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Synovectomy in a case of Acute Periprosthetic Infection ofthe Knee.

Microbiological Results in Prosthetic Knee InfectionsDiagnosed at Hospital Clinic of Barcelona(Spain) from 2007 to 2009

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Diagnosis and Management of Infected Total Knee Arthroplasty

In our patient, A. defectiva knee prosthesis infection was documented by the isolation and culture of the organism from a synovial fluid recovered under sterile procedures and the parallel detection of A. defectiva DNA from this specimen. Although only one joint fluid specimen was available for microbiological investigations, no other detection of A. defectiva had been made in our laboratory within the eight-week period preceding isolation of the A. defectiva strain here reported. Thus, laboratory contamination is unlikely.

14. Lentino JR. Prosthetic joint infections. Clin Inf Dis 2003;36:1157-1161.

The main characteristic of prosthetic infections is the formation of a biofilm on the surface of the implants. The relapse rate that is observed in orthopaedic implant infections, even after very prolonged treatment is due to the formation of this biofilm.

Prosthetic Joint Infection: Diagnosis and Management

25. Segreti J. Prosthetic joint infections. Curr Opinion Infect Dis 2000;2:200-207.

In terms of cellular counts, the parameters established by some authors [], with a threshold for leukocytic count of 1100 WBC/ml, have yielded 91% sensitivity and 88% specificity. A differential count (percentage of neutrophils) > 64 % is associated with 95% sensitivity and 94% specificity. It must be mentioned that these indicators are especially useful for chronic prosthetic infections. The biochemical study of the fluid obtained from joint aspiration of the acute prosthetic infection usually shows higher levels of leukocytes and the differential count very often remains above 90%.

It is important to maintain an antibiotic-free window period of approximately 15 days prior to the test (AAOS Clinical Practice Guideline Summary. Diagnosis of Periprosthetic Joint Infections of the Hip and Knee. 2011. Recommendation 8).

Prosthetic joint infection is the most feared complication of ..

6. Duggan JM, Georgiadis GM, Klenshinski JF. Management of prosthetic joint infection. Infect Med 2001;18:534-541.

Treatment usually is medical and surgical; it is recommended to obtain tissue samples or pre-antibiotic liquid; if the patient has a poor clinical condition, we recommend starting vancomycin and cephepime. The surgery depends on: etiology, time of the infection presentation from the implantation of the prosthesis and comorbidities. Surgical options include prosthetic replacement (in one or two [the recommended] times), debridement and retention of the prosthesis and prosthetic resection in case a reimplantation is not contemplated. A study in patients with RA and prosthetic infection concluded that prosthetic replacement in 2 times has a better prognosis. The choice of surgery in MT infection is controversial for the few cases reported. 6–9 months of treatment are recommended for osteoarticular tuberculosis (2 months of isoniazid, rifampicin, pyrazinamide and ethambutol, followed by 4–7 months of isoniazid and rifampicin), but can vary according to the patient characteristics and outcomes between 6 and 24 months.

This patient had a prosthetic infection secondary to a tuberculosis, but we recommend, according to the literature, a combined treatment: prosthetic replacement in 2-times and 4-tuberculosis drugs for a minimum of 6 months.

If an acute infection of a knee prosthesis is suspected, joint aspiration is a quick and recommended test.
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  • Prosthetic joint infection: Treatment

    The surgical cleaning performed for retaining prosthetic knee implants consists of two distinct parts:

  • Knee Infection Treatment - Verywell

    1. Anguita-Alonso P, Hanssen AD, Patel R. Prosthetic joint infection. Exp Rev Anti-Infective Therapy. 2005;3:797-804.

  • Infected prosthetic knees cause problems -- ScienceDaily

    29. Virk A, Osmon DR. Prosthetic Joint Infection. Current Treatment Options in Infectious Diseases 2001;3:287-300.

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The infected knee prosthesis | SpringerLink

Berbari and colleagues, in a retrospective case-controlled studies, of follow-up of 26,505 patients, found that development of superficial infection at the surgical wound site, a high NNIS index score, previous arthroplasty and systemic malignancy were predictors of prosthetic joint infections. The National Nosocomial Infection Score (NNIS) scoring system involves pre-operative anesthetic assessment score, duration of surgery and wound class. Staphylococcal bacteraemia is associated with a 34% risk of haematogenous prosthetic joint infection. However, McPhearson et al have outlined a more comprehensive stratification of risk factors considering systemic and local host factors which is shown in .

Prosthetic joint infection is the most feared ..

Infection is one of the most serious complications after total knee arthroplasty (TKA). This issue is not only a challenge to the orthopaedic surgeon but also to the patient and their families in terms of the physical and psychological impacts that are normally associated with this problem. It not only affects their quality of life but also their ability to return to their daily routine and leads to decreased functionality and quality of life results.

Infection after total knee replacement (IATJ) is a rare complication

Current data estimate between 5% and 10% of primary knee replacements will require revision within 10-15 years due to these and other complicating events. Recent data indicate ~40,000 revision total knee surgeries are performed each year currently with projections in 20 years to be at a rate of ~270,000 cases / yr if current trends in surgery continue which is a 625% increase in this procedure [1,2].

The infected knee prosthesis - ResearchGate

Another important aspect of prosthetic infection is its serious economic impact. The cost of curing this type of infection is approximately $70,000 dollars [] per patient depending on the number of surgeries, complications and antibiotic treatments the patient requires. In general, when prosthesis becomes infected, three to four times as many resources are required in comparison to a primary knee arthroplasty, and twice as many when compared to a prosthesis revision of aseptic etiology.

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