramedullary dowels, 89.8% of articulating spacers without intramedullary dowels, and 68.2% of static spacers with intramedullary dowels ( P = 0.074). Level of evidence: IV. 30. Nahhas CR, Chalmers PN, Parvizi J, et al: A randomized trial of static and articulating spacers for the treatment of infection following total knee arthroplasty. J Bone Joint Surg Am 2020;102(9):778-787. This randomized controlled trial of 68 patients found artic ulating knee spacers resulted in decreased length of stay, greater range of motion, and higher Knee Society Scores. Articulating spacers also required less extensile exposure and had a lower reoperation rate, but these results were not statistically significant ( P = 0.189 and P = 0.138, respectively). Level of evidence: I. 31. Nahhas CR, Chalmers PN, Parvizi J, et al: Randomized trial of static and articulating spacers for treatment of the infected total hip arthroplasty. J Arthroplasty 2021;36(6):2171-2177. This randomized controlled trial of 52 patients found artic ulating hip spacers with decreased length of stay and no difference in surgical time. Approximately twice as many patients with static spacers were discharged to an extended care facility as were those with articulating spacers ( P = 0.056). Level of evidence: I. 32. Spivey JC, Guild GN 3rd, Scuderi GR: Use of articulating spacer technique in revision total knee arthroplasty compli cated by sepsis: A systematic meta-analysis. Orthopedics 2017;40(4):212-220. 33. Pivec R, Naziri Q, Issa K, Banerjee S, Mont MA: Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J Arthroplasty 2014;29(3):553-557.e1. 34. Jones CW, Selemon N, Nocon A, Bostrom M, Westrich G, Sculco PK: The influence of spacer design on the rate of compli cations in two-stage revision hip arthroplasty. J Arthroplasty 2019;34(6):1201-1206. This retrospective study of hip spacers found complications in 48 of 185 patients (26%). Dislocations occurred in 17 (9%), and these were associated with reduced femoral offset greater than 5 mm and increased bone loss. Spacer fracture occurred in 14 (8%), and these were associated with molded spacers rather than handmade ones. Periprosthetic fracture was associated with increased offset greater than 5 mm and extended trochanteric osteotomy. Level of evidence: IV. 35. de Beaubien B, Belden K, Bell K, et al: Hip and knee section, treatment, antimicrobials: Proceedings of international con sensus on orthopedic infections. J Arthroplasty 2019;34(2 suppl):S477-S482. This is an article on the proceedings of the ICM, with liter ature review.

Section 4: Prosthetic Joint Infections

This retrospectively study reviewed 87 patients and found 4 categorized as infected and 68 were categorized as possi bly infected, none of which had a positive result for alpha- Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2023

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Orthopaedic Knowledge Update ® : Musculoskeletal Infection 2