Advertisement for orthosearch.org.uk
Results 1 - 15 of 15
Results per page:
Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 77 - 77
24 Nov 2023
Oehen L Morgenstern M Wetzel K Goldenberger D Kühl R Clauss M Sendi P
Full Access

Aim

One of the surgical therapeutic options for periprosthetic joint infection (PJI) includes debridement, antibiotics, and implant retention (DAIR). Prognostically favorable criteria for DAIR include short duration of symptoms, stable implant, pathogen susceptible to a ‘biofilm-active’ antimicrobial agent, and intact soft-tissue conditions. Despite this, there is a proportion of failures after DAIR, possibly because the duration of infection is underestimated. With the hypothesis that the duration of infection correlates with the bacterial load, and hence, the bacterial load is associated with failure after DAIR, we aimed to investigate the association of bacterial load in the sonication fluid of mobile parts and clinical outcome after DAIR.

Method

From our PJI cohort (2010–2021), patients with DAIR (both palliative and curative approaches) were reviewed retrospectively. Patients with hip, knee or shoulder arthroplasties fulfilling infection definition, available sonication results, and ≥2 years follow-up were included. Sonication results were categorized in ≤ or >1000 cfu/mL. Univariate analysis was performed to identify predictors for DAIR failure.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 75 - 75
24 Nov 2023
Reinert N Wetzel K Franzeck F Morgenstern M Clauss M Sendi P
Full Access

Background and aim

In 2019, specific diagnostic and antibiotic treatment recommendations for diabetic foot infection (DFI) and osteomyelitis (DFO) were introduced in our institution. They include principles on numbers of biopsies to obtain for microbiological/histopathological examinations, labeling anatomic localization, and antibiotic treatment (ABT) duration based on the aforementioned findings. ABT should be stopped after complete resection of infected bone. In case of incomplete resection, treatment is continued for 4–6 weeks. Two years after the introduction of these recommendations, we investigated the degree of implementation for hospitalized patients.

Method

Adult patients with DFI/DFO undergoing surgical intervention from 01/2019–12/2021 were reviewed retrospectively. Diagnostic procedures were assigned to each episode when performed ≤30 days before surgical invention. Chi-square and Mann-Whitney-U tests were performed where appropriate.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 9 - 9
24 Nov 2023
Stuetzle A Puelacher C Morgenstern M Sendi P Mueller C Clauss M
Full Access

Aim

Perioperative myocardial infarction/injury (PMI) is a common complication in noncardiac surgery, contributing to postoperative morbidity and mortality. We aimed to identify the risk for PMI in periprosthetic joint infection (PJI) in comparison to primary hip (THA) and knee arthroplasty (TKA) and to non-PJI revision surgery.

Methods

Patients undergoing primary/revision THA/TKA at a University Hospital who were eligible for the institutional PMI screening and response program were prospectively included. Revision arthroplasties were divided into 2 groups (PJI revision and non-PJI revision). PJI was defined according to the EBJIS criteria, and included DAIR, one-stage and two-stage revisions. Non-PJI revisions included partial and/or complete exchange of components. The primary endpoint was PMI, secondary endpoints were major adverse cardiovascular events (MACE) and all-cause mortality within 120 days.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_17 | Pages 49 - 49
24 Nov 2023
Azamgarhi T Perez-Sanchez C Warren S Scobie A Karunaharan N Houghton R Hassan S Kershaw H Sendi P Saeed K
Full Access

Aim

Dalbavancin is a lipoglycopeptide with a half-life of 14 days (range 6.1 to 18.4), significantly longer than other antimicrobials, which avoids the need for daily antibiotic dosing. This multi-centre observational study aims to describe the use of dalbavancin to facilitate discharge in treating bone and joint infections.

Method

All adult patients treated with dalbavancin from January 2017 to September 2022 in four UK bone infection units were included.

Data collected through a standardised data collection form included:

Clinical and microbiological characteristics.

Hospital length of stay.

Complications.

Patient suitability for hypothetical treatment options, such as Outpatient Parenteral

Antibiotic Team (OPAT)

Clinical outcome.

Treatment-related costs were calculated for dalbavancin and the preferred hypothetical treatment option that would have been administered for the same duration. The costs were subtracted to calculate the cost difference.

Clinical success was defined as the absence of definite failure in accordance with the OVIVA Trial protocol.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 15 - 15
1 Dec 2021
Müller SLC Morgenstern M Kühl R Muri T Kalbermatten D Clauss M Schaefer D Sendi P Osinga R
Full Access

Aim

Fracture-related infection (FRI) is a severe post-traumatic complication which can be accompanied with a soft-tissue defect or an avital soft-tissue envelope. In these cases, a thoroughly planned orthoplastic approach is imperative since a vital soft-tissue envelope is mandatory to achieve fracture union and infection eradication. The aim of our study was to analyse plastic surgical aspects in the management of FRIs, including the type and outcome of soft-tissue reconstruction (STR), and to investigate the long-term outcome of FRI after STR.

Method

Patients with a lower leg FRI requiring STR that were treated from 2010 to 2018 at our center were included in this retrospective analysis. STR involved the use of local, pedicled and free flaps. The primary outcome was the success rate of STR, and the secondary outcome was long-term fracture consolidation and cure of infection.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_15 | Pages 53 - 53
1 Dec 2021
Osinga R Eggimann M Lo S Kühl R Lunger A Ochsner PE Sendi P Clauss M Schaefer D
Full Access

Aim

Reconstruction of composite soft-tissue defects with extensor apparatus deficiency in patients with periprosthetic joint infection (PJI) of the knee is challenging. We present a single-centre multidisciplinary orthoplastic treatment concept based on a retrospective outcome analysis over 20 years.

Method

One-hundred sixty-seven patients had PJI after total knee arthroplasty. Plastic surgical reconstruction of a concomitant perigenicular soft-tissue defect was indicated in 49 patients. Of these, seven presented with extensor apparatus deficiency.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_14 | Pages 16 - 16
1 Dec 2019
Clauss M Hunkeler C Manzoni I Sendi P
Full Access

Aim

Debridement and implant retention (DAIR) is a valuable option for treating periprosthetic joint infection (PJI), provided that the criteria of the Infectious Diseases Society of America guidelines are fulfilled. The inflammation caused by infection and the surgical impact of DAIR may influence implant stability. In this study, we investigated the sequelae of DAIR on implant survival after total hip arthroplasty (THA).

Method

THAs from our database implanted between 1984 and 2016 were included in a retrospective double-cohort study. THAs were exposed (DAIR cohort) or not exposed to DAIR (control cohort). The control cohort comprised patients matched 3:1 to the DAIR cohort. The outcome—implant failure over time—was evaluated for (i) revision for any reason, (ii) aseptic loosening of any component, and (iii) radiographic evidence of loosening.


Bone & Joint Research
Vol. 8, Issue 10 | Pages 459 - 468
1 Oct 2019
Hotchen AJ Dudareva M Ferguson JY Sendi P McNally MA

Objectives

The aim of this study was to assess the clinical application of, and optimize the variables used in, the BACH classification of long-bone osteomyelitis.

Methods

A total of 30 clinicians from a variety of specialities classified 20 anonymized cases of long-bone osteomyelitis using BACH. Cases were derived from patients who presented to specialist centres in the United Kingdom between October 2016 and April 2017. Accuracy and Fleiss’ kappa (Fκ) were calculated for each variable. Bone involvement (B-variable) was assessed further by nine clinicians who classified ten additional cases of long bone osteomyelitis using a 3D clinical imaging package. Thresholds for defining multidrug-resistant (MDR) isolates were optimized using results from a further analysis of 253 long bone osteomyelitis cases.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 11 - 11
1 Dec 2018
Hotchen A Sendi P McNally M
Full Access

Aim

The B.A.C.H. system is a new classification for long bone osteomyelitis. It uses the four key inter-disciplinary components of osteomyelitis, namely, bone involvement, anti-microbial options, soft tissue status and host status. This study aims to assess the inter-user reliability of using the B.A.C.H. classification system.

Method

We identified 20 patients who had a diagnosis of long bone osteomyelitis using a previously validated composite protocol. For each patient, osteomyelitis history, past-medical history, clinical imaging (including radiology report), photographs of the affected limb and microbiology were presented to clinical observers on an online form. Thirty observers, varying in clinical experience (training grades and consultants, with a variety of exposure to osteomyelitis) and specialty (orthopaedic surgery, infectious diseases and plastic surgery) were asked to rate the twenty cases of osteomyelitis. Before rating, an explanation of how to use the classification system was given to the observers, in a structured ‘user key’. The responses were assessed by accuracy against a reference value and Fleiss' kappa value (Fκ).


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_22 | Pages 55 - 55
1 Dec 2017
Hotchen A Sendi P McNally M
Full Access

Aims

We have reviewed the published classifications of long-bone osteomyelitis. This review demonstrated the limitations and poor recognition of existing classifications. We have designed a new system which includes four easily identifiable variables which are Bone involvement, Antimicrobial availability, Soft tissue coverage and Host status. This is called the B.A.C.H. classification system. In this study, we aim to retrospectively validate this classification in a cohort of osteomyelitis cases.

Methods

We identified 100 patients who had received surgery for osteomyelitis between 2013–2015 in a single specialist centre. Each patient was classified retrospectively by two assessors who were not involved in the initial patient care. Osteomyelitis was confirmed in each patient by a validated composite protocol.


The Bone & Joint Journal
Vol. 99-B, Issue 3 | Pages 330 - 336
1 Mar 2017
Sendi P Lötscher PO Kessler B Graber P Zimmerli W Clauss M

Aims

To analyse the effectiveness of debridement and implant retention (DAIR) in patients with hip periprosthetic joint infection (PJI) and the relationship to patient characteristics. The outcome was evaluated in hips with confirmed PJI and a follow-up of not less than two years.

Patients and Methods

Patients in whom DAIR was performed were identified from our hip arthroplasty register (between 2004 and 2013). Adherence to criteria for DAIR was assessed according to a previously published algorithm.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_16 | Pages 26 - 26
1 Dec 2015
Lötscher P Sendi P Kessler B Graber P Zimmerli W Clauss M
Full Access

Debridement, antibiotics and implant retention (DAIR) is an established treatment option for periprosthetic joint infection (PJI). Success rates of more than 90% cure have been reported with proper patient selection. While a meticulous debridement of the joint and an appropriate postoperative antibiotic therapy is important for treatment success, the relevance of changing mobile parts is still a matter of debate. The latter procedure is only possible with an extensive soft tissue release, potentially destabilizing the joint. Though, it is impossible with polyethylene-inlays being no longer available. The aim of this study was to evaluate whether cure of PJI with DAIR is influenced by retaining the mobile parts.

Between 01/2004 and 12/2012, 36 patients with 39 episodes of THA-associated infections were treated with DAIR according to our algorithm (NEJM 2004). All patients met the IDSA criteria for DAIR with a stable implant and either a PJI diagnosed during the first postoperative month or a haematogenous PJI with infectious symptoms of less than three weeks. Patients were treated either with a complete debridement, including an exchange of all mobile parts (n=24), or with a complete debridement and retaining mobile parts (n=15). Postoperatively all patients received standardized antibiotic treatment (NEJM 2004).

The patients’ mean age at the time of infection was 74 (SD 9) years. Average time between onset of symptoms and DAIR were 3.6 (0–28) days; Five patients died before the 2-year-follow-up unrelated to PJI. Mean follow-up of the remaining patients was 45.6 (24–119) months. 20 PJI were early postoperative, 15 haematogenously acquired, and four unclear. The most frequent causative microorganisms were coagulase-negative staphylococci (n=16), S. aureus (n=8), streptococci (n=5) and E. coli (n=2). Ten episodes were polymicrobial, and nine cases culture-negative. The overall success rate of all 39 episodes treated with DAIR was 95% (37/39). Two treatment failures were observed, both after haematogenous S. aureus infection and exchange of mobile parts. One of them refused further surgery and was treated with a suppressive antibiotic therapy. The other one had a one-stage exchange four months after DAIR showing a loose cup intraoperatively.

Patients treated with DAIR strictly according to our treatment algorithm show a favourable result regarding overall success rate. From our data it seems debatable, whether the exchange of all mobile parts is mandatory, or should be individually evaluated in each case.


The Bone & Joint Journal
Vol. 96-B, Issue 6 | Pages 772 - 777
1 Jun 2014
Kessler B Knupp M Graber P Zwicky L Hintermann B Zimmerli W Sendi P

The treatment of peri-prosthetic joint infection (PJI) of the ankle is not standardised. It is not clear whether an algorithm developed for hip and knee PJI can be used in the management of PJI of the ankle. We evaluated the outcome, at two or more years post-operatively, in 34 patients with PJI of the ankle, identified from a cohort of 511 patients who had undergone total ankle replacement. Their median age was 62.1 years (53.3 to 68.2), and 20 patients were women. Infection was exogenous in 28 (82.4%) and haematogenous in six (17.6%); 19 (55.9%) were acute infections and 15 (44.1%) chronic. Staphylococci were the cause of 24 infections (70.6%). Surgery with retention of one or both components was undertaken in 21 patients (61.8%), both components were replaced in ten (29.4%), and arthrodesis was undertaken in three (8.8%). An infection-free outcome with satisfactory function of the ankle was obtained in 23 patients (67.6%). The best rate of cure followed the exchange of both components (9/10, 90%). In the 21 patients in whom one or both components were retained, four had a relapse of the same infecting organism and three had an infection with another organism. Hence the rate of cure was 66.7% (14 of 21). In these 21 patients, we compared the treatment given to an algorithm developed for the treatment of PJI of the knee and hip. In 17 (80.9%) patients, treatment was not according to the algorithm. Most (11 of 17) had only one criterion against retention of one or both components. In all, ten of 11 patients with severe soft-tissue compromise as a single criterion had a relapse-free survival. We propose that the treatment concept for PJI of the ankle requires adaptation of the grading of quality of the soft tissues.

Cite this article: Bone Joint J 2014;96-B:772–7.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 332 - 332
1 Jul 2011
De Man H Sendi P Maurer TB Zimmerli W Graber P Ilchmann T Ochsner P
Full Access

Introduction: In treatment for prosthetic hip joint infection (PHJI), the advantages of a 1-stage exchange over the classic 2-stage approach are the lower morbidity and earlier rehabilitation. Secondly, a recently published treatment algorithm for PHJI using well-defined selection criteria for 1-stage exchange had a 85–100% rate of cure for infection. Patient satisfaction after hip surgery is highly influenced by the functional result. We hypothesized that in our used algorithm the functional and radiological outcomes after a 1-stage exchange due to an implant-associated infection would be similar to a matched control group of 1-stage exchange due to aseptic loosening.

Material and Methods: Twenty-two cases (21 patients), with PHJI according to a well-defined definition, after 1-stage exchange of the prosthesis strictly according to the algorithm, with index-surgery between april 1996 and october 2004, were included in the studygroup. Case-matching was performed with aseptic revised cases for previous surgery, type of implant, use of transfemoral osteotomy, Charnley score, duration of follow-up, age, and sex. Outcome measures were perioperatively complications, functional results (Harris hip score, limping, and use of walking support) at two years, and the occurrence of revision for any reason and radiological loosening at latest follow-up. All outcomes were compared between both groups and with the results of the two stage revisions in our cohort. Finally, the eradication of infection was scored.

Results: In 86% of the 1-stage group (n = 19) there was an event-free follow-up for ≥ 2 years. The mean Harris hip score was 84, the incidence of limping 20% and 10% required two crutches. Two stems were revised due to aseptic loosening. Both functional and radiological outcomes were not different from the matched control group.

In the 2-stage group (n = 50) results were lower but not significantly, with 80, 30% and 28% respectively, and 2 stems and 1 cup were revised due to aseptic loosening.

One case (after one stage) developed an infection with a different pathogen and one case (after two stage exchange) had a relaps of infection.

Conclusion: By using the identical surgical technique in both septic and aseptic revision hip surgery, functional results are comparable between groups. These results indicate that 1-stage exchange according to a strict algorithm leads to a successful outcome in both maintaining functional mobility and eradicating infection.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 325 - 326
1 Jul 2011
Ochsner P de Man H Sendi P
Full Access

The Liestal algorithmus for the treatment of infected total joint arthroplasties proposes the abovementioned three groups for revisions with exchange.

One stage exchange is executed in the presence of a adequate soft tissue situation and in absence of bacteria difficult to treat.

Two stage revision with spacer and a interval of 2–3 weeks until re-implantation is indicated in bad soft tissue situations

Two stage revision without spacer, a curative intravenous antibiotic treatment period of 6 weeks, a break of 2 weeks followed by reimplantation is indicated in the presence of bacteria difficult to treat.

All patients of group 1 and 2 were treated with antibiotics for 3 months – the first two weeks intravenous.

The ones of group 3 only, if during reimplantation positive tissue cultures were harvested.

We analysed 72 episodes of ITHA, 22 with 1-stage exchange, 29 with 2-stage exchange with spacer, 21 with 2-stage exchange without spacer. All 16 cases but 1 with bacteria difficult to treat were included in the last group. In this presentation only cases are included following the algorithm completely as published. All patient had an overall treatment with antibioticsIn all patients the index operation was done more than two years prior to the latest control. Two patients died shortly after the operation, the result remaining unknown. Another 3 died between 1 and two years after the operation. They were regarded as probably cured. Only one case of group 2 suffered of a relapse being caused by a coagulase negative staphylococcus being resistant against Rifampin. 2-stage exchange without spacer was then successful. One case of reinfection with another bacterium happened in the group 1.

Conclusion: This analysis is indicating, that the presented algorithm allows positive results regarding elimination in around 95% of the cases. Better results may be provable when basing on a larger number of patients. It seems, that the selection of so called “easier cases” for 1-stage exchange does not lead to a higher number of relapses and helps for an overall more economic way of treatment.