Late summer is a risk factor for periprosthetic joint infection after total joint arthroplasty: A retrospective cohort study.

To explore whether season is a risk factor of periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) and explain it with the theory of traditional Chinese medicine. This was a retrospective cohort study. Only patients who suffered from PJI within 1 month after TJA were included in the study. Occurrence of PJI was the outcome of this study. Chi-squared test and t test was used to assess differences for baseline characteristics. Chi-square test was used to analyze whether season was related to the occurrence of PJI. Logistic regression was used to evaluate the association between season and occurrence of PJI. The incidence of PJI in summer is significantly higher than that in winter, whether after total knee arthroplasty (Chi-square value = 6.455, P = .011) or total hip arthroplasty (Chi-square value = 6.141, P = .013). Summer was an independent risk factor for PJI (OR = 4.373, 95% confidence interval = 1.899-10.673, P = .004). To be more exact, compared to nonlate summer (19.51%), and PJI is mainly concentrated in late summer (80.49%). Late summer was an independent risk factor of PJI after TJA. The infection rate of PJI after TJA in late summer is higher than other seasons. A more thorough preoperative disinfection procedure is needed in late summer.

Does Surgical Trainee Participation Affect Infection Outcomes in Primary Total Knee Arthroplasty?

OBJECTIVE: To evaluate whether the involvement of surgeons-in-training was associated with increased infection rates, including both prosthetic joint infection (PJI) and surgical site infection (SSI), following primary total knee arthroplasty (TKA). DESIGN: This was a retrospective review of outcomes following primary total knee arthroplasty. Surgeries were divided into two groups: (a) attending-only and (b) trainee-involved. Association with PJI and SSI were evaluated with univariate analysis and multivariate analysis to adjust for sex, age, body mass index (BMI), Charlson Comorbidity Index (CCI), year of surgery, operative time, and hospital/surgeon volume. SETTING: A single, large North-American integrated healthcare system between January 1, 2014 and December 31, 2017. PARTICIPANTS: A total of 12,664 primary TKAs with a minimum of one-year (mean of 2-years, range 1-4.5) follow-up were evaluated. RESULTS: Residents and fellows were more likely to participate in cases with longer operative times (p<0.001) than the attending-only group. A significant difference existed on univariate analysis between the trainee-involved group and attending-only group for PJI incidence (p=0.015) but not for SSI (p=0.840). After adjusting for patient- and procedure-related features, however, neither PJI nor SSI were independently associated with trainee involvement (PJI: p=0.089; SSI: p=0.998). CONCLUSIONS: Trainee participation did not directly correlate with increased infection risk, despite their association with longer-operative times and increased medical complexity. Further approaches to mitigating the risk of SSI and PJI for patients with increased comorbidities and in complex TKA cases, which demand longer operative times, are still required.

Poor Outcomes of Irrigation and Debridement in Acute Periprosthetic Joint Infection With Antibiotic-Impregnated Calcium Sulfate Beads.

BACKGROUND: One proposed strategy to increase the success of irrigation and debridement with implant retention for the treatment of acute periprosthetic joint infection (PJI) is the use of dissolvable antibiotic-impregnated calcium sulfate beads to provide a local depot of antibiotics. The purpose of this study was to evaluate the outcome of such an approach. METHODS: Thirty-two patients with acute hematogenous (18 patients; 1 bilateral) or acute postoperative (14 patients) PJIs who underwent irrigation and debridement with implant retention and addition of antibiotic-impregnated calcium sulfate beads were retrospectively reviewed. PJI followed 27 total knee arthroplasties and 6 total hip arthroplasties. The most common infecting organisms were methicillin-sensitive Staphylococcus aureus (13 of 33) and Streptococcus (9 of 33). The primary outcome parameter was recurrence of infection according to the Musculoskeletal Infection Society criteria. Patients were followed up for a minimum of 3 months or until failure. RESULTS: At a mean of 12.7 months (range, 3-30 months), 16 of the 33 patients failed (48%). Acute hematogenous and acute postoperative PJI had similar failure rates at 47% and 50%, respectively (P = .88). Seven failures required a 2-stage exchange, while 8 patients were treated with chronic antibiotic suppression, being unwilling or unable to undergo further surgical intervention. CONCLUSION: The addition of antibiotic-impregnated calcium sulfate beads does not appear to improve outcomes of irrigation and debridement with implant retention in the setting of acute hematogenous or acute postoperative PJI. Given the short follow-up in this report, this represents a best-case scenario and the overall failure rate may be higher with further follow-up.

Neonatal septic arthritis in a tertiary care hospital: a descriptive study.

PURPOSE: The study was conducted to evaluate clinical and microbiological profile of neonates with septic arthritis and also to assess changing epidemiology in the microbial etiology. METHODS: Twenty-nine neonates (1-28 days of life) presenting to the Department of Orthopaedics with acute septic arthritis were included in the study. This was a descriptive study, and the data were collected during the time of hospital admission. History and clinical examination of the neonates were taken, and diagnosis was made based on clinical and laboratory parameters. Emergency arthrotomy was performed to prevent catastrophic sequelae in all the cases given antibiotics as per the culture results. RESULTS: Female children predominated in our study. The children were brought to the OPD with an average of 2.7 days of fever. Thirty-four joints were involved in 29 neonates, out of whom five had more than one joint involvement. Joint effusion or subperiosteal abscess was found in 22 patients by USG. All children had leukocytosis with neutrophilic predominance. Twenty-one of twenty-nine patients had hip-joint involvement followed by knee in seven patients. Gram-negative organisms had grown more commonly, among which Klebsiella pneumonia was grown in nine patients. CONCLUSION: Prematurity and anemia still appear to be important risk factors for neonatal septic arthritis. As there is changing trend toward gram-negative infections, attention has to be given toward preventing nosocomial and community-acquired infections. This is very important in premature infants who are susceptible for infection when they are kept in resuscitative units in hospitals.

Atlanto-axial infection after acupuncture.

A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.

Septic arthritis of both knees following intra-articular injection of petrol.

A 70 years old man was referred to our center with bilateral knee arthritis following intra-articular petrol injection. Because of previous antibiotics use gram stain and culture were negative. Septic arthritis was diagnosed and antibiotics and drainage were started. After 2 years he improved eventually and was able to walk. But, some movement limitation remained.

An uncommon cause of Staphylococcus aureus sepsis.

We describe a case of Staphylococcus aureus sepsis after acupuncture for chronic fatigue syndrome (CFS). Sepsis is a rare, but potentially fatal complication of acupuncture. The most common cause of bacterial infection after acupuncture is S. aureus. The effectiveness of acupuncture for the treatment of CFS is not proven, therefore the potential benefits should be weighed against the risks.

Procedure-oriented sectional anatomy of the shoulder.

This is the first in a series of papers on procedure-oriented joint anatomy. This paper will review anatomy of the shoulder joint and focus on non-imaging-guided procedures. Needle procedures of the shoulder include glenohumeral, subacromial, and acromioclavicular joint injections; electromyography; trigger point and other intramuscular injections; bicipital tendon sheath injection; suprascapular nerve blocks; and botulinum toxin injections. The accuracy of these non-imaging-guided procedures is reviewed. Complications of these procedures include infection, damage to tendon, and local or systemic response to medication. This paper provides anatomically accurate schematics of the shoulder anatomy relevant to needle procedures. Cross-sectional schematics of the shoulder were drawn as they appear on axial and sagittal projections. Superficial and deep landmarks are highlighted and sources of potential complications. The schematics allow for safer and more accurate non-image-guided needle procedures in the shoulder region.

Treatment recommendations and strategies for the management of bone and joint infections.

Bone and joint infections are a cause of rising concern, mainly owing to the increasing number of traumatic accidents, the appearance of new groups of patients at risk, the widespread use of prosthetic devices and the emergence of new patterns of antimicrobial resistance. Treatment guidelines and particular strategies for the management of such infections are reviewed. Decisions regarding the best therapeutic modality can be challenging and take into account the factors involved in infection staging, along with a better knowledge of the bacterial biofilm status. Surgery and antibiotic therapy are the keystones of the management, but overall the timing and length of treatment and follow-up should be posed to obtain the best quality of life for the patient. These infections are characteristically intriguing and sometimes need multiple surgical interventions and several courses of therapy. A multi-disciplinary approach is worthwhile in each institution. The collaboration of a specialized team composed by surgeons, pathologists, microbiologists and clinicians will permit diagnostic and therapeutic protocol-guided decisions.

First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome.

We report the 1st case of methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis after acupuncture, with articular cartilage destruction and chronic osteomyelitis. The patient responded to arthrotomy, synovectomy, and 6 months of antibiotics. The emergence of community-associated MRSA infections would further aggravate the problem. Strict adherence to proper infection control guidelines is mandatory.

Preliminary report of the safety and efficacy of hyperbaric oxygen therapy for specific complications of lung transplantation.

BACKGROUND: Lung transplantation (LTx) is a complex therapy requiring immunosuppression and is associated with significant infective morbidity and mortality. Hyperbaric oxygen (HBO) therapy has been used successfully in the treatment of specific serious infections, ischemic injuries and cerebral arterial gas embolism. The purpose of this study was to evaluate the efficacy and safety of HBO therapy after LTx, generally as indicated for refractory infectious complications. METHODS: This investigation was a retrospective study of all lung transplant recipients treated with HBO therapy at the Alfred Hospital between March 1990 and August 2005. RESULTS: In this study we describe 9 patients (1.7%) from a total of 544 overall lung transplants performed over the period. Indications included: sternal osteomyelitis (n = 4); refractory cellulitis (n = 2); refractory septic arthritis (n = 1); ischemic toes (n = 1); and cerebral arterial gas embolism (n = 1). The patients received 1 to 25 HBO treatments at 100% Fio(2) and 100 to 180 kPa for 100 minutes per treatment. The treatment was generally well tolerated, although 2 patients ceased therapy prematurely due to a seizure and ear barotrauma (n = 1 each). Five patients had complete resolution of these life-threatening complications. Long-term survival and graft function were excellent, although graft function temporarily fell. CONCLUSIONS: HBO is a safe therapy for traditional HBO indications after LTx and appears useful, particularly in the management of infectious complications, whereas other therapies have failed or are contraindicated.

Acupuncture-associated arthritis in a joint with an orthopaedic implant.

Viral infection is a well-recognized complication of acupuncture therapy. Bacterial infection however is rare. We report a rare case of intra-articular bacterial knee infection due to inadvertent acupuncture needle penetration.

Septic arthritis of a lumbar facet joint due to pyonex.

We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.

[Pseudallescheria boydii osteoarthritis in a patient with acute lymphoblastic leukemia: a case report]. / Ostéoarthrite à Pseudallescheria boydii chez un patient porteur de leucémie aiguë lymphoblastique: à propos d'un cas.

INTRODUCTION: The outcome of neutropenic patients with Pseudallescheria boydii infection is poor. EXEGESIS: We report the first case of Pseudallescheria boydii hip arthritis in a patient treated for acute lymphoblastic leukemia. In vitro susceptibility testing showed that the strain was resistant to amphotericin B, fluorocytosine and nystatin, but susceptible to itraconazole. The patient received oral itraconazole (600 mg/day) and clinical symptoms initially resolved. Two months later, after a course of chemotherapy and high-dose steroids while receiving oral itraconazole treatment, the patient developed fever, skin lesions and disseminated lung infiltrates due to Pseudallescheria boydii and finally died. CONCLUSION: This case illustrates the severity of fungal infections due to Pseudallescheria boydii despite a presumably well-conducted antifungal therapy.

Unilateral sacroiliitis as an unusual complication of acupuncture.

Septic sacroiliitis is an uncommon disease and is rarely reported as a complication of acupuncture. We present a case of unilateral septic sarcoiliitis, which developed as a complication of acupuncture because of failure to sterilise the skin properly before treatment. Bone scan and computed tomography were positive for sacroiliitis. After a course of antibiotics with oxacillin for 6 weeks, the condition was completely improved. This case report stresses the importance of sterilisation procedures before acupuncture therapy.