Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Dec 2024
Initiating chemotherapy in joint arthroplasty patients increases the risk of periprosthetic joint infections.
Total Joint Arthroplasties (TJAs) are becoming more popular, resulting in a growing economic burden due to potential postoperative complications, with periprosthetic joint infections (PJIs) playing a significant role. The effect of immunosuppression on PJI risk, particularly in cancer patients following chemotherapy, is unknown. The hypothesis of this study investigated whether chemotherapy increases PJI rates in patients who received post-arthroplasty chemotherapy within one year of surgery. ⋯ This study reveals a possible relationship between postoperative chemotherapy and an increased incidence of PJI in patients with arthroplasty. Chemotherapy suppresses the immune system, rendering patients more vulnerable to infections. Additional research is required to confirm these findings.
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Arch Orthop Trauma Surg · Dec 2024
Comparative StudyKnee fusion versus above knee amputation as two options to deal with knee periprosthetic joint infection.
Periprosthetic joint infection (PJI) poses a significant challenge in total knee arthroplasty (TKA), with recurrence rates as high as 14-28%, leading to substantial morbidity and treatment costs. When conventional treatments fail, knee fusion and above-the-knee amputation (AKA) emerge as alternative options. Existing literature offers conflicting views on the efficacy and impact of knee fusion versus AKA with varied outcomes and limitations. ⋯ We found higher rates of 1-year thromboembolism, infection, acute renal failure, and readmission in the arthrodesis group. AKA patients had more sepsis and cerebrovascular accidents. A patient-centered conversation is best for persistent infections and failed revision TKA. Considering the patient's quality of life, goals, and health status, this discussion should cover each procedure's risks and complications.
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Arch Orthop Trauma Surg · Dec 2024
Modular component exchange has no advantage in Debridement, Antibiotics and Implant Retention (DAIR) for early onset hip and knee prosthetic joint infection.
Debridement, Antibiotics and Implant Retention (DAIR) has been the mainstay of treatment for early onset periprosthetic joint infection in spite of variable results. Modular component exchange is a widely recommended strategy to improve success rates with DAIR though very strong evidence to support its practice is still lacking. ⋯ We observed that modular component exchange did not improve infection eradication after DAIR for early onset PJI following hip and knee arthroplasty. Reasonable success rates can be expected after DAIR especially if the patient develops early clinical signs and the procedure is carried out as early as possible.
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Arch Orthop Trauma Surg · Dec 2024
Review Meta AnalysisIs asymptomatic bacteriuria a noticeable risk factor for periprosthetic joint infection following total joint arthroplasty? A systematic review and meta-analysis.
Total joint arthroplasty (TJA) is a common procedure that improves the quality of life for severe arthritis patients. The rising demand for TJA places enormous financial strain on the world's healthcare systems, which is exacerbated by postoperative readmissions for complications such as periprosthetic joint infections (PJIs). We conducted a systematic review and meta-analysis to determine if asymptomatic bacteriuria (ASB) increases infection risk. ⋯ This review and meta-analysis confirm that ASB correlate with heightened risks of PJI and superficial infection in TJA patients. However, no relationship was found between ASB and PJI microorganisms which raise doubts about the role of ASB microorganisms as the direct cause of infection following TJA.