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Introduction

Success rate after Debridement-Irrigation, Antibiotic Therapy and Implant Retention (DAIR) for treatment of Acute Haematogenous (AH) and Early Post-surgical (EP) periprosthetic joint infection (PJI) varies widely among published studies. Prosthesis exchange is recommended to treat PJI after a failed DAIR. However, no early postoperative prognostic factors permitting to identify future failures have been described.

Aim

Identify early prognostic factor of failure after DAIR in order to propose efficient treatment before onset of chronic PJI.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 90 - 90
1 Dec 2018
El Sayed F Roux A Bauer T Nich C Sapriel G Dinh A Gaillard J Rottman M
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Aim

Cutibacterium acnes, a skin commensal, is responsible for 5–10% of prosthetic joint infections (PJI). All current microbiological definitions of PJI require two or more identical commensal isolates to be recovered from the same procedure to diagnose PJI and rule out contamination. Unlike coagulase negative staphylococci, C.acnes shows a highly stereotypical susceptibility profile making impossible to phenotypically assess the clonal relationship of isolates. In order to determine the clonal relationship of multiple C.acnes isolates recovered from arthroplasty revisions, we analyzed by multi-locus sequence typing (MLST) C.acnes isolates grown from orthopedic device-related infections (ODRI) in a reference center for bone and joint infection.

Methods

Laboratory records from January 2009 to January 2014 were searched for monomicrobial C.acnes ODRI with growth of C. acnes in at least 2 intraoperative and/or preoperative samples. Clinical, biological and demographic information was collected from hospital charts. All corresponding isolates biobanked in cryovials (−80°C) were subcultured on anaerobic blood agar, and identification confirmed by MALDI-TOF-MS. C.acnes isolates were typed using the MLST scheme described by Lomholt et al. Plasmatic pre-operative C-reactive protein (CRP) levels were determined using DimensionEXL (Siemens). A threshold of 10 mg/L was used to determine serologically positive ODRIs from negatives.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 38 - 38
1 Dec 2017
Amara M Bauer T Bercot B Heym B Jacquier H Joste V Marmor S Salomon E France SCID
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Aim

The frequency of arthroplasty among older people is increasing. Taking care of Prosthetic Joint infection (PJI) in this specific population is a challenge. The purpose of this multicentric retrospective study was to evaluate the bacterial epidemiology of hip and knee PJI in octogenarians and nonagenarians over ten years.

Method

Data were collected using two softwares* in each of the 4 Centers participating.

Inclusion criteria:

age ≥ 80 years PJI (knee or hip)

between January 2007 and December 2016

microbiological data available (strains isolated from osteo-articular samples)

Bacterial identification: biochemical methods, followed by Malditof since 2009. For Staphylococcus aureus, Pseudomonas aeruginosa and Enterobacteriaceae, resistance profiles to antibiotics frequently used in PJI were collected. Antimicrobial susceptibility testing: disk diffusion (recommendations: French Society of Microbiology yearly updated).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 34 - 34
1 Dec 2017
El Sayed F Gruber A Sapriel G Fawal N Bauer T Heym B Dupont C Hello SL Gaillard J Rottman M
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Aim

According to Tsukuyama classification, late acute hematogenous prosthesis joint infections (PJI) should be treated with debridement and implant retention (DAIR). We report here a recurrent Salmonella Dublin hip prosthesis infection. Through this case, we show how a recurrence of chronic PJI may have an acute clinical presentation leading to an inadequate surgical treatment.

Method

Case report. On May 2011, a 74-year-old woman with bilateral hip prostheses (implanted in 1998 (right) and 2001 (left)), was admitted to intensive care for sepsis and pain of her left hip. Blood cultures and a joint aspiration of the left hip yielded pure cultures of S.Dublin. The patient had a recent history of febrile diarrhea after consuming dubious meat. The patient underwent DAIR followed by a six-week antibiotherapy. Three years later, she presented to the emergency room for an acute onset febrile PJI of the right hip. The patient underwent DAIR of the right hip. Blood cultures, joint aspiration fluid, and all intraoperative periprosthetic tissue samples yielded S.Dublin. Colonoscopy and abdomen ultrasound were negative. The patient received two weeks of intravenous combined antibiotherapy followed by oral antibiotics for further 10 weeks. Six weeks post operatively, the surgical wound was healed and the patient walked normally. One year later, the patient was referred by her primary care practitioner for night fevers without local signs or dysfunction of her prostheses. Radioleucoscintigraphy showed right hip inflammation. Bilateral hip biopsies were nevertheless performed, yet S. Dublin was recovered solely from the right hip biopsy. A one-stage exchange of the right hip was performed. All intraoperative periprosthetic tissue samples yielded S.Dublin. A six-week-combined antibiotherapy was undertaken. One year later, the patient appeared free of infection and walked normally.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 77 - 77
1 Dec 2017
El Sayed F Roux A Rabès J Mazancourt P Bauer T Gaillard J Rottman M
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Aim

Propionibacterium acnes is a skin commensal colonizing the deeper structures of the pilous bulb. It is responsible for 5–10% of lower limb prosthetic joint infections (PJI) but accounts for as many as 50% of shoulder arthroplasty infections. P. acnes PJIs characteristically feature limited systemic inflammation, limited polymorphonuclear infiltration and clinical signs compatible with aseptic loosening. All current microbiological definitions of PJI require two or more identical commensal isolates to be recovered from the same procedure to diagnose PJI to increase specificity and rule out contamination. Whereas the antimicrobial susceptibility patterns of coagulase negative staphylococci are highly polymorphic and commonly allow the ready distinction of unrelated strains, P. acnes shows a highly stereotypical susceptibility profile and it is impossible to phenotypically assess the clonal relationship of isolates. In order to determine the clonal relationship of multiple P. acnes isolates recovered from arthroplasty revisions, we analyzed by multi-locus sequence typing (MLST) P. acnes isolates grown from PJI in a reference center for bone and joint infection.

Method

We retrospectively selected all cases of microbiologically documented monomicrobial PJI caused by P. acnes diagnosed in our center from January 2009 to January 2014. Microorganisms were identified by MALDI-TOF mass spectrometry (Bruker Daltonics). All corresponding P.acnes isolates biobanked in cryovials frozen at −80°C were subcultured on anaerobic blood agar, DNA extracted by freeze-thawing and bead-milling, and typed according to the 9 gene MLST scheme proposed by Lomholt HB. and al.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 75 - 75
1 Dec 2015
Marmor S Desplaces N Bauer T Heym B Sol O Rogé J Mahé F Desire L Ghout I Ropers J Gaillard J Rottman M
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The diagnosis of prosthetic joint infections (PJI) represents a critical challenge for orthopedic surgeons and infectious disease specialists. The diagnosis of PJI is often delayed because non-invasive assays lack sensitivity and specificity. A novel multiplex immunoassay detecting antibodies against Staphylococci, Propionibacteria and Streptococcus agalactiae was developed and its performance evaluated in a prospective, multicenter, non-interventional study.

The Luminex-based assay measures serum IgG against a proprietary panel of recombinant purified antigens from Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus agalactiae and Propionibacterium acnes. Patients undergoing revision arthroplasty were included over a 2-year period (from 2012 up to 2014) in two French reference centers in compliance with IRB and French regulations. PJI cases were defined microbiologically (≥2 intraoperative samples yielding the same microorganism) for confrontation of microbiological and immunoassay data.

455 patients were eligible for study analyses. 149 patients (32.7%) were found to be infected. Among the most frequent infecting species recovered were S. aureus (30%), S. epidermidis (26%), P. acnes (9%), S. lugdunensis (6%), and S. agalactiae (4%). The sensitivity and specificity values of the test were, respectively, 75.9% (63/83) and 82.2% (180/219) for staphylococci (S. aureus, S. epidermidis, S. lugdunensis), 38.5% (5/13) and 81.9% (190/232) for P. acnes, and 66.7% (4/6) and 92.4% (208/225) for S. agalactiae. Interestingly, all cases (9/9) involving S. lugdunensis were detected by the test and the sensitivity for S. epidermidis reached 79.4% in patients more than three months after joint replacement. In a similar fashion, 89.5% (17/19) in the subpopulation with elevated inflammatory markers (ESR>30 and CRP>10).

The assay correctly identified 67% of the microbiologically positive patients that were negative by ESR or CRP screening.

This novel multiplex serological test allows the rapid and non-invasive diagnosis of the most frequent PJI pathogens, showing a good correlation with microbiological culture. and appears to be a new promising tool in the management of PJI, adding sensitivity to the current serological assays and enhancing the management of patients with pauci-inflammatory PJI.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 301 - 301
1 Mar 2013
Patel A Patel R Thomas D Stulberg SD Bauer T
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Introduction

Modular femoral necks have shown promising clinical results in total hip arthroplasty (THA) to optimize offset, rotation, and leg length. Given the wide variety of proximal femoral morphology, fine-tuning these kinematic parameters can help decrease femoroacetabular impingement, decrease wear rates and help prevent dislocations. Yet, additional implant junctions introduce additional mechanisms of failure. We present two patients who developed an abnormal soft tissue reaction consistent with a metal hypersensitivity reaction at a modular femoral neck/stem junction requiring revision arthroplasty.

Methods

Two patients underwent THA for primary osteoarthritis with the same series of components: 50 mm shell, a 36 mm highly-crosslinked polyethylene liner, uncemented titanium alloy modular stem with a 130 degree Cobalt Chromium (CoCr) modular femoral neck, and 36 mm CoCr head with a +5-mm offset. Patient 1 was a 63 year-old female who had an uneventful post-operative course but presented seven months later with progressive pain in the left hip. Patient 2 was an 80 year-old female who did well post-operatively, but presented with limp and persistent pain at 10 months post-op.

An initial evaluation of a painful THA to rule out aseptic loosening, infection, mal-positioning, loosening and osteolysis included radiographs, lab work (CBC, ESR, CRP, Cobalt & Chromium levels) and Metal Artifact Reduction Sequence (MARS) MRI.